Obesity

Disclaimer These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

 

Introduction

Childhood obesity affects one in twelve children and adolescents in Western Australia (WA)¹.

Early intervention during childhood and halting excessive weight gain can prevent obesity related diseases, such as:

• early cardiovascular disease
• type 2 diabetes
• some cancers
• stroke
• arthritis
• sleep apnoea
• negative self-image
• poor mental health.

Childhood obesity is primarily managed in the community setting but for children and adolescents with severe and / or complicated obesity, a referral can be made to the Perth Children’s Hospital Healthy Weight Service (HWS).

Children who are considered high risk for progressing to type 2 diabetes are also managed through this service. The Healthy Weight Service provides a comprehensive assessment and creation of individualised lifestyle modification programs for children and their families with the multi-disciplinary team. 

Pre-referral investigations

Patient medical history

• Patient antenatal, newborn and developmental history
• Height, weight and BMI trajectory
• Known medical, surgical and mental health conditions
• Previous weight management attempts
• Current medications
• Allergies
• Immunisations
• Causes and complications of obesity (i.e., thyroid disease, obstructive sleep apnoea, musculoskeletal, polycystic ovarian syndrome, diabetes, hypertension, liver dysfunction, headache)
• Family history (obesity, type 2 diabetes, gestational diabetes, obstructive sleep apnoea, liver disease, hypertension, weight loss surgery, mental health disorders)
• Social history, motivation / support for change.

Perform examination

• Height
• Weight
• Blood pressure
• Presence of acanthosis nigricans
• Calculate BMI z score 

Blood investigations

• FBP (Full blood picture)
• fasting glucose
• fasting insulin
• HbA1c
• fasting lipid profile
• c peptide
• iron studies
• TFT’s
• CRP
• LFT’s including AST
• Oral Glucose Tolerance Test when HbA1c level is 5.7% - 6.4% in children ≥ 10 years or pubertal

Children who have classic symptoms of diabetes should not have an OGTT and should have a random glucose to confirm the diagnosis.

Children with a diagnosis of diabetes must be discussed urgently with the PCH on call Endocrinologist via PCH switchboard on 6456 2222.

Measurements and evidence of investigations must be included for all categories.

Blood investigation results for children over 6 years must be within the last 6 months.

Pre-referral management

Consider the following:

• Provide education and resources (see PCH Healthy Weight Service)
• Chronic disease management plan
• Referral to community-based dietitian / nutritionist
• Source local community-based physical activity options. Consider eligibility for KidSport vouchers
• Referral to the Better health program
• Referral to Foodbank WA’s Food Sensations® for Parents of 0-5 years
• Referral to the Optimal Weight for Life (OWL) program at JustKidsHealth clinic for 2-18 year olds in the southern Perth region

When to refer

• Referral to the PCH Healthy Weight Service if child meets one of the three clinical categories below

The child <16 years must fall into one of the three following categories:

BMI z ≥ 2.5

or

BMI z-score ≥ 2.2 – <2.5 with at least 2 co-morbidities:

• Fasting insulin ≥ 16 mU/L
• Fasting dyslipidaemia: total cholesterol ≥ 6.0 mmol/L, HDL ≤ 0.8 mmol/L, LDL ≥ 2.9 mmol/L, Triglycerides ≥ 2.5 mmol/L
• Hypertension (≥ 95th percentile)
• Obstructive Sleep Apnoea
• Psychosocial (i.e., depression or anxiety)
• Polycystic Ovarian Syndrome
• Non-alcoholic fatty liver disease or Hepatic Steatosis
• Musculoskeletal complications

or

Pre-diabetes (fasting glucose ≥ 5.6 mmol/L or 120-min OGTT glucose 7.8-11.0 mmol/L)

Children with a diagnosis of diabetes must be discussed urgently with the PCH on call Endocrinologist via PCH switchboard on 6456 2222.

Essential information to include in your referral

• Weight
• Height
• BMI z-score
• Blood investigation results for children over 6 years within the last 6 months
• Oral Glucose Tolerance Test where appropriate
  • Please note: when most blood investigations are included or there is a valid reason for not including these, the referral can proceed onto the HWS referral team

Please ensure the patient meets the referral criteria before referring to HWS.

How to refer

• Routine non-urgent referrals from a GP or a Consultant are made via the Central Referral Service
• Routine non-urgent referrals from a nurse practitioner, non-medical referrers or private hospitals are made via the PCH Referral Office.

Useful resources

For additional information and patient resources, please refer to the PCH Healthy Weight Service.

Shape: weight education - WAPHA

References

1. Patterson C, Landrigan T, and Radomijac A. 2019. Health and Wellbeing of Children in Western Australia in 2018, Overview and Trends. Department of Health, Western Australia.

Reviewer/Team:	Endocrinology Department	Last reviewed:	May 2022
		Review date:	May 2025

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