Toolkit 2018-06-18T16:15:48+00:00
There is widespread international evidence to support the use of BMI to determine overall overweight and obesity in children older than 2 years of age.  BMI is not recommended for use in infants and children aged 0-2 years of age, for this age group it is recommended to monitor growth closely using the WHO growth charts.

As BMI varies with age due to changes in the rates of growth and weight gain, age and gender, specific thresholds and clinical judgement of the individual situation are required. It is important that clinicians consistently monitor children and adolescence against the same chart over time, and not across different charts.1

There are a number of national and international classifications of childhood overweight and obesity. Below are classification based on the CDC and WHO growth charts as recommended by the WHO report on Ending Childhood Obesity (2016)2 and NHMRC CP Guidelines for the Management of overweight and obesity in Adults, Adolescents and Children in Australia (2013)1.

Table 1: classification of childhood overweight and obesity

Classification Children from birth to 2 years of age

use WHO charts to monitor growth1

Children and adolescence (between the ages of 2-18 years)1
Healthy Weight

 

Weight for length ≤1 SD above or below the WHO Child Growth Standards median CDC: BMI between 5th and < 85th percentiles
WHO: BMI between the 3rd and <85th percentiles
Underweight

 

Weight for length ≥ 2 SD below the WHO Child Growth Standards median CDC: BMI <5th percentile
WHO: BMI <3rd percentile
Overweight

 

weight-for-height > 2 SD above WHO Child Growth Standards median2 CDC:  with a Body Mass Index (BMI) between 85th and  ≤ 95th percentiles
WHO: BMI between the 85th and 97th Percentiles
Obesity weight-for-height >3 Standard Deviation (SD) above the WHO Child Growth Standards median2 CDC: BMI ≥ 95th percentile
WHO: BMI >97th percentile
Extreme/severe Obesity3, 4 There is no consensus on the definition of severity of obesity, the most recent International Obesity Taskforce (IOTF)

Class 2 obesity:  BMI ≥120% of the 95th  percentile or ≥35 kg/m2 (CDC BMI charts)

Class 3 obesity: BMI ≥140% of the 95th  percentile or ≥40 kg/m2 (CDC BMI charts), or BMI Z score >3.5

Resources Girls:

Girls Length

Girls Weight

Girls Z scores:

0-2

2-18

CDC:

CDC Girls

CDC Boys

Boys:

Boys Length

Boys Weight

Boys Z scores

0-2

2-18

WHO:

WHO Girls 2-5yo

WHO Girls 5-19yo

WHO Boys 2-5yo

WHO Boys 5-19yo

Weight

How to ensure accurate measurements of weight measurement are collected:

  • Use a regularly calibrated scale on a hard, level surface
  • Ask the child to remove shoes and heavy outer garments (coats, jackets)
  • Ask the child to stand centred on the scale with weight evenly on both feet without moving
  • Record the weight
  • If weight cannot be measured, use other anthropometric measurement such as measuring mid upper arm circumference (MUAC)

Length and Height

How to ensure accurate measurements of length and height are collected:

Accurately measuring growth

  1. Utilise accurate and consistant equipment (stadiometer, lengthboard)
  2. Use appropriate measures according to age
    • Supine length <2 years
    • Standing height >24months
  3. Child is bare up until 1 year, then measurements taken with minimal clothing
  4. Take an average of three measurments
    1. Serial measurements are required to establish a growth pattern over time

Body Mass Index (BMI)

Calculation2: BMI = weight (kg)/height (m2)

  1. Calculate BMI
  2. Determine BMI percentiles
  3. Interpretation of weight category by percentiles

Interpretting Percentiles

Assess height, weight, calculate BMI and plot the measurements on the gender appropriate height/length-for-age, weight-for-age and BMI-for-age growth charts. Identify major shifts in growth patterns by examining previous centile ranks, when an increase in weight for age and BMI-for-age has occurred and potential causative factors during that time.

