ICAS Assessment Standard No.11
Applicant health (Weight)
Intercountry Adoption Service (ICAS)
1. Scope
This standard should be read in conjunction with the Intercountry Adoption Service (ICAS) Manual and other
ICAS Assessment Standards
This standard applies to all employees of ICAS, contractors to ICAS and applicants to the ICAS at each stage of
the ICAS process including application, assessment and post placement support.
2. Relevant Legislation
Section 35e of the Adoption Regulations states:
(a) the health of the applicants, including emotional, physical and mental health is suitable;
(e) the applicants have the capacity to provide a stable, secure and beneficial emotional and physical
environment during a child's upbringing until the child reaches social and emotional independence;
ICAS is committed to the safety and wellbeing of all Intercountry children placed through the service to ensuring
that adoptive parents are fit and able to provide appropriate care through to an adopted child reaching
independence.
3. Reason for Standard
A review of relevant literature indicates that there are serious health consequences of being both overweight
and underweight.
Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. A
definition of severe and morbid obesity is where serious medical conditions occur as a direct result of the
obesity.
The health risks for being overweight can
include:
The health risks for being underweight can
include:
Cardiovascular disease
Low energy levels
Diabetes
Lack of concentration
High blood pressure
Mood swings
High blood cholesterol
Compromised immune function
Gall bladder disease
Respiratory disease
Joint problems
Cancer
Breathing difficulties
Osteoporosis
Certain types of cancers
Department of Health & Human Services
4. Requirements
There is an expectation that all applicants to the ICAS are in good health at the time of assessment and
reassessment. It is required that consideration of the following are included in the medical examination and
report undertaken by an applicant’s General Practitioner: (1) body mass, (2) waist measurement, (3) blood
pressure and (4) cholesterol levels. Each of these measures are outlined below. Any one of these measures
being outside of the normal range may indicate a relevant health issue.
4.1 Measure of Health
Body Mass Index (BMI).
BMI is calculated by dividing the weight in kilograms by the square of the height in metres of an individual.
Healthy weight range can also be calculated by using the Body Mass Index as per the table below.
Classification of Body Mass Index
Classification
BMI
Risk of Co-Morbidities
Underweight
<18.50
Low (other clinical risks increased)
Normal healthy weight range
18.50 – 25.00
Average
Overweight
>25.00
Overweight/Preobese
25.00 – 30.00
Increased
Obese
30.00 – 35.00
Moderate increase
Severely obese
35.00 – 40.00
Severe increase
Morbidly/very severely obese
>40.00
Very severe increase
The risk of health problems increase at both ends of the BMI Scale. There are some notable exceptions to the
BMI indicating a health issue. These can include body builders/weight lifters; high performance athletes;
differences in height and people of different ethnic groups. In assessing ‘risk’, age is an important factor. For
example, an applicant aged 30 yrs is not anywhere at the same level of risk as an applicant aged 50 years,
although they may have the same BMI.
BMI is only one method used to estimate weight levels and waist circumference is seen as a more accurate
measure.
Waist Measurement
Waist circumference is a useful measure in monitoring weight In most cases, a waist measurement of greater
than 94 cm for men and 80 cm for women is an indicator of internal fat deposits. (These measurements are a
guide for Caucasian adults only.)
Current clinical evidence indicates that waist measurement is an accepted indicator of risk for some lifestyle
related chronic diseases such as Type 2 diabetes, cardiovascular disease and some cancers.
Classification by Waist Circumference
Abdominal overweight
Abdominal obesity
Men
> 94 cm
> 102 cm
Women
> 80 cm
> 88 cm
ICAS Assessment standard 11 Applicant health (Weight)
2
Blood Pressure
Hypertension is the medical term for high blood pressure:
 Normal Blood Pressure: A blood pressure reading of 120/80 or lower is considered normal.
 Normal to High Blood Pressure: Between 120/80 and 140/90.
 High Blood Pressure: 140/90 or higher and if higher than 180/110 it is considered very high blood pressure.
Other lifestyle factors which increase the risks of serious problems associated with high blood pressure include:
 Smoking
 Increased alcohol consumption (more than one to two standard drinks per day)
 Lack of regular exercise
 High blood cholesterol
 Being overweight/obese
 Having diabetes
Cholesterol
There are two types of cholesterol:
 Low density lipoprotein (LDL) cholesterol. (Labelled the ‘bad cholesterol’)
 High density lipoprotein (HDL) cholesterol. (Labelled the ‘good cholesterol’)
Safe blood cholesterol levels are considered to be no higher than 5.5mmols per litre providing there are no other
risk factors present. If there are other cardiovascular risk factors, such as elevated weight, diabetes, smoking
(or pre-existing cardiovascular/heart disease), then the aim for the LDL levels would be less than 2.5mmols per
litre.
