G465(P) The role of the school doctor today: an advocate for children with obesity

Abstract

Aims To evaluate school doctor service with regard to weight problems in a Secondary School for students with special needs Background School medicals are only offered based on teacher's concerns and there was no existing health screen of potential need. The school doctor was concerned about potential unaddressed weight problems. Methods All students were offered a medical by opt-out permission letters to parents, also asking about concerns (diet, sleep, behaviour or other). Teachers were asked to identify students they felt had an unhealthy BMI. All students consenting were measured by multidisciplinary team (School doctors, School Nurse, Special Needs specialist dietician, Specialist nurse for obesity). We calculated BMI centile on WHO growth charts. An action plan was developed by the school doctor and team as part of this service evaluation. Results 1 family and 2 students refused. 2 parents concerned about appetite. Teachers correctly identified 13 / 29 students as having a problem with their weight. 76 / 79 students assessed. BMI range 15 to 50. 30/76 (35%) met criteria for referral to special needs dietician, increasing service yearly caseload by a third. 27/76 (35%) were >91st BMI centile. 13/76 (17%) were >98th centile (see Figures 1 and 2). There was no local Tier 2 or 3 weight management services available for this age group. The school doctor action plan included education of teachers on obesity and introducing Tier 2 lifestyle weight management programme as pilot for secondary students. The special needs dietician negotiated a reduction of puddings. The dietetics service commissioners were informed of the need, resulting in plans to expand the service. Conclusions There were many overweight students previously unidentified that required further management. Teachers did not accurately identify students that are overweight and therefore might not be best placed to initiate referrals. There are gaps in school health service including screening for obesity and services that should be in place for this age group according to NICE guidance. In today's obesogenic environment the school doctor role should include advocating for students to attain healthy weight, (Measuring Up 2013). (Figure Presented).