Useful websites

Waist Circumference

National and international guidelines do not support the use of waist circumference (WC) in identifying overweight or obesity in children.1, 3  This is due to data lacking its effectiveness when utilised with BMI or in the place of the BMI.3 In addition to this, the relationship between WC and metabolic complications in children and adolescents is yet to be defined. However, in children age 6 years old and over, measurement of WC can be used as a simple, non-invasive screening tool to identify increased cardiovascular risk and in longitudinal assessment of weight management.1

When measuring WC1:

  • Ask the child to remove heavy outer garments, loosen any belt and empty pockets
  • Ask the child to stand with their feet fairly close together (about 12–15 cm) with their weight equally distributed, and to breathe normally
  • Holding the measuring tape firmly, wrap it horizontally at a level midway between the lower rib margin and iliac crest (approximately in line with the umbilicus). The tape should be loose enough to allow the measurer to place one finger between the tape and the child’s body at the navel
  • Record the measurement on an exhalation

Waist to Height Ratio

Waist-to-height ration is assessed by: WC (cm) divided by height (cm)

Waist-to-height ratio of ≥ 0.5 may be used to guide consideration of the need for further assessment of cardiovascular risk in children.1

WC > half the height suggests a need for more thorough weight assessment1

Weight4KIDS is a professional development online learning program for all health professionals. It offers a series of 11 e-learning modules (developed by experts with the specific purpose of providing information and education to health professionals from all disciplines) in the assessment and treatment of children and adolescents who are above a healthy weight range.

  • Describes a service delivery model to be used by HPs when promoting the prevention, assessment and management of a child or adolescent who is above a healthy weight
  • Builds on the “Healthy Kids” message and program initiatives devised by the NSW Ministry of Health
  • Adapted from the evidence-based framework adopted by health professionals in NSW for smoking cessation (5As Approach)

Hosted by the children’s hospital at Westmead Child Health Promotion Unit/Sydney Children’s Hospital Network website has the fact sheets

Weight4KIDS e-learning portal

The Weight4KIDS e-learning program is free of charge

The AAP Institute for Healthy Childhood Weight have a series of educational modules for management of childhood obesity in the primary care setting. Access is free (require internet access), and include 6 modules:

  • Module 1: The Childhood Obesity Epidemic and the Role of the Healthcare Provider
  •  Module 2: Building a System to Improve Primary Care
  • Module 3: Introduction to the Childhood Obesity Algorithm: Obesity Assessment and Management
  •  Module 4: Childhood Obesity and the Primary Practice Team: Setting your office up for success and a practical approach to starting treatment in your PCP office
  • Module 5: Management and Treatment of Comorbidities of Obesity
  • Module 6: Motivational Interviewing: A Strategy to Stimulate Change Talk

The modules can be accessed on https://ihcw.aap.org/Pages/childhoodobesitypc.aspx

The Talking with Parents about Children’s Weight training is available in online. Designed for health and community professionals, the training aims to provide information and training for professionals working with children and families in various capacities, who may have a role to play in raising the issue of weight with families or encouraging referrals to appropriate services.

Participants are provided with information including:

  • The causes and consequences of child overweight and obesity
  • How to accurately define and measure obesity in childhood
  • How to explain weight status in a way that is sensitive, non-judgemental and promotes lifestyle change
  • How to apply these skills to their own professional background and setting

Please note, the training is free for health and community professionals in WA due to funding from the WA Department of Health under the Healthy Children’s Initiative. Individual cost for non-WA clinician ~AUD$175

To find out more or to register, please visit www.talkingaboutweight.org

How to talk to your child about their weight: a guide for parents and carer (The Sydney Children’s Hospitals Network)

Currently, the Personal Health Record (PHR) or “Red Book” is a parent-held booklet for recording vaccinations, development and major health events for their child. It is provided free to every parent at the time of birth of their child, and has been provided by Queensland Health since 1995.8 Red Book online will incorporate a structure and features similar to the current paper-based Red Book. The creation of an electronic, interactive and longitudinal PHR allows access and input from both parents and health professionals across the lifespan.

