Introduction

This quality standard covers ways of preventing adults (aged 18 and over) from becoming overweight or obese and the provision of lifestyle weight management programmes for adults who are overweight or obese. Although local definitions vary, these programmes are usually tier 2 interventions that may include weight management programmes, courses or clubs, and form 1 part of a comprehensive approach to preventing and treating obesity.

This quality standard does not cover specialist management (tier 3 interventions) or bariatric surgery (tier 4 intervention). For more information see the obesity: prevention and management in adults topic overview.

NICE quality standards focus on aspects of health and social care that are commissioned locally. Areas of national policy, such as legislative changes and marketing of calorific drink and food products, are therefore not covered by this quality standard.

Why this quality standard is needed

Avoidable illness is placing an increasing financial burden on health and social care services. The NHS Five Year Forward View (October 2014) sets out a vision for the future of the NHS with a specific focus on the sharply rising burden of avoidable illness. It provides the framework for further detailed planning about how the NHS needs to evolve over the next 5 years. The NHS Prevention Board has proposed priority areas that include:

  • a diabetes prevention programme

  • a wider prevention debate.

The Diabetes Prevention Programme aims to reduce the incidence of type 2 diabetes by providing behavioural interventions targeted at individuals who are at high risk of developing type 2 diabetes. Furthermore, the NHS Prevention Board will take an active role in the wider prevention debate to provide strategic direction to stimulate national action on obesity, other major health risks and the wider determinants of health. It is expected that the key improvement areas outlined in The NHS five year forward view will contribute to a reduction in obesity prevalence alongside this quality standard.

According to Public Health England's Adult obesity slide set, around a quarter of adults in England are obese, and 42% of men and 33% of women aged 16 or older are overweight. Although overweight and obesity exist in all population groups, obesity is associated with social disadvantage and ethnicity.

Being overweight or obese can lead to chronic and severe medical conditions. The National Obesity Observatory report Obesity and life expectancy estimated that life expectancy is reduced by an average of 2–4 years for people with a BMI of 30–35 kg/m2, and 8–10 years for those with a BMI of 40–50 kg/m2. The National Audit Office report Tackling obesity in England estimated that women who are obese are around 13 times more likely to develop type 2 diabetes and 4 times more likely to develop hypertension than women who are not obese. Men who are obese are estimated to be around 5 times more likely to develop type 2 diabetes and 2.5 times more likely to develop hypertension than men who are not obese.

The Department of Health's obesity strategy as outlined in the Foresight report, (Tackling obesities: future choices) estimated that the cost to society and the economy of overweight and obesity was almost £16 billion in 2007 (more than 1% of gross domestic product). It could rise to just under £50 billion in 2050 (based on 2007 prices) if obesity rates continue to rise at the current rate.

The Department of Health's obesity strategy aims to reduce 'the level of excess weight averaged across all adults by 2020'. It advocates a range of local interventions that both prevent obesity and treat people who are already overweight or obese.

In many areas, public, private or voluntary organisations are commissioned to provide tier 2 individual or group lifestyle weight management services. People can also self‑refer to commercial or voluntary programmes, for example by attending a local class or club.

This quality standard is expected to contribute to improvements in the following outcomes:

  • excess weight in adults

  • physical activity

  • time spent being inactive or sedentary

  • dietary habits

  • mental wellbeing

  • health‑related quality of life

  • prevalence of obesity‑related comorbidities.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – patient safety, patient experience and clinical effectiveness – for a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 Public health outcomes framework for England, 2013–16

Domain

Objectives and indicators

2 Health improvement

Objective

People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities

Indicators

2.11 Diet

2.12 Excess weight in adults

2.13 Proportion of physically active and inactive adults

2.17 Recorded diabetes

2.23 Self‑reported well‑being

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities

Indicators

4.3 Mortality from causes considered preventable** (NHSOF 1a)

4.4 Under 75 mortality rate from all cardiovascular diseases (including heart disease and stroke)* (NHSOF 1.1)

4.5 Under 75 mortality rate from cancer* (NHSOF 1.4)

4.6 Under 75 mortality rate from liver disease* (NHSOF 1.3)

4.13 Health‑related quality of life for older people

Alignment across the health and social care system

* Indicator is shared

** Indicator is complementary

Table 2 NHS Outcomes Framework 2015–16

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicators

1a Potential years of life lost (PYLL) from causes considered amenable to healthcare

i Adults

1b Life expectancy at 75

i Males ii Females

Improvement areas

Reducing premature mortality from the major causes of death

1.1 Under 75 mortality rate from cardiovascular disease (PHOF 4.4*)

1.3 Under 75 mortality rate from liver disease (PHOF 4.6*)

1.4 Under 75 mortality rate from cancer (PHOF 4.5*)

Reducing premature death in people with a learning disability

1.7 Excess under 60 mortality rate in adults with a learning disability

2 Enhancing quality of life for people with long‑term conditions

Overarching indicator

2 Health‑related quality of life for people with long‑term conditions** (ASCOF 1A)

Improving quality of life for people with multiple long‑term conditions

2.7 Health‑related quality of life for people with three or more long‑term conditions** (ASCOF 1A)

4 Ensuring that people have a positive experience of care

Overarching indicators

4a Patient experience of primary care

i GP services

4d Patient experience characterised as poor or worse

i Primary care

Alignment across the health and social care system

* Indicator is shared

** Indicator is complementary

Indicators in italics are in development

Service user experience and safety issues

Ensuring that care is safe and that people have a positive experience of care is vital in a high‑quality service. It is important to consider these factors when planning and delivering services relevant to preventing and managing obesity in adults.

NICE has developed guidance and an associated quality standard on patient experience in adult NHS services (see the NICE pathway on patient experience in adult NHS services) which should be considered alongside this quality standard. They specify that people receiving care should be treated with dignity, have opportunities to discuss their preferences, and be supported to understand their options and make fully informed decisions. They also cover the provision of information to patients. Quality statements on these aspects of patient experience are not usually included in topic‑specific quality standards. However, recommendations in the development sources for quality standards that affect patient experience and are specific to the topic are considered during quality statement development.

Coordinated services

The quality standard for obesity in adults: prevention and lifestyle weight management programmes specifies that services should be commissioned from and coordinated across all relevant agencies. A person‑centred, integrated approach to providing services is fundamental to delivering high‑quality care to adults who are overweight or obese.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high‑quality overweight and obesity prevention and management service for adults are listed in related quality standards.

The Health and Social Care Act 2012 also references the legal duties on commissioning organisations to have regard to the need to reduce health inequalities and to provide integrated services where these will reduce inequalities with respect to access to services and outcomes achieved. Given the strong relationship that exists between obesity and deprivation, reducing inequalities is of particular importance for obesity prevention and lifestyle weight management in adults. Therefore it may be important to consider focusing interventions in deprived areas when implementing the quality standard.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All health, public health and social care practitioners involved in assessing, caring for and treating adults who are overweight or obese should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development source(s) on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting adults who are overweight or obese. If appropriate, practitioners should ensure that family members and carers are involved in the decision‑making process about initiatives to help adults maintain a healthy weight or prevent excess weight gain and actively participate in lifestyle weight management programmes for adults who are overweight or obese.