When talking about growth with children and teens, the focus should be on overall health, fitness, and wellbeing—not just weight or body size. Making small, healthy lifestyle changes that lower the risk of future health problems is more important than aiming for an “ideal” weight.

Your Role as a Parent Matters
For younger children, parents are often the biggest motivators for change. For teens, it’s important to give them space to set their own health goals, while offering guidance and support.

Creating a Healthy Home Environment
Children learn from what they see at home. Your habits and the environment you create can shape their food choices, activity levels, and screen time. You can help by:

• Encouraging active play and movement
• Offering nutritious meals and snacks
• Limiting access to high-calorie foods and sugary drinks

Setting Realistic Goals Together
When discussing lifestyle changes, make sure goals are realistic and achievable for your family. Involving everyone shifts the focus from weight to overall health. For older kids and teens, let them choose short-term goals they feel confident about—this makes long-term success more likely.

Your GP or Paediatrician is your main medical partner. They can provide a thorough check-up of your child’s health and growth, and support your family with regular reviews along the way. They can also connect you with local allied health professionals for extra help when needed.

Before coming to the Complex Clinical Obesity Assessment Service, we recommend families first explore local community services. These might include:

• Dietitians for nutrition advice
• Physiotherapists or Exercise Physiologists for movement and activity support
• Psychologists for emotional wellbeing

Please speak with your GP or Paediatrician about how to access these services.

Mental health matters too. If your child needs emotional or psychological support, it’s important to arrange this through local services when making a referral. Our psychologist at the Weight Management Service will assess your child and help link you to community supports, but they do not provide ongoing therapy.

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 diet, lifestyle and psychosocial 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:

Talking to families and children about their weight: a guide for healthcare professionals

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.

Things to remember

• Use the appropriate growth charts as a reference for assessing a child’s weight. This will reassure the child/parent that you are making a standardised assessment rather than giving your own opinion of their child’s weight
• Focus on:
• health - the aim of weight management is to diminish risk of morbidity and mortality with an emphasis on improving health and fitness
• improving social functioning rather than aesthetic ideals
• Use an encouraging and empowering approach that is age appropriate. Avoid using negative language such as ‘fat’, ‘chunky’ or ‘obese’. Use phrases like ‘above his/her healthiest weight’ or ‘the healthiest weight for your child is…’
• Explore the family’s:
• motivation for making healthy lifestyle changes
• barriers to being able to make changes – consider referrals to other healthcare professionals, e.g. social work or psychologist, to assist with overcoming these hurdles.
• Get the whole family involved in the conversation – what is good for one child is good for the entire family
• Try not to label food/activities as ‘good’ and ‘bad’, uses words like ‘healthy’, ‘healthier option/choice’, ‘sometimes/occasional food’
• NO DIETS! Diets often encourage unhealthy and, at times, unsafe eating behaviours. When considering suggesting a dietary change you should consider whether the child/family will be able to incorporate this change into their regular meal pattern for the rest of their life. If you are unsure you can seek advice from a healthcare professional, e.g. dietitian.

GP/Paediatrician assessment of the overweight child

• Pubertal stage (e.g. using Tanner staging)
• Acne and hirsutism
• Blood pressure (with appropriate cuff size)
• Morning headache and visual disturbance (potential benign intracranial hypertension)
• Abnormal gait, problems with feet, hips and knees, difficulties with balance and coordination
• Gastrointestinal symptoms (vomiting, abdominal pain, constipation, gastrointestinal reflux)
• Nocturnal enuresis and daytime dribbling
• Hip and knee joint pain
• Presence of intertrigo
• Presence of hepatomegaly
• Signs of dysmorphism
• Thyroid function (e.g. presence of goitre)
• Acanthosis nigricans (velvety, light brown-to-black markings usually on the neck, under the arms or in the groin), which suggests significant insulin resistance
• Short stature, a low growth velocity, or bruising or purple striae (may indicate an endocrine cause for weight gain)
• Dental health

Diet and exercise history

• Average daily food intake (refer to dietitian)
• Activity levels
• Time spent watching TV/computer

Screening investigations

Baseline:

• Blood lipids
• Liver function tests

Consider the following when clinically indicated

• Blood sugar and HbA1c or OGTT
• Hormone function, such as thyroid hormone levels
• Vitamin and nutrient levels (such as Iron, vitamin D, Vitamin B12)

Management

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:

• Dietitian
• Psychologist
• Social worker
• Exercise physiologist/physiotherapist
• Occupational therapist
  

Referral to the RCH specialist weight management clinic is required when:

BMI >95th percentile with:

• Neurological or physical disability (ASD, GDD, ID, Physical Disability) 
  AND
  
• restricted eating with risk of micronutrient deficiencies (Iron, Vit A,C,E, B12) OR other medical diagnosis necessitating ongoing specialist paediatric care 

BMI >95th percentile with NO DISABILITY but with at least one established obesity related comorbidity:

• LFT abnormality
• Hyperlipidaemia
• Hypertension
• Impaired glucose tolerance
• Obstructive sleep apnoea (please also refer to Respiratory at the time of referral to Weight Management, faxed as separate referral)
• Orthopaedic complication (NB: SUFE must have Endocrinology referral and assessment prior to being referred to Weight Management Service)

Please note

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.