In specific relation to paediatric overweight and obesity, an electronic PHR:

  • encourages parental awareness of height and weight milestones,
  • offers a medium for resource support,
  • can be personalised with dietary and physical-activity-based strategies and resources, and
  • is useable beyond childhood into adolescence and adulthood.

Also incorporated will be novel tools and resources designed to encourage parental involvement and awareness of child health-related issues, particularly in the long-term prevention of overweight- and obesity-associated chronic disease, such as type 2 diabetes mellitus, hyperlipidaemia and hypertension.

When talking to families, the following need to be considered:

  • Review the stage of change the family is at
  • What do they think about making some changes at the moment?
  • How important is to make changes to address the family lifestyle including eating habits, activity level, screen time, sleep? (E.g. does the family want to work towards making healthy lifestyle changes to support good health for all family members?)
  • Why is it important to them to make some changes to address the family lifestyle (diet and activity level)?
  • If there are identified weight concerns: How important is it to make some changes to address their child’s weight? How is the child’s weight affecting their life currently?
  • If they do decide to make some changes, how confident do they feel to be able to do this? What would make them feel more confident?
  • The family need to have accepted overweight or obesity is an issue and be ready to work with you to make some healthy lifestyle modifications.
  • Ask if the family had previous lifestyle interventions:
  • Were these successful?
  • What worked well, what did not and why?
  • What were/are the barriers to implement change? (such as knowledge, time, strategies to manage challenging behaviour in children when implementing changes, parents/other caregivers have differing beliefs about lifestyle)
  • If indicated – offer available support (such as parenting support programs: Triple P®)

Useful resources

Healthy lifestyle family-focused programs

Desirable Aspects of Online Healthy Lifestyle Programs  

Researchers have described various aspects of online education programs to enhance effectiveness.

The following may be useful criteria by which to assess supportive online programs:

  • Model:
  • Family-centred
  • Incorporate nutrition, physical activity and psychology, including a behaviour change/modification component, meal plans, physical activity plans
  • Have a mechanism for follow up
  • Be facilitated by health professionals and capability for interaction with a health professional e.g. live chat, email support, question forum for individual tailoring
  • Mixture of a number of modalities including face-to-face, telephone and electronic
  • Pitched at an appropriate educational level i.e. year 5/6
  • Interactive
  • Available on all online platforms e.g. desktop, tablet, smart phone
  • Engaging
  • Accessibility:
    • Low/cost or free of charge
    • Available to all
    • Ability for content to be accessed at the completion of the program
    • Culturally appropriate
    • Replicable
    • Non-structured program to allow flexibility for users to log-on and off as desired
  • Evidence, Research and Evaluation:
  • Based on current evidence pertinent to the region
  • Have published results
  • Ability to be evaluated
  • An ongoing program vs a research tool
  • Endorsed by a reputable source

Physical Activity 

Increasing physical activity and reducing sedentary behaviour (e.g. screen time) can contribute to overall health and can reduce the risk of developing lifestyle related diseases such of overweight and obesity and T2DM. Physical activity can also help improve child’s development and wellbeing.2

The following document is a Physical Activity Overview, which includes the following information:

  1. Policy Context
  2. Queensland Data
  3. Queensland mapping (provides insight)
  4. Resources and Evidence
  5. School-based programs

Download the Physical Activity Overview

Resources developed by NSW Health to support physical activity include:

Nutrition

Healthy eating habits are developed from a very young age and are affected by a number of factors including genetics/biology, behaviour, culture and environment.  An understanding of the effect of healthy eating habits on health, and the required behaviours to develop these habits is crucial in making healthy food chices.2

Resources to support health eating habits include:

Heart Foundation – Great fruit & veg tips for kids

The clinical assessment aims to identify possible causes for childhood overweight and obesity, and indicators of co-morbidities and include1, 3:

