Obesity Referral Access Criteria

• New diagnosis of diabetes = polyuria and/or polydipsia and random BSL ≥ 11.1mmol/L. Must be discussed urgently with the PCH on call Endocrinologist via PCH switchboard 
• 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)

• Severe obesity with complications that fulfil the HWS Referral Criteria (external site) OR

• BMI >= 85^th percentile with pre-diabetes as per HWS Referral Criteria (external site)

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
• Blood pressure
• Weight
• Height / length
• BMI, BMI z-score, and BMI z-score as a percentage of the 95th percentile as per
  • CDC Growth calculator for 2 to 20 years (external site)
  • WHO Growth Standard for 0 to 24 months (external site)

• Nil

• For children aged >5 years within the last 6 months:
• FBC
• Fasting BSL
• Fasting insulin
• HbA1c
• C peptide
• Fasting lipids
• Fe studies
• TSH, T4
• CRP
• LFT including AST
• Oral Glucose Tolerance Test when HbA1c level is 5.7% - 6.4% in children ≥ 10 years (or pubertal)
• Children who have classic symptoms of diabetes should NOT have an OGTT and should have a random glucose to confirm the diagnosis

• Past medical history (inclusive of pregnancy, birth, immunisation and development history)
• BMI trajectory
• Previous weight loss attempts
• Any known allergies
• 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)
• Social history, motivation/support for change

• Nil

• Nil

Category 1

Appointment within 30 days

• BMI >= 85^th percentile and one of the following:
  • 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%
• Under 24 months of age with a BMI z-score >= +2.5
• BMI >=120% of 95^th 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)

Category 2

Appointment within 90 days

• Under 24 months of age with a weight for length z-score >= +2.5
• BMI >= 135% of 95^th percentile and three or more of the below factors
  • Under 60 months
  • Family identifies as Aboriginal or Torres Strait Islander
  • MASLD: ALT > 1.5 x upper laboratory limit
  • Dyslipidaemia: LDL >= 3.0 mmol/L +/- Triglycerides >= 2.5 mmol/L
  • Hypertension >= 95th 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

Category 3

Appointment within 365 days

• BMI >= 135% of 95^th percentile and two of the below 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 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
• BMI>=150% of 95^th percentile

• Do not fulfil HWS Referral Criteria (external site)
• Family declined to attend

• For inclusion criteria, also see HWS pre-referral guidelines (external site) or HWS referral pictorial guide (external site)
• Patients referred in the following referral categories must have had at least 6 months community-based interventions prior to referral, with details included in the referral
  • BMI >= 135% of 95th percentile and only two complications
  • BMI >= 150% of 95th percentile with no complications

Monitoring

• Ensure correct age- and sex-specific growth charts are used:
  • BMI-for-age (z-scores) for girls (external site) and boys (external site) 0-2 years
  • CDC Extended BMI-for-age percentiles for girls (external site) and boys (external site) 2–18 years

Management

• See Clinician Assist WA: Childhood Obesity (external site)
• Consider referral to general paediatrics
• Consider chronic disease management plan if appropriate
  • See Clinician Assist WA: Chronic Disease Management Items (external site)
• Consider referral to community-based programs
  • See Clinician Assist WA: Child Exercise and Healthy Eating Programs (external site)
• Consider referral to community-based Dietitian or Nutritionist