B
BUDDSBarnet Unified Document
for Down Syndrome

Dietetic Service and Weight Management

Paediatric dietetic services, obesity assessment, weight management programmes (Healthy Weight Nurses, Xplore, GroHealth), and specialist multi-disciplinary services

Barnet Paediatric Dietetic Service - Oral Feeding

Barnet Paediatric Dietetic Service only accept referrals from Paediatric consultants and does not accept referrals for patients with the following conditions:

  • Simple overweight/obesity, unless you have a comorbidity, e.g. Down Syndrome/Autism.
  • Fussy eaters (if no faltering growth). Please refer back to GP to be seen by Health Visitors/Children's Centres.
  • General Weaning Advice. Please refer back to GP to be seen by Health Visitors/ Children's Centres.
  • Iron Deficiency Anaemia.
  • Constipation.
  • Eating disorders.

Referrals can be made online using the EPR system (dietician - paediatric form) or in writing.

Parent leaflet: Paediatric Nutrition and Dietetic Service.

Email: rf-tr.bcfhdieteticpaeds@nhs.net.

Referrals and Appointments

Internal referrals - There is currently an internal EPR issue with some referrals being cancelled automatically by EPR. Please refresh after the referral is made.

When raising a paediatric dietetic referral:

  1. Click on "request/care plan" on the left-hand tab.
  2. Click on the "add" tab.
  3. Please type "dietitian", and that should quickly take you to.
  4. Diet - Paed OP referral (BH).
  5. Complete the referral as before.

If you have a Barnet Hospital general patient query, please email the generic Paediatric DT email on rf-tr.bcfhdieteticpaeds@nhs.net and one of the Paediatric DTs will respond to your query.

For Royal Free Hospital patients, call 0207 794 0500 ext 35716.

Home Enteral Paediatric Dietician - Non Oral Feeding

Referral forms.

New home enteral feeders (HEFT) (this is a different part of the dietetic service).

Note: Some children with DS who also have a significant cardiac history as well may well have a period of non-oral feeding/ NGT (nasogastric tube) feed - some children go on to have PEG (gastrostomy) and these children need to be seen by both SLT (Dysphagia team/speech and language therapist) and specialist HEFT (home enteral feeding) Dietitian.

Children's Dietetics home enteral feeding referral form.

Obesity

Clinical assessment

History

  • Syndromic or monogenic causes - Early onset of rapid weight gain in infancy with severe obesity in children aged under 2 years, hyperphagia, and learning disability.
  • Obstructive sleep apnoea - Disturbed sleep, pauses in breathing at night, daytime sleepiness, loud snoring with gasping.
  • Genetic predisposition - Family history of familial dyslipidaemia (eg, early ischaemic heart disease or stroke) or type 2 diabetes.
  • Polycystic ovary syndrome - Hirsutism, oligomenorrhoea.
  • Psychological conditions - Depression, self-harm, suicidal ideation, and eating disorders.
  • Psychosocial issues - Social history, social care involvement, safeguarding concerns.

Examination

  • Insulin resistance and/or type 2 diabetes - acanthosis nigricans.
  • Syndromic obesity - Dysmorphic features.
  • Genetic or endocrine causes of obesity - Short stature or slowed growth velocity (calculate genetic height potential), Cushingoid features.
  • Cardiovascular comorbidity - Blood pressure (ensure correct technique and cuff size, and plot using the centile chart downloadable here).

First-line blood tests

Indicated if BMI is on or above the 98th centile, or if comorbidities or complex features are present:

  • Fasting lipid profile.
  • Fasting insulin*, glucose * and HbA1C.
  • Liver function tests (LFTs) **
  • Thyroid function tests (TFTs).
  • Vitamin D.

*Insulin and glucose are used to calculate the Homeostatic Model Assessment Score (HOMA-IR or HOMA-B), which helps to ascertain insulin resistance and long-term risk of type 2 diabetes.

**An ultrasound scan of the abdomen should be arranged if LFTs are abnormal.

Referrals

Universal services (Tier 1) - Prevention

These include Health Visitors, School Nurses, GPs, and Early Help Services.

Community Services (Tier 2) - Lifestyle Management

Child Weight Management Service - Healthy Weight Nurses Team: One-to-one weight management support for children aged 4-12 who are above the 99.6th Centile. The team is made up of one nutritionist, one healthy weight nurse and one child weight management practitioner. They support families over three face-to-face sessions. The team accepts referrals from school nurses, families, teachers, GPs and other health professionals. Complete the Healthy Weight Nurses Team (4-12 years) Referral Barnet - Whittington form and send to whh-tr.barnethealthyweightteam@nhs.net.

Self-referral email: whh-tr.barnethealthyweightteam@nhs.net.

Tel: 07785 800 224/07785 809 386.

Exclusions:

  • Children who reside and have a GP outside of Barnet.
  • No complex needs or other underlying health conditions.
  • Primary special schools.

Further information: Healthy Child Programme for Barnet.

Xplore Lifestyle Weight Management Programme

Xplore's eight-week lifestyle weight management programme (tier 2) supports families to make sustained lifestyle and dietary changes, helping children and young people who are over the healthy weight range to move more, eat well and feel good.