  • Weight, height/length and BMI
  • Blood pressure
  • Acanthosis nigricans and skin tags
  • Extreme acne and hirsutism
  • Pubertal age (e.g. Tanner stages)
  • Headaches or visual disturbances
  • Abnormal gait or difficulties with balance or coordination
  • Gastrointestinal symptoms (e.g. vomiting, constipation, abdominal pain, gastrointestinal reflux)
  • Tenderness and range of motion of the knee, leg, or foot. Hip or knee joint pain, significant mobility problems
  • Peripheral oedema, thyroid examination for goitre)
  • Presence of intertrigo
  • Presence of hepatomegaly
  • Signs of dysmorphism
  • Abnormal glucose or insulin metabolism
  • Short stature or low growth velocity
  • Dental health (e.g. cavities)
  • Obstructive Sleep Apnoea (OSA) & snoring
  • Dyslipidaemia

Children or adolescents with a BMI ≥85th percentile are to be evaluated for potential comorbidities3. The following comorbidities should be screened for3:

  • Prediabetes HbA1c
  • Diabetes mellitus
  • Dyslipidaemia
  • Prehypertension and hypertension
  • Non-alcoholic Fatty Liver Disease (NAFLD)
  • Polycystic Ovary Syndrome (PCOS)
  • Obstructive sleep apnoea (OSA)
  • Psychosocial

Genetic obesity syndromes – a medical assessment of children and adolescents that are overweight or obese can help rule out underlying secondary-obesity causes, such as:

  • Hypothyroidism
  • Cushing’s syndrome
  • Growth hormone deficiency
  • Prader-Willi syndrome

A doctor may conduct further investigations for an underlying cause of overweight or obesity and /or evidence of nutrient deficiency. Investigation may include:

  • Fasting glucose, electrolytes and  liver enzymes
  • Full blood count
  • Ferritin and iron studies
  • Thyroid function tests
  • Genetic testing
  • Bone age/other imaging
  • Reviewing medications which may contribute to weight gain, e.g. steroid/prednisone/inhaled steroid puffers, antipsychotics

Childhood Obesity – QH Referral Criteria to weight management clinic/service

Category 1 (appointment within 30 calendar days) as per published Paediatric Obesity CPC 9

  • Hypertensive >95% for age with appropriate size cuff
  • Type 2 diabetes
  • Severe obstruction in sleep with repeated arousals and distress

Category 2 (appointment within 90 calendar days):

  • Aged between 2 and 18 years, and have a BMI well above the 95th percentile on CDC growth charts or the 97th percentile on WHO growth charts
  • Younger than 2 years, above the 97th percentile on WHO growth charts and/or gaining weight rapidly
  • Serious related comorbidities that require weight management (e.g. sleep apnoea, orthopaedic problems, risk factors for cardiovascular disease or type 2 diabetes, psychological distress)
  • An underlying medical or endocrine cause is suspected, or there are concerns about height and development. Including identified secondary or genetic causes of obesity

Category 3 (appointment within 365 calendar days):

  • No cat 3 criteria
  • BMI between 85-95th percentile with no related comorbidities (management within primary health care setting or community setting in the meantime)

Referral Pathway is currently under development

Medicare Item Numbers

  • Chronic Disease Management (Items 721-732)
  • Individual Allied Health Services for chronic Disease Management (Items 10950 to 10970)
  • Provision of monitoring and support for a person with a chronic disease by a practice nurse or Aboriginal and Torres Strait Islander health practitioner (item 10997)
  • Multidisciplinary Case Conferences (Items 735 to 758)
Healthy dietary behaviour Improve physical activity Sleep Hygiene
·  Drink plenty of water

·  Limit/avoid intake of energy dense (high fat, high sugar) processed food and fast food

·  Limit/avoid intake of sugary drinks(e.g. cordial, energy drinks, sport drinks, soft drinks, fruit drinks, juice, and vitamin/flavoured water)

·  Portion control

·  Increase intake of vegetables and fruit

·  Take a family approach to improving nutrition and be a good role model

·  Ensure children have regular meals, including breakfast and snacks, in a sociable atmosphere

·  Whenever possible, eat meals as a family

·  Separate eating from other activities such as watching television or using the computer

·  Encourage children to listen to internal hunger cues and to eat to appetite

·  Have healthy foods readily available

·  Explain the concept of foods that are appropriate ‘often’ or ‘sometimes’

