About this guideline

What does this guideline cover?

This guideline is a partial update of Obesity, NICE clinical guideline 43 (2006). It provides recommendations on lifestyle weight management services for overweight and obese adults aged 18 and over (see the scope).

The recommendations replace section 1.1.7 in Obesity.

This guideline does not cover:

  • services that focus on preventing obesity (usually called tier 1 services) or address the wider determinants of health

  • pharmacological treatments

  • specialist weight management services (usually called tier 3 services)

  • surgical treatments for obesity (usually called tier 4 services)

  • the additional needs of adults with a range of complex conditions

  • children and young people under 18 years of age

  • pregnant women.

The recommendations should be considered alongside NICE guidance on obesity identification and management (NICE clinical guideline 43) and the local strategic approach to obesity (NICE public health guidance 42). (Also see Related NICE guidance for other recommendations that may be relevant to managing obesity among adults, children and young people.)

How was this guidance developed?

The recommendations are based on the best available evidence. They were developed by the Programme Development Group (PDG).

Members of the PDG are listed in Membership of the Programme Development Group and the NICE project team.

For information on how NICE public health guidelines are developed, see the NICE public health guidance process and methods guides.

What evidence is the guideline based on?

The evidence that the PDG considered included:

  • Evidence reviews:

    • Review 1 was divided into 3 sections and was carried out by the University of Oxford. The principal authors were: Paul Aveyard, Jamie Hartmann-Boyce and David Johns.

      • Review 1a, 'The clinical effectiveness of long-term weight management schemes for adults'.

      • Review 1b, 'How components of behavioural weight management programmes affect weight change'.

      • Review 1c, 'Weight regain after behavioural weight management programmes'.

    • Review 2: 'Managing overweight and obese adults' was carried out by the University of Oxford. The principal authors were: Paul Aveyard, Jamie Hartmann-Boyce and David Johns.

  • Economic modelling: 'Economic modelling and cost consequence analysis' was carried out by the UK Health Forum and the University of East Anglia. The authors were: Martin Brown, Tim Marsh, Lise Retat, Ric Fordham, Marc Suhrcke, David Turner, Richard Little and Oyebanji Filani.

  • Commissioned report: 'Practical and process issues in the provision of lifestyle weight management services for adults' was carried out by GK research. The principal author was Graham Kelly.

  • Expert papers:

    • Expert paper 1 'Weight bias and stigma and the effectiveness of weight management programmes' by Jane Ogden, Professor in Health Psychology, University of Surrey.

    • Expert paper 2 'Experience from practice – psychological issues' by Rachel Holt, Consultant Clinical Psychologist/Service Lead at Derbyshire Tier 3 Weight Reduction Service.

    • Expert paper 3 'Weight bias and the impact of weight stigma on emotional and physical health' by Dr Rebecca Puhl, Director of Research and Weight Stigma Initiatives at the Rudd Center for Food Policy and Obesity, Yale University.

    • Expert paper 4 'Commissioning and working with health and wellbeing boards' by Stephen Watkins, Director of Public Health, Stockport.

Note: the views expressed in the expert papers above are the views of the authors and not those of NICE.

In some cases the evidence was insufficient and the PDG has made recommendations for future research, see Recommendations for research and Gaps in the evidence.

Status of this guideline

The draft guideline, including the recommendations, was released for consultation in October 2013. At its meeting in February 2014, the PDG amended the guideline in light of comments from stakeholders and experts. The guideline was signed off by the NICE Guidance Executive in April 2014.

The guideline replaces section 1.1.7 of Obesity, NICE clinical guideline 43 (2006).

All healthcare professionals should ensure people have a high quality experience of the NHS by following NICE's recommendations in Patient experience in adult NHS services.

The recommendations should be read in conjunction with existing NICE guidance unless explicitly stated otherwise. They should be implemented in light of duties set out in the Equality Act 2010.

The guideline is available on NICE's website. The recommendations are also available in a pathway for professionals whose remit includes public health and for interested members of the public.

NICE produces guidance, standards and information on commissioning and providing high-quality healthcare, social care, and public health services. We have agreements to provide certain NICE services to Wales, Scotland and Northern Ireland. Decisions on how NICE guidance and other products apply in those countries are made by ministers in the Welsh government, Scottish government, and Northern Ireland Executive. NICE guidance or other products may include references to organisations or people responsible for commissioning or providing care that may be relevant only to England.


Implementation should follow the usual principles of person-centred care (see NICE clinical guideline 43).

NICE guidelines can help:

NICE has developed tools to help organisations put this guideline into practice.

Updating the recommendations

This guideline will be reviewed 3 years after publication to determine whether all or part of it should be updated. Information on the progress of any update will be posted on the NICE website.

Your responsibility

This guideline represents the views of the Institute and was arrived at after careful consideration of the evidence available. Those working in the NHS, local authorities, the wider public, voluntary and community sectors and the private sector should take it into account when carrying out their professional, managerial or voluntary duties.

Implementation of this guideline is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guideline, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guideline should be interpreted in a way which would be inconsistent with compliance with those duties.


© National Institute for Health and Care Excellence 2014. All rights reserved. NICE copyright material can be downloaded for private research and study, and may be reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for commercial purposes, is allowed without the written permission of NICE.

ISBN 978-1-4731-0569-0

  • National Institute for Health and Care Excellence (NICE)