1 Recommendations

This guideline replaces section 1.1.1 of Obesity, NICE guideline CG43 (2006).

Who should take action

All those who provide information to help different population groups maintain a healthy weight or prevent excess weight gain. This includes practitioners providing information or advice to children and adults in primary care, community based settings, early years settings, schools and workplaces. The guideline is also aimed at everyone who commissions, designs, implements or evaluates activities and interventions that directly or indirectly help these population groups.

Read this guideline in conjunction with other NICE guidance (see related NICE guidance) for recommendations on effective activities and interventions. This includes how to tailor activities and information for specific groups, such as for people with disabilities or from different age, gender, socioeconomic, or ethnic groups.

1 Encourage people to make changes in line with existing advice

Encourage everyone to:

  • Establish and maintain a combination of increased physical activity and healthier dietary habits to achieve and maintain energy balance (see recommendations 2 and 3).

  • Follow existing advice on the recommended level of physical activity because it is likely to help increase energy expenditure and reduce the risk of diseases associated with excess weight. (For existing advice on physical activity see NHS Choices.)

  • Follow existing advice on healthy eating because it will make it easier to have an appropriate energy intake. (For existing advice on healthy eating see NHS Choices.)

  • Avoid extreme physical activity or dietary behaviours (such as obsessively exercising or aiming to avoid all carbohydrates) because they are difficult to sustain and may not be accompanied by wider improvements in health.

  • Identify perceptions, habits or situations that may undermine efforts to maintain a healthy weight or prevent excess weight gain in the long term, and offer practical examples of helpful alternatives. These may include:

    • drinking water instead of drinks containing free sugars (including sports drinks) while being physically active

    • not overestimating how much physical activity is being done

    • avoiding overeating after being physically active

    • maintaining healthier physical activity and dietary habits most days (including at weekends) and during holidays (for example, the school summer holiday)

    • avoiding giving 'sweet treats' as a reward or giving them regularly as gifts

    • checking food and drink labels as a guide to appropriate portion sizes

    • being aware that even food and drinks perceived as 'healthy' (such as olive oil, fruit juice, nuts) can contribute to weight gain if large amounts are consumed.

2 Encourage physical activity habits to avoid low energy expenditure

Encourage people to be more physically active and to reduce sedentary behaviour. Encourage people to build activity into daily life, developing routines and habits that gradually increase the amount and intensity of activity they do. This may include:

  • Increasing regular walking, particularly brisk walking, or cycling as a form of active travel (to school, work or other local destinations). (See NICE's guideline on walking and cycling.)

  • Increasing activities during leisure time and breaks at work or school (including some periods of moderate-to-vigorous physical activity). This could include any form of physical activity, sport or exercise such as walking, cycling, swimming, dancing or gardening.

  • Increasing activity as part of daily routines (such as taking regular breaks from sitting at home or work, and taking the stairs instead of the lift).

  • Reducing TV viewing and other screen time. Advise people that any strategy that reduces TV viewing and other leisure screen time may be helpful (such as TV‑free days or setting a limit to watch TV for no more than 2 hours a day).

3 Encourage dietary habits that reduce the risk of excess energy intake

Encourage everyone to follow a dietary pattern that is mainly based on vegetables, fruits, beans and pulses, wholegrains and fish. In addition, everyone should be encouraged to:

  • Reduce the overall energy density of the diet. Practical ways to achieve this may include:

    • reducing how often energy dense foods and drinks (such as fried foods, biscuits, savoury snacks, confectionery and drinks made with full fat milk or cream) are eaten

    • substituting energy dense items with foods and drinks with a lower energy density (such as fruit and vegetables or water)

    • using food and drink labels to choose options lower in fat and sugar

    • choosing smaller portions or avoiding additional servings of energy dense foods.

  • Limit consumption of energy dense food and drinks prepared outside the home, particularly 'fast' or 'takeaway' foods.

  • Avoid sugary drinks (including carbonated drinks, sports drinks, squashes and any other drinks that contain free sugars). Everyone should be encouraged to choose water or other drinks that do not contain free sugars. Other suitable drinks may include coffee, tea or drinks containing non-nutritive sweeteners, such as 'diet' versions of carbonated drinks or squashes.

