High risk groups 1–4
- From families whose diets are high in saturated fats and sugars
- Formula fed infants
- Socioeconomic disadvantaged
- Living in rural and remote locations
- Adverse childhood experiences e.g. disability, bullying, violence, abuse
- Increased sedentary behaviours and reduced physical activities
- Poor sleep
- Perinatal factors (below)
Considerations in pregnancy 3,6
- Diabetes in pregnancy increases the risk of a child being born large, becoming obese in later life and acquiring Diabetes
- A weight gain ≥ 9 kg if maternal BMI > 30 kg/m2or smoking during pregnancy predisposes babies to overweight and obesity as adults
- Small for gestational age babies are at risk of obesity
Referral 1,2
- Refer to paediatric services if:
- management has been unsuccessful
- medicines are being considered for a child
- a very-low-calorie diet or lifestyle modifications have been unsuccessful achieving healthy weight
1. What is overweight or obesity in children?
- As per Overweight and obesity (adult)
2. Diagnosis of overweight or obesity in children 1,2,7
- Identified by routine Child health checks
- BMI and waist-to-height for age measurements is used to support a diagnosis in children > 2 years
- Assessment and monitoring is undertaken using:
- WHO growth and BMI-for-age charts for < 2 years. See Resource 1.
- US-CDC or WHO growth and BMI-for-age charts for 2–18 years
- waist-to-height ratio by dividing waist circumference by height in centimetres (cm)
- In children 2–18 years a diagnosis of overweight is:
- BMI ≥ 85th to < 95th centile
- waist-to-height ratio 0.5–0.59
- In children 2–18 years a diagnosis of obesity is:
- BMI ≥ 95th centile
- waist-to-height ratio ≥ 0.6
- All children > 10 years of age with a BMI > 85th centile are assessed annually (see Special considerations (child) for the following comorbidities:
- pre-diabetes and diabetes
- dyslipidaemia
- pre-hypertension and hypertension
- polycystic ovary syndrome (PCOS)
- OSA
- social-emotional wellbeing
- non-alcoholic fatty liver disease (NAFLD)
3. Management of children who are overweight or obese 1,2,4,8–10
- The goals of managing overweight and obesity is for children to avoid developing chronic conditions and to lead healthy active lives by:
- encouraging parents to take responsibility for lifestyle changes of children especially if < 12 years of age
- supporting Diet and nutrition, and Physical activity and sleep family behaviours
- focusing on weight maintenance rather than weight loss
- promoting positive family lifestyle behaviours
Children who are obese between 2–6 years of age are at high risk of obesity in adolescence. Support families early to achieve healthy behaviours for life long healthy growth and development
- Support child self-management 1,2,5
- Build a therapeutic partnership with the family to support children live healthily by modelling healthy behaviours. See Engaging our patients
- Ensure ongoing management by single health professional as an adolescent transitions from paediatric to adult health services
- Provide resources and discuss the positive effects of Diet and nutrition, and Physical activity and sleep on weight control. See Resource 2–5.
- Discuss the risks associated with developing chronic conditions in adulthood
- Social-emotional support 1,2,5
- Overweight and obesity is a sensitive topic, particularly if a child experiences teasing or bullying. Consider:
- asking permission to discuss child's weight
- using neutral words e.g. unhealthy weight vs fat or obese
- Refer to the child and youth mental health team, psychologist or social worker for disordered eating, poor body image, low self-esteem, depression and anxiety, weight-related bullying or family barriers to healthy lifestyle behaviours
- See Social-emotional wellbeing
- Overweight and obesity is a sensitive topic, particularly if a child experiences teasing or bullying. Consider:
- Lifestyle plan 1
- Weight loss is not recommended for most children and should be limited to post-pubertal adolescents who are assessed as obese
- Involve the child and parent to develop a lifestyle plan to:
- develop goals focusing on family behaviours and ways to manage hunger
- maintain weight and grow toward a healthy BMI without weight loss
- monitor and record BMI, waist circumference and waist-to-height ratio. See Resource 3.
- Review progress and goals frequently so:
- waist circumference, weight and BMI are stable or trending toward healthy ranges
- weight-to-height ratio is approaching < 0.5
- family diet and physical activity habits are improving
- the effects of goals on family function and relationships are positive
- Refer to social worker, psychologist or mental health team if:
- changes to lifestyle behaviours are unsuccessful
- social-emotional issues have developed
- complex family problems impede dietary behaviours e.g. food insecurity
- parents feel unable to influence the child's eating or sedentary behaviours
- Diet and nutrition 1,2,4,5,7,8
- Infants, children and adolescents need sufficient Diet and nutrition to maintain consistent growth and development
- When discussing dietary approaches to a lifestyle plan consider:
- a whole of family approach to role modelling nutrition and exercise
- dietary preferences of the child and family
- the availability, affordability and ability to store healthy foods (food security)
- maintaining regular meals in a social family environment
- separating mealtimes from screen based activities
- discussing internal hunger cues and eating to appetite
- avoiding restricting or controlling the child's food intake
- strategies to encourage eating. See Poor growth (child)
- introducing the traffic light food system (Resource 6.):
- green foods eaten always and often e.g. fruit, veg, meat, water
- amber foods eaten sometimes e.g. full fat dairy, added sugar cereals
- red foods eaten rarely or never e.g. fast food, soft drinks, donuts
- identifying non-food treats or rewards for children:
- swimming or fishing
- park visits
- cuddles and affection
- listening and talking
- reading and attention
- Provide Diet and nutrition related Resources 2–5.
- Physical activity 1,2,5,9,10
- When discussing Physical activity and sleep approaches to a lifestyle plan, encourage family to:
- move more and be active with children
- get involved in local activities i.e. park, fishing, walking, camping, footy
- role model physical activity themselves
- support children to make daily routines active e.g. walking to school
- When discussing Physical activity and sleep approaches to a lifestyle plan, encourage family to:
- Surgery 1,2,5
- Not recommended in children or young people unless exceptional circumstances where lifestyle modifications have been unsuccessful achieving healthy weight
4. Medicines for children who are overweight or obese 1
- Not recommended in children < 12 years unless severe comorbidities are present and lifestyle modifications alone have failed
- Only provided with specialist consultation and with multidisciplinary support
5. Cycle of care
Cycle of care summary for children who are overweight or obese | ||
|---|---|---|
Action | Dx | Ongoing |
Height | ||
Weight | Mthly for 3 mths then 3 mthly | |
BMI | ||
Waist circumference | ||
Blood pressure | If > 10 years of age with a BMI > 85th centilethen 12 annually See Special considerations (child) | |
Lipids | ||
Fasting blood glucose or HbA1c | ||
Alanine transaminase (ALT) | ||
Polycystic ovary syndrome (PCOS) | ||
Obstructive sleep apnoea (OSA) | ||
Lifestyle plan | Each visit particularly Diet and nutrition, and Physical activity and sleep | |
Behavioural change | ||
Client self-management support | ||
Lifestyle modification | ||
Social-emotional wellbeing | ||
Influenza vaccine | Recommended. See the | |
Pneumococcal vaccine | ||
Dietitian | Wkly for 1 month then 3 mthly | |
RN/IHW review | Each visit | |
MO/NP review | 3 mthly then annually | |
6. References
- All Chronic Conditions Manual references are available via the downloadable References PDF