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Obesity: identification, assessment and management of overweight and obesity in children, young people and adults [CG189]

Measuring the use of this guidance

Recommendation: 1.1.6.2

Workplaces should provide opportunities for staff to eat a healthy diet and be more 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.

What was measured: Trusts that had healthy food promoted in the staff restaurant
Data collection end: September 2010
61.35%
Number that met the criteria: 173 / 282
Area covered: National
Source: Preece R et al. (2012). Measuring implementation of evidence-based guidance on promoting workers’ health. Occupational medicine, 62(8), 627-631.

What was measured: Trusts that had healthy food promoted for hospitality events
Data collection end: September 2010
50.35%
Number that met the criteria: 142 / 282
Area covered: National
Source: Preece R et al. (2012). Measuring implementation of evidence-based guidance on promoting workers’ health. Occupational medicine, 62(8), 627-631.

What was measured: Trusts that had healthy food promoted in vending machines
Data collection end: September 2010
31.91%
Number that met the criteria: 90 / 282
Area covered: National
Source: Preece R et al. (2012). Measuring implementation of evidence-based guidance on promoting workers’ health. Occupational medicine, 62(8), 627-631.

What was measured: Trusts that had healthy food promoted in shops for staff and clients
Data collection end: September 2010
30.5%
Number that met the criteria: 86 / 282
Area covered: National
Source: Preece R et al. (2012). Measuring implementation of evidence-based guidance on promoting workers’ health. Occupational medicine, 62(8), 627-631.

What was measured: Trusts provide overweight and obese staff multi-component interventions that address physical activity, eating behaviour and weight reduction together
Data collection end: September 2010
30.5%
Number that met the criteria: 86 / 282
Area covered: National
Source: Preece R et al. (2012). Measuring implementation of evidence-based guidance on promoting workers’ health. Occupational medicine, 62(8), 627-631.

What was measured: Trusts that encourage staff to walk or cycle to external meetings
Data collection end: September 2010
52.84%
Number that met the criteria: 149 / 282
Area covered: National
Source: Preece R et al. (2012). Measuring implementation of evidence-based guidance on promoting workers’ health. Occupational medicine, 62(8), 627-631.

What was measured: Trusts that encourage staff to take the stairs through signage at strategic points and written information
Data collection end: September 2010
47.52%
Number that met the criteria: 134 / 282
Area covered: National
Source: Preece R et al. (2012). Measuring implementation of evidence-based guidance on promoting workers’ health. Occupational medicine, 62(8), 627-631.

What was measured: Trusts that provide information about walking and cycling routes to and from work
Data collection end: September 2010
52.13%
Number that met the criteria: 147 / 282
Area covered: National
Source: Preece R et al. (2012). Measuring implementation of evidence-based guidance on promoting workers’ health. Occupational medicine, 62(8), 627-631.

What was measured: Trusts that provide information about walking and cycling routes around the worksite
Data collection end: September 2010
50.35%
Number that met the criteria: 142 / 282
Area covered: National
Source: Preece R et al. (2012). Measuring implementation of evidence-based guidance on promoting workers’ health. Occupational medicine, 62(8), 627-631.

What was measured: Trusts that encourage staff to take short walks during work breaks
Data collection end: September 2010
61.35%
Number that met the criteria: 173 / 282
Area covered: National
Source: Preece R et al. (2012). Measuring implementation of evidence-based guidance on promoting workers’ health. Occupational medicine, 62(8), 627-631.

What was measured: Trusts that encourage staff to use local leisure facilities
Data collection end: September 2010
81.91%
Number that met the criteria: 231 / 282
Area covered: National
Source: Preece R et al. (2012). Measuring implementation of evidence-based guidance on promoting workers’ health. Occupational medicine, 62(8), 627-631.


Recommendation: 1.2.1

Use clinical judgement to decide when to measure a person's height and weight. Opportunities include registration with a general practice, consultation for related conditions (such as type 2 diabetes and cardiovascular disease) and other routine health checks

What was measured: Proportion of people with HIV who had their body mass index (BMI) recorded in the last year of attendance
Data collection end: December 2013
81%
Area covered: Local
Source: Howe BH & E (2015) Obesity in HIV audit and pathway development: Are we addressing an expanding problem? HIV Medicine, Conference (var.pagings): April.


Recommendation: 1.2.2

Use BMI as a practical estimate of adiposity in adults. Interpret BMI with caution because it is not a direct measure of adiposity.

What was measured: Public Health Outcomes Framework indicator 2.12: Proportion of adults classified as overweight or obese using BMI, calculated from the adjusted height and weight variables.
Data collection end: January 2015
64.6%
Area covered: England
Source: Sport England - Active people survey


Recommendation: 1.2.2.4

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

What was measured: Children with autism spectrum disorder who had BMI calculated
5%
Number that met the criteria: / 77
Area covered: Local
Source: Grylls EK et al (2013) Obesity in Children with Autism Spectrum Disorder Audit. Archives of Disease on Childhood. Vol 98 Suppl 1 pA52


Recommendation: 1.2.3.10

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).

