This is the first national guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children in England and Wales. The guidance aims to:
stem the rising prevalence of obesity and diseases associated with it
increase the effectiveness of interventions to prevent overweight and obesity
improve the care provided to adults and children with obesity, particularly in primary care.
The recommendations are based on the best available evidence of effectiveness, including cost effectiveness. They include recommendations on the clinical management of overweight and obesity in the NHS, and advice on the prevention of overweight and obesity that applies in both NHS and non-NHS settings.
The guidance supports the implementation of the 'Choosing health' White Paper in England, 'Designed for life' in Wales, the revised GP contract and the existing national service frameworks (NSFs). It also supports the joint Department of Health, Department for Education and Skills and Department for Culture, Media and Sport target to halt the rise in obesity among children under 11 by 2010, and similar initiatives in Wales.
Rationale for integrated clinical and public health guidance
Public health and clinical audiences share the same need for evidence-based, cost-effective solutions to the challenges in their day-to-day practice, as well as to inform policies and strategies to improve health. Complementary clinical and public health guidance are essential to address the hazy divisions between prevention and management of obesity.
The 2004 Wanless report 'Securing good health for the whole population' stressed that a substantial change will be needed to produce the reductions in preventable diseases such as obesity that will lead to the greatest reductions in future healthcare costs. In addition to recommending a more effective delivery framework for health services providers, the report proposed an enhanced role for schools, local authorities and other public sector agencies, employers, and private and voluntary sector providers in developing opportunities for people to secure better health.
It is unlikely that the problem of obesity can be addressed through primary care management alone. More than half the adult population are overweight or obese and a large proportion will need help with weight management. Although there is no simple solution, the most effective strategies for prevention and management share similar approaches. The clinical management of obesity cannot be viewed in isolation from the environment in which people live.