1 Recommendations

The Programme Development Group (PDG) considers that the recommended approaches are cost effective.

The evidence statements underpinning the recommendations are listed in appendix C.

For the gaps in research, see appendix D.

The evidence reviews, supporting evidence statements and economic modelling report are available at the NICE website.

Guiding principles

The recommendations should be undertaken in parallel, wherever possible as part of a system-wide approach to preventing obesity. Ideally, to be as cost effective as possible, they should be implemented as part of integrated programmes that address the whole population, but with a scale and intensity that is proportionate to addressing locally identified inequalities in obesity and associated diseases and conditions.

The guidance provides a framework for existing NICE guidance (community based or individual interventions) that directly or indirectly impacts on obesity prevention or management. (For more details see implementation and related NICE guidance respectively.)

Other NICE guidance can also be used to ensure effective delivery of the recommendations made in this guidance (see below).

Community engagement

The prerequisites for effective community engagement are covered in community engagement (NICE guideline NG44 [2016]).

Behaviour change

The prerequisites for effective interventions and programmes aimed at changing behaviour are covered in Behaviour change: the principles for effective interventions (NICE public health guidance 6 [2007]). In summary, NICE recommends that interventions and programmes should be based on:

  • careful planning, taking into account the local and national context and working in partnership with recipients

  • a sound knowledge of community needs

  • existing skills and resources, by identifying and building on the strengths of individuals and communities and the relationships within communities.

In addition, interventions and programmes should be evaluated, either locally or as part of a larger project, and practitioners should be equipped with the necessary competencies and skills to support behaviour change. This includes knowing how to use evidence-based tools. (NICE recommends that courses for practitioners should be based on theoretically informed, evidence-based best practice.)

Cultural appropriateness

The prerequisites for culturally appropriate action are outlined in Preventing type 2 diabetes – population and community interventions (NICE public health guidance 35 [2011]). The guidance emphasises that culturally appropriate action takes account of the community's cultural or religious beliefs and language and literacy skills by:

  • Using community resources to improve awareness of, and increase access to, interventions. For example, they involve community organisations and leaders early on in the development stage, use media, plan events or make use of festivals specific to black and minority ethnic groups.

  • Understanding the target community and the messages that resonate with them.

  • Identifying and addressing barriers to access and participation, for example, by keeping costs low to ensure affordability, and by taking account of different working patterns and education levels.

  • Developing communication strategies that are sensitive to language use and information requirements. For example, they involve staff who can speak the languages used by the community. In addition, they may provide information in different languages and for varying levels of literacy (for example, by using colour-coded visual aids and the spoken rather than the written word).

  • Taking account of cultural or religious values, for example, the need for separate physical activity sessions for men and women, or in relation to body image, or beliefs and practices about hospitality and food. They also take account of religious and cultural practices that may mean certain times of the year, days of the week, settings, or timings are not suitable for community events or interventions. In addition, they provide opportunities to discuss how interventions would work in the context of people's lives.

  • Considering how closely aligned people are to their ethnic group or religion and whether they are exposed to influences from both the mainstream and their community in relation to diet and physical activity.

Whose health will benefit from these recommendations?

Everyone in a locally defined community but, in particular, vulnerable groups and communities where there is a high percentage of people who are at risk of excess weight gain or who are already overweight or obese (this includes those from particular ethnic or socioeconomic groups, those who are less likely to access services, people with mental health problems, a learning or physical disability). For more information, see public health need and practice).

Recommendation 1 Developing a sustainable, community-wide approach to obesity

Who should take action?

  • Council leaders and elected members.

  • Local authority chief executive officers.

  • Health and wellbeing boards.

  • Directors of public health.

  • Executive directors of local authority services.

  • Local NHS trusts.

  • Local Healthwatch.

  • Leaders of local voluntary and community organisations.

  • Clinical commissioning groups.

  • Local education and training boards.

What action should they take?

