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 the NICE quality standards on obesity in children and young people: prevention and lifestyle weight management programmes and obesity in adults: prevention and lifestyle weight management programmes. 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.
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
maintenance of weight loss
quality of life
remission in people with type 2 diabetes.
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:
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.
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 NICE quality standards.
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.
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.