Medical screening for children with obesity, by BMI category

BMI: body mass index; ALT: alanine aminotransferase; AST: aspartate aminotransferase.
* If results of the fasting lipid profile are normal, we suggest repeating the screening every 3 to 5 years. If the results are abnormal, annual monitoring usually is appropriate. (Refer to UpToDate topic on pediatric prevention of adult cardiovascular disease.)
¶ In this weight category, screening for abnormalities in blood glucose or hemoglobin A1c, AST, and ALT is recommended if the patient is 10 years or older and has 1 or more of the following risk factors: personal history of elevated blood pressure, lipid levels, tobacco use, or family history of obesity-related diseases (type 2 diabetes, lipid abnormalities, heart disease).
Δ Hemoglobin A1c is now an accepted approach to screening for diabetes mellitus in adults; a hemoglobin A1c level ≥6.5% on 2 occasions can be used to diagnose diabetes, and patients with A1c values between 5.7 and 6.4% are at high risk for developing diabetes. The utility of hemoglobin A1c as a screening tool in children and adolescents has not been fully evaluated.