  • All of the above should ensure, through the health and wellbeing board, a coherent, community-wide, multi-agency approach is in place to address obesity prevention and management. Activities should be integrated within the joint health and wellbeing strategy and broader regeneration and environmental strategies. Action should also be aligned with other disease-specific prevention and health improvement strategies such as initiatives to prevent type 2 diabetes, cancers, and cardiovascular disease, as well as broader initiatives, such as those to promote good maternal and child nutrition or mental health or prevent harmful drinking.

  • Health and wellbeing boards, supported by directors of public health, should ensure joint strategic needs assessments (JSNAs) address the prevention and management of obesity. They should ensure JSNAs:

    • consider the full range of factors that may influence weight, such as access to food and drinks that contribute to a healthy and balanced diet, or opportunities to use more physically active modes of travel

    • consider inequalities and the social determinants of obesity

    • consider local evidence on obesity (such as data from the National Child Measurement Programme).

  • Health and wellbeing boards should ensure tackling obesity is one of the strategic priorities of the joint health and wellbeing strategy (based on needs identified in JSNAs).

  • Health and wellbeing boards and local authority chief executive officers should encourage partners to provide funding and other resources for activities that make it as easy as possible for people to achieve and maintain a healthy weight. This includes, for example, activities to improve local recreation opportunities, community safety or access to food that can contribute to a healthier diet. Partners should be encouraged to provide funding and resources beyond one financial or political cycle and have clear plans for sustainability.

  • Health and wellbeing boards should work in partnership with local clinical commissioning groups to ensure a coherent approach to tackling obesity that spans both prevention and treatment.

  • Health and wellbeing boards should work with partners to optimise the positive impact (and mitigate any adverse impacts) of local policies on obesity levels. This includes strategies and policies that may have an indirect impact, for example, those favouring car use over other modes of transport, or decisions to remove park wardens, that affect people's use of parks.

  • Health and wellbeing boards, through their performance infrastructure, should regularly (for example, annually) assess local partners' work to tackle obesity (taking account of any relevant evidence from monitoring and evaluation). In particular, they should ensure clinical commissioning group operational plans support the obesity agenda within the health and wellbeing strategy.

Recommendation 2 Strategic leadership

Who should take action?

  • Directors of public health and public health teams.

  • Chairs of local health and wellbeing boards.

  • Executive directors of local authority services.

  • Council leaders and elected members.

  • Leaders of local voluntary and community organisations.

  • Clinical commissioning group leads for obesity (where they exist).

  • Clinical commissioning representatives on local health and wellbeing boards.

  • Local education and training boards.

What action should they take?

  • All of the above should provide visible, strategic leadership to tackle obesity at all levels and ensure an effective team is in place.

  • Directors of public health and public health teams should ensure all those responsible for activity that impacts on obesity understand the needs and priorities of the local community, as outlined in JSNAs. They should ensure all partners understand JSNA priorities and be prepared to decommission services, if necessary, to divert resources to priority areas.

  • Local authority chief executive officers and directors of public health should:

    • regularly brief elected members on the local prevalence of obesity, the health risks and the local factors that may have an impact

    • help elected members identify what they can do to ensure obesity prevention is integrated across the breadth of council strategies and plans.

  • Directors of public health should seek to secure high-level commitment to long-term, integrated action on obesity, as part of the joint health and wellbeing strategy. This includes:

    • local indicators and targets being established collaboratively with all partners

    • ensuring the strategy defines long-term goals and also includes short and intermediate measures

    • cross-sector and two-tier (as appropriate) coordination and communication between transport, planning and leisure services at strategic level and better involvement of local communities in each of these policy areas

    • ensuring performance management focuses on processes that support effective partnership working as well as measuring outputs and outcomes

    • ensuring the strategy on obesity is reviewed regularly (for example, every 3 to 5 years), based on needs identified in JSNAs and mapping of local assets.

