In this section
Children become overweight due to a combination of different factors. The most common reason is a chronic imbalance between energy intake (food and drink) and energy use (physical activity). Family eating habits have changed considerably with greater consumption of take-away, lower consumption of homemade meals and larger portion sizes. In addition, it has become much easier to access higher energy snack-foods and sugary drinks (juice, soft drink, flavoured milk) which provide your child with unnecessary additional calories contributing to excess weight gain.
Children are spending a lot more time watching television and playing computer games than participating in sports and active play. Australian children watch, on average 2½ hours of television per day, in addition to other screen based activities (computer, electronic games). This is well above the current recommendations.
It is important to recognise, however, that there are also some rare medical problems that can cause children to gain weight excessively. Part of the healthcare professional's assessment in an overweight child will be to look for and rule out these rare medical conditions
The majority of children and adolescents who are overweight are physically healthy. If you have concerns regarding your child's weight, these should be discussed with your local doctor. The doctor will assess your child's weight, height, family background, dietary intake and activity levels and may request specific tests to assess for weight-related problems.
Discussing a weight problem is as important as discussing any other health concern. However, the focus of the conversation should be related back to healthy lifestyle behaviours and good health rather than overweight or obesity itself.
Parents are often seen as the key motivator of change for younger school-age children, whereas adolescents can, and should, have the chance to make goals and changes separately from (but with the support of) their parents. It is important that the goals are realistic and appropriately targeted towards achieving a healthy weight. The emphasis is on improving health, fitness and social functioning. Reducing the risk of weight-related problems is much more preferable than goals that are aimed at achieving an ideal body weight. Young people often report that temptation is everywhere. Removing temptations from the household is often a good way to start. Choose short term goals that help your child/adolescent feel like they achieving their goals. If they know the effort they are putting in is helping them meet their goals they will be much more likely to achieve long term successful weight management.
GP/Paediatrician – your primary medical carer is often the best place to start. They will be able to complete a comprehensive assessment of your child's health and weight status. They can offer continued support with regular reviews during your family's weight management journey as well as referring you to local allied health services for additional support.
**Don't forget to ask your GP if your child qualifies for a Medicare Benefits Schedule Chronic Disease Management Plan which will enable them to have regular subsidised visits with an allied health team.
Primary care is generally the first point of contact for people seeking medical advice. It is also a well-supported environment for families seeking advice around overweight and obesity.
As overweight and obesity is often the result of exogenous dietary and lifestyle factors it is important to create a support network of allied health practitioners to assist the family in addressing these contributors to excess weight gain. This may include a nurse, dietitian, social worker, counsellor/psychologist and/or exercise physiologist.
For a general practitioner or paediatrician performing an initial consult and examination for childhood obesity the following is recommended as a baseline:
As with any other health issue, concern about a child’s weight should be discussed with the child and their family/carers. Healthcare professionals are at time reluctant to raise concerns about obesity with patients and families, having concerns about their own discomfort or family discomfort, particularly if other family member are also overweight or obese. It is important to remember that parents expect healthcare professionals to raise and address all of their concerns about a child’s health.
When BMI is above the 95th percentile (US-CDC growth chart) and there are NO comorbidities or other medical or developmental conditions that would require specialist weight management support ongoing management and support should continue in primary care, coordinated by the GP/paediatrician +/- practice nurse.
Consider referral to the appropriate allied health:
BMI >95th percentile with:
BMI >95th percentile with NO DISABILITY but with at least one established obesity related comorbidity:
As with many hospital-based services there may be a waiting period to see the RCH Weight Management Service. GP/Paediatrician management of obesity with the support of community/primary care allied health clinicians should continue until a referral to the RCH Weight Management Service has been accepted and the child has been assessed by the Weight Management team to decide whether the child should continue with primary or tertiary care management.