·  Avoid using foods as treats or rewards

·  Comfort children with attention, listening and affection instead of food

·  Encourage children to develop healthy ways of regulating emotions (i.e. that don’t involve food)

·     Explain that being active is good for overall health as well as being fun

·      Encourage both moderate and vigorous activities every day

·      Be active with children (e.g. playing games with balls, or walking or bike riding together)

·      Support children to include physical activity in daily activities (e.g. walking to school, household tasks)

·      Encourage children to be involved in team sports

·      Reduce inactive leisure time

·      limit non-academic screen time to 1 to 2 hours per day

·      Get the family involved in local activities (e.g. sports clubs)

·      Make use of local opportunities for physical activity (e.g. swimming pool, walking tracks)

·      Be a good role model by being physically active yourself

Australia age specific recommendations:

·      Infants (Birth to 1 year): for healthy development in infants, physical activity – particularly supervised floor-based play in safe environments – should be encouraged from birth.

·      Toddlers (1 to 3 years) & Pre-schoolers (3 to 5 years): should be physically active every day for at least 3 hours, spread throughout the day.

·      5-12 years should accumulate at least 60 minutes of moderate to vigorous intensity physical activity every day

·      13-17 years should accumulate at least 60 minutes of moderate to vigorous intensity physical activity every day

·   Ensure age appropriate and adequate sleeping patterns

·   Limit screen time at least 60 minutes prior to bed

·   Limit TV’s in children’s bedrooms

The role of the dietitian in paediatric weight management is to:

  • Accurately Identify children at risk of childhood obesity and additional adverse health problems
  • Conduct a comprehensive assessment of the child’s dietary intake and eating patterns
  • Determine an appropriate, individualised and patient/family-centred nutritional care plan to promote healthy behaviours
  • Discuss strategies and goals effectively with patients and families to support sustainable behavioural changes for healthy eating, physical activity and sleeping habits

To aid the management of children who are overweight or obese, dietitians and clinicians can utilise the CHQ Paediatric Obesity Management Tool Kit (draft) – a systematic collation of clinical guidelines and education resources, providing clinicians and Dietitians with efficient access to standardised protocols and resources for use within consultations.

View the toolkit

The role of the psychologist in weight management clinics/service is to support changes in child and family health behaviours, including:

  • Assess the family/child readiness to take part in the weight management clinic
  • Discuss the reasons that motivate families to address the child’s weight
  • Assess and discuss family and child’s level of confidence to implement changes to the child’s diet and physical activity
  • Assess and discuss factors related to the child, the family and other areas that might interfere with ability to make changes
  • Introduce strategies to facilitate changes with the family

The role of a weight management clinic psychologist is outlined further here.

Weight Management Clinic’s Psychologist learnings and tips.

Other useful resources

The Family Partnership Model

“The Family Partnership Model is an innovative approach based upon an explicit model of the helping process that demonstrates how specific helper qualities and skills, when used in partnership, enable parents and families to overcome their difficulties, build strengths and resilience and fulfil their goals more effectively12.”

The Satter Feeding Dynamics Model

“The Satter Feeding Dynamics Model (fdSatter) illustrates that when parents feed according to a developmentally appropriate Division of Responsibility in Feeding (sDOR),1-3 children gradually accumulate attitudes and behaviors that characterize adult Eating Competence. sDOR encourages parents to take leadership with the what, when, and where of feeding and give children autonomy with the how much and whether of eating13”.

  • family focused
  • comprehensive and include counselling for:
    • healthy diet and/or weight reduction;
    • improve physical activity/reduced sedentary/screen time
    • use of behavioural management counselling
  • provide >25 hours of contact with child and/or family over a period of 6 months
  • Number of contact hours:
    • moderate intensity 26-75 contact hours
    • high intensity: >75 contact hours
  • Length of intervention:
    • 6 to 12 months initially + across the lifespan (integrated approach – across all levels of service delivery)
  • Individual family appointment or a mixture of individual and group sessions

We acknowledge that this level of contact (frequency and length) may not be achievable in all health services, and hence the goal should be to provide as best a service as you can (even if that mean less contact hours).

