Study Highlights Lack of Adherence to Recommended Testing in Pediatric Obesity

A new study is underlining the need for specific, actionable guidelines for screening of obesity-related co-occurring conditions in children with obesity.

A cross-sectional analysis of well-child visits among children with obesity, results of the study detail the overuse and underuse of American Academy of Pediatrics (AAP) recommended and nonrecommended screening tests, with data demonstrating 27.3% of children diagnosed with obesity underwent screening that was adherent to AAP guidelines and 23% underwent unnecessary thyroid or insulin testing.

“In this cross-sectional study, similar proportions of children diagnosed with obesity at well-child visits received recommended and nonrecommended screening tests for obesity-related co-occurring conditions, suggesting that specific actionable guidelines and interventions are needed to prevent overuse and underuse of screening tests among children with obesity,” wrote investigators.

With rates of pediatric obesity continuing to climb, a trio of clinicians representing the Yale School of Medicine, US Centers for Disease Control and Prevention, and Michigan Medicine designed the current study with the intent of assessing rates of AAP-adherent screening and unnecessary endocrine testing at well-child visits in the US. To do so, investigators designed a cross-sectional study using data from the IBM MarketScan Commercial Database and the IBM MarketScan Multi-State Medicaid Database for 2018-2019.

From these databases, investigators identified 156,773 children aged 10-18 years with obesity diagnosis codes who underwent a well-child visit from December 1, 2018, through November 30, 2019. The overall study cohort had a mean age of 13.5 (SD, 2.5) years, 53.1% were male, and 62.3% were publicly insured. Of the 97,595 publicly insured individuals, 13,167 were Hispanic or Latino, 34,792 were non-Hispanic Black, 42,029 were non-Hispanic White, 3850 were of other race and/or ethnicity, and 3757 (3.8%) were of unknown race and ethnicity. Investigators pointed out race and ethnicity were not available for commercially insured patients because that data is not reported in the commercial claims database.

The primary outcomes of interest for the investigators’ analyses were the portion of children who received AAP-adherent screening during a timeframe beginning 729 prior to and ending 30 days after a well-child visit and the proportion of children who received 1 or more potentially unnecessary thyroid or insulin tests during the same period. Analyses assessing proportions of children by payer type were performed using logistic regression models adjusted for age and sex. Investigators pointed out the proportion of children without AAP-adherent screening before visits but within 30 days was calculated to assess screening potentially ordered by a primary care provider.

Initial analysis revealed 27.3% (n=42,849) of the overall study cohort received AAP-adherent screening during the period of interest, including 23.6% of privately insured children and 29.6% of publicly insured children (average marginal effect for public insurance: 6.8 [95% CI, 6.3-7.2] percentage points). Further analysis indicated 29.7% of the overall cohort received potentially unnecessary thyroid or insulin tests, including 21.7% of privately insured children and 23.8% of publicly insured children (average marginal effect for public insurance: 2.4 [95% CI, 2.0-2.8] percentage points). When assessing the proportion of children without adherent screening prior to visit but within 30 days after, investigators found 11.7% received this screening within 30 days.

“The AAP is expected to release a new obesity clinical practice guideline in the second half of 2022. Our findings suggest that these guidelines could be most beneficial if they explicitly recommend a parsimonious set of tests, more emphatically discourage unnecessary testing, and include guidance on implementation strategies, such as clinical decision support tools, which could increase the use of appropriate testing and decrease the use of inappropriate testing,” investigators added.

This study, “Assessment of Underuse and Overuse of Screening Tests for Co-occurring Conditions Among Children With Obesity,” was published in JAMA Network Open.