Weight Management Checklist
Patients with BMI>95th percentile
Nutrition	Nutritional Consult from Registered Dietitian Doctor Ordered Calorie Count Healthy Snacks/ No sweetened drinks from nurse’s station	□ □ □
Screening / PHYSICAL assessment
Measurements	Weight Circumference Body Mass / Fat composition	□ □
Labs	Lipid Profile Liver Enzymes Hemoglobin A1c Measurement Fasting Insulin	□ □ □ □
Screening	Obtain Family Medical History Look for signs of Type 2 Diabetes (Acanthosis Nigricans/ Polyuria/ Polydipsia) Asthma Blount Disease (tibia vara) Sleep Apnea (Listen for loud snoring and pauses in breathing during sleep/ daytime sleepiness)	□ □ □ □ □
Proper Equipment	Large Blood Pressure Cuff / Appropriately Sized Wheelchair Stepping Stools Assess Special Needs of Patient’s Family (ex Adequate space in patient’s room) Educational Material that Promotes a Healthy Lifestyle (Coloring Books/ Puzzles/ Activity sheets)	□ □ □ □
Psychological Assessment
Psych. Screening	Order Psychological Consult High Risk of: (Depression, Anxiety, ADHD, Eating Disorders)	□ □
Referral	Refer to Weight Management Clinic	□