Obesity prevention

Main conclusions from previous 6 year surveillance review

Previous surveillance update decisions for the guideline are on our website. At the last surveillance review in 2011 an expert panel with representation from the Guidance development group Chair and members that developed CG43 and the collaborating centre lead at the University of Teesside assessed the new evidence identified as part of the surveillance review for CG43. The panel concluded that none of the new evidence contradicted any of the recommendations, but could strengthen and add nuance to the existing recommendations. There was uncertainty as to whether there was sufficient new evidence to warrant a review to all or parts of the public health aspects of the guideline, and they concluded that it was not a good time to update given the uncertainties surrounding changes to the NHS and public health system at that time. They agreed that there was new intervention evidence available on "lifestyle" management of obesity in non-clinical settings for children and adults, particularly in relation to commercial weight management programmes. It was felt that areas where there was new evidence were likely to be covered by public health guidance in development (that has now been published):

New evidence from 10 year surveillance review process on CG43, public health recommendations (section 1.1)

The first recommendations section (1.1) in CG43 consists of public health recommendations (sections 1.1.1–1.1.7).

Section 1.1.1 has been replaced by preventing excess weight gain (NG7) and section 1.1.7 replaced by weight management: lifestyle services for overweight or obese adults (PH53) in line with the surveillance review decisions made in 2011.

The remaining public health recommendations cover the NHS (1.1.2), local authorities and partners in the community (1.1.3), early years settings (1.1.4), schools (1.1.5) and workplaces (1.1.6).

The process for this surveillance review has taken a non-standard approach. Obesity prevention (CG43) was not scheduled for a surveillance review, but has been considered in the context of the evidence identified during the surveillance process of the other diet management guidelines^[1], where relevant; and discussions have taken place with public health internal guidelines team, who indicated that the recommendations on the NHS (1.1.2), local authorities and partners in the community (1.1.3) were not a priority for surveillance review/update, while recommendations on early years settings (1.1.4), schools (1.1.5) and workplaces (1.1.6) should be looked at.

While a specific search for new evidence was not undertaken, the surveillance review search process for 'weight management: lifestyle services for overweight or obese children and young people' (PH47) identified a large volume of cluster randomised controlled trials that were excluded on the basis of their focus being on obesity prevention and/or management of school children, regardless of weight status. This evidence is however likely to impact on the schools recommendation in CG43, which does not provide any specific intervention details. The recommendation in CG43 on early years' settings provides only general principles to addressing obesity management in this population. Evidence specific to workplaces was not identified. It is proposed that the following recommendations are updated:

Implementation

No implementation feedback was requested for obesity prevention (CG43).

Equalities

There has been no evidence to indicate that the guidelines do not comply with anti-discrimination and equalities legislation.

Implications for other NICE programmes

Work that was undertaken in the mapping of the diet management guidelines and for the whole public health catalogue has indicated that there are some gaps concerning the coverage of 'promotion of health and wellbeing in schools' within the public health guideline portfolio. The areas requiring update within obesity prevention (NICE guideline CG43) covers early years settings and schools and weight management: lifestyle services for overweight or obese children and young people (NICE guideline PH47) covers school-aged children and young people, but is a service(s) provided outside of school. Given that the same populations are covered within CG43 (update areas) and PH47, It is proposed that these guidelines are amalgamated to cover the 'promotion of health and wellbeing in children and young people.'

Overall decision

We decided that a partial update is necessary for this guideline, taking into account new evidence on intervention content for the prevention and management of obesity in children and young people in early years' settings (recommendation 1.1.4) and schools (recommendation 1.1.5). And the update of these recommendations should be amalgamated with the update of weight management: lifestyle services for overweight or obese children and young people (PH47) to deliver a guideline covering the 'promotion of health and wellbeing in children and young people'.

Date of next surveillance

The timing of the next check to decide whether the guideline should be updated is to be confirmed.

NICE Public Health and Social Care Surveillance project team

Kay Nolan
Associate Director

Beth Shaw
Senior Technical Advisor

Charlotte Haynes
Senior Technical Analyst

ISBN: 978-1-4731-2479-0