Table 1. Screening procedures for obesity-related comorbidities.

Comorbidity	Screening procedures and criteria
Cardiovascular	Clinical and laboratory evaluation
Hypertension	Blood pressure (3 separate readings BP >95% age, height, sex (28))
Hyperlipidemia	Fasting lipids (Total cholesterol >170, LDL-cholesterol >110, triglyceride >100, HDL-cholesterol >45) (29)
Pulmonary	Assess persistent snoring, pauses in breathing, nocturnal enuresis, and daytime somnolence; refer for sleep study if symptoms present; consider otolaryngology referral if symptomatic and tonsils are enlarged
Obstructive sleep apnea
Obesity hypoventilation syndrome
Psychiatric	Clinical evaluation
Depression	Clinical symptoms (eg, anorexia, poor sleep, suicidal ideation, anhedonia)
Orthopedic	Symptom and examination screening
Blount disease	Blount = pain at medial aspect of knee (adolescents), 80% unilateral, difference in leg length
SCFE	SCFE = hip/knee pain, decreased internal rotation of hip, may progress to inability to bear weight/decreased range of motion
Endocrinologic	Clinical and laboratory evaluation
Diabetes/insulin resistance	Acanthosis nigricans suggests hyperinsulinemia
	Fasting glucose: diabetes ≥126 mg/dL, impaired 100–126 mg/dL
	2-h oral glucose tolerance test: diabetes >200 mg/dL, impaired 140–200 mg/dL
	Hemoglobin A1c: diabetes ≥6.5%, prediabetes 5.7%–6.4% (30)
	Diagnosis of diabetes requires abnormal tests on 2 different days unless there is “unequivocal hyperglycemia”
Polycystic ovarian syndrome	Rotterdam criteria: presence of any 2 of 3 features (a) Oligo/amenorrhea (b) Clinical hyperandrogenism (c) Polycystic ovaries (>10 cysts)—pelvic ultrasound

HDL = high-density lipoprotein; LDL = low-density lipoprotein; SCFE = slipped capital femoral epiphysis.