Clinical Toolkit

Clinical tools to support best practice in childhood obesity.

Clinicians Hub

Clinical Toolkit

We’ve gathered and developed a broad range of resources to help support clinicians across all areas of childhood obesity. Please find them below.

  • Age boxes (similar to the model of care boxes) for ‘Pregnancy and Antenatal’ ‘0-5 years’ ‘Children and Adolescents’ ‘Adults’, ‘Older Adults (>65), that open to new pages for each. The resources would then sit under these.
  • Those resources that sit under Preconception and Antenatal will then sit under ‘Pregnancy and Antenatal’.
  • Resources grouped – by Growth Charts, Clinical Practice Guidelines, Early Identification and intervention, Treatment and Management, Education and Training.
  • Tools, resources and education to support professionals to provide evidence-based, practical advice when supporting Queenslanders to introduce healthy behaviours for better weight management.
  • Include the 3A’s Matric for Primary Health Care
  • Then include the age-boxes as above
  • Each age box to open a new window.
Pregnancy growth charts
Pregnancy weight gain monitoring chart for BMI less than 25kg/m2
Queensland Health
Pregnancy weight gain monitoring chart for BMI greater than 25kg/m2
Queensland Health
Pregnancy weight gain chart for twins and triplets for BMI less than 25kg/m2
Queensland Health
Pregnancy weight gain charts for twins and triplets for BMI greater than 25kg/m2
Queensland Health
Clinical Practice Guidelines
Queensland Clinical Guidelines Obesity in pregnancy
Queensland Health
RANZCOG ‘Management of obesity in pregnancy’ guidelines
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
NHMRC Pregnancy Care Guidelines 2018
Queensland Health
Healthy Pregnancy, Healthy Baby
PD self-paced to support respectful conversations about pregnancy weight gain
Healthy weight gain in pregnancy
Online module to increase knowledge in pregnancy and weight management
Maternal Health: Nutrition and Physical Activity
Description – Education module to support healthy behaviour change in pregnancy
Healthy Eating during Pregnancy
Brochure from NHMRC
Australian Breastfeeding Association Resources
Explanation ‘Support for families in breastfeeding from pregnancy through to 12 months and beyond’
NAQ Introduction to solids
Quick introduction on when to start solids.

Promote healthy habits during pre-conception and antenatal stages

A woman’s preconception weight and gestational weight gain (GWG) are two of the most important and independent predictors of childhood obesity.[11] In Queensland, half of all women already live with overweight or obesity at conception.[3]

It is recommended that health professionals use GWG charts in consultation with women throughout their pregnancy. The charts should be provided to a pregnant woman during the first ante-natal visit and used to support ongoing discussion about weight at each antenatal visit.[20]

Ask and Assess

  • Pre-conception: Ask women about planning a pregnancy, and ask permission to discuss and assess preconception weight and explain its relevance.
  • Antenatal: Calculate BMI at entry to care, weigh and plot at every antenatal visit.

Advise and Assist

  • Pre-conception: Advise women of their weight range.
  • Antenatal: Advise women of recommended GWG based on their pre-pregnancy BMI. Regularly monitor and discuss pattern and rate of weight gain. Encourage self-monitoring. Provide general information on optimal nutrition, physical activity and sedentary time.

Arrange and Ask Again

Referral to allied health services for women identified as at-risk. Ask women for follow-up appointment for weight monitoring.

Australian National Breastfeeding Strategy: 2019 and Beyond
Analysis & Policy Observatory
Infant Feeding Guidelines for health professionals
National Health and Medical Research Council
Infant Feeding and Allergy Prevention Guidelines
Australasian Society of Clinical Immunology and Allergy (ASCIA)

0-5 Years

Promote breastfeeding and support introduction of healthy first foods

Breastfeeding gives babies the best start to a healthy life and confers life-long protective effects for the health and wellbeing of mothers and babies. All health professionals have a responsibility to encourage, support and promote breastfeeding.

Ask and Assess

  • Ask if mother intends to breastfeed, for how long, any difficulties experienced, any contact with Child Health Services.
  • Ask the family about timing and choice of first foods.

Advise and Assist

  • Encourage exclusive breastfeeding for around the first six months of life, with breastfeeding continuing to at least 12 m and beyond, for as long as mother and baby desire. Where breastfeeding is not desired or possible, infants should be fed infant formula.
  • First foods should be introduced when developmentally appropriate (around 6 m but not before 4 m) with iron -rich foods included first. Avoid ‘baby’ juices.
  • Full cream cows milk can be given as a drink from 12m. Toddler formulas are not required unless medically indicated. Recommend using a cup and discourage use of a feeding bottle.
  • Provide resources to assist family.

Arrange and Ask Again

  • Refer to local child health services or 13 HEALTH: Note must request to speak with a child health nurse.  Provide contact details for the Australian Breastfeeding Association.
  • Ask family for follow-up appointment infant feeding and support.

