Adam Brinkman
Age: 11 years old male
Full Case
Patient’s Data
Age: 11 years old male
Past medical history
- Bronchiolitis at age 3.
Drug and Allergy history
- Nil
Recent notes/ consultation
Seen 3 days ago by Kate Hollaway (Health Care Assistant)
Presenting complaint: Mum brought Adam in routinely to check his weight
Examination Findings: BMI:31 — this plots between the 98th and 99.6th percentile on the growth chart.
Plan: Advised mum to book a follow-up appointment with a GP to discuss concerns around Adam’s weight
Mum, Amy Brinkman, booked a routine appointment to discuss her son’s weight.
Patient's Story (Role player’s brief)
You are Amy, the mother of 11-year-old Adam, and you’ve booked this appointment to talk about concerns regarding his weight. You’ve noticed he’s been putting on a lot of weight recently, and it’s becoming a real worry for you.
ONLY SAY THE BELOW IF ASKED
Idea: You believe Adam’s weight gain is largely due to an unhealthy diet. He regularly consumes fizzy drinks, enjoys McDonald’s, and often snacks on chocolate at night. You feel partly responsible, as your new job has made life hectic and left little time for cooking, so meals have become more convenience based. However, you’ve recently started ordering balanced meals through “Hello Fresh” a meal kit company, in an effort to improve the family’s eating habits.
Concerns: You’re worried not just about his physical health, but also the emotional toll this is taking. He’s been bullied at school because of his weight and now feels reluctant to attend school. Although his general mood seems okay, you’ve noticed he’s withdrawn and no longer engages as well socially.
Expectations: You’re hoping the doctor can prescribe something to help with weight loss. You personally use Orlistat and have found it effective for yourself, and you’re wondering if something similar might help Adam.
Social history: You and your family have a history of being overweight — you are overweight, Adam’s 23-year-old brother is also overweight, and so is his dad. You all live together. Adam currently does no regular exercise. He spends a lot of time playing video games. He says he likes football but avoids playing because he feels he can’t keep up. You’ve tried cutting out fizzy drinks, but his weight continues to be a concern.
Say NO to any other questions asked outside of the details already provided in the scenario. Accept anything offered to you by the doctor.
Marking Scheme
Data Gathering and Diagnosis
- Explore the reason for seeking help with weight loss at this time – what has prompted the concern now?
- Ask about the psychological impact of weight gain, including experiences of bullying or teasing, low self-esteem or changes in confidence, signs of low mood, reduced school attendance or academic performance, withdrawal from social activities or friendships
- Ask about possible physical effects of excess weight, such as joint or back pain, snoring or suspected sleep apnoea, breathing difficulties or reduced exercise tolerance
- Explore contributing lifestyle factors like sedentary behaviours (e.g., screen time, physical inactivity), diet patterns (e.g., frequency of takeaways, sugary drinks etc.), level and type of physical activity, family history or environment (e.g., are other family members overweight? Studies show that obese children often have obese parents, suggesting a genetic link), poor sleep (sleep deprivation is now recognised as a contributing factor to obesity)
- Consider screening for symptoms of underlying medical causes such as hypothyroidism (constipation, feeling cold more than others, skin dryness or other changes), growth hormone deficiency (possible signs include weight gain along with delayed puberty), polycystic ovarian syndrome in females ( irregular periods, hirsutism etc.)
- Ask what has been tried already to manage the weight and whether any methods have been successful
- Ask about over-the-counter medications or any other medical conditions
- Take a brief PBIND history: pregnancy and birth history, immunisations, nutrition and developmental milestones
- Make a diagnosis of Childhood obesity
Example of explanation to patient
Thank you so much for getting in touch to talk about Adam today. I can see how concerned you are about his weight, and it’s great that you’ve taken this step to get support, it’s really important for his overall health and wellbeing.
I had a look at his recent weight check, and when we plotted it on the growth chart we use for children, it showed that his weight is higher than what we’d expect for his age.
You mentioned orlistat, and I understand why you’re asking about it, especially since you’ve used it yourself. However, orlistat isn’t recommended for children. Orlistat works by preventing the absorption of fat from food. This also means that essential fats, which are needed to absorb important vitamins like A, D, E, and K, may not be absorbed properly. These vitamins are crucial for his growth and overall health, so it’s not a suitable option for him at this age. Also, the medicine can cause uncomfortable side effects like stomach pain, oily stools, and urgent bowel movements, which can be quite upsetting for a child.
Instead, we can focus on healthy lifestyle changes, like a balanced diet with plenty of fruits, vegetables, and whole grains, as well as cutting back on sugary drinks and snacks. It’s also important to encourage regular physical activity. For Adam, at least 60 minutes of moderate intensity exercise every day is a good goal. Activities like joining a football club, swimming, or even just walking can be fun and help him stay active.
