Obesity: Guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children

NICE guidelines [CG43] Published date:

Key priorities for implementation

Key priorities for implementation

The prevention and management of obesity should be a priority for all, because of the considerable health benefits of maintaining a healthy weight and the health risks associated with overweight and obesity.

Public health

NHS

  • Managers and health professionals in all primary care settings should ensure that preventing and managing obesity is a priority, at both strategic and delivery levels. Dedicated resources should be allocated for action.

Local authorities and partners

  • Local authorities should work with local partners, such as industry and voluntary organisations, to create and manage more safe spaces for incidental and planned physical activity, addressing as a priority any concerns about safety, crime and inclusion, by:

    • providing facilities and schemes such as cycling and walking routes, cycle parking, area maps and safe play areas

    • making streets cleaner and safer, through measures such as traffic calming, congestion charging, pedestrian crossings, cycle routes, lighting and walking schemes

    • ensuring buildings and spaces are designed to encourage people to be more physically active (for example, through positioning and signing of stairs, entrances and walkways)

    • considering in particular people who require tailored information and support, especially inactive, vulnerable groups.

Early years settings

  • Nurseries and other childcare facilities should:

    • minimise sedentary activities during play time, and provide regular opportunities for enjoyable active play and structured physical activity sessions

    • implement Department for Education and Skills, Food Standards Agency and Caroline Walker Trust[1] guidance on food procurement and healthy catering.

Schools

  • Head teachers and chairs of governors, in collaboration with parents and pupils, should assess the whole school environment and ensure that the ethos of all school policies helps children and young people to maintain a healthy weight, eat a healthy diet and be physically active, in line with existing standards and guidance. This includes policies relating to building layout and recreational spaces, catering (including vending machines) and the food and drink children bring into school, the taught curriculum (including PE), school travel plans and provision for cycling, and policies relating to the National Healthy Schools Programme and extended schools.

Workplaces

  • Workplaces should provide opportunities for staff to eat a healthy diet and be physically active, through:

    • active and continuous promotion of healthy choices in restaurants, hospitality, vending machines and shops for staff and clients, in line with existing Food Standards Agency guidance

    • working practices and policies, such as active travel policies for staff and visitors

    • a supportive physical environment, such as improvements to stairwells and providing showers and secure cycle parking

    • recreational opportunities, such as supporting out-of-hours social activities, lunchtime walks and use of local leisure facilities.

Self-help, commercial and community settings

  • Primary care organisations and local authorities should recommend to patients, or consider endorsing, self-help, commercial and community weight management programmes only if they follow best practice (see recommendation 1.1.7.1 for details of best practice standards).

Clinical care

Children and adults

  • Multicomponent interventions are the treatment of choice. Weight management programmes should include behaviour change strategies to increase people's physical activity levels or decrease inactivity, improve eating behaviour and the quality of the person's diet and reduce energy intake.

Children

  • Interventions for childhood overweight and obesity should address lifestyle within the family and in social settings.

  • Body mass index (BMI) (adjusted for age and gender) is recommended as a practical estimate of overweight in children and young people, but needs to be interpreted with caution because it is not a direct measure of adiposity.

  • Referral to an appropriate specialist should be considered for children who are overweight or obese and have significant comorbidity or complex needs (for example, learning or educational difficulties).

Adults

  • The decision to start drug treatment, and the choice of drug, should be made after discussing with the patient the potential benefits and limitations, including the mode of action, adverse effects and monitoring requirements and their potential impact on the patient's motivation. When drug treatment is prescribed, arrangements should be made for appropriate health professionals to offer information, support and counselling on additional diet, physical activity and behavioural strategies. Information about patient support programmes should also be provided.

  • Bariatric surgery is recommended as a treatment option for adults with obesity if all of the following criteria are fulfilled:

    • they have a BMI of 40 kg/m2 or more, or between 35 kg/m2 and 40 kg/m2 and other significant disease (for example, type 2 diabetes or high blood pressure) that could be improved if they lost weight

    • all appropriate non-surgical measures have been tried but have failed to achieve or maintain adequate, clinically beneficial weight loss for at least 6 months

    • the person has been receiving or will receive intensive management in a specialist obesity service

    • the person is generally fit for anaesthesia and surgery

    • the person commits to the need for long-term follow-up.

  • Bariatric surgery is also recommended as a first-line option (instead of lifestyle interventions or drug treatment) for adults with a BMI of more than 50 kg/m2 in whom surgical intervention is considered appropriate.

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