Early Years 0-5

Childhood overweight and obesity can persist into adulthood and increases risk of cardiovascular disease, type 2 diabetes, stroke and poor mental health. Healthy weight checks need to start before the age of five; one in five Australian children are already affected by overweight or obesity at this age. Primary Health Care (PHC) providers can provide anticipatory guidance to prospective parents, families and children to support healthy weight and weight-related behaviours.

Measuring growth and monitoring change

Measuring growth should be a part of standard, routine paediatric clinical practice. Regular growth assessments make it easier to recognise an abnormal growth trajectory and identify children who are at risk of developing overweight and obesity. Serial measurements also normalise growth monitoring and provide an opportunity to discuss growth charts and healthy growth with the family in a standardised, non-stigmatising way.

Parents are the primary influence on the development of child eating, physical activity and sedentary behaviours with parenting styles playing a role in developing healthy lifestyles. However, the ability of families to make healthy food choices can be challenging in Australia’s obesogenic environment.

It is recommended that weight, length/height and BMI are measured, assessed and reviewed at least yearly in addition to the key milestone growth reviews in the Personal Health Record during the first two years of life.

Using percentile charts to measure growth and monitor change

Growth status in children and adolescents (age 0-18 years old) is assessed using age- and sex- specific reference values, as the appropriate ratio of weight to height varies during development. Measuring growth should always be contextualised to a child’s clinical condition.  For younger children, faster growth across centiles can indicate later overweight/obesity risk (REF)

  • For children 0-2 years, use WHO growth charts (calculate weight, length and weight for length for age) Using the BMI-for-age growth chart is not recommended for children younger than age 2 years.
  • Link to Growth Charts

**Queensland Health use WHO chart for children 0-2 years and CDC growth charts for children 2-18 years of age

Classification of Overweight and Obesity

Class Age Group Description
Overweight 0 – 2yrs (WHO) Weight-for-height > 2 SD above WHO Child Growth Standards Median
2 – 18yrs (CDC) 85th to 95th %ile
Obese 0 – 2yrs (WHO) Weight-for-height > 3 SD above WHO Child Growth Standards Median
2 – 18yrs (CDC) ≥ 95th %ile
*There is no consensus on the definition of severity of obesity, the most recent International Obesity Taskforce (IOTF) recommendations suggested these definitions:
• 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
Early Identification
Raising the topic of a child’s weight
Growing Good Habits
Australian Guide to Healthy Eating
Eatforhealth.gov.au
Early Intervention
Australian Dietary Guidelines
Eatforhealth.gov.au
Australia's Physical Activity and Sedentary Behaviour Guidelines and the Australian 24-Hour Movement Guidelines
The Department of Health (Australian Government)
Growth Charts
Clinical charts with 3rd and 97th percentiles
Center for Disease Control and Prevention
The WHO Child Growth Standards
World Health Organization

Children and Adolescents

Prevention of overweight and obesity in children

Childhood overweight and obesity can persist into adulthood and increases risk of cardiovascular disease, type 2 diabetes, stroke and poor mental health. Healthy weight checks need to start before the age of five; one in five Australian children are already affected by overweight or obesity at this age. Primary Health Care (PHC) providers can provide anticipatory guidance to prospective parents, families and children to support healthy weight and weight-related behaviours.

During primary school, parents continue to be a key influence in the development of child eating, physical activity and sedentary behaviours with parenting styles playing a role in developing healthy lifestyles.  Role modelling healthy eating, positive body diversity and being active are key to encouraging children to do so also. However, the ability of families to make healthy food choices can be challenging in Australia’s obesogenic environment.

Prevention of overweight and obesity needs to be available across ‘critical time periods’ in the life course: pre-conception and pregnancy; infancy and early childhood; and older childhood and adolescence.

Ask and Assess

  • Opportunistically measure growth and plot annually throughout school years
  • Assess and review at least yearly – is the child maintaining consistent growth velocity?

Advise and Assist

  • Discuss child’s growth pattern regularly with the family (using growth charts) and normalise growth monitoring.
  • Mention that it is part of standard care.
  • Recommend family to also keep child’s growth records until 18 years.

Arrange and Ask Again

  • Ask family for follow-up appointments for growth monitoring (opportunistic at all presentations, minimum yearly).

Measuring growth and monitoring change

Measuring growth is part of standard, routine paediatric clinical practice. Regular growth assessments make it easier to recognise an abnormal growth trajectory and identify children who are at risk of developing overweight and obesity. Serial measurements also normalise growth monitoring and provide an opportunity to discuss growth charts and healthy growth with the family in a standardised, non-stigmatising way.

It is recommended that weight, length/height and BMI are measured, assessed and reviewed at least yearly until age 18 years.

