GPs should use their ‘clinical judgement’ to decide when a child’s obesity becomes a safeguarding concern because of a ‘significant threat’ to their health and wellbeing, NICE has said in updated guidelines on overweight and obesity.
The committee said that guidance was needed to help healthcare professionals balance the need for person-centred care with the duty of care to the child or young person ‘when there is a serious risk to their long-term health’.
NICE also said families or carers should be encouraged to take the main responsibility for behavioural changes in children and young people, especially children under 12 years.
The new 180-page document updates and replaces seven previous guidelines covering prevention and management of weight in different groups.
It encourages clinicians to take into account the wider determinants and context of overweight and obesity and to ask patients permission to discuss their weight and respect their choice if they decline.
And GPs should ensure that people from ethnic minority backgrounds are aware that they are prone to central adiposity and so are at an increased risk of chronic weight-related health conditions at a lower BMI.
Many of the recommendations in the updated guidelines repeat advice that NICE had already issued, including measuring waist-to-height ratio as well as BMI.
It also now says to consider a child or young person’s waist circumference and calculating waist-to-height ratio to predict health risks associated with central adiposity.
But NICE added a warning against diagnostic overshadowing in adults or children by ‘attributing all symptoms to overweight or obesity’.
Where a patient is presenting with another health problem such as hip pain, this should be addressed first ‘before deciding whether it is appropriate to ask permission to discuss weight’, the recommendations state.
GPs should also address the drivers of overweight and obesity, such as social context, mental health and wellbeing, if possible, and discuss and agree ‘realistic, personalised health goals’.
The updated guidelines were published on the same day as a Lancet Commission called for a move away from BMI to other measures that focus on central adiposity.
NICE has published several recent recommendations on weight loss drugs for obesity agreeing to a slow rollout of tirzepatide as to not overwhelm the NHS.
Professor Azeem Majeed, a GP and professor of primary care and public health at Imperial College London, said the updated NICE guidance highlighted the difficult balance GPs must strike.
‘It highlights the balance GPs must navigate when addressing safeguarding concerns in children and young people whose weight or weight-related comorbidities pose a serious risk to their health.
‘While the emphasis on person-centred care and respecting the choices of children and families is important, GPs are also responsible for recognising when non-engagement or serious health risks require intervention as part of their duty of care to the child.
‘This requires significant clinical judgement, sensitivity in communication, and a nuanced understanding of safeguarding thresholds. GPs will also need to consult with social services and paediatric teams in these situations.’
He added it did place ‘a significant responsibility’ on GPs to identify when weight or weight-related comorbidities pose a safeguarding concern.
‘This can be challenging, as it requires not only clinical insight but also the ability to navigate sensitive conversations while maintaining trust with the child and their family.’
He added that attributing all symptoms to weight can lead to missed diagnoses and delays in treatment and it was good to see NICE highlight this in their guidance.
New NICE guidelines on overweight and obesity management
- If there is concern that obesity or weight or weight-related comorbidities pose a significant threat to the child or young person’s health: refer to emotional health and wellbeing support and services; and refer to specialist management for any other comorbidities.
- Use clinical judgement to decide when it is necessary to intervene as part of the duty of care to the child or young person
- Ensure healthcare professionals are aware that people from some ethnic minority backgrounds are prone to central adiposity and so are at an increased risk of chronic weight-related health conditions at a lower BMI
- Ensure people from these ethnic minority backgrounds (and the families and carers of children and young people from these backgrounds) are aware that they are prone to central adiposity and so are at an increased risk of chronic weight- related health conditions at a lower BMI. Explain these risks in an inclusive and non-stigmatising way
- Avoid attributing all symptoms to overweight or obesity (diagnostic overshadowing). If the person is presenting with another health problem or condition (such as hip pain), address this problem or condition first before deciding whether it is appropriate to ask permission to discuss weight
- Ask for permission each time before discussing overweight, obesity or central adiposity and before taking measurements
- If permission is given, use suitable opportunities to measure and record a person’s: height; weight; waist circumference in people with BMI below 35 kg/m2 so that waist-to-height ratio can be calculated. Opportunities could include registration with a GP, routine consultation for long-term conditions, and other routine health checks
Source: NICE
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READERS' COMMENTS [3]
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GPs should also address the drivers of overweight and obesity, such as social context, mental health and wellbeing, if possible, and discuss and agree ‘realistic, personalised health goals’. yup all easy in 10 minutes while you deal with 3 other probelms the patient is actually seeking help for. Thanks NICE
180pages. Think a walk may help more than sitting reading the bleedin obvious. But to Gregs or Pretemanger? Depends on live where
Some Classic NICE pearls here……
– linking obesity to patient’s ethnicity …..expect a letter from the GMC when that complaint rolls in
-obese 17 yr old- ?child abuse. But when he turns 18, it’s a disease. And don’t be surprised when those pesky GMC letters arrive after you start referring fat kids to Safeguarding (who will refuse the referral any way).
-“seek permission to weigh patients”….because at the moment we drag them kicking and screaming to the scales. I use 2 hefty receptionists armed with clubs threatening GBH if the patient refuses to be weighed, maybe I should have a rethink.
-and those incredibly accurate waist measurements…..just see if 2 clinicians manage to obtain the same reading on the same patient.