Patients living with obesity, but who have not yet developed complications, would be more appropriately managed by other services.
A GP or Paediatrician would usually need to screen for complications before referral, to enable triage. Depending on the complications found, and given that five to 10 percent of all children have complications, most children are managed in primary or secondary care.
Resources
Professionals
Please read the toolkit below:
Child Healthy Weight Toolkit (pdf) - Healthier Together
Parents/carers and young people can read 'Resources for Families' in this toolkit.
See sections on:
identifying raised BMI
referrals / signposting to other services (e.g. BeeZee / Tier 2)
resources for families (e.g. YouMove)
training.
GPs may also have access to social prescribing / health coaches.
More detailed guidance on medical and dietetic management is available via the Paediatric Innovation, Education and Research (PIER) network guidelines:
The assessment and management of overweight and obesity in children and young people - PIER network
These include:
history
examination
investigations
management of scenarios such as:
raised HbA1c
liver disease
genetic testing
medications
dietary advice.
Comorbidities / complications
Please follow NICE Guidance in history and examination:
Overview | Overweight and obesity management | Guidance | NICE
If BMI is greater than the 98th centile, consider:
TFT
U&E
LFT
HbA1c
± nutritional bloods (FBC, iron studies, folate, vitamin D and B12)
and, if aged 11 years or over (or acanthosis):
blood pressure (BP)
fasting glucose
insulin
C-peptide
lipid profile.
Consider testing for underlying genetic / endocrine cause if other clinical features of these (see PIER guidelines).
If complications are identified, Oxfordshire GPs usually refer to / seek advice from General Paediatrics / Endocrinology as per toolkit or follow local pathways.*
If no complications are identified, ongoing monitoring / follow-up would usually be warranted, and - if BMI centile not improving - repeat screening for complications every year or so, depending on symptoms/ progression.
Further information
Children and young people with ASD / ADHD are at increased risk of obesity, so may benefit from specific advice.
Autism Spectrum Disorder (ASD)
Eating - a guide for all audiences - National Autistic Society
Nutrition and autism | Autism Speaks
Attention Deficit Hyperactivity Disorder (ADHD)
How to support a child with ADHD with food and eating - Family Action
Eating well with ADHD (pdf) - Hertfordshire Community NHS Trust
Resources - Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
Videos
Helping children with additional needs, and goal-setting.
Webinars on Weight Management in Children - NHS Patient Webinars
Referrals
*To be referred to CEW, patients must have a local Paediatrician / Endocrinologist to help coordinate local care and other health needs, so direct referrals from primary care are not usually accepted.
For urgent complications such as IIH / OSA referred to Paediatrics / Endocrinology, CEW can be involved if needed.
CEW is a tertiary (tier 3) weight management service, so most patients should have tried community tier 2 services (unless unavailable or not appropriate) alongside secondary (or other tertiary) care input before referral.
If the BMI centile is reducing, the complications should start resolving.
Urgent complications
Some complications are more urgent than others.
Type 2 diabetes is urgent and should be referred to the on-call Paediatric Diabetes team (without the need for an additional CEW MDT).
IIH can affect vision, and OSA can have significant impact on daily functioning, and so weight loss may also be semi-urgent.
Patients with borderline diabetes may also be semi-urgent as we may be able to prevent diabetes from developing, for ecample HbA1c >44 mmol/mol; or impaired fasting glucose (5.6 - 6.9).
Other complications like fatty liver disease or 'low-level' prediabetes (for example hbA1c 39-41) can have a serious long-term prognosis, but may be less urgent and could be monitored in primary / secondary care while working on reducing the BMI with input from other services.
Raised HbA1c without raised BMI, or one which is not improving, warrants screening for pre-type 1 diabetes auto-antibodies; and safety netting around recognising symptoms of diabetes which should prompt an urgent blood glucose check.
How to refer
Please refer by letter or email.
Email cew.clinic@ouh.nhs.uk
Please include the following information.
Complications identified, and those ruled out, for example:
IIH
OSA
prediabetes
acanthosis
NAFLD (also called MASLD)
hypertension
dyslipidaemia
orthopaedic complications like SUFE, PCOS
significantly reduced mobility
related mental health concerns.
Please also include:
latest BMI centile (z-score) and trajectory
any possible underlying endocrine or genetic diagnoses
Include other medical history, including:
age of onset of obesity
developmental / learning / behavioural difficulties
asthma / other respiratory illness
renal disease
previous chemotherapy.
Also:
relevant family / social history / ethnicity.
examination / BP / relevant blood results.
best email and phone number for family.
Please discuss first with the family to check they are happy to be referred, able to travel, and willing to engage in intensive MDT work.
Please let them know the referral will be triaged but most referrals are managed with advice initially; if things do not improve during the following months, please do send an updated referral.
If there are difficulties with engagement, concerns that a child's needs are not being met for whatever reason, or other safeguarding concerns (see toolkit above), please consider local support from early help or children's social care. It may be useful to gather information from other services and/or schools before referral.
If there are mental health concerns, please refer to local services as we cannot provide long-term mental health support for all patients.
Please also consider specialist input for certain complications, for example:
ENT or resp for OSA
neuro for IIH
gynae/endo for PCOS etc.
