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Care of Childhood Obesity (COCO)

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Checked: 23-08-2020 by Vicky Ryan Next Review: 23-08-2021

Overview

COCO provides a complex Tier 3 and Tier 4 weight management service for children in BNSSG.

For information on tier 1 and 2 services please see the Weight management for children (tier 1 and 2) page.

Referral criteria

Children over 2 years of age and under 17 years old and resident in Bristol, North Somerset and South Gloucestershire. August 2023 - Please note waiting list are over 12 months so it is likely that referrals for patients over 16 years old will be rejected
BMI >40
BMI >99.6^th centile and serious comorbidity or complex needs (including child safeguarding concerns with obesity as a primary concern)
Previously engaged (with evidence) with tier 2 community based services for weight management in areas where a service is offered. (Failure to engage with lower tier services will be an exclusion criterion unless child safeguarding concerns).
Genetic cause for obesity diagnosed or suspected
Associated endocrine disorder (for example polycystic ovarian disease)
Rare obesity comorbidity (Idiopathic intracranial hypertension, fatty liver disease, sleep apnoea requiring active intervention)
Established and managed Type 2 diabetes needing weight reduction as part of therapy (same service referral only)
Iatrogenic cause of obesity (pituitary surgery)
Consideration for pharmacological treatments or Bariatric Surgery

Referral

Refer to Bristol Royal Hospital for Children via eRS, general endocrinology highlighting they are Obesity or COCO.

Referrals will be triaged by Dr Dinesh Giri & Prof Julian Hamilton-Shield (Paediatric Endocrinology). If the referral is accepted an appointment will be sent. If the referral is declined, a letter will be sent to the referrer and the family.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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