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Tertiary obesity clinics on the other hand report improvements in body mass index z score in most children, with a third achieving reductions associated with definite decreases in fat and risk factors for heart disease and diabetes.11 12 13 Such clinics can only see a small minority of obese children, however, and over time the caseload typically becomes skewed to adolescents with psychological and social problems.13The recent Cochrane review of treatment of childhood obesity concluded that behavioural lifestyle interventions can produce a meaningful reduction in weight compared with standard care or self help.14 In many developed countries (including Australia), general practitioners are seen as central to such efforts,15 representing the only healthcare service that is universally accessible throughout childhood. General practitioners themselves consider that management of childhood obesity falls within their role.16 With training, they can report high comfort and competence in detecting and broaching this problem, which can in turn flow on into active management.17 18Nevertheless, randomised trials comparing primary care weight management interventions with usual or no care have proved disappointing.19 For example, neither of the Live, Eat and Play (LEAP) or the High Five for Kids trials reported lasting benefits to body mass index from diet, physical activity, and sedentary behaviour counselling provided in primary care settings by general practitioners, paediatricians, or paediatric nurses.18 20 21 Furthermore, outside the research context, general practitioners typically measure and interpret body mass index infrequently,22 often under diagnose overweight and obesity,22 have low confidence in managing overweight/obesity and achieving weight change,22 23 and only rarely treat obese children actively for their weight.24A shared care model involving tertiary obesity specialists and general practitioners might combine “the best of both worlds” for greater success. Cochrane reviews of shared models of care for chronic conditions are mixed; Smith et al found insufficient evidence to support shared primary specialist care,25 but Gruen et al reported that “specialist outreach can improve access, outcomes and service use, especially when delivered as part of a multifaceted intervention.”26 More specifically, for obese adults attending a tertiary weight management clinic, shared care with general practitioners outperformed the specialist arm in short term (10 week) weight loss and dietary habits and achieved comparable six month weight loss.27 The only childhood trial so far published randomised obese 5 16 year olds to either shared care (a single tertiary care visit followed by nurse led primary care) or wholly tertiary care, achieving similar reductions in 12 month body mass index z scores of 0.17 and 0.15.28 However, lack of a true control group was a limitation pandora jewelry, and the potential of shared care approaches remains to be confirmed.This paper reports outcomes of a randomised controlled trial that aimed to determine whether, compared with non intervention control children, a 12 month shared care obesity management intervention reduced body mass index z score (primary outcome) and improved body fat, waist circumference, physical activity, and quality of diet (secondary outcomes) 15 months post enrolment and whether intervention children showed evidence of harm (for example, poorer health status, body satisfaction, or global self worth).