Obesity Referral Access Criteria

• New diagnosis of diabetes = polyuria and/or polydipsia and random BSL ≥ 11.1mmol/L
• Respiratory distress or chest pain
• Acute onset hip pain/limp

• Nil

To contact the relevant service, see Clinician Assist WA: Acute Paediatric Assessment (external site)

• Excessive weight gain
• Pre-diabetes = fasting plasma glucose 5.6-6.9mmol/L or OGTT 2-hour level 7.8-11.0mmol/L or HbA1c 5.7%-6.4%
• Obesity complications
• Excessive weight related co-morbidities

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.

• Current medication list
• Any known allergies
• Weight
• Height
• BMI z-score

• Nil

• For children aged >6 years within the last 6 months:
  • FBC
  • Fasting BSL
  • Fasting insulin
  • HbA1c
  • Fasting lipids
  • C peptide
  • Fe studies
  • TSH, T4
  • CRP
  • LFT including AST
• For children aged >10 years: OGTT when HbA1c is 5.7% to 6.4%

• Past medical history (inclusive of pregnancy, birth, immunisation and development history)
• Previous weight loss attempts
• Causes and complications of obesity (i.e. thyroid disease, obstructive sleep apnoea, musculoskeletal, polycystic ovarian syndrome, hypertension, liver dysfunction, headaches)
• Familial history (i.e. obesity, type 2 diabetes, gestational diabetes, obstructive sleep apnoea, liver disease, hypertension, weight loss surgery, mental health disorders)
• Motivation/support for change

• Nil

• Nil

Category 1

Appointment within 30 days

• Pre-diabetes = Fasting plasma glucose 5.6 - 6.9 mmol/L or OGTT 2-hour level 7.8 - 11.0 mmol/L or HbA1c 5.7% - 6.4%
• Age <6 years with rapid weight gain suspected to have medical or endocrine cause
• Cardiac compromise secondary to obesity

Category 2

Appointment within 90 days

• BMI z-score that is either:
  • Accelerating and in excess of >+3
  • +2.5 with evidence of 1 or more complications
  • ≥+2.2 – <2.5 with at least 2 co-morbidities:
    • Fasting insulin ≥16 mU/L
    • Fasting dyslipidaemia: total cholesterol ≥ 6.0 mmol/L, HDL ≤ 0.8 mmol/L, LDL ≥ 2.9 mmol/L, Triglycerides ≥ 2.5 mmol/L
    • Hypertension (≥ 95th percentile)
    • Obstructive sleep apnoea
    • Psychosocial (i.e., depression or anxiety)
    • Polycystic ovarian syndrome
    • Non-alcoholic fatty liver disease or hepatic steatosis
    • Musculoskeletal complications             

Category 3

Appointment within 365 days

• BMI z-score ≥ +2.5 with no evidence of obesity related co-morbidities

• Obesity with a BMI z-score < 2.5 without co-morbidities.
  • Refer to community-based dietitian or nutritionist. See Clinician Assist WA: Child Exercise and Healthy Eating Programs (external site)
  • See Clinician Assist WA: Childhood Obesity (external site)

• To calculate BMI z-score: Paediatric Z-Score Calculator (external site)

Monitoring

• Use BMI charts to monitor growth.
  • Interpretation of BMI values in children and adolescents aged 2–18 years is based on sex-specific BMI percentile charts.
  • Ensure same chart is used over time for consistent monitoring of growth
• Australian Practice: Growth of children less than 2 years of age is monitored using World Health Organization (WHO) growth charts (external site).

Management

• See Clinician Assist WA: Childhood Obesity (external site)
• See PCH pre-referral guidelines: Obesity (external site)
• Consider chronic disease management plan if appropriate
  • See Clinician Assist WA: Chronic Disease Management Items (external site)
• Consider referral to community-based dietitian or nutritionist
  • See Clinician Assist WA: Child Exercise and Healthy Eating Programs (external site)