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OxfordshireChildren's Services Procedures Manual

Guidelines for Medical Advisers and Social Workers Regarding Adult Applicants for Adoption and Fostering who have been found to have a BMI above 25

Contents

  1. Introduction
  2. General Principles
  3. For all Applicants
  4. BMI 25-30 kg/m2: Overweight
  5. BMI 30-40 kg/m2: Obese
  6. BMI >40 kg/m2: Morbid Obesity
  7. Decision-Making about Applicant Suitability

    Appendix A: Proforma of a Letter to GP of Applicant with BMI >30 kg/m2

    Appendix B: Suggestions for Social Workers Conducting Home Studies of Applicants who are Identified as being Obese

1. Introduction

Overweight and obesity is increasingly common in society in general, and therefore is common in adult applicants for adoption and fostering.

BAAF have issued guidance about this matter and it is based on this that these guidelines have been written (Evaluating Obesity in Substitute Carers, Mary Mather and Karen Lehner, BAAF 2010).

2. General Principles

  • BMI should not be the sole factor in preventing an applicant being approved as an adopter or foster-carer;
  • If overweight or obesity is identified as part of the medical examination, then, as with any other health risk factor, it is important that the applicant is made aware of the potential consequences and given opportunities to reduce the risk to their future health;
  • As BMI increases, so do the potential risks to health, it is worth giving different advice and recommendations accordingly, taking into consideration any additional risk factors.

3. For all Applicants

For all applicants, whatever their BMI, the home study should include exploring the applicant’s understanding of a healthy lifestyle, and how they plan to incorporate a healthy diet and appropriate physical exercise into the life of a child/ children in their care.

4. BMI 25-30 kg/m2: Overweight

As BMI is a measure which does not take into account body composition, so some applicants within this category may be fit and healthy.

If an applicant’s weight is increasing over time, it is important to emphasise healthy lifestyles and the increased risks associated with smoking, high blood pressure and diabetes.

5. BMI 30-40 kg/m2: Obese

Waist measurement and waist-to-hip ratio are additional measures which help to identify applicants who are at risk of obesity-related complications. (Waist measurements >100cm in a man and >90cm in a woman increases cardio-vascular risk 20-fold). Other risks factors e.g. high blood pressure, high cholesterol, and diabetes should be assessed and, if indicated, treated.

Applicants should be advised by the social worker to visit their GP to have these additional measurements taken, discuss their weight and the management of other identified risk factors.

Social workers assessing the applicants should include in their assessment, the degree to which the applicant has taken messages about obesity on board, what their understanding is of how their obesity might affect a child in their care, and what action they have taken/or are taking to address it.

6. BMI >40 kg/m2: Morbid Obesity

This group of applicants is at high risk of significant morbidity and early mortality, which could impact on their ability to care for a child. It is helpful for the medical advisor to request that the GP use an on-line resource to assess the individual’s cardiovascular risk, if sufficient information has not been provided in the initial paperwork.

Applicants should be referred to their GP for ongoing assessment and management of morbid obesity and its complications according to NICE guidance.

The social worker’s assessment and report should include information on the applicant’s understanding of the risks of their medical condition both to themselves and to a child in their care, and their motivation and attitude to change, as well as what action they have taken/ are taking to address it. In applicants in whom it is clear from the outset that weight may be an issue, a medical assessment early in the process is recommended, so that the applicant may have the time and opportunity to address their weight during the months in which the home-study is being conducted.

7. Decision-Making about Applicant Suitability

The final decision about the application must be made on a case-by-case basis following a multi-agency discussion, and be sensitive to the feelings of the applicant and the needs of the children needing placement.

At panel, aspects which may help in making a decision could include exploring factors in the applicant’s history which may have contributed to the applicant’s weight gain, what has/is motivating them to make changes to their lifestyle, any documented weight loss and over what time-frame the loss has been sustained.

Morbid obesity with complications is a very serious medical condition which might not be compatible with the physical and emotional challenges of substitute parenting. In applicants who have not shown an understanding of the implications of their obesity either for themselves or for a child placed in their care, and/or who are resistant or unable to making the necessary changes to their own lifestyle, serious consideration needs to be taken as to their suitability to be long-term carers.

Appendix A: Proforma of a Letter to GP of Applicant with BMI >30 kg/m2

Dear

 

In my role as medical advisor to the adoption panel, I have reviewed your report regarding Mr/ Mrs who is applying to become an adopter/foster carer.

I note that the applicant’s BMI is >30 kg/m2, and therefore in order to further evaluate the risk posed by obesity to their health, I wonder if you could update me as to:

  • The results of their fasting lipid profile;
  • Their 10-year risk of heart disease or stroke, calculated using a computer-based tool such as QRISK or similar;
  • Any current medical input they are currently receiving or have received with respect to weight management and any referrals which have been made.

The BAAF guidelines clearly state that an applicant’s BMI alone would not prevent an approval as an adopter or foster carer, however as complications from obesity could affect their ability to care for a child, further information to evaluate the applicants risk of complications would be very helpful to me in advising the panel.

With best wishes,

Yours sincerely,

 

Appendix B: Suggestions for Social Workers Conducting Home Studies of Applicants who are Identified as being Obese

It would be useful to explore at least some of the following areas during the home study and comment on the responses in your report. Please note these are suggestions to help guide you, and it is not designed as an exhaustive list.

Knowledge/ Understanding of Healthy Lifestyle and Obesity

  • What does the applicant understand of the causes of obesity and how it contributes to ill-health? In their individual case, what factors/ combination of factors do they think have caused obesity?
  • What does the applicant understand by a healthy diet for their family? Are other family members overweight or obese? Have previous children placed with this applicant gained excessive weight?

Attitudes

  • What is the applicant’s attitude to physical exercise currently? What was their attitude in the past?
  • Does the applicant what to lose weight? Has the applicant tried to lose weight in the past? What happened?
  • How would the applicant support a child in their care who is overweight/ underweight and needs help and support to lose/gain weight?

Behaviours

  • What is the applicant currently doing in order to live a healthy life-style (in terms of dietary intake and physical activity)? Has this changed over time? Since when? What has been the result?
  • Is the applicant able to provide a child with 1-2 hours of physical activity every day? How would they do that?
  • What is the applicant’s capacity to engage in physical activity? What physical activity do they currently do (include walking to work as well as more formal physical activity e.g. going to gym)? How often?
  • Do they become breathless climbing a flight of stairs? Two flights of stairs?
  • Could they chase a young child who is running towards a road?
  • Does the applicant have the time/resources to successfully lose weight?
  • Are they receiving support? From whom (partner, family, friends, GP, practice nurse, staff at gym, weight watchers…)?
Outcomes
  • How much weight has the applicant lost? Over what period of time? How have they achieved this? Could this be continued when a child is placed with them?