Using percentile charts to measure growth and monitor change

Growth status in children and adolescents (age 0-18 years old) is assessed using age- and sex- specific reference values, as the appropriate ratio of weight to height varies during development. Measuring growth should always be contextualised to a child’s clinical condition.

  • For children 2-18 years, use CDC growth charts** (calculate BMI-for-age, weight and height for age).
  • Link to Growth Charts

**Queensland Health use WHO chart for children 0-2 years and CDC growth charts for children 2-18 years of age

Class Age Group Description
Overweight 2 – 18yrs (CDC) 85th to 95th %ile
Obese 2 – 18yrs (CDC) ≥ 95th %ile
*There is no consensus on the definition of severity of obesity, the most recent International Obesity Taskforce (IOTF) recommendations suggested these definitions:
• 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

Early Intervention for children and families

Early intervention is indicated if a child is at-risk of developing overweight or obesity from simple risk factors (see ‘Identifying risk’) identifiable in the first 1,000 days, or later in life if there is a family history of overweight and obesity and the family are demonstrating unhealthy lifestyle behaviours.

Ask and Assess

  • Assess child’s growth (BMI-for-age) and discuss growth pattern with famly (using growth charts)
  • Ask about current lifestyle behaviours (fruit and vegetables, sugary drink intake, family meals, take away/eating out, tv and screen time, physical activity/active play, sleep routines).

Advise and Assist

  • Discuss weight in a non-judgmental, sensitive manner.
  • Empower and encourage families to make healthy lifestyle changes. Provide healthy eating and physical activity advice and resources (increase fruit and vegetables intake, water as the main drink, avoid sugary drinks and fruit juices, promote family meals, reduce screen time, active play and vigorous physical activity , healthy sleep routines).

Arrange and Ask Again

  • Refer identified/at risk children and their families to allied health/healthy lifestyle programs or 13 HEALTH (note must request to speak with a child health nurse. Available 7d/week).
  • Refer to Healthier. Happier. website.
Clinical Assessment
Motivational Interviewing for Diet, Exercise and Weight
UCONN Rudd Center for Food Policy & Obesity
Motivational interviewing techniques
The Royal Australian College of General Practitioners (RACGP)
Intervention
Chronic Disease Management — allied health individual services
The Department of Health (Australian Government)
Clinical Practice Guidelines for the management of overweight and obesity
National Health and Medical Research Council (Australian Government)
Motivational Interviewing
Insight (Queensland Health)

Treatment and management should take place when a child has experienced rapid weight gain or weight is identified as being in the overweight or obese category. Goals of treatment include improvements in sustainable healthy lifestyle behaviours, preventing further weight gain (weight maintenance) and in some cases where appropriate, weight reduction, for example:

  • Overweight:weight maintenance rather than weight loss can sometimes be the goal during growth (i.e. to allow gradual decline in BMI as height increases).
  • Obesity:goal is often weight loss. Most children and adolescents with obesity will require multicomponent (dietary, physical activity, behavioural), prescriptive advice to promote a decrease in energy intake.

These recommendations are dependent on the situation and the child’s individual factors. Clinical judgment is also required when recommending weight maintenance or weight loss.

Childhood overweight and obesity (without co-morbidities) should be managed in primary health care using multi- disciplinary services coordinated by the PHC provider, unless referral to hospital or specialist services is indicated (with co-morbidities).

The components of successful clinical treatment and management include:

  • Clinical assessment.
  • Behaviour change strategies (e.g. motivational interviewing).
  • Active parental involvement – “family-based”.
  • Multi-component lifestyle interventions (e.g. diet, physical activity, sleep, screen time).

Clinical Assessment

Relevant history in the context of weight assessment includes developmental history, physical and mental health, and current health behaviours. It is also important to complete a clinical assessment to identify any concerns or potential causes for overweight and obesity and comorbidities.

Additionally, a feeding and sensory assessment should be undertaken and if sensory-motor issues are identified a referral to appropriate services (e.g. speech pathology, occupational therapy or feeding clinic/services) completed.

All of these factors will provide background and information that can be used to form an achievable treatment plan.

Ask and Assess

  • Conduct clinical, developmental, psychosocial and behavioural assessment**
  • Regularly monitor growth by measuring height, weight and BMIusing age and sex appropriate percentile charts. (weight-for-age, height/length-for-age, and BMI-for-age).

Advise and Assist

  • Discuss overall assessment and child’s growth pattern with the family (using growth charts) and discuss weight in a non-judgmental, sensitive manner.
  • Recommend family to also keep child’s growth record.

Arrange and Ask Again

  • Refer to local allied health/healthy lifestyle programs.
  • Refer to hospital and specialist services if indicated: e.g. severe BMI classification; and/or comorbidity; and/or suspicion of genetic or secondary obesity.
  • Ask family for frequent follow-up appointments for monitoring and support.

