Testing creates a nice roadmap to address the major imbalances that lead a child to obesity: diet, exercise, stress, hormones, inflammation and poor detoxification. Screening for major complications of obesity: lipid imbalances, high blood pressure, and diabetes is also important. Depending on symptoms, screening for other complications of obesity such as early/delayed puberty, polycystic ovarian syndrome, abnormal clotting tendency, asthma, sleep apnea, acid reflux, constipation, gallstones, fatty liver, bone/joint problems and emotional imbalances may also be necessary. 

Diet. Food protein intolerances particularly to gluten are often overlooked as a contributing factor for overweight children. Blood testing is helpful to check for such food protein intolerances. I test for both food allergies (IgE-mediated) and food sensitivities (IgG-mediated). Be sure to use a lab that tests for all four subclasses of IgG such as ImmunoLabs and Alletess Medical Laboratory. You can contact both these labs to find a practitioner in your area to order food allergy and sensitivity testing for your child. 

Be sure your child is thoroughly blood tested for gluten intolerance. Helpful tests include IgG to gluten, IgG and IgA anti-gliadin antibodies, IgA antibodies to tissue transglutaminase, anti-endomysial IgA, total IgA, and HLA typing for celiac disease (a genetic mutation test). Some of these tests can be run through standard labs, while others are run through specialty labs such as ImmunoLabs and Alletess Medical Laboratory. Depending on the clinical situation, I may also test for gluten intolerance through stool testing, measuring levels of stool anti-gliadin IgA and tissue transglutaminase. Since the immune system reactions to foods are centered within the intestinal tract, an earlier way to detect gluten sensitive individuals can be through this specialized stool testing available through EnteroLab.

Inflammation. Inflammation is connected to most chronic diseases, including obesity. More inflammation leads to weight gain and more weight leads to more inflammation. 

Food protein intolerances cause inflammation, so identifying them through testing mentioned above is a great way to identify and remove problem foods, and reduce inflammation in the process. Though non-specific, there are a few other tests to help measure inflammation in the body: C-Reactive Protein (CRP), Eosinophil Protein X (EPX) and Calprotectin.

C-reactive protein is a protein in the blood, levels rise in response to inflammation. So it measures the general level of inflammation within the body, but does not specify the source of inflammation. A CRP level greater than 1.0 mg/dL, is considered high.

Eosinophil Protein X (EPX) is a protein found within an eosinophil (a type of white blood cell) that is released once the eosinophil has been activated. Eosinophils are involved in many diseases, including those with inflammation. Measuring fecal EPX is a non-invasive way to measure eosinophil activity within the gut, or intestinal inflammation. Elevated EPX can occur in response to food allergies, gluten intolerance, parasite infections, inflammatory bowel disease, and more. So it's non-specific like CRP, but it offers us another marker for inflammation, this time in the gut.

Another marker of inflammation within the digestive system is calprotectin. Calprotectin is a protein released from neutrophils (another type of white blood cell).  Neutrophils increase in the intestines when there is inflammation there. Measurements of fecal calprotectin levels have been strongly correlated with intestinal inflammation. Like CRP and EPX, elevated levels of calprotectin are non-specific and can occur in response to inflammatory bowel disease, infection, polyps, cancer and more.

Why all the focus on fecal tests for inflammation? Remember from a holistic perspective, your digestive health is key to your overall health. People know their digestive system is responsible for digesting and absorbing their food, but most don’t realize that this sacred process of “digestion” is how we nourish every cell in our body. What is more important than the way we “feed” our cells?  Not much. The cell is where it all happens ~ the functional basic unit of life. We feed our cells through proper digestion of food and absorption of nutrients. This all takes place in your digestive system. Please repeat:

Your digestive system is key to your overall health.  In other words, if your digestive system is not functionally optimally, the rest of “yourself” is compromised. 

A helpful test I use to evaluate a patient’s digestive health is a comprehensive digestive stool analysis, which includes EPX and calprotectin levels. Genova Diagnostics to does this test and you can find a practitioner in your area to order this test for your child. This test evaluates digestion, absorption, bacterial balance and tests for yeasts as well as parasites. It's helpful as a beginning “snapshot” of digestive imbalance, and sequential re-testing is helpful to evaluate benefit from therapeutic interventions. 
 

Stress and Hormones. Stress elevates the adrenal hormone cortisol, which can make it difficult to shed excess pounds. A number of labs offer saliva testing to measure cortisol levels throughout the day. You can also measure cortisol levels in the urine with 24-hour urinary cortisol test.  In general, I don't find these tests necessary to guide a patient on the right treatment path, since most individuals in today's society are "stressed". 

The master metabolic hormone is the thyroid hormone.  For optimal metabolism, your thyroid must be balanced.  To get a complete picture measure the following: thyroid-stimulating hormone (TSH), free T4, free T3, and the thyroid antibody called anti-TPO antibody. Ideally your TSH level should be less than 1.5 mIU/L. Often children (and adults) with under active thyroids are overlooked due to their TSH levels falling within the laboratory's normal range, and the other thyroid tests not being done. If you feel your child may have an under active thyroid, find a physician who will perform these additional tests.

Poor Detoxification. As Mark Hyman, MD discusses in his book Ultrametabolism: The Simple Plan for Automatic Weight Loss, toxins produced within our body and toxins from our environment can be a contributing factor in obesity. There are genetic tests that look for "weak links" in your detoxification pathways, and you can also measure heavy metals (an external toxin) in blood, hair, stool and urine. These tests are best done and interpreted by physicians specializing in detoxification.

Complications of Obesity. Screening for major complications of obesity: lipid imbalances, high blood pressure, and diabetes is important. Depending on the patient's symptoms, screening for other complications of obesity may be necessary. Standard tests for co-existing conditions include HDL (the "good" HDL cholesterol), LDL (the "bad" cholesterol), triglycerides, fasting glucose, fasting insulin, liver function tests, as well as serum ferritin and uric acid levels.