The programme takes place in leisure centres after school to ensure that parents and children are able to attend. Parents will receive nutritional workshops from licensed nutritionists, while children will attend a physical activity workshop. At the end of the programme, the two approaches are combined and the children receive healthy eating advice.

Xplore flyer.

Eligibility Criteria

Inclusions

Children and young people who:

  • Live in/are registered with a Barnet GP and/or attend a school or college in Barnet.
  • Aged 4-13 years old.
  • Overweight or obese > 91st BMI centile.
  • Simple overweight/obesity (i.e. no co-morbidities, psychological, psychiatric or serious behaviour problems).

Please note: If the child has any medical, physical, psychological, educational or emotional conditions, the team may need to consult with the appropriate healthcare professional before they begin on the programme.

Exclusions

  • > 999.6th BMI centile.
  • Complex needs.

GroHealth

Healthy lifestyle and weight management service specifically designed for young people in Barnet aged 12-19 (up to 25 with SEND), including their parents and carers.

Gro Health offers free weight management support. It takes a holistic approach to health. The programme includes support around nutrition, physical activity, mental and emotional health, and sleep to help young people improve their overall health and wellbeing, and maintain a healthy weight.

Gro Health provides tailored age-appropriate health education, supporting resources and behaviour change activities that the whole family can get involved with, to help young people to be a healthy weight. Key focus points are listed below:

  • Healthy eating education, family-friendly topics including eating at school, dental health, and building a healthy relationship with food, all supported with additional downloadable resources, factsheets and 2000+ recipes.
  • Getting active: With fun on-demand exercise videos and education topics, including the benefits of exercise, types of exercise, overcoming barriers, setting goals and staying active as a family.
  • Improving mental health: education around friendships and relationships, managing emotional and mental stress, stopping smoking, self-esteem and exam prep helps young people prepare for and navigate challenges.
  • Better sleep: sleep has a big impact on health, and support includes bedtime stories, guided meditations, music to sleep to and sleep education, to help get that all-important shut-eye.

Self-referrals and professional referrals can be made by completing the Gro Health online form.

Inclusions

  • Aged 12-19 years old (or up to 25 with SEND).
  • 91st BMI centile or higher.
  • Barnet resident or registered with a Barnet GP.

Contact Details

Specialist services (Tier 3) - Multi-disciplinary Weight Management

Consultant Paediatricians with special interest in Endocrine and Diabetes

Dr Nirit Braha/Dr Victoria Dublon (Royal Free Hospital), Dr Esther Freeman (Barnet Hospital).

Suspected endocrine cause of obesity, such as but not limited to:

  • Insulin resistance (high HOMA-IR or low HOMA-B).
  • Type 2 diabetes.
  • Cushingoid features (needing a dexamethasone suppression test).
  • Abnormal TFTs.
  • Polycystic ovary syndrome.

To investigate for medical complications of obesity.

Familial Hypercholesterolaemia (FH) Clinic at Royal Free Hospital

  • FH detected on genetic screening or fasting LDL cholesterol > 3mmol.
  • Note:
    • Paediatric clinic for CYP up to the age of 18 years.
    • Recommendation for parents fasting lipid profile (including LDL cholesterol) be done via GP before referral.

Consultant Paediatrician with special interest in Diabetes and Obesity at University College London Hospital (UCLH)

Dr Billy White.

  • For CYPs who live locally to UCLH.
  • Management of medical complications of obesity requiring medical management, such as but not limited to:
    • Abnormal LFTs.
    • Idiopathic/benign intracranial hypertension.
    • Other medical symptoms relating to obesity.

Complications of Excess Weight Clinic (CEW)

We are sorry to announce that our GOSH Complications of Excess Weight (CEW) clinic has closed on 30 June 2025.

Our CEW clinic was part of a national pilot project funded by NHS England. There is currently a national evaluation of CEW services, and we await their findings and future recommendations.

There is currently no CEW provision for families living in North Central London ICS (London boroughs Camden, Islington, Haringey, Barnet and Enfield). Commissioners are currently considering future options for future CEW services.

There is currently no NHS funding for weight loss medications or bariatric surgery in young people under 18 years, and doctors cannot offer these at present. We hope that this will change soon.

Please consider other support for your patient:

  • Community Weight management services in Camden, Islington, Haringey, Barnet and Enfield.
  • Early help pathways include youth work, family support workers.
  • Social care for disability, child in need or safeguarding concerns.
  • Mental health pathways where mental health difficulties are driving eating behaviours and suspected eating disorders.
  • Neuro-developmental pathways where suspected autism is driving eating behaviours.

Referrals for medical assessment should be based on medical needs:

  • GP for screening of causes and complications where diabetes or thyroid disease is suspected (both are rare).
  • Referral to local DGH general paediatrics:
    • Early onset severe obesity (zBMI more than three by five years) for genetic testing (R149 gene panel).
    • Concerns of a genetic condition (early onset obesity, dysmorphic features, growth abnormalities, developmental abnormalities).
    • Features of the underlying endocrine condition, such as Cushing disease.