5. Medical Consultation
ICAS receive a report completed by applicants and provided to the General Practitioner as well as a report
completed by the General Practitioner. While the General Practitioner does not assess the suitability of the
application to adoption, they provide a medical opinion regarding their likely longevity and functioning for the
time required to parent an adopted child. Therefore any concerns need to be discussed with the General
Practitioner who completed the medical form. If applicants have more than one risk factor for cardiovascular
disease the risks will increase exponentially. However, if the risk factors are controlled, this will bring back the
risk toward normal.
There are health risks associated with both being overweight and underweight. Where an applicant’s BMI is in
the ‘underweight’ category, follow up with the applicant’s General Practitioner is always required to establish the
possible cause and to establish if there are any clinical risks of being underweight for the particular applicant.
Where there is any relevant concern, further specialist report/s may be requested and request for advice from
ICAS Medical Consultant would be warranted.
ICAS will consult regularly with the Senior Medical Officer to ensure current medical developments in the field of
the impact of weight upon general health are taken into consideration and this opinion and recommendation
which will form part of the management decision about the suitability of the applicant to meet the adoption
regulation requirements.
ICAS Assessment standard 11 Applicant health (Weight)
3
6. Impact on the Application
6.1 Application Proceeds
Most applicants are found to have sufficiently likely to have the longevity and functioning for the time required to
parent an adopted child.
6.2 Application Proceeds with Management Plan
Where an applicant has a BMI in the ‘underweight’, ‘overweight’ or ‘obese’ category, but is not deemed to be
likely to have the longevity and functioning for the time required to parent an child, then these applicants will not
be precluded from making an application to ICAS. Even where there are issues the applicant may be required
to address the issue with their General Practitioner whilst the application proceeds. This depends on the issue, if
they are not deemed to be likely to have longevity of life, then this suggests a major issue and we would not
proceed to clear the application until we had more info about the issue.
6.3 Application is Deferred/Placed on Hold
In a very small number of circumstances ICAS cannot be confident that an applicant is sufficiently healthy to
meet the requirements of the Adoption Regulations. If an application under such circumstances is to be
accepted, the applicant must address the health issue. If there are ongoing concerns/treatment required, these
need to be forwarded to the ICAS medical consultant for review and advice.
Applications may be placed ‘on hold’ and/or deferred. Evidence of sustained lifestyle change will be expected.
Healthy weight loss takes time and needs to be sustainable in the long term. Advice and guidance needs to
occur with the General Practitioner and/or accredited health professional. Evidence of weight loss and
reduction of other health risk factors will need to be provided to ICAS.
Where an applicant is in the ‘severely’ and ‘very severe/morbidly’ obese or underweight category (and will
undoubtedly have a decreased or increased waist measurement also), but has no other health risk factors, this
is still of major concern due to the increased risk of chronic diseases which may develop in the near future and
the possible impact on the applicant’s longevity. Discussions need to take place with both the relevant General
Practitioner and the ICAS Medical Consultant. In these circumstances reassessments will be placed on hold or
deferred, and new applications will be deferred whilst applicants seek medical advice/strategy for losing weight
under the guidance of a General Practitioner and or accredited health professional. Evidence of weight loss and
reduction of other health risk factors will need to be provided to ICAS.
A decision regarding timeframes for placing an application ‘on-hold’ or ‘deferral’ needs to be assessed on a
case by case basis and will depend on the particular health risks identified in the report/s. The decision would
be made after consultation with the relevant General Practitioner and/or Specialist/s as well as the ICAS
Manager and ICAS Medical Consultant. Advice from the Medical Consultant indicates that as a general rule, at
least three months would be a reasonable time frame for review. Repeating cholesterol levels or BMI under that
time is unlikely to give a significant result.
7. Overseas Program Requirements
Some Overseas programs have additional requirements regarding weight and BMI in addition to these
guidelines for assessing health.
8. Key Responsibilities and Authorities
ICAS is responsible for ensuring the overall responsibility for the implementation of this policy, review of this
policy and dissemination of this policy to staff, contractors and applicants to ICAS.
ICAS Assessment standard 11 Applicant health (Weight)
4
9. Further Information, Resources and Support
Contact Details
 Intercountry Adoption Service. 20/570 Bourke Street Melbourne. Victoria 3000. Telephone 8608-5700 or
1300 769 926.
 Information sourced from:
 Monash University – Centre for Obesity Research and Education (CORE): www.core.monash.org
 Heart Foundation: www.heartfoundation.org.au
 World Health Organisation: www.who.int/mediacentre/factsheets
 Department of Health: www.betterhealth.vic.gov.au
If you would like to receive this publication in an accessible format, please phone
(03) 8608 5700 using the National Relay Service 13 36 77 if required.
This document is available as a Word document on the internet at:
www.dhs.vic.gov.au/about-the-department/documents-and-resources/policies,guidelines-and-legislation/intercountry-adoption-service-assessment-standards
Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne.
January 2015
ICAS Assessment standard 11 Applicant health (Weight)
5