GPs should allow children to ‘grow into their weight’ says NICE
GPs should focus on helping overweight and obese children maintain their existing weight in the short term so that it improves over time as they grow, recommends NICE.
The draft public health guidance on weight management also calls on GPs to monitor the body mass index of children they have referred to weight management services, both during and after completion of the programme.
The latest advice forms part of a new long-term drive to develop lifestyle weight management programmes and ensure different providers follow evidence-based practice.
GPs and community teams are advised to refer children or young people and their families who are willing to accept the idea of weight management, which should cover diet and eating habits and physical activity as well strategies for changing the behaviour not only of the child or young person but also their close family members.
The guidance places an emphasis on motivational approaches to carefully explaining to parents the benefits of attending a programme and the risks of not addressing their child’s weight, with families encouraged to enroll in the future if not immediately ready to attend.
The recommendations state: ‘Explain what can be realistically expected in terms of results over the duration of the programme itself. For example, explain that maintaining their existing weight is a realistic short-term aim.’
Dr Rachel Pryke, a GP in Redditch and RCGP lead on nutrition for health, said to Pulse: ‘It is reassuring that there is a much stronger focus on motivational and patient-led goals and a move away from didactic advice and narrow BMI change outcomes. There is consistent reference to the need for sensitivity empathy and greater understanding of the problem amongst health professionals.
‘Whilst critics may suggest the document risks being woolly, I think it is reflective of the need to develop comprehensive approaches, to understand in particular the need to address the co-existing emotional issues and to recommend weight stability as a significant short-term goal.’
Dr Pryke cautioned that GPs need more training to understand BMI change in childhood, as they are more complex than adult BMI reference ranges.
The draft guidance recommends using UK 1990 centile charts for children aged 4 years and older to determine their BMI centile for age and gender, and the World Health Organisation Child Growth Standard for those under 4 years.
‘A further issue of slight concern is the recommendation to refer to Tier 3 obesity management services for those who continue to gain weight,’ Dr Pryke added. ‘Currently provision is at best patchy even for adults, and many areas have no child obesity services at all. There is not even a wide consensus over what a Tier 3 service should look like or who it should be run by.’
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