Stage-Based Paediatric Obesity Care in Malaysia: When Primary Care Is Enough, and When Referral Should Not Wait

Which baseline metabolic tests are appropriate in an adolescent with obesity and acanthosis nigricans?

Order baseline screening for dysglycaemia, dyslipidaemia, and fatty liver disease now. In an adolescent with obesity + acanthosis nigricans, the minimum practical baseline panel is fasting plasma glucose and/or HbA1c, fasting lipid profile, and ALT; add AST if doing liver tests locally. - Acanthosis nigricans is a clin

How should I evaluate a child with obesity and suspected polycystic ovary syndrome features?

Assess for true adolescent PCOS criteria first, not ovarian ultrasound alone. In a child/adolescent with obesity and suspected PCOS features, confirm pubertal stage and years since menarche, document clinical/biochemical hyperandrogenism, and exclude mimics before labelling PCOS. - Rapid virilisation: voice deepening,

What does effective family-based behavioural treatment for paediatric obesity actually involve?

Use a structured, intensive family programme that treats the parent and child together. Effective family-based behavioural treatment is not just “eat less and move more”; it is a multicomponent intervention with parent involvement, concrete behaviour-change skills, and enough contact time — typically at least 26 contac

When should I screen a child with obesity and snoring for obstructive sleep apnoea?

Screen for OSA now in any child with obesity who snores habitually; do not wait for daytime symptoms. If snoring is frequent plus any additional OSA feature is present, arrange further evaluation and consider overnight polysomnography as the diagnostic standard. - Obesity + regular snoring substantially raises the like

How do I decide whether the same BMI value warrants primary care management or specialist referral?

Use the BMI percentile/class to assess obesity severity, but base referral on the whole-risk pattern—puberty/menstrual maturity, hyperandrogenic features, growth pattern, metabolic comorbidity, and diagnostic uncertainty—not the same BMI value alone. A child/adolescent with the same BMI may stay in primary care if stab