Introduction

This quality standard covers a range of approaches at a population level to prevent children and young people aged under 18 years from becoming overweight or obese. It includes interventions for lifestyle weight management. These statements are particularly relevant to local authorities, NHS organisations, schools and providers of lifestyle weight management programmes.

The standard does not cover the clinical assessment and clinical management of obesity in children and young people, nor does it cover the prevention, assessment or management of obesity in adults. These topics will be covered by separate quality standards.

This standard does not cover encouraging physical activity in people in contact with the NHS, including staff, patients and carers. This is covered in NICE quality standard 84 (Physical activity: encouraging activity in all people in contact with the NHS [2015]).

For more information see the obesity: prevention and lifestyle weight management in children and young people overview.

NICE quality standards focus on aspects of health and social care that are commissioned locally. Areas of national policy, such as legislative changes, are therefore not covered by this quality standard.

Why this quality standard is needed

In 2013/14 in England, over a fifth (22.5%) of children measured through the National Child Measurement Programme – England, 2013–14 in Reception (children aged 4 to 5 years) were either overweight or obese. For children in Year 6 (aged 10 to 11 years), this proportion increased to over a third (33.5%). More specifically, the percentage of children who were obese in Year 6 (19.1%) was more than double that of children in Reception (9.5%).

The Health Survey for England 2012 found that although the prevalence of obese and overweight children and young people increased between 1995 and 2004, since 2004 the rate has levelled off for children aged 2 to 15 years. Despite this, in 2011 in England, around 3 out of 10 boys and girls aged 2 to 15 years were either overweight or obese (31% and 28% respectively). In this group, mean BMI was higher overall in girls than boys. BMI generally increased with age in both sexes (Statistics on obesity, physical activity and diet – England, 2013, Health and Social Care Information Centre 2013).

Obesity prevalence varies across the country and between urban and rural areas. The south east, east midlands and east of England had the lowest obesity prevalence in 2013/14 in Reception, and the south east, east of England and south west had the lowest obesity prevalence in Year 6. London reported the highest obesity prevalence for both age groups (National Child Measurement Programme – England, 2013–14, Health and Social Care Information Centre 2014).

Obesity prevalence is higher in urban areas than in rural areas. Data from the National Child Measurement Programme – England, 2013–14 show that the prevalence of obesity in Reception year children living in urban areas in 2013/14 was 9.8%, compared with 8.2% and 7.8% living in town and village areas respectively. Similarly, obesity prevalence in Year 6 children living in urban areas was 19.9%, compared with 16.1% and 15.0% living in town and village areas respectively.

A strong positive correlation exists between deprivation (as measured by the 2010 Index of Multiple Deprivation [IMD] score) and obesity prevalence for children in each age group. In the least deprived decile, the obesity prevalence was 6.6% among Reception children compared with 12.0% in those in the most deprived decile. Similarly, obesity prevalence in Year 6 children in the least deprived decile was 13.1% compared with 24.7% in those in the most deprived decile (National Child Measurement Programme – England, 2013–14, Health and Social Care Information Centre 2014).

It is well recognised that children who are obese are likely to have obese parents. Obesity that runs in families can be due to environmental factors (such as poor eating habits learned during childhood), or due to relational and behavioural factors (such as poor boundary setting), as well as certain genetic traits being inherited from parents. Therefore, family involvement in interventions is important to ensure improvements in outcomes benefit the whole family and can be maintained.

Up to 79% of children who are obese in their teens are likely to remain obese as adults, according to NICE's guideline on managing overweight and obesity among children and young people. This can lead to health problems in adulthood such as type 2 diabetes, heart disease and certain cancers. Various diseases or conditions may be associated with obesity in children. Type 2 diabetes, a condition previously found almost entirely in adults, is now being diagnosed in children and young people. Being overweight as a child can also impact on selfesteem and quality of life, and cause depression.

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

  • excess weight in children and young people under 18 years

  • dietary habits

  • time spent being inactive or sedentary

  • prevalence of type 2 diabetes in children and young people

  • use of children and adolescent mental health services (CAMHS)

  • self‑esteem

  • mental wellbeing.

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 highquality 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 outcomes framework published by the Department of Health:

Table 1 shows the outcomes, overarching indicators and improvement areas from the framework that the quality standard could contribute to achieving.

Table 1 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

1.16 Utilisation of outdoor space for exercise/health reasons

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** (NHSOF 1a)

4.4 Under 75 mortality rate from all cardiovascular diseases (including heart disease and stroke)* (NHSOF 1.1)

4.5 Under 75 mortality rate from cancer* (NHSOF 1.4i)

4.6 Under 75 mortality rate from liver disease* (NHSOF 1.3)

4.11 Emergency readmissions within 30 days of discharge from hospital* (NHSOF 3b)

* Indicator shared with the NHS Outcomes Framework.

** Complementary to indicators in the NHS Outcomes Framework.

Service user experience and safety issues

Ensuring that care is safe and that people have a positive experience of care is vital in a highquality service. It is important to consider these factors when planning and delivering services relevant to children and young people who are overweight or obese.

Coordinated services

The quality standard for overweight and obesity prevention and lifestyle weight management in children and young people specifies that services should be commissioned from and coordinated across all relevant agencies. A person‑centred, integrated approach to providing services is fundamental to delivering highquality care to children and young 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 overweight and obesity prevention and management service in children and young people are listed in related quality standards.

The Health and Social Care Act 2012 also references the legal duties on commissioning organisations to have regard to reducing health inequalities and to provide integrated services where these will reduce inequalities with respect to access to services and outcomes achieved. Given the strong relationship that exists between obesity and deprivation, reducing inequalities is of particular importance for obesity prevention and lifestyle weight management in children and young people. Therefore it may be important to consider focusing interventions in deprived areas when implementing the quality standard.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All health, public health and social care practitioners involved in assessing and caring for children and young 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 source(s) 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 children and young people who are overweight or obese. If appropriate, professionals should ensure that family members and carers are involved in the decisionmaking process about initiatives to help children and young people maintain a healthy weight or prevent excess weight gain and actively participate in lifestyle weight management services for children and young people who are overweight or obese.