Healthy Weight Service - For health professionals
Raising the issue of weight
If you would like assistance on talking with families about weight in a sensitive way, Novo Nordisk have developed a brochure
Rethink Obesity Education to assist with initial conversations and helping patients over time.
Referrals
The following criteria apply for inclusion in the Healthy Weight Service (HWS); please carefully assess if the child is eligible to receive care through the HWS. It is essential that all supporting information be provided to avoid delay in referral processing and increased wait times for families.
Pre-referral guidelines are also available.
Please note:
Children and young people who have classic symptoms of diabetes should NOT have an OGTT and should have a random glucose to confirm the diagnosis.
Children and young people with a diagnosis of diabetes must be discussed urgently with the PCH on call Endocrinologist via PCH switchboard (08) 6456 2222.
Appropriate calculations for BMI percentiles and z-scores must be used:
CDC Growth calculator for 2 to 20 years
WHO Growth Standard for 0 to 24 months
WACHS patients may be suitable for HWS/WACHS Shared Care Pathway.
When to refer
The child or young person must be under 16 years of age at the time of referral and meet the criteria of one of the following pathways. Pictorial version also available. Measurements and evidence of investigations must be included for all categories. Children and young people referred via pathways D, E or F should have 6 + months of community-based weight management interventions prior to referral. Please include details of interventions with the referral.
A: Prediabetes:
1. BMI >= 85th percentile and one of the following:
- Fasting glucose 5.6 – 6.9 mmol/L (Impaired Fasting Glucose (IFG))
- 120-minute OGTT glucose 7.8 – 11.0 mmol/L (Impaired Glucose Tolerance (IGT))
- HbA1c 5.7– 6.4 %
B: High medical need:
BMI >= 120% of 95th percentile and high medical need, where obesity is compromising health such as at least one of the following:
- Metabolic dysfunction-Associated Fatty Liver Disease (MAFLD) diagnosed by gastroenterologist
- History of Slipped Upper Femoral Epiphysis (SUFE)
- Intracranial hypertension diagnosed via neurologist
- Moderate/Severe Obstructive Sleep Apnoea (OSA) diagnosed via sleep study
- Requires weight loss for surgery to proceed
- Currently being treated pharmacologically for hypertension
- Requires weight loss for solid organ transplant to proceed
- Known obesity syndrome diagnosed via genetic testing excluding Prader-Willi Syndrome (provide results of genetic testing).
C: Under 24 months:
Under 24 months of age with a BMI z-score >= +3
D: Other factors:
BMI >= 135% of 95th percentile and at least 2 other factors:
- Under 60 months
- Family identifies as Aboriginal or Torres Strait Islander
- MAFLD: ALT > 1.5 x upper laboratory limit
- Dyslipidaemia: LDL >= 3.0 mmol/L +/- Triglycerides >= 2.5 mmol/L
- Hypertension >= 95th percentile on at least 2 occasions
- On pharmacotherapy that increases the risk of insulin resistance such as anti-psychotics
- Musculoskeletal complications that limit ability to undertake daily activities
- Mild OSA diagnosed by sleep study/awaiting sleep study.
E: Extreme obesity:
BMI >= 150% of 95th percentile
F: Under 24 months:
Under 24 months of age with a BMI z-score >= +2.5
How to refer
Essential information to include in your referral
Please ensure the patient meets the referral criteria for the selected pathway before referring to the HWS and include:
- Weight, height/length and date of measurement
- BMI, BMI z-score, and BMI z-score as a percentage of the 95th percentile as per
- Blood investigation results for children over 5 years within the last 6 months (include Oral Glucose Tolerance Test where appropriate):
- Full blood picture
- Fasting glucose
- Fasting insulin
- HbA1c
- Fasting lipid profile
- C peptide
- Iron studies
- Thyroid function test
- C-reactive Protein
- Liver function test including AST
- Oral Glucose Tolerance Test when HbA1c level is 5.7% - 6.4% in children ≥ 10 years (or pubertal)
- When only partial blood investigations are included, or there is a valid reason for not including these, please indicate this in the referral information and/or discuss with the Triage team.
- Whether the child or young person is cared for under WACHS and suitable for HWS/WACHS Shared Care
- Referrals via Pathways D, E or F require at least 6 months of community-based interventions prior to referral. Please include details of these interventions with the referral.
Useful resources
The following resources also assist when making referrals:
For additional information and patient resources, please refer to the PCH Healthy Weight Service webpage.
[1] Pre-diabetes ranges as per ADA Standards of Care in Diabetes 2024 and ISPAD Clinical Practice Consensus Guidelines 2022