Demographic, clinical and quality of life profiles of children and young people attending 35 NHS Complications of Excess Weight Clinics in England: an observational study

Abstract

Background: Severe childhood obesity is a chronic, relapsing condition that often persists into adulthood and is associated with early onset cardiometabolic, respiratory, neurological and psychosocial complications, leading to reduced quality of life and life expectancy. In response, NHS England launched a national pilot of Tier 3 Complications of Excess Weight (CEW) clinics in 2021 to provide holistic, person-centred care for children and young people with severe obesity and related conditions. Aims: To describe the demographic, clinical and quality of life characteristics of children and young people attending 35 CEW clinics across England. Methods: A cross-sectional descriptive analysis was conducted using patient-level data from 35 Tier 3 paediatric weight management clinics across England, and three sources of general population comparison data. The study population comprised 5,699 children and young people registered at a CEW clinic between January 2021 and October 2025. Outcomes included sociodemographic and anthropometric measurements; prevalence of eight obesity-related complications and seven neurodevelopmental or psychological conditions; health-related quality of life (PedsQL-4.0). Results: Median age was 12.1 years (IQR:8.4-14.5), 52.4% male; 40% identified with non-White British ethnic groups; 26.5% lived in the most deprived decile; median BMI z-score 3.72 (IQR:3.39-4.08). The most prevalent complications were metabolic dysfunction-associated steatotic liver disease (29.3% of 4,572 assessed), dyslipidaemia (17.5% of 1,411), hypertension (17.0% of 3,870), obstructive sleep apnoea (17.0% of 4,379), type 2 diabetes (6.0% of 3,676). Autism spectrum disorder (28.6%), learning disability (23.6%), attention deficit disorder (12.4%), anxiety (8.7%) and deliberate self-harm (8.7%) were common (across >3,800 patients assessed). PedsQL scores were substantially below general population norms and those reported for other health conditions. Conclusions: Clinics are reaching individuals with highly complex medical and neurodevelopmental complications/comorbidities, many of which may be preventable or modifiable through weight loss or early intervention. They also engage disproportionately high numbers of individuals from minority ethnic groups and deprived areas.