  • Leaders of local voluntary and community organisations should ensure the local approach to obesity:

    • fully engages and addresses marginalised groups at particular risk of obesity

    • addresses inequalities in obesity and associated diseases.

  • All clinical commissioning groups should be encouraged to identify an obesity or public health lead to work with the public health team on joint approaches to tackling obesity.

Recommendation 3 Supporting leadership at all levels

Who should take action?

  • Directors of public health and public health teams.

  • Health and wellbeing board chairs.

  • Clinical commissioning groups.

  • Executive directors of local authority services.

  • Council leaders and elected members.

  • Chief executive officer of the local education and training board.

What action should they take?

  • Public health teams should identify and work with 'champions' who have a particular interest or role in preventing obesity in local authority and NHS strategy groups and public, private, community and voluntary sector bodies. This includes, for example, those involved in planning, transport, education and regeneration.

  • All of the above should work to build and support a network of leaders from all organisations and partnerships that could make a contribution to preventing obesity. This should include relevant local authority and NHS services, voluntary and community organisations and the private sector.

  • Directors of public health should support leaders at all levels (including senior and middle managers and frontline staff) of all the partnerships involved in local action on obesity, to ensure local people and organisations are empowered to take action. This means:

    • providing regular opportunities for partners to meet and share learning in both formal meetings and informal, open environments, as appropriate

    • addressing any overlapping, fragmented or competing agendas among different partners and considering options to enhance cooperation and joint working (options might include workshops or away days)

    • funding small-scale community-led projects such as local gardening, cooking and walking groups; and exploring how such initiatives can contribute to defined long-term goals and can be evaluated in a proportionate way

    • fostering a 'learning culture' by explicitly supporting monitoring and evaluation, especially for innovative interventions, and allowing partnerships to build on effective action and change or discard less effective solutions (see recommendations 10 and 11).

Recommendation 4 Coordinating local action

Who should take action?

  • Health and wellbeing boards.

  • Executive directors of local authority services.

  • Directors of public health and public health teams.

  • Community-based health workers, volunteers, groups or networks.

  • Community engagement workers such as health trainers.

What action should they take?

  • Local authority chief executive officers should ensure there is an effective public health team in place to develop a coordinated approach to the prevention of obesity. This should include:

    • a director or lead public health consultant to provide strategic direction

    • a senior coordinator who has dedicated time to support the director or consultant in their work on obesity and oversee the local programme. The coordinator should have:

      • specialist expertise in obesity prevention and community engagement

      • the skills and experience to work across organisational boundaries

    • community 'health champions' (volunteering with community or voluntary organisations) and other people who work directly with the community (such as health trainers and community engagement teams) to encourage local participation and support delivery of the programme.

  • Coordinators should advise commissioners on contracts that support the local obesity agenda to ensure a 'joined-up' approach. They should encourage commissioners to promote better integration between providers through the use of joint contracts and supply chain models that provide a range of local options. The aim is to tackle the wider determinants of obesity and support local people to make changes in their behaviour to prevent obesity.

  • Directors of public health should ensure coordinators engage frontline staff (such as health visitors, environmental health officers and neighbourhood wardens) who can contribute to local action on obesity.

  • Directors of public health should ensure frontline staff set aside dedicated time to deliver specific aspects of the obesity agenda and receive training to improve their understanding of the needs of the local community and improve their practical implementation skills.

  • Coordinators and community engagement workers (such as health trainers and community development teams) should work together to develop and maintain a map of local people and assets that could support a community-wide approach to combating obesity. This includes:

    • community-based health workers such as health visitors, community pharmacists or weight management group leaders

    • existing networks of volunteers and 'champions', health trainers and community organisations such as religious groups, sports clubs, school governors or parent groups

    • people working in the community, such as the police, park wardens, leisure centre staff, active travel coordinators, school crossing patrol officers or school and workplace canteen staff

    • physical activity organisations and networks such as county sport physical activity partnerships

    • unused open spaces or meeting places that could be used for community-based events and courses.