What was measured: Children with autism spectrum disorder who were referred to the local healthy lifestyle programme
18%
Number that met the criteria: / 77
Area covered: Local
Source: Grylls EK et al (2013) Obesity in Children with Autism Spectrum Disorder Audit. Archives of Disease on Childhood. Vol 98 Suppl 1 pA52

What was measured: Overweight children with autism spectrum disorder who were referred to the dietician
86%
Number that met the criteria: / 77
Area covered: Local
Source: Grylls EK et al (2013) Obesity in Children with Autism Spectrum Disorder Audit. Archives of Disease on Childhood. Vol 98 Suppl 1 pA52


Recommendation: 1.2.6.1

Bariatric surgery is recommended as a treatment option for people 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/m2and other significant disease (for example, type 2 diabetes or high blood pressure) that could be improved if they lost weight (1) • 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(2) • 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

What was measured: Patient selection in accordance with NICE criteria
Data collection end: August 2010
85.5%
Number that met the criteria: 295 / 345
Area covered: National
Source: NCEPOD - Bariatric Surgery: Too Lean a Service?

What was measured: Adequate dietetic input, as decided by the assessors, prior to surgery
Data collection end: August 2010
77.5%
Number that met the criteria: 200 / 258
Area covered: National
Source: NCEPOD - Bariatric Surgery: Too Lean a Service?


Recommendation: 1.2.6.9

Surgery for obesity should be undertaken only by a multidisciplinary team that can provide: - Preoperative assessment, including a risk–benefit analysis that includes preventing complications of obesity, and specialist assessment for eating disorder(s) - Information on the different procedures, including potential weight loss and associated risks - Regular postoperative assessment, including specialist dietetic and surgical follow-up - Management of comorbidities - Psychological support before and after surgery - Information on, or access to, plastic surgery (such as apronectomy) where appropriate - Access to suitable equipment, including scales, theatre tables, Zimmer frames, commodes, hoists, bed frames, pressure-relieving mattresses and seating suitable for patients undergoing bariatric surgery, and staff trained to use them.

What was measured: Number of private units offering multidisciplinary team meeting prior to deciding if patient is ready for surgery
Data collection end: August 2010
29.5%
Number that met the criteria: 18 / 61
Area covered: National
Source: NCEPOD - Bariatric Surgery: Too Lean a Service?

What was measured: Number of NHS units operating a multidisciplinary team meeting prior to deciding if a patient is ready for surgery
Data collection end: August 2010
86.7%
Number that met the criteria: 39 / 45
Area covered: National
Source: NCEPOD - Bariatric Surgery: Too Lean a Service?

What was measured: Proportion of patients discussed at MDT
Data collection end: August 2010
66.6%
Number that met the criteria: 251 / 377
Area covered: National
Source: NCEPOD - Bariatric Surgery: Too Lean a Service?

What was measured: Bariatric surgeon follow up available on site
Data collection end: August 2010
90%
Number that met the criteria: 95 / 105
Area covered: National
Source: NCEPOD - Bariatric Surgery: Too Lean a Service?

What was measured: Dietician follow up available on site
Data collection end: August 2010
82%
Number that met the criteria: 86 / 105
Area covered: National
Source: NCEPOD - Bariatric Surgery: Too Lean a Service?

What was measured: Specialist Nurse follow up available on site
Data collection end: August 2010
55%
Number that met the criteria: 58 / 105
Area covered: National
Source: NCEPOD - Bariatric Surgery: Too Lean a Service?

What was measured: Psychologist / Psychiatrist follow up available on site
Data collection end: August 2010
23%
Number that met the criteria: 24 / 105
Area covered: National
Source: NCEPOD - Bariatric Surgery: Too Lean a Service?

What was measured: Unit that performs bariatric surgery has appropriate surgical equipment for morbidly obese patients
Data collection end: August 2010
96.2%
Number that met the criteria: 100 / 104
Area covered: National
Source: NCEPOD - Bariatric Surgery: Too Lean a Service?

What was measured: Unit that performs bariatric surgery has appropriate anaesthetic equipment for morbidly obese patients
Data collection end: August 2010
97.1%
Number that met the criteria: 102 / 105
Area covered: National
Source: NCEPOD - Bariatric Surgery: Too Lean a Service?

What was measured: Unit that performs bariatric surgery has specialised transfer equipment for morbidly obese patients
Data collection end: August 2010
93.3%
Number that met the criteria: 98 / 105
Area covered: National
Source: NCEPOD - Bariatric Surgery: Too Lean a Service?

What was measured: Unit that performs bariatric surgery has specialist training in place for care of the morbidly obese patient
Data collection end: August 2010
87.5%
Number that met the criteria: 91 / 104
Area covered: National
Source: NCEPOD - Bariatric Surgery: Too Lean a Service?


Recommendation: 1.2.12

Relate BMI measurement in children and young people to the UK 1990 BMI charts to give age- and gender-specific information.

What was measured: Public Health Outcomes Framework indicator 2.06i: Proportion of children aged 4-5 years classified as overweight or obese according to age and sex, using the 1990 growth reference (UK90).
Data collection end: March 2012
22.6%
Data collection end: March 2013
22.2%
Data collection end: March 2014
22.5%
Data collection end: March 2015
21.9%
Area covered: England
Source: HSCIC - National Child Measurement

What was measured: Public Health Outcomes Framework indicator 2.06ii: Proportion of children aged 10-11 years classified as overweight or obese according to age and sex, using the 1990 growth reference (UK90).
Data collection end: July 2012
33.9%
Data collection end: July 2013
33.3%
Data collection end: July 2014
33.5%
Data collection end: July 2015
33.2%
Area covered: England
Source: Public Health England. Public Health Outcomes Framework



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