Obesity Referral Access Criteria

Referrers should use this page when referring patients to public paediatric endocrinology and diabetes outpatient services for obesity. This RAC is applicable to referrals for patients aged <16 years only.
Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
  • New diagnosis of diabetes = polyuria and/or polydipsia and random BSL ≥ 11.1mmol/L
  • Respiratory distress or chest pain
  • Acute onset hip pain/limp
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate paediatric endocrinology assessment (seen within 7 days):
  • Nil

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

Clinical indications for outpatient referral
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
  • 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
Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason).

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.

History
  • Current medication list
  • Any known allergies
  • Weight
  • Height
  • BMI z-score
Examination
  • Nil
Investigations
  • 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%
Highly desirable
History
  • 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
Examination
  • Nil
Investigations
  • Nil
Indicative clinical urgency category

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
Exclusions
Useful information

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

Feedback

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Last reviewed: 18-03-2024