A weight and a BMI centile are the start of the assessment, not the assessment. The complications that change management are mostly silent, and most are found by things that take under five minutes.
Blood pressure with a correctly sized cuff is the one most often got wrong — a cuff too small reads high, and a child labelled hypertensive on a narrow cuff gets a workup they did not need. The bladder should cover about 80% of the arm circumference and roughly 40% of its width. Then ask about snoring, witnessed apnoea and daytime sleepiness; look at the neck and axillae for acanthosis nigricans; and check for hip or knee pain, which in an adolescent with obesity should raise slipped capital femoral epiphysis rather than be attributed to weight.
Ask one question about how the child is treated at school and at home about their weight. Weight stigma predicts disengagement from care, and a child who has been shamed in the waiting room will not come back for the follow-up you are arranging.
- Size the blood pressure cuff to the arm before recording a reading — bladder about 80% of circumference
- Screen for snoring, witnessed apnoea and daytime somnolence at every review
- Look for acanthosis nigricans at the neck and axillae as a marker of insulin resistance
- Take hip or knee pain seriously; consider slipped capital femoral epiphysis rather than attributing it to weight
- Ask directly about teasing and weight stigma — it predicts whether the family returns
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