Low Energy Diet (LED) is a prescriptive diet which aims to achieve energy deficit. It includes a specific meal plan and/or addition of some meal substitute.16 This is required to be undertaken with the help of a dietitian to ensure age appropriate and balanced diet is achieved.

A referral to a paediatrician is recommended if the child has significant comorbidity or complex needs4, 17:

  1. Children meeting the obesity classification who fulfil the following criteria:
    1. the child or family are seeking help/treatment
    2. the child has one or more risk factors for either possible underlying pathology or future morbidity
  2. Any child with extreme obesity (BMI Z score>3.5) – refer to OSCA Obesity Assessment Protocol for further details17

OSCA Obesity Assessment Protocol

Paediatrician Role

  • Take part in the initial clinic assessment to complete a medical history and physical exam, along with appropriate diagnostic tests
  • Talk with the families about their child’s medical history and any family health concerns
  • Perform a physical examination of the child
  • Discuss with the family any further tests or assessments that may be required e.g. blood tests, referral to a Specialist

Multidisciplinary Team (MDT) Role

Multi-professional paediatric weigh management clinic. This may include a medical doctor, dietitian, psychologist, physiotherapist/exercise physiologist and or Registered Nurse. The MDT focuses on the management of overweight and obesity in children and adolescents.

What to expect in the Weight Management Clinic:

  • A comprehensive assessment of general health and growth
  • Clinical investigations as appropriate
  • Dietary Assessment
  • Psychological and social assessment if required
  • Specialist advice and education on diet and lifestyle modification
  • In some cases, medical and or surgical treatments may be discussed

Very low-caloric/energy diets (VLCDs or VLEDs)  reduced energy intake by substituting meal with formulated meal replacement may produce rapid weight loss and should be combined with physical activity.16

Recent recommendations from the America Endocrine Society Pediatric Obesity Clinical Practice Guideline suggested that pharmacotherapy can be used for management of paediatric obesity “only after a formal program of intensive lifestyle modification has failed to limit weight gain or to ameliorate comorbidities”3.

The Australian Obesity Management Algorithm (ANZOS 2016) also suggests that “Weight loss pharmacotherapy may be useful in assisting with the initial weight loss, to maintain weight loss at the end of a VLED or to prevent weight regain. While weight loss pharmacotherapy will usually be required on a long-term basis, data on long-term safety and effectiveness of weight loss medication are limited. Only three drugs have been approved by the TGA for the treatment of obesity in Australia, Phentermine, Orlistat and Liraglutide”16. However, this is an adult obesity guideline and hence paediatric applications need to be considered.

Detailed information pharmacotherapy available in the Australian Obesity Management Algorithm 16

Limited data is available to determine if there are long term beneficial or harmful consequences post bariatric surgery (>12 months).1 However, surgery should be considered as an option when all other avenues have been exhausted and with reference to the position paper Recommendations for Bariatric Surgery in Adolescents in Australia and New Zealand 18.

More recently, the America Endocrine Society Pediatric Obesity Clinical Practice Guideline made the following recommendations in regards to bariatric surgery for paediatrics3:

  • “the patient has attained Tanner 4 or 5 pubertal development and final or near-final adult height, the patient has a BMI of >40 kg/m2 or has a BMI of >35 kg/m2 and significant, extreme comorbidities”
  • extreme obesity and comorbidities persist despite compliance with a formal program of lifestyle modification, with or without pharmacotherapy
  • psychological evaluation confirms the stability and competence of the family unit [psychological distress due to impaired quality of live (QOL) from obesity may be present, but the patient does not have an underlying untreated psychiatric illness]
  • the patient demonstrates the ability to adhere to the principles of healthy dietary and activity habits
  • there is access to an experienced surgeon in a paediatric bariatric surgery centre of excellence that provides the necessary infrastructure for patient care, including a team capable of longterm follow-up of the metabolic and psychosocial needs of the patient and family.”

