Care pathway guide: overweight and obesity in children and adolescents

This guide describes the care, support and medical follow-up of children/adolescents with overweight or obesity. It reasserts the importance of early identification, coupled with a lifestyle assessment. It details the role of each of the professionals involved in the care pathway, and looks at the situations in which they may be called upon.

From the time of diagnosis of overweight or obesity and delivery of this diagnosis, coordination between the professionals involved in the care pathway, the prevention of stigmatisation, communication with families and the co-construction of a personalised care programme are crucial aspects central to this pathway.

This guide updates the good practice guidelines "Overweight and obesity in children and adolescents" published in 2011. This good practice guidelines is removed from the website of the Haute Autorité de Santé.

The guide proposes:

• A summary of the critical points in the care pathway
• 10 key messages to improve practices
• 9 toolkit guides reiterating the roles of professionals and the arrangements for sharing information with the primary care physician

 
10 key messages to improve practices

1. Measure BMI throughout childhood and adolescence in order to identify and diagnose overweight or obesity early on.
2. Target the prescription of laboratory tests.
3. Draw on a multi-component assessment whenever overweight or obesity is diagnosed and the diagnosis delivered.
4. Scale and adapt care and support based on the complexity of the situation.
5. Propose care and support from the time of diagnosis of overweight or obesity. 
6. Losing weight is not a priority goal except in the event of complications.
7. If necessary, supplement with a stay in a follow-on care and rehabilitation unit in complex situations.
8. Ensure continuity of the care pathway: prepare the transition to adulthood from the start of adolescence.
9. Support children and adolescents with disabilities, and their parents: common points and specificities.
10. Encourage the involvement of users’ representatives.

Screening and diagnosis

While absolutely necessary, measurement of body mass index (BMI) and analysis of its evolution over time are not in themselves sufficient to characterise a situation of overweight or obesity.

Immediately a situation of overweight or obesity has been diagnosed, a multi-component assessment is essential in order to support lifestyle changes and take early action in the event of psychological difficulties, dietary problems or eating disorders and any form of social vulnerability. This assessment makes it possible to scale care and support, and adapt it over time, mobilising the different professional skills and resources required to address individual and family needs.

Care and support  

This care must be personalised and scaled based on the complexity of the situation and its evolution. The common points and specificities of two situations are described: overweight or obesity without complications, and severe obesity with an accumulation of associated factors.

Irrespective of the situation, it is necessary to propose and continue patient education facilitating lifestyle changes, to support the young person in their relationship with their body and, if necessary, the functional and aesthetic impact, in both girls and boys, as well as psychological, social and school difficulties. Regular multidisciplinary follow-up over a period of several years makes it possible to adjust care, and its intensity, based on needs.

In a situation of complex obesity, in addition it is necessary to alleviate symptoms, treat complications, propose adaptations to facilitate day-to-day life and schooling and assess the need for a stay in a follow-on care and rehabilitation facility, at the same time stepping up coordination with the support of a local coordinator.

Ma Santé 2022
This work was conducted jointly with the French national health insurance fund, in the context of the healthcare system transformation strategy, to meet the objectives of the “Ma santé 2022” [“My Health 2022] programme. It was produced with the assistance of a multidisciplinary working group and patient association representatives, drawing on the international literature.