A. Simple obesity with no family history of IRS | Obese but with no signs or symptoms suggestive of secondary obesity or obesity complications | Baseline bloods |
Fasting glucose |
Fasting insulin |
Fasting lipids (total and HDL cholesterol, triglycerides) |
Liver function (bilirubin and ALT) |
Thyroid function (T4, TSH) |
| FBC, U&E |
| | Accurate blood pressure using an adequately large cuff. Comparison to BP centiles for age and sex |
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B. Simple obesity with family history or signs of IRS | Obese with acanthosis nigricans or family history of IRS | Oral glucose tolerance test |
Baseline bloods as above |
Blood pressure |
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C. Marked abdominal obesity, with or without family history of IRS | | Bloods as per (B) |
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D. Extreme obesity | BMI z score ⩾3.0 | Bloods as per (B) plus DNA screening for monogenic forms of obesity (if onset <5 years) |
| | Sleep study for obstructive sleep apnoea if significant symptoms (snoring, difficult to wake, nightmares, daytime somnolence) |
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E. Suspected secondary obesity | Signs or symptoms suggestive of secondary obesity | Bloods as per (B) plus |
Karyotype |
Midnight and 8 am cortisol |
Referral to endocrinologist or geneticist as appropriate |