Additionally, I’d like to consider some blood tests, such as checking his thyroid function, blood sugar levels and lipids, to make sure there are no underlying health issues that could be contributing to his weight, or that may have developed as a result of his weight.
I’m really sorry to hear that Adam has been experiencing bullying, that’s understandably very upsetting, and it can have a big impact not just on his confidence but also on how he feels about going to school. I would encourage you to speak with the school, they are usually very experienced and well-trained in handling bullying sensitively. Many parents worry that things might get worse if it’s reported, but schools are aware of this and put steps in place to make sure that doesn’t happen.
They can often offer support through pastoral staff or the school counsellor, and sometimes just knowing the adults are aware can help a child feel safer. We just want to make sure Adam feels supported both emotionally and at school.
If you feel Adam’s mood or confidence has been more affected, we can also look at offering him some additional emotional support, like talking therapies or CBT (cognitive behavioural therapy), to help him cope with how he’s feeling and build resilience. The goal is to make sure he feels supported emotionally as well as physically
Let’s plan to review him in 4 weeks so we can assess his progress and provide further support if needed. We’re here to help him live a healthier, happier life.
Management
Management
- Explain to the mother that Orlistat isn’t usually recommended for children, as it can interfere with the absorption of important nutrients like vitamins A, D, E, and K — which are vital for a growing child’s development. In addition, Orlistat can cause gastrointestinal side effects, including oily stools, flatulence, and faecal urgency, which may be particularly distressing and poorly tolerated by children.
- Offer a face-to-face appointment to check his blood pressure and arrange blood tests, including thyroid function, Hba1c and lipids, to rule out any underlying concerns.
- Provide practical advice on healthy eating — encourage plenty of fruit and vegetables, healthy snacks, and balanced meals. Reassure her that carbs don’t need to be completely restricted, but choosing wholegrains and avoiding processed options is helpful. A food diary can be a great starting point, and you can offer a referral to a dietitian for extra support.
- Recommend regular physical activity — children and teens should aim for at least 60 minutes a day of moderate exercise. This could include walking, dancing, playing sports, or cycling. Reducing time spent on screens or video games can also make a difference. It’s important to explore options together and find something patient enjoys, so it feels manageable and becomes part of his routine.
- Consider offering referral to a local family wellbeing or lifestyle service, which can support the whole household with practical advice on diet, shopping, meal prep, and exercise ideas that suit the family’s routine. Please note, while involving the whole family has traditionally been encouraged, recent research, such as the Health Technology Assessment of the ‘Families for Health’ programme, suggests that these programmes may not always be effective or cost-efficient, so the support offered should focus on what is most realistic and helpful for the family’s individual needs.
- Suggest that mum speaks with the school regarding the bullying, this can help with emotional support and any impact on attendance. You can also suggest involving the school counsellor or, if needed, offer a referral for CBT to help Adam manage any emotional effects from bullying and his weight concerns.
- Arrange a follow-up in 4 weeks to check in on progress, offer encouragement, and adjust the plan if needed.
Learning point from this station:
Managing childhood obesity in primary care requires a holistic, compassionate, and evidence-based approach. A key lesson is the need to explore contributing factors, including diet, physical activity, screen time, psychological impact (such as bullying), and family lifestyle. Sleep hygiene should also be considered, as sleep deprivation can contribute to weight gain.
NICE recommends that the UK 1990 BMI centile charts be used to assess weight in children:
- BMI >91st centile = overweight
- BMI >98th centile = obese
- BMI >99.6th centile = severely obese
Drug treatment, such as orlistat, is generally not recommended in children and is not licensed for use in those under 12 years of age except under specialist supervision in exceptional cases. Even in adolescents over 12, its use must follow thorough evaluation after lifestyle interventions have been tried. When used, a 6–12-month trial with specialist initiation and monitoring is advised. In addition, supplementation with multivitamins may be necessary due to its effect on fat-soluble vitamin absorption.
Referral to a paediatrician should be considered if the child has:
- BMI >98th centile with complications such as sleep apnoea or orthopaedic problems
- Evidence of growth concerns, such as height <9th centile or delayed/precocious puberty
- Symptoms suggesting endocrine or genetic disorders
- Severe or progressive obesity under age 2
- Significant learning disabilities or other concerns
Complications of obesity in children include:
- Type 2 diabetes and insulin resistance
- Breathing problems (e.g., sleep apnoea)
- Musculoskeletal issues
- Non-alcoholic fatty liver disease
- Vitamin D and iron deficiency
- Polycystic ovary syndrome
- Psychosocial effects and stigma
Emotional impacts, such as bullying and low self-esteem, should also be addressed. Signposting to school support or mental health services like CBT can be beneficial. Collaboration with the school can help ensure bullying is managed effectively.