Most children living with overweight or obesity can be managed in primary care. See this referral framework for further guidance.
Where obesity is severe/complex or intractable, pharmacological treatments or bariatric surgery may be considered in children over the age of 12 years, in specialist MDT clinics (such as the complications of excess weight [CEW] pilot clinics). Decisions should include the medical consultant, specialist MDT and family. See the referral framework above for further guidance.
Uncomplicated or simple obesity
Children who have overweight or obesity but who do not have additional complications have simple or uncomplicated overweight and obesity. These children can be managed in the community by accessing Tier 2 services. Assessment and management of children with overweight or obesity differs according to age as described below.
Rapid weight gain during infancy and early childhood
Rapid weight gain during the first 2 years of life is associated with higher risk of obesity in later childhood and adulthood. Children who experienced rapid weight gain (defined as crossing growth centiles upwards by one major centile space) during this period were 3.6 times more likely to have overweight or obesity in childhood or adulthood.
Rapid weight gain in infancy and early childhood is therefore a risk factor for later excess weight gain. Healthcare professionals are advised to look for other underlying risk factors and causes for excess weight gain such as inappropriate infant feeding practices (non-responsive feeding, over concentrating or fortifying infant formulas and introduction of complementary foods before the age of 4 months).
For further information, the American Academy of Pediatrics Clinical Practice guideline is recommended.
Severe or complex obesity
Obesity is defined as severe where BMI is ≥99.6th centile +2.68 standard deviations or ≥98th +2.05 standard deviations including:
- Thyroid disease
- Idiopathic intracranial hypertension
- Fatty liver disease
- Sleep apnoea
- Type 2 diabetes
- Iatrogenic cause of obesity (pituitary surgery)
Biochemical Assessment
Biochemical Assessment should be carried out in children with obesity (BMI for age and gender ≥98th +2.05 standard deviations) to ascertain whether comorbidities are present. Investigations should include:
- Fasting plasma glucose
- Liver Function Tests
- Lipid Profile
- HbA1C
- Sex hormone binding globulin (females only)
- Calcium and phosphate
Where endocrine disorders are suspected specific assessments should be carried out including:
- Thyroid Function Tests
- Menstrual cycle function (irregularities may indicate polycystic ovary disease)
Psychological and social complications
Psychological co-morbidities (such as depression, anxiety, low self-esteem) should not be overlooked. Attention should be paid to psychological status throughout the child’s journey. MDT working with clinical psychologists, as well as social care is crucial.