Childhood obesity has now reached epidemic proportions, and large numbers of children are presenting for medical care. The Royal College of Paediatrics and Child Health (RCPCH) has produced a document contending that most of these children should be seen in primary care.¹ However the House of Commons Health Select Committee sees otherwise and has called upon the National Health Service to ensure obese children have access to specialist care.²

The paediatrician’s role in managing obesity therefore needs clarifying, particularly in the context that any recommendations for identification, investigation, and treatment have enormous financial and service implications.

In this article I map out what is known about the diagnosis, epidemiology, complications, and treatment of the condition, and conclude by examining published guidelines with some thoughts about the shape that services might take.

THE DIAGNOSIS OF OBESITY

Obesity can simply be defined as an excess of body fat. Although there are more accurate methods for measuring body fat, body mass index (BMI) is the only method that is feasible outside the realms of research. BMI is calculated from the formula BMI = weight (kg)÷height² (m).

By convention in the UK, the cut-offs for overweight and obesity are taken to be the 91st and 98th centiles on the 1990 UK reference charts.³ These cut-offs have some rationale as epidemiological studies show that the risk for eventual morbidity significantly increases above the 95th centile.⁴

There are two versions of the BMI charts (fig 1⇓). The version for managing obesity is recommended (fig 1A⇓ rather than 1B) as it provides extra centile lines above the 99.6th to allow for mapping the progress of severely obese children over time.

EPIDEMIOLOGY

Childhood obesity has shown a dramatic increase in the last decade. Figures vary as …