  • Coordinators and community engagement workers should jointly plan how they will work with population groups, or in geographic areas, with high levels of obesity. Plans should consider the motivations and characteristics of the target groups, in relation to obesity. Coordinators should also map where public, private, community and voluntary organisations are already working in partnership to improve health or on other relevant issues.

  • Coordinators, supported by the director of public health, should encourage and support partnership working at both strategic and operational levels. They should ensure partner organisations are clear about their contribution and responsibilities. They should consider asking them to sign an agreement that pledges specific relevant actions in the short and long term.

Recommendation 5 Communication

Who should take action?

  • Directors of public health and public health teams.

  • Local government and NHS communications leads.

What action should they take?

  • Directors of public health and local government communications leads should ensure elected members and all management and staff working with local communities, both within and across partner organisations, are aware of the importance of preventing and managing obesity. The commitment of middle managers and those with a strategic role is particularly important. For example, they should:

    • be aware of, and committed to, the obesity agenda in the health and wellbeing strategy

    • be aware of the impact of obesity on other priorities (for example, the rising local incidence of type 2 diabetes, due to obesity).

  • Local government communications leads should ensure obesity prevention programmes are highly visible and easily recognisable. Recognition may be increased – and costs kept to a minimum – by adapting a widely known brand for use locally (such as the DH's Change4Life). Where appropriate, branding should be agreed by elected members and the health and wellbeing board.

  • Communications leads should ensure partners have shared vision, speak with 'a common voice' and are clearly identifiable to the community. This can be fostered by promoting all relevant activities under the obesity programme 'brand' and using this branding consistently over the long term.

  • Health and wellbeing board chairs and executive directors of local authority services should advocate for action on obesity in any discussions with partners or the local media.

  • Directors of public health and local government communications leads should carefully consider the type of language and media to use to communicate about obesity, tailoring language to the situation or intended audience. Local insight may be particularly important when developing communications to subgroups within a community or specific at-risk groups. For example, in communications to some local communities, it might be better to refer to a 'healthier weight' rather than 'preventing obesity', and to talk more generally about health and wellbeing or specific community issues. Making explicit the relevance of a wide range of initiatives for tackling obesity, for example in annual reports, may be helpful.

  • The local coordinator and public health teams should ensure the results of all monitoring and evaluation are made available to all those who can use them to inform their work, both in the local community and nationally. For example, log evaluation reports in the Obesity Learning Centre or healthy places databases, or the NICE shared learning database.

  • The local coordinator and communications leads should ensure information from monitoring and evaluation is accessible and easy to use by everyone in the community, including those involved with obesity prevention, local groups and networks, the media and the public. This includes presenting information in accessible formats and different languages.

Recommendation 6 Involving the community

Who should take action?

  • Local Healthwatch.

  • Local authority community involvement teams.

  • Directors of public health and public health teams.

  • Local voluntary and community organisations, champions and networks.

  • Council leaders and elected members.

  • Clinical commissioning groups.

What action should they take?

  • Local Healthwatch, community involvement and public health teams should engage local people in identifying their priorities in relation to weight issues. For example, residents may feel that issues such as crime, the siting of hot food takeaways or alcohol outlets, the lack of well-maintained green space, pavement parking, speeding, or the lack of a sense of community are their top priorities. Where possible, it should be made explicit that local concerns often can (and do) impact on levels of obesity in the community.

  • Community involvement and public health teams should work with local people, groups and organisations to decide what action to take on obesity. They should recognise local concerns both in terms of the focus of programmes or services and how they might be delivered. This includes involving local groups, networks or social enterprises in any discussions about service redesign and ensuring that they receive feedback about decisions taken.

