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Referral
Complications of Excess weight (CEW) in Children
Scope
Obesity affects one in four children in the UK and can increase the likelihood of a child developing serious health issues such as Type 2 diabetes, liver conditions and early heart disease.
Children living with obesity can also develop difficulties such as breathing problems, sleep issues and mental health problems, which can dramatically impact their quality of life. However early action can prevent the onset of these long-term health problems which is beneficial for the health outcomes of patients and the sustainability of the NHS.
The number of children living with obesity almost doubles from the start of primary school to the end of primary school. The latest data shows one in four children aged 10-11 are obese in England. Two and a half million children in England are affected by excess weight or obesity, with 1.22 million significantly obese and eligible for treatment according to NICE guidance.
Complications from Excess Weight (CEW) clinics use a holistic approach to treating conditions related to obesity in children and young people (CYP). Fifteen CEW clinics will be rolled out in a pilot scheme. Clinics will be delivered by a multidisciplinary team (MDT), linked to a specialist children’s hospital.
The three aims of the service are to:
- Identify the factors involved in the development of severe obesity. Assessment should be holistic with equal consideration for mental health, physical health and social needs.
- Treat complications associated with severe obesity and coordinate / refer onto other services where required.
- Consider an individualised holistic plan. This may include interventions such as family-based therapy, behavioural coaching, dietary strategies, and mental health support. This aims to address health inequalities by considering culturally appropriate factors and a personalised approach.
Complications of Excess Weight (CEW) Clinic, Derriford Hospital Plymouth (Tier Three)
- Dr Yolanda Alins-Sahun – Consultant Paediatrician
- Supported by paediatric dietitian, specialist nurse, psychologist, social worker, youth worker, community wellbeing practitioner.
Complications of Excess Weight (CEW), Royal Cornwall Hospital (Tier Two)
- Dr Rachel Nicholls – Consultant Paediatrician
- Louise Tee – Paediatric Dietitian
Referral Criteria
Children over 2 years of age and under 17 years old and resident in Plymouth or Cornwall
- BMI greater than 40 or;
- BMI greater than or equal to 3.5 SD above the mean or;
- BMI greater than 99.6th centile and serious comorbidity or complex needs (including child safeguarding concerns with obesity as a primary concern). Co-morbidities include:
- Hypertension
- Metabolic liver disease
- Idiopathic intracranial hypertension
- Obstructive sleep apnoea requiring intervention
- Polycystic ovarian disease
- Impaired fasting glucose
- Established and managed Type 2 diabetes needing weight reduction as part of therapy (same service referral only)
- Genetic cause for obesity diagnosed or suspected
- latrogenic cause of obesity (pituitary surgery)
- Previously engaged (with evidence) with tier 2 community based services for weight management in areas where service offered. (Failure to engage with lower tier services will be an exclusion criterion unless child safeguarding concerns).
- Consideration for pharmacological treatments of bariatric surgery
The Referral letter must come with the referral template, if not the letter will be returned for completion of the template.
Referral Instructions
Send letter and referral template to plh-tr.cewservice@nhs.net
Referral Forms
CEW referral form EMIS
Pathway Group
This guideline has been signed off on behalf of NHS Devon
Publication date: July 2022
Updated: February 2024
