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
Immediately 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)

Immediate referral

Immediately contact on-call registrar or service to arrange immediate paediatric endocrinology assessment (seen within 7 days):

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

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
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)

Useful information
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)

Useful information

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)

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Last reviewed: 18-03-2024

Obesity Referral Access Criteria

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