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Living with excess weight in childhood is associated with a plethora of complications, which can persist into adulthood. Early intervention may limit excess weight gain and prevent the onset of associated long-term health conditions. Complications of Excess Weight (CEW) clinics are tier 3 paediatric weight management services, set up in 2021, run across England by the National Health Service. CEW clinics use a holistic approach to treating conditions related to severe obesity in children and young people.
The aim of this work was to highlight the demographics, and frequency of complications/comorbidities, of patients able to access CEW clinics in England.
The national operation of CEW clinics is ongoing; therefore, data is being collected continuously. Baseline demographic data was collected for all new patients seen at 32 CEW clinics across England. Patients were screened for multiple complications of excess weight and neurodevelopmental disorders.
Since 2021, 4,784 patients have been registered at 32 CEW clinics across England. Available data, as of April 2025, is presented for their characteristics (table one) and complications of excess weight / comorbidities (table two).
The distribution of children attending a CEW clinic differs significantly across deprivation deciles compared to the expected distribution based on 606,000 children measured in the National Child Measurement Programme1 (NCMP) in year 6 in 2023/2024 (χ2 = 1193, P < 0.001), and also compared with 8,240,816 children aged 5-16 in 2020 Office for National Statistics data2 (χ2 = 1497, P < 0.001). Children in the most deprived deciles (1–3) were significantly over-represented in CEW clinics, while those in the least deprived deciles (6–10) were significantly under-represented.
Children who identified as black and minority ethnic groups were significantly overrepresented in CEW clinics compared with children of a white ethnicity, when using expected distributions based on 465,742 year 6 children measured in the 2023/2024 NCMP1 (χ2 = 30.7, P < 0.001), and 8,176,006 children aged 5-16 in 2020 Office for National Statistics data3 (χ2 = 122, P < 0.001).
| Patient characteristics | |
|---|---|
| Sex | Male: 52.9% , n=2529 Female: 47.1%, n=2249 |
| Age , years | 12.4 (8.9–14.7), n=4736 |
| Weight, kg | 96.7 (66.5–119.0), n=4240 |
| BMI, kg/m2 | 36.7 (31.6–42.2), n=4213 |
| Body fat, % | 46.3 (41.2–51.8), n=2437 |
| Waist circumference, cm | 110 (97–124), n=2332 |
| Ethnicity (n = 3,665) | n (%) |
|---|---|
| White British | 2,197 (59.9) |
| Any other ethnic group | 278 (7.6) |
| Asian or mixed white and Asian | 423 (11.5) |
| Any other white background | 323 (8.8) |
| Mixed white and black Caribbean | 84 (2.3) |
| Black or black British – African | 169 (4.6) |
| Mixed white and black African | 53 (1.4) |
| Black or black British – Caribbean | 81 (2.2) |
| Black or Black British – Any other Black background | 48 (1.3) |
| White Irish | 9 (0.2) |
* Data are presented as median (IQR), expect n (%) for sex and ethnicity.
| Percentage diagnosed (number with complication / total assessed*) | |
|---|---|
| Hypertension | 21.3 (614/2,876) |
| Type 2 diabetes | 8.2 (183/2,237) |
| Dyslipidaemia | 21.2 (188/888) |
| Metabolic dysfunction-associated steatotic liver disease (MASLD) | 30.0 (1014/3,274) |
| Obstructive sleep apnoea (OSA) | 21.4 (588/2,747) |
| Use of non-invasive ventilation | 8.2 (180/2,177) |
| Idiopathic intercranial hypertension | 3.3 (106/3,257) |
| Neurodevelopmental disorders | |
| Autism spectrum disorder (ASD) | 24.0 (914/3,810) |
| Learning disability | 23.1 (757/3,270) |
*Assessment completed prior to, within, or as a result of CEW service.
This data illustrates the complexity of complications resulting from high levels of excess weight in children and young people in England. The NHS Complications of Excess Weight clinics are serving a typically underserved demographic. A substantial proportion of patients were diagnosed with complications such as MASLD, OSA, and ASD. These data highlight the clinical need for tier 3 weight management services at a young age.
Work relating to this abstract was funded by the National Institute for Health Research (Award ID: NIHR158453). We would like to thank our patient group, the ARROWS, as well as NHS England and Prescribing Services Limited for their help with this work.
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