How should I approach the management of childhood obesity in primary care, including lifestyle interventions and referral criteria?

In primary care, management of childhood obesity should involve discussing the potential reasons for weight concerns with children, young people, and their families, and offering behavioural overweight and obesity management interventions that include long-term support and maintenance advice to improve health and wellbeing ¹.

Interventions should focus on weight maintenance and growing into a healthier weight, rather than solely weight loss, depending on the child's age, growth stage, and degree of overweight or obesity ¹.

Referral to higher-level interventions such as specialist overweight and obesity management services, for example, complications from excess weight clinics or paediatric services, should be considered for children with weight-related comorbidities or who need specialist support, and the approach should be tailored to the child's clinical needs ¹.

Classify overweight and obesity in children using BMI percentiles: overweight (BMI 91st centile + 1.34 SDs), clinical obesity (BMI 98th centile + 2.05 SDs), and severe obesity (BMI 99.6th centile + 2.68 SDs) ¹.

Assess central adiposity using waist-to-height ratio: healthy (0.4–0.49), increased (0.5–0.59), and high (≥0.6), with the goal of keeping waist less than half of the child's height ¹.

Identify comorbidities early, especially in children with BMI at or above the 98th centile, and manage these comorbidities promptly without waiting for weight loss ¹.

Implement behavioural interventions that involve both individual and group sessions, tailored to the child's and family's needs, and ensure interventions are accessible, convenient, and involve regular contact and review ¹.

Support families and carers by discussing their support and readiness, exploring barriers to participation, and involving children and families in decision-making about interventions ¹.

In cases where lifestyle interventions are insufficient or not feasible, consider referral for specialist interventions, including medicines or surgical options, especially for children with significant comorbidities or severe obesity ¹.