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    Equality and health inequalities assessment (EHIA): GID-IND10333 Weight management: BMI recording (long term conditions)

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    STAGE 1. Consultation

    What approaches have been used to identify potential equality and health inequalities issues during indicator development?

    This indicator is an update of published NICE indicator IND151. The following summary of approaches is derived from development of draft weight management indicators IND2023-158 and IND2023-159 which have been previously consulted on, as well as issues identified during the development of the draft overweight and obesity management quality standard.

    The approaches for those indicators were:

    • Review of existing EIA/EHIA on the guideline topic.

    • Consultation with NICE IAC committee.

    The quality standard reviewed the following sources to identify potential equality and health inequalities issues:

    What potential equality and health inequalities issues have been identified during indicator development?

    As raised during development of draft weight management indicators IND2023-158 and IND2023-159 and the draft quality standard on overweight and obesity management:

    1. Protected characteristics outlined in the Equality Act 2010

    Age:

    • Older people have comorbidity risk factors that are of concern at different BMIs.

    Disability:

    • People with a learning disability are more at risk of obesity than the general population and may require additional support for some interventions. A smaller proportion of people with learning disabilities have overweight (27% of people with learning disabilities compared to 31.8% of people without a learning disability). However, higher proportions have obesity (37% of people with learning disabilities compared to 30.1% of people without learning disabilities). There are close links to broader social disadvantage, such as poverty, poor housing and social isolation, which is experienced disproportionately by people with learning disabilities.

    • The British Dietetic Association (BDA) cautions that chronic constipation is a frequent problem for people with learning disabilities and this can distort assessing their weight. In addition, BMI is not always an appropriate measure for people with atypical body shape and there can be challenges in measuring height and weight accurately for some individuals.

    • Certain physical disabilities may impede the accuracy of measurements of overweight and obesity to determine health risk, for example, those with scoliosis and those with a different body composition due to lower muscle mass for a given weight. This may result in people wrongly being classified as ineligible for some weight management treatments.

    • People with severe mental health problems are more at risk of living with overweight or obesity and may require additional support for some interventions.

    Gender reassignment:

    • Nothing found.

    Pregnancy and maternity:

    • Nothing found.

    Race:

    • People of South Asian descent (defined as people of Pakistani, Bangladeshi and Indian origin) living in England tend to have a higher percentage of body fat at a given BMI compared to the general population. People of South Asian descent are also more likely to have more features of the metabolic syndrome (for example, higher triglycerides and lower high-density lipoproteins in females and higher serum glucose in males) at a given BMI. Likewise, compared to white European populations, people from black, Asian and other minority ethnic groups are at equivalent risk of type 2 diabetes but at lower BMI levels.

    Religion or belief:

    • Nothing found.

    Sex:

    • Nothing relevant found.

    Sexual orientation:

    • Nothing relevant found.

      1. Socioeconomic status and deprivation

    • Nothing relevant found.

      1. Geographical area variation

    • Nothing relevant found.

      1. Inclusion health and vulnerable groups

    • Nothing relevant found


    How have the committee's considerations of equality and health inequalities issues identified in 1.2 been reflected in the indicator?

    Not applicable. The committee will deliberate relevant equalities issues at a future meeting..

    Could any indicators potentially increase inequalities?

    No.

    Based on the equality and health inequalities issues identified in 1.2 do you have representation from relevant stakeholder groups for the indicator consultation process, including groups who are known to be affected by these issues? If not, what plans are in place to ensure relevant stakeholders are represented and included?

    Registered national stakeholders include Age UK, British Medical Association, Carers UK, Mind, National Obesity Forum, Obesity UK, Office for Health Improvement and Disparities, Royal College of General Practitioners.

    Has it been proposed to exclude any population groups from coverage by the indicator? If yes, could these exclusions further impact on people affected by any equality and health inequalities issues identified?

    The indicator excludes people aged under 18. This exclusion would not have further impact on equality and health inequalities based on identified issues.

    What questions will you ask at the stakeholder consultation about the impact of the indicator on equality and health inequalities?

    • Do you think there is potential for differential impact (in respect of age, disability, gender and gender reassignment, pregnancy and maternity, race, religion or belief, and sexual orientation)? If so, please state whether this is adverse or positive and for which group.

    • If you think any of these indicators may have an adverse impact in different groups in the community, can you suggest how the indicator might be delivered differently to different groups to reduce health inequalities?

    Completed by lead analyst: Daniel Smithson

    Date: 24/06/2025

    Approved by NICE quality assurance lead: Peter Shearn

    Date: 25/06/2025

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