Table 1.

Selected findings on obesity-focused history, review of systems, and physical exams that narrow the differential diagnosis of causes of weight gain to drive diagnosis of obesity-related comorbidities and preoperative diagnostic testing.

Systems Involved	Causal Etiologies of Obesity	History	Review of Systems	Physical Exam	Obesity-related conditions or comorbidities	Recommended Pre-Operative Diagnostic Testing (If Clinically Indicated)*
Cardio-Pulmonary		Sleep-related irregularities	Snoring Morning headaches Daytime somnolence	Tonsil size	OSA	ECGCXREchocardiographyLipid panelDVT evaluation
Endocrine	Cushing’s syndrome Growth Hormone Deficiency Hypothyroidism Albright hereditary osteodystrophy Pseudohypoparathyroidism	Attenuated stature and/or height velocity relative to genetic potential and pubertal stage	Proximal muscle weaknessCold intoleranceConstipationAlopecia	Tanner staging		1 mg overnight dexamethasone test 24-hour urinary free Cortisol 11 PM salivary Cortisol
	Hypothyroidism	Menstrual cycle irregularities	Dysmenorrhea	Hirsutism and acne	PCOS	TSH Total/bioavailable Testosterone DHEASDelta-4-androstenedioneBeta-HcG**Baseline measurement of lean/fat mass**
				Acanthosis nigricans	Insulin resistance / Diabetes mellitus	Fasting blood glucoseHbA1c (if diabetes suspected) Oral Glucose Tolerance Test**
Gastrointestinal						Clinical nutrition evaluationIron studiesFolic acid25-vitamin DH pylori screeningLFTsGallbladder UltrasoundEndoscopy
Neurological	Intracranial insult	Developmental delay	Headaches	Nystagmus		Genetic testing
		Congenital midline defects	Visual distrubances	Optic disc swelling
		Neurological deficits		Visual field deficits
		History of intracranial irradiation, trauma, or surgery		Hearing loss
				Micro/macrocephaly
		Single gene defects in leptin-melanocortin pathway (i.e. Prader-Willi Syndrome, MC4)		Congenital midline defecits
Musculoskeletal				Range of hip motion	SCFE / Blount	DEXA**
Psychiatric / Behavioral				Enamel erosion	Disordered eating	Psychosocial behavioral evaluation

^*Based on the AACE/TOS/ASMBS Preoperative Bariatric Surgery Checklist [72], in addition to routine preoperative lab testing at the individual MBS/GI Surgery Program, which most often includes CBC, Lipid panel, kidney function, UA, PT-INR, Type & Screen

^**Additional recommended diagnostic testing (if clinically indicated) according to International Pediatric Endosurgery Group Standards and Safety Committee [25]