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In January 2025, the National Institute for Health and Care Excellence (NICE) published guidance for ‘Overweight and obesity management’ (NG 246),1 with advice to think about ‘wider determinants’ of overweight or obesity, including ‘adverse childhood experiences’ and ‘neurodevelopmental conditions and special educational needs and disabilities (SEND)’. A survey undertaken in a city in the North West of England suggests the extent to which children living with extreme amounts of excess weight might be experiencing these issues.