**This may include assessment of the following:

  • Developmental History:pregnancy and birth history (including birth weight, maternal GDM); infant growth and development milestones; early feeding practices.
  • Physical: growth patterns.
  • Family history: g. Type 2 diabetes, hypertension, polycystic ovarian syndrome, dyslipidaemia
  • Psychosocial: bullying, school problems; depression and mental health history (e.g. child and parents, including
    parenting stress and mood).
  • Health behaviours:diet history; diet behaviours; sleep routine; physical activity; and family ability to implement changes (e.g. parenting style and behaviour), attempted lifestyle changes.
  • Medical Assessment:comorbidities (including endocrine disorders, hypertension, musculoskeletal and psychological concerns); underlying causes of overweight or obesity and /or evidence of nutrient deficiency.
  • Socioeconomic and environmental history: family and living arrangements, cultural and religious practices, parental occupational status, suburb, exposure to unhealthy behaviours, trauma, and limited health literacy level.

The complexity of the clinical assessment highlights the importance of the team approach to the management of childhood overweight and obesity. If other underlying causes are identified or the child’s health issues are multi-factorial, referral to hospital and specialist services may be indicated.

Intervention for children and families

Encourage a family-centred approach to improving nutrition and physical activity and empower parents to be the agents of change.

Children can remain under the care of the PHC provider if they have a weight classification in the overweight range or obesity weight range with no/or minor co-morbidities.

Referral to hospital and specialist services is indicated for children with:

  • Severe BMI classification*; and/or
  • Co-morbidities; and/or

Suspected underlying medical or endocrine cause.

Ask and Assess

  • Ask about previous lifestyle interventions.
  • Assess the family’s readiness and ability to make and sustain behavioural changes.
  • Involve the whole family and emphasise the benefits to the family unit. This is especially important for separated families where a child may live in more than one household.

Advise and Assist

  • Co-design an action plan with the child and family (frame positively, focusing on healthy growth and healthy lifestyle behaviour).
  • Develop SMART goals (healthy eating, family meal behaviours, vigorous physical activity/active play, screen time, healthy sleep routine).

Arrange and Ask Again

  • Refer to local allied health/healthy lifestyle programs.
  • Refer to Growing Good Habits website.
  • Refer to hospital and specialist services if indicated.
Brief Interventions for a healthy lifestyle: Maternity and Child Health
Clinical Skills Development Service
Childhood Obesity: From Diagnosis to Treatment I World Obesity I European Childhood Obesity Group
World Obesity Federation
Childhood Overweight and Obesity ECHO® Learning Series
Health and Wellbeing Queensland
Weight4KIDS - online learning program
Healthy Kids for Professionals (NSW Government)
Childhood Obesity in primary care: Education Modules
American Academy of Paediatrics (AAP) Institute for Healthy Childhood Weight

References

  1. Pregnancy growth charts  for BMI <25
  2. Pregnancy growth charts  for BMI >25
  3. Pregnancy growth charts  for BMI >25 and multiples
  4. Pregnancy growth charts  for BMI <25 and multiples
  5. Qld Clinical Guidelines Obesity in Pregnancy
  6. RANZCOG Mx of obesity in pregnancy
  7. NHMRC Pregnancy Care Guidelines
  8. Healthy Pregnancy, Healthy Baby. PD self-paced to support respectful conversations about pregnancy weight gain
  9. Healthy weight gain in pregnancy. Online module to increase knowledge in pregnancy and weight management
  10. Maternal Health: Nutrition and Physical Activity. Education module to support healthy behaviour change in pregnancy
  11. Healthy Eating during Pregnancy. Brochure from NHMRC 
  12. Aust Nat BF Strategy
  13. Infant feeding guidelines
  14. Allergy Prevention Guidelines
  15. Australian Breastfeeding Association Resources. Explanation ‘Support for families in breastfeeding from pregnancy through to 12 months and beyond’
  16. Quick introduction on when to start solids.
  17. NAQ Introduction to solids
  18. Raising the topic of a Child’s weight
  19. Physical Activity guidelines for 0-5 years
  20. Growth Charts 2-18
  21. HP Training
  22. Raising the topic of a Child’s weight
  23. Dietary guidelines for all Australians (Indigenous)
  24. Physical Activity guidelines for children and young people
  25. Insight. Short-module. An introduction to brief interventions for a healthy lifestyle
  26. Australian Guide to Healthy Eating. Printable reference
  27. Physical activity guidelines for adults. 18-64 years
  28. Physical activity recommendaitons for people with disability or chronic conditions
  29. Insight. Short-module. An introduction to brief interventions for a healthy lifestyle
  30. Australian Guide to Healthy Eating. Printable reference
  31. Physical Activity Guidelines for 65y+

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Last updated 23 September 2022