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Dietary interventions and advice for adults

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Diet HAI

About

What is covered

Having a healthy balanced diet helps prevent obesity, cardiovascular and many other conditions. This pathway covers recommendations for everyone about diet and lifestyle, and recommendations for health professionals on interventions to encourage people to follow a healthy diet. It is for mothers and children, particularly those from low-income households, and on weight management before and during pregnancy.
The pathway also includes NICE's recommendations on local and national strategy for diet to prevent cardiovascular disease, and recommendations for schools, and the leisure and weight management industries.
The pathway also includes recommendations about dietary supplements for children and women before, during and after pregnancy. It does not cover breastfeeding. Recommendations on breastfeeding are in the postnatal care pathway.
Align actions to improve diet with strategies to prevent obesity at a community level to ensure a coherent, integrated approach (see the obesity: working with local communities pathway).

Updates

Updates to this pathway

26 November 2014 Update to reducing calorie intake for adults who are obese and dietary strategies for children who are obese on publication of obesity (NICE guideline CG189).
22 July 2014 Links to cardiovascular disease prevention and constipation pathways added.
11 March 2014 Link to community engagement pathway added
20 January 2014 Minor maintenance updates
2 January 2014 Minor maintenance updates
17 December 2013 Minor maintenance updates
17 October 2013 Link to the NICE pathway on 'Obesity: working with local communities' added to this pathway.
30 August 2013 Minor maintenance updates
10 August 2012 Minor maintenance updates
25 May 2012 Minor maintenance updates
25 October 2011 Minor maintenance updates

Diet and obesity

Although body weight and weight gain are influenced by many factors, including people's genetic makeup and the environment in which they live, the individual decisions people make also affect whether they maintain a healthy weight.
A person needs to be in 'energy balance' to maintain a healthy weight – that is, their energy intake (from food) should not exceed the energy expended through everyday activities and exercise.
People tend to gain weight gradually, and may not notice this happening. Many people accept weight gain with age as inevitable but the main cause is gradual changes in their everyday lives, such as a tendency to being less active, or small changes to diet. People also often gain weight during particular stages of their life, such as during and after pregnancy, the menopause or while stopping smoking.
Small, sustained improvements to daily habits help people maintain a healthy weight and have wider health benefits – such as reducing the risk of coronary heart disease, type 2 diabetes and some cancers. But making changes can be difficult and is often hindered by conflicting advice on what changes to make.

Women and children from disadvantaged groups

Women from disadvantaged groups have a poorer diet and are less likely to take folic acid or other supplements than those who are better off. They are more likely to be overweight or show low weight gain during pregnancy and their babies are more likely to have a low birth weight.
Mothers from these groups are also less likely to breastfeed and more likely to introduce solid foods earlier than recommended. As a result of many of these factors, their children are more likely to be underweight as infants while also being more prone to obesity later in childhood.

Cardiovascular disease: a national framework for action

Cardiovascular disease (CVD) is a major public health problem. Changes in the risk factors can be brought about by intervening at the population and individual level. Government has addressed – and continues to address – the risk factors at both levels.
Interventions focused on changing an individual's behaviour are important. But changes at the population level could lead to further substantial benefits.
Population-level changes may be achieved in a number of ways but national or regional policy and legislation are particularly powerful levers.
The national framework would be established through policy, led by the Department of Health. It would involve government, government agencies, industry and key, non-governmental organisations working together.
The final decision on whether these policy options are adopted – and how they are prioritised – will be determined by government through normal political processes.

Local authorities and their partners in the community

Concerns about safety, transport links and services have a huge impact on people's ability to eat healthily and be physically active. Effective interventions often require multidisciplinary teams and the support of a range of organisations.

Schools

Improving diet and physical activity levels helps children develop a healthy lifestyle that will prevent them becoming overweight or obese in adulthood. Other benefits may include higher motivation and achievement at school, and better health in childhood and later life.

Workplaces

An organisation's policies and incentive schemes can help to create a culture that supports healthy eating and physical activity. Action will have an impact, not only on the health of the workforce but also in savings to industry.

Short Text

This pathway covers interventions, programmes and strategies to encourage children and adults to have a healthy, balanced diet. The pathway also includes recommendations about dietary supplements for children and women before, during and after pregnancy.

What is covered

Having a healthy balanced diet helps prevent obesity, cardiovascular and many other conditions. This pathway covers recommendations for everyone about diet and lifestyle, and recommendations for health professionals on interventions to encourage people to follow a healthy diet. It is for mothers and children, particularly those from low-income households, and on weight management before and during pregnancy.
The pathway also includes NICE's recommendations on local and national strategy for diet to prevent cardiovascular disease, and recommendations for schools, and the leisure and weight management industries.
The pathway also includes recommendations about dietary supplements for children and women before, during and after pregnancy. It does not cover breastfeeding. Recommendations on breastfeeding are in the postnatal care pathway.
Align actions to improve diet with strategies to prevent obesity at a community level to ensure a coherent, integrated approach (see the obesity: working with local communities pathway).

