In view of the rising prevalence of overweight youth, screening children and adolescents for overweight and risk for overweight has assumed a prominent place in pediatric practice (the medical specialty devoted to diagnosis and treatment of children) and public health programs. The American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care advise a frequent schedule of accurate weight and height measurements to determine whether children require further assessment or treatment for overweight. Figure 4.10 shows how screening for overweight distinguishes between youths who are not at risk of overweight, at risk of overweight, and overweight. Those deemed overweight receive an in-depth medical assessment; those considered at risk are assessed for changes in BMI, blood pressure, and cholesterol levels; and annual screening is advised for those who are not at risk of overweight.

The comprehensive assessment performed on children and adolescents considered overweight generally includes obtaining a detailed medical history to identify any underlying medical conditions that may contribute to overweight and analyzing family history for the presence of familial risks for overweight or obesity. Relevant familial factors include the occurrence of obesity, eating disorders, Type 2 diabetes, heart disease, high blood pressure, and abnormal lipid profiles such as high cholesterol among immediate family members. The assessment also may involve:

FIGURE 4.10
Recommended overweight screening procedure

• Dietary evaluation to consider the quantity, quality, and timing of food consumed to identify foods and patterns of eating that may lead to excessive calorie intake. A food record or food diary may be used to assess eating habits.
• An evaluation of daily activities. This assessment involves an estimate of time devoted to exercise and activity as well as time spent on sedentary behaviors such as television, video games, and computer use.
• A physical examination to provide information about the extent of overweight and any complications of overweight, including high blood pressure. Children and adolescents with a BMI-for-age at or above the 95th percentile and who are athletic and muscular may be further assessed using triceps skinfold measurement to assess body fat. A measurement of greater than the 95th percentile indicates that the child has excess fat rather than increased lean body mass or a large frame.
• Laboratory tests, such as cholesterol screening, dictated by the degree of overweight, family history, and the results of the physical examination. Table 4.8 shows the range of values for total blood cholesterol and LDL cholesterol that are considered acceptable, borderline, and high.
• A mental health evaluation to determine the readiness of children and adolescents to change behaviors and to identify a history of eating disorders or depression that may require treatment. An assessment of the family's ability to support a child's weight-loss or weight-management efforts also may be performed.

TABLE 4.8
National Cholesterol Education Program classification of cholesterol levels in high-risk children and adolescents*