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Summary of Results

Health Topic:   Endocrine, nutritional and metabolic
Guidance:   Obesity
Description:   The summary of the published clinical guideline on Obesity. It links to the published guidance and key documents.

NICE implementation uptake reports

Implementation uptake report Assessment Published Date Coverage
NICE Implementation Uptake Report: Surgical and pharmacological interventions for obesity Doubts about or mixed impact in practice 2010 National

External literature

External literature Assessment Coverage

NHS Information Centre for Health and Social Care (2009) Use of NICE appraised medicines in the NHS in England-Experimental Statistics

Description: Estimated numbers of eligible patients were derived from NICE costing templates. Data for orlistat and sibutramine was obtained from: Prescription Cost Analysis database (PCA), Prescription and Cost system (ePACT), Hospital Pharmacy Audit Index. The NICE costing template expected an annual number of 311.3 thousand patients. The observed use in 2008 was 40,676.9 thousand defined daily doses, a ratio of 0.5 to 1.

Doubts about or mixed impact in practice National

Office of Health Economics (2010) Shedding the pounds: obesity management, NICE guidance and bariatric surgery in England

Description: Questionnaires were sent to all 152 PCT's. Of these 93 returns were received by August 3rd 2010. PCT's were invited to assess whether they follow the NICE guidelines for obesity. Nearly 4 in 10 reported that their referral guidelines were in line with NICE in all respects. Nearly half responded by stating that elements of their local guidelines matched NICE. One in ten PCT's responded that they do not follow the NICE guideline at all.

Practice appears to be in line with guidance National

Burns E et a (2010) Introduction of laparoscopic bariatric surgery in England: observational population cohort study British Medical Journal 341:c4296

Description: The authors conducted an observational population cohort study. 6953 primary bariatric procedures were carried out during the study period. A marked increase occured in the numbers of bariatric procedures done, from 238 in 2000 to 2543 in 2007, with an increase in the percentage of laparoscopic procedures over the study period (285 (66/238) in 2000 compared with 74.5% (1894/2543) in 2007.

Practice appears to be in line with guidance National

Haboubi NY et al (2010) Effectiveness of multi-disciplinary weight management clinics Obesity reviews 11 (Suppl. 1) 1-472

Description: A retrospective case controlled study was carried out on 114 randomly selected patients who have attended a clinic for at least 12 months. 91.2% of the study population lost on average 14.8kg relating to 6.9% of their initial body weight. 87.7% of those achieved the guidelines maintained there weight loss up to 12 months as compared to 70.8% of those who exceeded the NICE guidelines.

Practice appears to be in line with guidance Local

O'Callaghan M et al (2010) Management of obesity in medical clinics within Children's Community Health Service in relation to recently published NICE guidance Journal of Clinical Audits Vol 2(2); p11-22

Description: Identification of overweight and obese children under the direct care of Children's Community Health Service (CCHS) by Single Point Access referrals and Patient Audit Tracking forms. The ultimate cohort was 25 cases. Results found that recorded family history was not taken in 20 cases, case histories of recorded psychosocial distress was not taken in 19 cases. Height and weight were recorded in all cases but was rarely converted and plotted to give BMI.

Practice appears not to be in line with guidance Local

Royal College of Physicians (2011) Implementing NICE public health guidance for the workplace: a national organisational audit of NHS trusts in England

Description: 282 trusts in England participated in the audit. This comprised 91% of ambulance trusts, 73% of acute trusts, 67% of mental health trusts and 52% of primary care trusts.Participating trusts employ nearly 900,000 NHS staff. Results found 32% of trusts had a policy to encourage and support employees to be more physically active. Only 15% of trusts had a plan or policy to help reduce obesity amongst their staff. 73% of trusts had a plan or policy to encourage and support employees to stop smoking.

Doubts about or mixed impact in practice National

Puttha R et al (2010) Management of childhood obesity and overweight in a paediatric out-patient setting Archives of Disease in Childhood 95 Suppl 1

Description: Clinical notes and letters of patients attending paediatric out-patients over a selected time period were reviewed. Of the 105 children audited in a district general hospital (DGH) 21% were obese and 10% overweight. At the childrens hospital (CH) 24% were obese and 5% overweight, out of 42 children. No overweight children (both hospitals) were identified as overweight and did not have tailored intervention or assessment. 47% and 62% of DGH and CH obese patients respectively had an assessment.

Doubts about or mixed impact in practice Local

Highton, L. et al (2012) Post-bariatric surgery body contouring in the NHS: A survey of UK Bariatric Surgeons Journal of Plastic, Reconstructive and Aesthetic Surgery. 65 (4) (pp 426-432), 2012

Description: In this 2010 survey of UK Bariatric Surgeons, 61/86 (71%) responded to a questionnaire aimed at identifying how treatment of patients undergoing bariatric surgery could be improved. NICE recommend that patients undergoing bariatric surgery should have information on, or access to plastic surgery where appropriate, but only 66% of the respondents routinely counsel patients about the problems relating to skin redundancy after weight loss before they undergo bariatric surgery.

