While there has been a recent plateauing in the prevalence of obesity in Australian children – although not adolescents - the prevalence of severe or morbid obesity in this age group continues to increase, as does that of central adiposity. Children and adolescents affected by overweight and especially obesity also present more frequently to primary, secondary and tertiary care services than would be expected from the background prevalence of the problem, although they are only infrequently treated for it. At the same time, most paediatric health professionals feel ill-equipped to manage patients affected by obesity; existing clinical services in Australia and New Zealand are sparse, poorly coordinated and at times inequitable; and there remains significant institutional, health professional and community stigma towards affected individuals.
The chronic disease care pyramid provides a model for delivering services to people with obesity. This is based upon a tiered level of service delivery relating to severity of disease, at primary, secondary and tertiary level. Thus, although most people affected by the problem of obesity can be managed via self-care or family-based care, with support from primary care or community-based health-service professionals, treatment by multidisciplinary care teams and possibly tertiary care clinics is needed for those who are more severely affected. Access to bariatric surgery should also be available at the tertiary care level. Individual clinicians and health service providers/funders should be aware of the presence of other services within their geographical region, and the capacity of these services to take referrals or to co-manage patients. These services could include group programs, individual consultations with allied health professionals or nurses, or specialised tertiary services.
There is a need for development and evaluation of cost-effective healthcare pathways that fit in with existing paediatric clinical services and which have broad reach, especially to more socially disadvantaged people. Further, significant investment in ongoing health care professional training is required at undergraduate and postgraduate level at different levels of intensity.