Introduction

This quality standard covers the clinical assessment and management of obesity in children, young people and adults. This includes those with established comorbidities and those with risk factors for other medical conditions.

This quality standard does not cover public health strategies to prevent people becoming overweight or obese, or the delivery of lifestyle weight management interventions. These are covered by obesity in children and young people: prevention and lifestyle weight management programmes (NICE quality standard 94) and obesity in adults: prevention and lifestyle weight management programmes (NICE quality standard 111). For more information see the obesity: clinical assessment and management 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 national programmes, are therefore not covered by this quality standard.

Why this quality standard is needed

The Health Survey for England – 2013 (Health and Social Care Information Centre 2014) reported that approximately a quarter of adults (26% of men and 24% of women) were obese and 41% of men and 33% of women were overweight (but not obese). In addition, 30% of boys and 29% of girls aged 2–15 were either overweight or obese.

Obesity is directly linked to several illnesses including type 2 diabetes, fatty liver disease, hypertension, gallstones, gastro-oesophageal reflux disease and psychological and psychiatric morbidities. For example, Tackling obesity in England (National Audit Office 2001) 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.

Healthy lives, healthy people: a call to action on obesity in England (Department of Health 2011) highlighted that the estimated costs to society and the economy of overweight and obesity were almost £16 billion in 2007 (over 1% of GDP) and that this could reach almost £50 billion by 2050 if obesity rates continue to rise unchecked.

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

  • change in weight, BMI and waist circumference

  • functional status

  • long-term mortality

  • maintenance of weight loss

  • obesity-related comorbidities

  • quality of life

  • remission in people with type 2 diabetes.

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 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 ii Children and young people

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*

1.2 Under 75 mortality rate from respiratory disease*

1.3 Under 75 mortality rate from liver disease*

1.4 Under 75 mortality rate from cancer*

i One- and ii Five-year survival from all cancers

Reducing premature mortality in people with mental illness

1.5 i Excess under 75 mortality rate in adults with serious mental illness*

ii Excess under 75 mortality rate in adults with common mental illness*

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**

Improvement areas

Ensuring people feel supported to manage their condition

2.1 Proportion of people feeling supported to manage their condition

Improving functional ability in people with long-term conditions

2.2 Employment of people with long-term conditions* **

Reducing time spent in hospital by people with long‑term conditions

2.3 i Unplanned hospitalisation for chronic ambulatory care sensitive conditions

ii Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s

Enhancing quality of life for people with mental illness

2.5 i Employment of people with mental illness**

ii Health-related quality of life for people with mental illness**

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**

3 Helping people to recover from episodes of ill health or following injury

Overarching indicators

3a Emergency admissions for acute conditions that should not usually require hospital admission

3b Emergency readmissions within 30 days of discharge from hospital*

Improvement areas

Improving outcomes from planned treatments

3.1 Total health gain as assessed by patients for elective procedures

i Physical health-related procedures

ii Psychological therapies

iii Recovery in quality of life for patients with mental illness

4 Ensuring that people have a positive experience of care

Overarching indicators

4a Patient experience of primary care

i GP services

4b Patient experience of hospital care

4c Friends and family test

4d Patient experience characterised as poor or worse

i Primary care

ii Hospital care

Improvement areas

Improving people's experience of outpatient care

4.1 Patient experience of outpatient services

Improving hospitals' responsiveness to personal needs

4.2 Responsiveness to inpatients' personal needs

Improving children and young people's experience of healthcare

4.8 Children and young people's experience of inpatient services

Improving people's experience of integrated care

4.9 People's experience of integrated care**

Alignment with Adult Social Care Outcomes Framework and/or Public Health Outcomes Framework

* Indicator is shared

** Indicator is complementary

Indicators in italics in development

Table 2 Public health outcomes framework for England, 2013–16

Domain

Objectives and indicators

1 Improving the wider determinants of health

Objective

Improvements against wider factors that affect health and wellbeing and health inequalities

Indicators

1.3 Pupil absence

1.9 Sickness absence rate

1.16 Utilisation of outdoor space for exercise/health reasons

1.18 Social isolation*

2 Health improvement

Objective

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

Indicators

2.6 Excess weight in 4–5 and 10–11 year olds

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, whilst reducing the gap between communities

Indicators

4.3 Mortality rate from causes considered preventable**

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

4.5 Under 75 mortality rate from cancer*

4.6 Under 75 mortality rate from liver disease*

4.7 Under 75 mortality rate from respiratory diseases*

4.13 Health-related quality of life for older people

Alignment with Adult Social Care Outcomes Framework and/or NHS Outcomes Framework

* Indicator is shared

** Indicator is complementary

Indicators in italics in development

Safety and people's experiences of care

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 the clinical assessment and management of obesity.

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: clinical assessment and management specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole obesity care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to people 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 obesity service are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating people 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 sources 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 people who are overweight or obese. If appropriate, healthcare professionals should ensure that family members and carers are involved in the decision-making process about investigations, treatment and care.