Doubts about or mixed impact in practice Local

National Confidential Enquiry into Patient Outcome and Death (2012) Too Lean a Service? A review of the care of patients who underwent bariatric surgery

Description: This report describes variability on the process of care for patients undergoing bariatric surgery in England, Wales and N. Ireland. In total, 397 clinician and 105 organisational questionnaires, and 381 case notes were assessed on adult patients who underwent surgery between 1st June and 31st August 2010. Results showed that for 295/345 (86%) of cases where it was possible to make an assessment, NICE criteria were adhered to.

Practice appears to be in line with guidance National

Royal College of Physicians (2013) Action on obesity: Comprehensive care for all. Report of a working party

Description: This report aims to raise awareness of weight management issues and makes recommendations based upon a mixture of research literature, patient experience and professional expertise. To ascertain the presence or absence of current multidisciplinary bariatric services in secondary and tertiary care in the UK, a questionnaire was sent to healthcare professionals. Analyses of 122 responses showed 37% had dedicated multidisciplinary medical outpatient services for bariatric patients.

Practice appears not to be in line with guidance National

Royal College of Physicians (2013) Implementing NICE public health guidance for the workplace: Overcoming barriers and sharing success

Description: This report presents findings from the Staff health improvement project, which assessed how NHS trusts have successfully implemented the NICE public health guidance for the workplace. The data is based on 41 telephone interviews carried out with staff from 22 trusts in England. Findings showed the level of familiarity with the guidance varied greatly, though all interviewed trusts welcomed the existence of the guidance and most had used it to some extent to shape their Health & Wellbeing work.

Doubts about or mixed impact in practice National

Preece, R. et al (2013) Measuring implementation of evidence-based guidance on promoting workers' health. Occupational Medicine (Oxford). 62(8):627-31, 2012 Dec.

Description: This study measured the implementation of NICE guidance on workplace health and attempted to identify opportunities to improve this. All NHS organizations in England were invited to participate in an online audit of implementation of NICE guidance during autumn 2010, 282 (63%) NHS organisations partook. Results found that 268 (95%) trusts provide access to stop smoking support; but only 179 (63%) allowed staff to attend smoking cessation services during working hours without loss of pay.

Doubts about or mixed impact in practice National

Health and Social Care Information Centre (2013) Statistics on Obesity, Physical Activity and Diet: England, 2013

Description: This annual report on obesity, physical activity and diet analysed data from the HSCICs Hospital Episode Statistics (HES) databank and from the Prescribing Unit at the HSCIC. Findings include that in 2011 there were 0.9 million prescription items for drugs for the treatment of obesity in England of which almost all were for Orlistat. In 2011/12 there were 8,794 recorded finished consultant episodes with a primary diagnosis of obesity and a main or secondary procedure of bariatric surgery.

Doubts about or mixed impact in practice National

Patel, C. et al (2012) A clinical audit investigating the adherence of general practitioners in ellesmere port and neston regarding orlistat and sibutramine Prescribing in accordance with NICE Guidance. International Journal of Pharmacy Practice. Conference Publication: (var.pagings). 20 (pp 100-101), 2012.

Description: This study investigated the adherence of GPs to guidance when prescribing Orlistat and former prescribing of Sibutramine from 2007 to 2011 across the 13 medical practices of Ellesmere Port and Neston. Between 2007 and 2011, 1291 patients were reported as using Orlistat, and 233 using Sibutramine across the 13 surgeries. Considering overall compliance, 57% +/- 4.6% and 59% +/- 5.6% of patients met the NICE criteria for initial and continued prescribing for Orlistat and Sibutramine respectively.

Doubts about or mixed impact in practice Local

Grylls, E.K. et al (2013) Obesity in Children with Autism Spectrum Disorder Arch Dis Child 2013 98: A52

Description: This audit aimed to evaluate whether overweight / obese children in Colchester diagnosed with autism spectrum disorder (ASD) are managed in accordance with guidelines. Medical notes were analysed from a sample of 77 children with ASD, of which 47% were overweight / obese. Results found that a concern had been raised in 51% of these children. In these cases, interventions including discussion with parents (95%), advice on diet/exercise (77%), and regular weighing (91%) were done in most cases.

Practice appears to be in line with guidance Local

Health and Social Care Information Centre (2014) Statistics on Obesity, Physical Activity and Diet: England, 2014

Description: This annual report presents a range of information on obesity, physical activity and diet, from a variety of sources. Key findings for 2012 are: drug items prescribed for treating obesity fell by 56.3% to 392,000 (2011: 898,000) and; there were 8,024 recorded finished consultant episodes with a primary diagnosis of obesity and a main or secondary procedure of bariatric surgery in 2012-13 (2011-12 : 8,794).

Doubts about or mixed impact in practice National

Royal College of Physicians, Faculty of Occupational Medicine (2014) Implementing NICE public health guidance for the workplace: a national organisational audit of NHS trusts in England - Round 2

Description: This second round of the audit was conducted from June to August 2013. Of all 244 NHS trusts in England, 178 (73%) completed the audit. Participating trusts employ 862,365 staff, representing 73% of all NHS staff in England. Results found that all trusts have a sickness absence policy and 75% have one for smoking cessation, but only 57% have one for mental wellbeing, 44% for physical activity and only 28% have an obesity plan.

Doubts about or mixed impact in practice National

This page was last updated: 01 February 2014

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Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.