The question of how to manage childhood obesity is one that perplexes health professionals, and many are cautious about whether to intervene. As with adult obesity, making a thorough assessment will help to establish the most suitable course of action for an individual child and their family.

In making an assessment:

• Take measurements of height and weight and plot this on the appropriate BMI centile chart
• Record measurements of waist circumference and refer to the appropriate centile chart*
• Note the child's and the family's weight history
• Consider whether there may be any underlying medical causes
• Assess patterns of eating and physical activity
• Collect information about the child's physical and psychological health
• Determine the expectations from treatment of both the child and their parent/guardian

The SIGN guidelines recommend referring the following groups to paediatric consultants:

• All children under the age of 24 months with BMI >99.6^th centile
• Children over 24 months with BMI >99.6^th centile who are at higher risk of obesity-related morbidity
• Children who have already developed a serious obesity-related morbidity e.g. hypertension, sleep apnoea, orthopaedic problems, hypoventilation syndrome and psychological morbidity
• Children with a suspected underlying medical casue of obesity

Factors, which may alert a health professional to an underlying medical cause of obesity include:

• Developmental delays
• Poor growth in height
• Dysmorphic features
• Hypogonadism