They also recommend against bariatric surgery “in preadolescent children, pregnant or breast-feeding adolescents (and those planning to become pregnant within 2 years of surgery), and in any patient who has not mastered the principles of healthy dietary and activity habits and/or has an unresolved substance abuse, eating disorder, or untreated psychiatric disorder.” 3

Following a recent meeting of the Queensland Clinical Senate (QCS), recommendations on bariatric surgery in the public sector included19:

  • “in addition to focusing on promoting healthy lifestyles and weight management through diet and exercise, bariatric surgery is provided as a publicly funded intervention for specific groups of patients in Queensland:
    • Recognising workforce capability constraints and the importance of evaluating outcomes, in the short term bariatric surgery services should be provided using a ‘centre of excellence’ model but with a focus on equity of access.
    • A transparent and evidence-based process is implemented to identify and prioritise the patients most likely to benefit.
  • The Department of Health develop a published policy position on access to and eligibility for bariatric surgery in Queensland public hospitals.” (in print)

Project ECHO: a Queensland-based paediatric overweight and obesity model

How does Project ECHOTM work?

Project ECHOTM (Extension for Community Healthcare Outcomes) is a collaborative model of medical education and case management that empowers clinicians everywhere to provide care for patients they would otherwise need to refer on.  GPs and other healthcare professionals can access evidence-based, multidisciplinary advice for their patients with overweight and obesity from a panel of paediatrics experts.  

What is required of participants?

  • An intention to attend a minimum of 6 (out of 8) 60min, weekly videoconferences
  • A willingness to present at least one patient case during the 8-week series, to fellow participants
  • Completion of brief surveys, pre- and post-ECHOTM training

Why participate in ECHO™?

  • Increase your skill and competence in childhood overweight and obesity management
  • Acquire 40 free category 1 CPD points*
  • Receive ongoing access to multidisciplinary advice for your overweight and obese patients (children), beyond completion of the series
  • Become part of an engaged community of practice and increase your professional satisfaction

* accredited as an active learning module through the RACGP QI&CPD Program (2017-2019 Triennium).

Further information

Important aspects of service delivery that can often be overlooked or considered as an afterthought are various research, monitoring and evaluation activities. These activities are an integral part of assessing and improving the quality, effectiveness and suitability of current services, and contribute greatly to the planning of sustainable future services.

Coding (during hospital admission including day patients and inpatients admissions, not applicable for outpatients):

