Table 1

Investigations to consider for screening of weight-related comorbidities

Enquiry/investigation	Rationale
Family history and age-onset obesity	Children with a very strong parental history of obesity and early-onset obesity (<5 years) are more likely to have a monogenic cause for their obesity.20
Assess growth and puberty	Children with endocrinopathy tend to be short and overweight, while those with nutritional obesity tend to be tall and overweight (compared with mid-parental height). Individuals with endocrinopathies such as Cushing’s show arrested growth.
Blood pressure	Up to 20% children with severe obesity may have hypertension.
Liver function tests	Non-alcoholic fatty liver disease (NAFLD) as a consequence of obesity is common. An ALT >twice the upper limit of normal range suggests fatty liver.13
Lipids	Risk of raised cholesterol and triglycerides is increased sevenfold in severe obesity.
Fasting insulin and fasting glucose	If the fasting insulin and glucose are raised with a high HOMA score (>4.5), consider an oral glucose tolerance test.8 HOMA is a measure of insulin resistance
Thyroid function	Exclude hypothyroidism though modest rises in TSH are common in obese children. It is not recommended that mild subclinical hypothyroidism (TSH <10.0) is treated.21
Consider obstructive sleep apnoea	Enquiring about snoring and consideration of a screening questionnaire may assist in identifying those who may need further investigation for obstructive sleep apnoea.22
Enquire about menstrual irregularities and hirsutism	In overweight/obese girls, ovarian hyperandrogenism is common and menstrual irregularities and hirsutism frequently occur. Investigation of follicle stimulating hormone (FSH), lutenising hormone (LH), sex hormone binding globulin (SHBG) and testosterone may be indicated.
Consider screening for vitamin D deficiency	Vitamin D deficiency is common in overweight/obese children as a consequence of vitamin D deposition in fatty tissues and diet.

HOMA, Homeostatic Model Assessment.