Intended for healthcare professionals

Practice Practice Pointer

Approach to a child or young person with concerns about excess weight

BMJ 2023; 380 doi: (Published 16 February 2023) Cite this as: BMJ 2023;380:e074255
  1. Oliver T Mytton, honorary public health consultant1,
  2. Dasha Nicholls, child and adolescent psychiatrist2,
  3. Sonia Saxena, professor of primary care3,
  4. Russell M Viner, professor in adolescent health1
  1. 1UCL Great Ormond Street Institute of Child Health, London, UK
  2. 2Division of Psychiatry, Department of Brain Sciences, Imperial College London, UK
  3. 3School of Public Health, Imperial College London, UK
  1. Correspondence to O Mytton o.mytton{at}

What you need to know

  • Excess weight can contribute to poor health in childhood or may be an indicator of other physical or emotional problems

  • Use child specific tools (eg, z-BMI) alongside clinical judgment to assess a child’s weight status and to identify children who may benefit from intervention

  • Use sensitive and appropriate language when discussing weight with parents and their children, and where possible offer practical strategies for changing eating habits, activity patterns, or sleeping behaviours

  • An increasing range of treatments and other interventions is available to support children with excess weight, although access to services varies by area

Excess weight (overweight or obesity) in childhood is common.1 In England, 22.2% of children in school reception year (age 4-5) have excess weight, and 37.7% in year 6 (age 10-11). Excess weight can contribute to substantial physical and emotional problems in childhood, as well as in later life, and may be an indicator of health problems.1

Discussing weight can be emotive, and raising the issue in a short consultation without implying blame or judgment can be challenging, particularly where a child’s weight is not perceived as a problem by the parents and is not the presenting issue.

Excess weight is a public health issue that needs to be addressed using public health measures,12 and genetic and environmental factors that contribute to its development may be outside the influence of doctors or parents, but doctors (particularly GPs and paediatricians) still have an important role in managing it.1 These clinicians are well placed to identify the issue and offer or signpost evidence informed support to families and children.123 Understanding and reflecting some of the challenges of managing excess weight can be important when raising the issue in consultations.

This article offers an approach to recognising and discussing excess weight …

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