  • Overweight and Obesity Coding : code E66 – Obesity and overweight:
    • 3 – To code for overweight please document ‘Overweight’ in patient chart
    • 9 – To code for Obesity please document ‘Obesity’ in patient chart
  1. National Health and Medical research Council (NHMRC), Department of Health and Aging, Australian Government. Clinical Practice Guidelines for the Management of overweight and obesity in Adults, Adolescents and Children in Australia. Canberra: NHMRC; 2013. [internet] Available from: https://www.nhmrc.gov.au/guidelines/publications/n57
  2. World Health Organisation. Report on Ending Childhood Obesity. Geneva, Switzerland: WHO; 2016 [Internet]. Available from: http://apps.who.int/iris/bitstream/10665/204176/1/9789241510066_eng.pdf?ua=1
  3. Styne DM, et al. Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2017; 102(3):709–757. Available from: https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2016-2573
  4. Viner RM, White B, Barrett T, et al. Assessment of childhood obesity in secondary care: OSCA consensus statement. Archives of Disease in Childhood – Education and Practice 2012; 97(3):98-105 [Internet]. Available from: http://ep.bmj.com/content/97/3/98
  5. The Children’s Hospital at Westmead, New South Wales Ministry of Health. Weight4KIDS [Internet]. Available from: https://kidshealth.schn.health.nsw.gov.au/childhood-obesity
  6. The American Academy of Pediatrics (AAP), Institute for Healthy Childhood Weight. Childhood Obesity in Primary Care: a series of educational modules [Internet]. Available from: https://ihcw.aap.org/Pages/childhoodobesitypc.aspx
  7. Department of Health Government of Western Australia, New South Wales Ministry of Health and better health company. Talking with parents about children’s weight, [Internet]. Available from: http://www.talkingaboutweight.org/
  8. Queensland Health, Queensland Government. Personal Health Record (‘Red Book’). Brisbane: Queensland Government, 2016 [Internet]. Available from: https://www.childrens.health.qld.gov.au/wp-content/uploads/PDF/brochures/personal-health-record-booklet.pdf
  9. Queensland Health, Queensland Government. Clinical Prioritisation Criteria, General Paediatrics, Paediatric Obesity Minimal Referral Criteria. 2017 [Internet]. Available from: https://cpc.health.qld.gov.au/Condition/272/paediatric-obesity
  10. Ministry of Health, New Zealand. Weight management in 2-5 year olds for primary health care. Wallington: Ministry of Health; 2016 [Internet]. Available from: http://www.health.govt.nz/publication/weight-management-2-5-year-olds
  11. The Department of Health, Australian Government. Australia’s Physical Activity and Sedentary Behaviour Guidelines. Canberra: DoH; 2014 [Internet]. Available from: http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines#npa05
  12. National Health Service, Department of Health, UK. The Family Partnership Model. London: NHS; 2007 [Internet]. Available from: http://www.cpcs.org.uk/index.php?page=about-family-partnership-model
  13. Ellyn Satter Institute. The Satter Feeding Dynamics Model [Internet]. Available from: http://www.ellynsatterinstitute.org
  14. Wilfley DE, et al. Improving Access and Systems of Care for Evidence-Based Childhood Obesity Treatment: Conference Key Findings and Next Steps. Obesity 2017; 25 (1):19-26 [Internet]. Available from : http://onlinelibrary.wiley.com/doi/10.1002/oby.21712/epdf
  15. National Institute for Health and Care Excellence (NICE) Clinical Guideline, Obesity: identification, assessment and management. UK: NIC; 2014 [Internet]. Available from: https://www.nice.org.uk/guidance/cg189
  16. Australian and new Zealand Obesity Society (ANZOS). The Australian Obesity Management Algorithm. 2016 [Internet]. Available from: http://anzos.com/assets/Obesity-Management-Algorithm-18.10.2016.pdf
  17. Obesity Services for Children and Adolescents (OSCA) Network Group. OSCA consensus statement on the assessment of obese children & adolescents for paediatricians. London: OSCA; 2012 [Internet]. Available from: https://www.cornwallhealthyweight.org.uk/OSCA_Guidelines.pdf
  18. Baur LA and Fitzgerald DA. Recommendations for Bariatric Surgery in Adolescents in Australia and New Zealand. A position paper from the Australian and New Zealand Association of Paediatric Surgeons, the Obesity Surgery Society of Australia and New Zealand and the Paediatrics & Child Health Division of The Royal Australasian College of Physicians. Journal of Paediatrics and Child Health 2010; 46(12): 704–707 [Internet]. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1754.2010.01875.x/epdf
  19. Queensland Health, Queensland Government. Queensland Clinical Senate Meeting Report, Challenges in Healthcare Meeting Report. Brisbane: Queensland Health; 2017 [Internet]. Available from: https://www.health.qld.gov.au/__data/assets/pdf_file/0027/652608/qcs-meeting-report-201703.pdf )
  20. Queensland Health, Queensland Government. A Better Choice – Healthy Food and Drink Supply Strategy for Queensland Health Facilities. Brisbane: Queensland Health; 2007 [Intranet]. Available from: https://www.health.qld.gov.au/__data/assets/pdf_file/0025/437272/32511.pdf
  21. Queensland Health, Queensland Government. Healthier drinks for healthcare facilities, Best Practice Guide. Brisbane: Queensland Health; 2016 [Intranet]. Available: https://www.health.qld.gov.au/__data/assets/pdf_file/0023/656024/best-practice-healthier-drinks.pdf
  22. School of Medicine, University of New Mexico. Project ECHOTM. 2017 [Internet]. Available from: http://echo.unm.edu/about-echo/