Table 11.

Guidelines for treatment of obesity in primary care^*

Features that should trigger referral to paediatrician	Weight management options and contraindications
• Serious morbidity related to obesity (such as sleep apnoea, orthopaedic problems, type 2 and non-insulin dependent diabetes mellitus, hypertension)	• No weight gain as height increases
• Height below 9th centile, unexpectedly short for family, or slowed growth rate	• Weight gain slower than height gain
• Precocious or late puberty (before 8 years, or no signs at 13 in girls or 15 in boys)	• Rapid weight loss and strict dieting are not appropriate for growing children unless under specialist care
• Severe learning disability	Action
• Symptoms and signs of genetic or endocrine abnormalities	• Successful interventions involve the family and are tailored to each individual
• Severe and progressive obesity before age 2	• The multidisciplinary team needed may include a general practitioner, practice nurse, health visitor, school nurse, and other professionals if available (such as paediatric dietician, clinical psychologist, community paediatrician)
• Other serious concerns	• Negotiate realistic goals and monitoring plans
	• Provide information on local physical activity facilities, healthy eating, local parenting support groups

^*Adapted from the Royal College of Paediatrics and Child Health and National Obesity Forum. An Approach to Weight Management in Children and Adolescents (2-18 years) in Primary Care. 2002 (www.rcpch.ac.uk/)