4. Assessment of Overweight Children and Adolescents

In-depth assessments are required to determine if children and adolescents with BMI-for-age > 95th percentile are truly overfat and at increased risk for health complications related to overweight. In-depth assessments allow for a diagnosis of the underlying causes of overweight and provide a basis for management plans. Among children over 7 years, practitioners should pay particular attention to family history and secondary complications of overweight, such as hyperlipidemia and hypertension. The child's or adolescent's concern about his or her own weight should also be taken into consideration before beginning a weight loss program.

An assessment might include the following:

 

	Medical History will help identify any underlying syndromes or secondary complications of overweight.
	Family History will identify familial risks for overweight or obesity. This includes the presence of obesity, eating disorders, type II diabetes, heart disease, high blood pressure, and abnormal lipid profiles (high cholesterol, abnormal lipid profile).
	Dietary Assessment will evaluate eating practices, including the quantity, quality and timing of food intake to identify foods and patterns of eating that may lead to excessive calorie intake. A 24-hour recall, food record, or food frequency method of diet assessment may be used.
	Physical Activity Assessment assesses daily activity levels. This assessment should include an estimate of time spent on exercise and activity, as well as time spent on sedentary behaviors, such as television, video viewing, and computer use.
	Physical Examination will provide information about the degree of overweight and any potential underlying complications of overweight such as high blood pressure. Those children and adolescents with a BMI-for-age at or above the 95th percentile and who are very athletic or whose family history suggests large frame size may be further assessed using triceps skinfold measurement to assess body fat (Barlow and Dietz, 1998). Although measurement of skinfold thickness can be unreliable, a measurement of greater than the 95th percentile measured by an experienced observer provides evidence that the child has excess fat rather than increased lean body mass or large frame size.
	Laboratory Tests to be administered will be determined by the degree of overweight, family history and results of the physical exam. A physician should schedule appropriate laboratory tests such as cholesterol screening.
	Psychological Evaluation may be needed for children and adolescents who require weight management to determine their readiness to change behaviors and to identify a history of eating disorders or depression which may require a referral. Also, evaluation of the parents' psychological readiness to change is important.