  • Public health teams should use community engagement and capacity-building methods to identify networks of local people, champions and advocates who have the potential to co-produce action on obesity as part of an integrated health and wellbeing strategy. These networks include:

    • people who are active and trusted in the community

    • people who have the potential to be local health champions

    • people who represent the needs of subgroups within the community (such as people with disabilities or mental health problems)

    • marginalised groups such as asylum seekers or homeless people (where there is no established network or partnership working, additional action may be needed to get them involved)

    • local champions (such as managers of youth or children's centres, school governors or parent groups, or those who organise walking or gardening groups)

    • people who can provide a link to local business or the private or voluntary sector

    • advocates who have a strong voice in the community, who can challenge social norms and beliefs of the community or who can champion obesity prevention and management as part of their usual role (this includes local elected members, GPs, head teachers, pharmacists, local weight management group leaders, health trainers, community leaders and representatives of local voluntary groups)

    • patient or carer groups.

  • Public health teams should ensure those identified are provided with the resources and training they need to take action on obesity.

  • Clinical commissioning groups should make their GP practices aware of local obesity prevention and treatment services. They should encourage GPs to:

    • make all their patients aware of the importance of a healthy diet and physical activity in helping to prevent obesity

    • signpost people to relevant community programmes.

  • Council leaders and elected members should raise the profile of obesity prevention initiatives through informal meetings with local people and groups and at formal ward meetings.

Recommendation 7 Integrated commissioning

Who should take action?

  • Local authority, NHS and other local commissioners.

  • Directors of public health and public health teams.

What action should they take?

  • Commissioners and public health teams should foster an integrated approach to local commissioning that supports a long-term (beyond 5 years) system-wide health and wellbeing strategy.

  • Public health teams should ensure commissioners understand the demographics of their local area, and consider local insight on the motivations and characteristics of subgroups within local communities that may impact on obesity levels.

  • Commissioners and public health teams should create an environment that allows the 'local system' to take a truly community-wide approach to obesity. They should consider:

    • which 'packages' of interventions are most effective (including cost effective)

    • the 'intensity' of effective programmes (for example, the number of interventions which make up an effective programme or the percentage of the population that should be reached)

    • synergies between common actions to tackle obesity.

  • Commissioners should focus on all of the following areas (focusing on just one at the expense of others may reduce effectiveness):

    • raising awareness of the health problems caused by obesity and the benefits of being a healthier weight among partners and the public

    • training to meet the needs of staff and volunteers (prioritising those who are working directly with local communities)

    • influencing the wider determinants of health, including, for example, ensuring access to affordable, healthier food and drinks, and green space and built environments that encourage physical activity

    • aiming activities at both adults and children in a broad range of settings

    • providing lifestyle weight management services for adults, children and families

    • providing clinical services for treating obesity.

  • Commissioners should fund both targeted and universal services that can help people achieve or maintain a healthy weight. The specific package of services should be based on local needs, but should include both 'top-down' approaches such as planning cycle routes and food procurement specifications and 'bottom-up' approaches such as running activities in local parks and breastfeeding peer support (as appropriate). They should include interventions that are known to be effective as outlined in existing NICE guidance:

  • Commissioners should allocate some of their budget to help establish and sustain local community engagement activities such as small community projects or local community groups. This can be done by, for example, funding the expenses of the leaders of community walking groups, or providing small grants to hire meeting spaces.

  • Commissioners should allocate some of their budget to innovative approaches to obesity prevention that are based on sound principles, have the support of the local community and are likely to be effective, but for which there is limited evidence. Funds for innovative approaches should be allocated within a framework of action learning and evaluation.

  • All contracts should include requirements for regular monitoring or evaluation (see recommendations 10 and 11). Commissioners should ensure some flexibility in contracts to allow programmes or services to be adapted and improved, based on early or ongoing monitoring. Any changes should be clearly documented and carefully monitored. Clear processes should be put in place for learning and evaluation, especially for new approaches.

  • Commissioners should ensure service specifications and contracts encourage local partnership working and reduce unnecessary duplication and overlap, particularly for local services provided by the voluntary and community sector (for example, by specifying a joint rather than separate approach for physical activity and food and nutrition initiatives).

