Background The prevalence of obesity in the paediatric population continues to rise. There is emphasis on developing effective strategies to treat and control this epidemic. However, the initial step of identifying these children is in itself a crucial step in the management of obesity.

Aim The aims of this study were, firstly to determine the rate of identification of overweight and obesity in children and adolescents in the out-patient setting. Secondly to evaluate referral reasons and obesity related complications and their overall management.

Design A retrospective review of medical records of children aged 1 to 16 years, referred to the OPD in a district general hospitals, in the UK was undertaken. Data on reasons for referral, patient height and weight (converted to BMI SD scores) were recorded.

For those we identified as being overweight and obese (based on the UK 1990 growth charts), the case notes were reviewed and information on recognition of their weight status, dietary history or referral to dietician, blood pressure monitoring, further investigations and follow-up was extracted.

Results A total of 864 children were seen in various clinics in this time period. 763 were included in the study. Of these, 46 (6%) were obese (male=female) and 92 (12%) overweight. 5 children had been referred due to concerns with their weight. Only a further (10) 7.2% were identified by the clinician to be either obese or overweight (Of the obesity group). 26% of the children in the obesity group had been referred with secondary problems such as headaches, hypertension, abdominal pain (indigestion) and knee/joint problems. Children identified as obese, received some management specific to their obesity, including education, screening, dietary changes and increased activity. However, there were many who were not identified, discharged from follow-up or treated for the secondary conditions with no input on the obesity management. There was a low rate of evaluation of obesity related problems.

Conclusion This study shows that obesity is both under-identified and under-treated by the paediatricians, despite it being increasingly common. It highlights the need for more awareness of the sequelae of obesity and its use in managing both the primary and secondary issues.