Updates

Updates to this pathway

26 November 2014 Update to reducing calorie intake for adults who are obese and dietary strategies for children who are obese on publication of obesity (NICE guideline CG189).
22 July 2014 Links to cardiovascular disease prevention and constipation pathways added.
11 March 2014 Link to community engagement pathway added
20 January 2014 Minor maintenance updates
2 January 2014 Minor maintenance updates
17 December 2013 Minor maintenance updates
17 October 2013 Link to the NICE pathway on 'Obesity: working with local communities' added to this pathway.
30 August 2013 Minor maintenance updates
10 August 2012 Minor maintenance updates
25 May 2012 Minor maintenance updates
25 October 2011 Minor maintenance updates

Sources

NICE guidance

The NICE guidance that was used to create the pathway.
Obesity. NICE guideline CG43 (2006)
Prevention of cardiovascular disease. NICE guideline PH25 (2010)
Maternal and child nutrition. NICE guideline PH11 (2008)

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Pathway information

Diet and obesity

Although body weight and weight gain are influenced by many factors, including people's genetic makeup and the environment in which they live, the individual decisions people make also affect whether they maintain a healthy weight.
A person needs to be in 'energy balance' to maintain a healthy weight – that is, their energy intake (from food) should not exceed the energy expended through everyday activities and exercise.
People tend to gain weight gradually, and may not notice this happening. Many people accept weight gain with age as inevitable but the main cause is gradual changes in their everyday lives, such as a tendency to being less active, or small changes to diet. People also often gain weight during particular stages of their life, such as during and after pregnancy, the menopause or while stopping smoking.
Small, sustained improvements to daily habits help people maintain a healthy weight and have wider health benefits – such as reducing the risk of coronary heart disease, type 2 diabetes and some cancers. But making changes can be difficult and is often hindered by conflicting advice on what changes to make.

Women and children from disadvantaged groups

Women from disadvantaged groups have a poorer diet and are less likely to take folic acid or other supplements than those who are better off. They are more likely to be overweight or show low weight gain during pregnancy and their babies are more likely to have a low birth weight.
Mothers from these groups are also less likely to breastfeed and more likely to introduce solid foods earlier than recommended. As a result of many of these factors, their children are more likely to be underweight as infants while also being more prone to obesity later in childhood.

Cardiovascular disease: a national framework for action

Cardiovascular disease (CVD) is a major public health problem. Changes in the risk factors can be brought about by intervening at the population and individual level. Government has addressed – and continues to address – the risk factors at both levels.
Interventions focused on changing an individual's behaviour are important. But changes at the population level could lead to further substantial benefits.
Population-level changes may be achieved in a number of ways but national or regional policy and legislation are particularly powerful levers.
The national framework would be established through policy, led by the Department of Health. It would involve government, government agencies, industry and key, non-governmental organisations working together.
The final decision on whether these policy options are adopted – and how they are prioritised – will be determined by government through normal political processes.

Local authorities and their partners in the community

Concerns about safety, transport links and services have a huge impact on people's ability to eat healthily and be physically active. Effective interventions often require multidisciplinary teams and the support of a range of organisations.

Schools

Improving diet and physical activity levels helps children develop a healthy lifestyle that will prevent them becoming overweight or obese in adulthood. Other benefits may include higher motivation and achievement at school, and better health in childhood and later life.

Workplaces

An organisation's policies and incentive schemes can help to create a culture that supports healthy eating and physical activity. Action will have an impact, not only on the health of the workforce but also in savings to industry.

Supporting information

Support for workplaces

Health professionals such as occupational health staff and public health practitioners should establish partnerships with local businesses and support the implementation of workplace programmes to prevent and manage obesity.

Changing behaviour

Evidence-based behaviour change advice includes:
  • understanding the short, medium and longer-term consequences of people's health-related behaviour
  • helping people to feel positive about the benefits of health-enhancing behaviours and changing their behaviours
  • recognising how people's social contexts and relationships may affect their behaviour
  • helping plan people's changes in terms of easy steps over time
  • identifying and planning situations that might undermine the changes people are trying to make and plan explicit 'if–then' coping strategies to prevent relapse.
For more information see the NICE pathway on behaviour change.
Tailor dietary changes to food preferences and allow for a flexible and individual approach to reducing calorie intake.
Do not use unduly restrictive and nutritionally unbalanced diets, because they are ineffective in the long term and can be harmful.
Encourage people to improve their diet even if they do not lose weight, because there can be other health benefits.

Glossary

Paths in this pathway

Pathway created: May 2011 Last updated: November 2014

© NICE 2014

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