  • Reduce total fat intake. Practical ways of doing this may include choosing lower fat options of the main sources of fat in the diet, reducing portion size or frequency of consumption of foods high in fat (such as meat and meat products, milk and dairy products, fats and oils, and baked foods such as pizza, biscuits and cakes).

  • Eat breakfast but do not increase overall daily energy intake. Breakfast choices should reflect existing healthy eating advice (see recommendation 1). Practical ways to achieve this may include opting for unsweetened wholegrain cereals or bread, lower fat milk and a portion of fruit.

  • Increase the proportion of high fibre or wholegrain foods eaten. Practical ways to do this may include:

    • choosing wholemeal bread and pasta and wholegrain rice instead of 'white' versions

    • opting for higher-fibre foods (such as oats, fruit and vegetables, beans, peas and lentils) in place of food and drinks high in fat or sugar.

  • Limit intake of meat and meat products. Follow existing advice from NHS Choices to eat no more than 70 g of red and processed meat a day on average. Practical ways to do this may include reducing the portion size of meat or how often meals including meat are eaten.

4 Further advice for parents and carers of children and young people

In addition to the advice in recommendations 1, 2 and 3, encourage parents, carers and everyone in regular contact with children and young people to:

  • Encourage and support them to be active at every opportunity (such as active play, travel, sport or leisure activities). (See NHS Choices and NICE's guideline on promoting physical activity for children and young people).

  • Eat meals with children and young people.

  • Help children and encourage young people to get enough sleep. Explain to parents and carers that this is because lack of sleep may increase the risk of excess weight gain in children and young people. Provide parents and carers with information on age-specific recommendations on sleep (for more information, see NHS Choices).

5 Encourage adults to limit the amount of alcohol they drink

  • Adults should not exceed recommended levels of alcohol consumption.

  • Advise adults that all alcoholic drinks are a source of additional energy. For example, a man drinking the upper daily limit of 3–4 units will be consuming around 200–325 extra calories a day and a woman drinking the upper daily limit of 2–3 units will be consuming around 140–260 extra calories a day. Practical ways to limit alcohol consumption may include replacing alcoholic drinks with non‑alcoholic drinks that do not contain free sugars (see recommendation 3) and increasing the number of alcohol‑free days. For more information see advice on drinking alcohol on the NHS Choices website.

6 Encourage self-monitoring

7 Clearly communicate the benefits of maintaining a healthy weight

  • Clearly communicate the broad range of benefits of maintaining a healthy weight through being more physically active and improving dietary habits. These should include 'non health' benefits as well as improvements to health. For example:

    • The enjoyment gained from shared, social physical activities.

    • The reduced risk of developing diseases associated with excess weight such as coronary heart disease, hypertension, liver disease, osteoarthritis, stroke, type 2 diabetes and some cancers.

    • Improved mental wellbeing.

    • Reduced breathless, improved fitness and other benefits from increased physical activity that are independent of weight.

    • Lower blood cholesterol, improved oral health and other benefits from improved dietary habits that are independent of weight.

8 Clearly communicate the benefits of gradual improvements to physical activity and dietary habits

  • Clearly communicate that even small, gradual improvements to physical activity and dietary habits are likely to be helpful. Emphasise that:

    • Improving dietary habits and being physically active are as important for people who are currently a healthy weight as for people who are already overweight.

    • Weight gain in adulthood is not inevitable. It is possible to avoid gaining weight with age by being physically active and eating a diet based on foods and drinks with a lower energy density.

    • No single physical activity, food or drink will maintain a healthy weight – a combination of actions is needed.

9 Tailor messages for specific groups

10 Ensure activities are integrated with the local strategic approach to obesity

  • Ensure that any activities promoting behaviours that may help people maintain a healthy weight or prevent excess weight gain are integrated with the local strategic approach to obesity (see recommendation 1 in NICE's guideline on obesity: working with local communities). Activities should:

    • address both physical activity and diet (see recommendation 1)

    • use effective methods for encouraging and enabling behaviour change (see NICE's guideline on behaviour change: individual approaches)

    • target and tailor activities, using local knowledge (such as the Joint Strategic Needs Assessment or local surveys), to meet the needs of the population, recognising that some groups may need more support than others (for example, see recommendation 3 in NICE's guideline on walking and cycling and recommendation 2 in NICE's guideline on preventing type 2 diabetes).

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