  • Where possible, commissioners should consider extending effective programmes or services, recommissioning effective small-scale projects and commissioning small-scale projects or prototypes that fill a gap in provision. (Such actions should be based on local experience, monitoring and evaluation.)

  • Commissioners should consider redesigning or decommissioning programmes or services that are identified by local Healthwatch or other local bodies with a scrutiny function (such as health overview and scrutiny committees) as ineffective or not meeting the community's needs.

Recommendation 8 Involving businesses and social enterprises operating in the local area

Who should take action?

  • Directors of public health and public health teams.

  • Local authority communications leads.

  • Chambers of commerce.

  • Environmental health departments.

  • Council leaders and elected members.

What action should they take?

  • Public health coordinators, with support from directors of public health, should establish methods for involving business and social enterprises in the implementation of the local obesity strategy. This includes, for example, caterers, leisure providers, weight management groups, the local chamber of commerce, food retailers and workplaces. They should consider developing local activities based on national initiatives to achieve this.

  • Public health teams and local authority communications leads should develop mechanisms of governance for working with business and social enterprises that are in the public interest. For example, they could address issues around appropriate sponsorship or competing priorities, with transparent mechanisms to address real or perceived conflicts of interest.

  • All of the above should encourage all businesses and social enterprises operating in the local area to recognise their corporate social responsibilities in relation to health and wellbeing. This should be in relation to:

    • employees – for example, supporting and encouraging employees (and employee's families) to adopt a healthy diet or developing and implementing active travel plans to encourage walking and cycling

    • products – for example, ensuring the range and content of the food and drinks they sell does not create an incentive to overeat and gives people the opportunity to eat healthily

    • wider social interests – such as actively supporting wider community initiatives on health and wellbeing.

See also NICE guidance on obesity, physical activity in the workplace, preventing cardiovascular disease, preventing harmful drinking and type 2 diabetes.

Recommendation 9 Local authorities and the NHS as exemplars of good practice

Who should take action?

  • Chief executive officers.

  • Executive directors of local authority services.

  • Local authority and NHS commissioners.

  • Directors of public health and public health teams.

  • Council leaders and elected members.

What action should they take?

  • Public health teams should ensure local authorities and NHS organisations develop internal policies to help staff, service users and the wider community achieve and maintain a healthy weight.

  • Local authorities, NHS executive directors and commissioners should promote healthier food and drink choices (and discourage less healthy choices) in all onsite restaurants, hospitality suites, vending machines, outreach services and shops. They should do this through contracts with caterers, pricing and the positioning of products, information at the point of choice and educational initiatives[1].

  • Local authorities and NHS organisations should introduce and monitor an organisation-wide programme that encourages and supports staff and, where appropriate, service users, to be physically active[2]. This includes, for example, introducing physically active travel plans for staff to promote walking and cycling to and from work. It also includes considering the design of working environments to increase opportunities for physical activity.

  • Local authorities and NHS organisations should offer lifestyle weight management service(s) (in line with best practice outlined in section 1.1.7 of NICE's guidance on obesity) for overweight or obese staff who would like support to manage their weight.

  • Local authority and NHS commissioners should consider how their decisions impact on obesity in the local community. For example, ensuring the provision of healthier choices is included in food contracts for leisure centres may have a positive impact on the diet of people who visit or work at these centres.

Recommendation 10 Planning systems for monitoring and evaluation

Who should take action?

  • Directors of public health and public health teams.

  • Local authority, NHS and other local commissioners.

  • Providers of local authority or NHS commissioned services that have a direct or indirect impact on obesity.

What action should they take?

  • All of the above should ensure sufficient resources are set aside for planning, monitoring and evaluation, and that all partners and providers appreciate the importance of monitoring and evaluation.

