BACKGROUND AND CLINICAL SIGNIFICANCE:According to AIHW 3 in 5 Australian adults are overweight or obese and 1 in 4 Australian children are overweight or obese(600,000 children in age group of 5-17yrs according to Australian Beaureau of Statistics and 12 million adults).The clinical guidelines set down by NHMRC and DOHA in 2013 clearly states the comorbidities and recommended medical approach.
DESIGN OF MODEL OF CARE : A program to prevent this evergrowing chronic condition requires two arms,one aimed at disease screening and public education for prevention of further cases.The second arm deals with limitation of morbidity and mortality of the affected individuals.The two arms can function via a three tier system of care .
METHODOLOGY AND WORK DISTRIBUTION:Education should begin in childcare and school with healthy lifestyle being a core subject.Screening and prevention should be at primary level where the general practitioner conducts mandatory and medicare rebatable screening of all children and families using BMI and waist circumference to categorises to low,medium and high risk .
Medium risk individuals(overweight with no comorbidities require intense allied health input in community.High risk individuals(obese with or without comorbidities)should be referred to Paediatrician with view of 12wk intense community based program aimed at lifestyle modification which on failing requires 12 wk in hospital program using low calorie /low energy diet.
Baratric surgery continues to be the only definitive treatment.Children especially adolescents who have finished growing,who are obese and with comorbidities and have failed to loose weight despite paediatrician driven intense program should be considered for bariatric surgery in tertiary paediatric facility .
RESULT:A well structured free screening program should help in early detection and intervention,thereby preventing new cases.The paediatrician in peripheral hospitals and tertiary services should be involved in limiting morbidity and mortality and thereby changing the natural progression of the condition.