  • All of the above should ensure all monitoring and evaluation considers the impact of strategies, policies and activities on inequalities in obesity and related health issues.

  • All of the above should ensure all strategies, policies and activities that may impact on the obesity agenda (whether intended or not) are monitored in a proportionate manner. Monitoring arrangements should be built into all relevant contracts.

  • All of the above should ensure sufficient resources are set aside to thoroughly evaluate new or innovative pieces of work (for example, 10% of project budgets).

  • Local authority, NHS and other commissioners should ensure, when commissioning services, there is an appropriate lead-in time for baseline data collection, and data are stratified so that the impact on inequalities can be considered.

  • All of the above should use simple tests to assess value for money (such as resources saved by working in partnership).

  • All of the above should encourage a reflective learning approach that builds on effective practice and changes or discards practices that are found to be less effective.

  • All of the above should ensure monitoring arrangements address the information needs and expectations of a broad range of groups by:

    • assessing a broad range of process indicators such as the views and experience of people who have participated in the obesity programme, feedback from partner organisations, programme referral rates and impact on community wellbeing

    • ensuring the results of monitoring are fed back to teams delivering projects to improve implementation

    • recognising the input of all organisations involved

    • ensuring positive findings are used to motivate all those involved in the programme (for example, by capturing success stories in media campaigns).

Recommendation 11 Implementing monitoring and evaluation functions

Who should take action?

  • Public Health England.

  • Directors of public health and public health teams.

  • Academic health networks and other academic institutions.

  • Local authority, NHS and other local commissioners.

  • Provider organisations.

What action should they take?

  • Public Health England is encouraged to develop a framework for monitoring and evaluating integrated community-wide approaches to obesity to ensure consistency and comparability across all local areas.

  • Directors of public health and public health teams should develop methods to capture changes in know of what it means to be a healthy weight and the benefits of maintaining a healthy weight.

  • Academic health networks and academic institutions should:

    • establish links with local practitioners to help with planning, collecting and analysing data on obesity strategies and interventions

    • identify aspects of partnership working or cooperation that can achieve health benefits at a negligible or lower cost (extensive economic modelling of partnership working is not needed on a routine basis).

  • All of the above should encourage all partners to measure a broad range of outcomes to capture the full benefits of a sustainable, integrated health and wellbeing strategy. Appropriate outcomes include:

    • anthropometric measures such as body mass index (BMI) or waist circumference

    • indicators of dietary intake (for example intake of fruit and vegetables or sugar sweetened drinks), physical activity (for example time spent in moderately vigorous activities such as brisk walking) or sedentary behaviour (for example screen time or car use)

    • prevalence of obesity-related diseases

    • wider health outcomes such as indicators of mental health

    • process outcomes such as service use, engagement of disadvantaged groups, establishment or expansion of community groups

    • indicators of structural changes (such as changes to procurement contracts).

Recommendation 12 Cost effectiveness

Who should take action?

  • Academic health networks and other academic institutions.

  • Directors of public health and public health teams.

  • Local authority, NHS and other local commissioners.

  • Provider organisations.

What action should they take?

  • All of the above should use simple tests to assess value for money of local action to tackle obesity. This may include determining whether resources would be saved by working in partnership, or measuring whether benefits in one sector (such as health) are sufficient to offset costs incurred in another (such as transport or leisure services).

  • All of the above should ensure evaluation frameworks assess the value for money of partnership working and collaboration compared with working as separate entities.

  • All of the above should identify aspects of partnership working or cooperation that can achieve health benefits at negligible or low cost (extensive economic modelling is not needed on a routine basis).

Recommendation 13 Organisational development and training

Who should take action?

  • Health and wellbeing boards.

  • Local education and training boards.

  • Directors of public health and local public health providers.

  • Academic health networks and other academic institutions.

  • Professional bodies providing training in weight management, diet or physical activity.

What action should they take?

  • Health and wellbeing boards, local education and training boards, and public health teams should ensure partners across the local system have opportunities to increase their awareness and develop their skills to take forward an integrated approach to obesity prevention. Local organisations, decision makers, partners and local champions, including those from public, private, community and voluntary sector bodies working in health, planning, transport, education and regeneration, should receive training to:

    • increase their awareness of the local challenges in relation to public health and preventing obesity (in particular, increasing their awareness of the local JSNAs)

    • understand the local systems and how their own work can contribute to preventing and managing the condition (for example when developing local commissioning plans, local planning frameworks or care provision)

    • develop their community engagement skills to encourage local solutions and ensure co-production of an integrated approach

    • understand the importance of monitoring and evaluation to the approach.

  • Local education and training boards should ensure health promotion, chronic disease prevention and early intervention are part of the basic and post basic education and training for the public health workforce.

  • Local education and training boards and the other groups listed above should ensure health and other relevant professionals are trained to be aware of the health risks of being overweight and obese and the benefits of preventing and managing obesity. This training should include:

    • understanding the wider determinants of obesity (such as the impact of the local environment or socioeconomic status)

    • understanding the local system in relation to the obesity agenda (such as who the key partners are)

    • understanding methods for working with local communities

    • knowing the appropriate language to use (referring to achieving or maintaining a 'healthy weight' may be more acceptable than 'preventing obesity' for some communities)

    • understanding why it can be difficult for some people to avoid weight gain or to achieve and maintain weight loss

    • being aware of strategies people can use to address their weight concerns

    • being aware of local services that are likely to be effective in helping people maintain a healthy weight

    • being aware of local lifestyle weight management services that follow best practice as outlined in section 1.1.7 of NICE's guidance on obesity.

  • All of the above should ensure training addresses the barriers some professionals may feel they face when initiating conversations about weight issues. For example, they may be overweight themselves, or feel that broaching the subject might damage their relationship with the person they are advising.

  • All of the above should ensure all relevant staff who are not specialists in weight management or behaviour change can give people details of:

    • local services that are likely to be effective in helping people maintain a healthy weight

    • local lifestyle weight management services that meet best practice as outlined in section 1.1.7 of NICE's guidance on obesity.

  • All of the above should promote, as appropriate, web resources which encourage a community-wide approach to obesity. Resources include: Healthy Weight, Healthy Lives: a toolkit for developing local strategies, the Obesity Learning Centre and Healthy Places resources.

Recommendation 14 Scrutiny and accountability

Who should take action?

  • Local bodies with a scrutiny function (such as health overview and scrutiny committees).

  • Local Healthwatch.

What action should they take?

  • Local bodies with a scrutiny function (such as health overview and scrutiny committees) should assess local action on preventing obesity, ensuring that commissioning meets the breadth of the joint health and wellbeing strategy. This includes:

    • the impact of wider policies and strategies

    • organisational development and training on obesity to ensure a system-wide approach

    • the extent to which services aimed at tackling obesity are reaching those most in need and addressing inequalities in health.

  • Local bodies with a scrutiny function should be encouraged to include plans of action to prevent obesity within their rolling programme of service reviews.

  • Local Healthwatch should ensure the views of the local community are reflected in the development and delivery of the local approach to obesity. They should also scrutinise the priority given to obesity prevention by local health and wellbeing boards and the implementation of local obesity strategies.



[1] See also recommendation 20 in Prevention of cardiovascular disease (NICE public health guidance 25 [2010]) and recommendation 8 in Preventing type 2 diabetes – population and community interventions (NICE public health guidance 35 ([2011]).

[2] See also recommendation 21 in Prevention of cardiovascular disease (NICE public health guidance 25 [2010]); recommendation 10 in Preventing type 2 diabetes – population and community interventions (NICE public health guidance 35 [2011]); and NICE guidance on Promoting physical activity in the workplace (NICE public health guidance 13 [2008]).

  • National Institute for Health and Care Excellence (NICE)