Diet

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.

Introduction

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).

Source guidance

The NICE guidance that was used to create the pathway.
Obesity. NICE clinical guidance 43 (2006)
Weight management before, during and after pregnancy. NICE public health guidance 27 (2010)
Prevention of cardiovascular disease. NICE public health guidance 25 (2010)
Maternal and child nutrition. NICE public health guidance 11 (2008)

Quality standards

Quality statements

Effective interventions library

Successful effective interventions library details

Implementation

Assessment tools

The baseline and self-assessment tools are Excel spreadsheets that can be used by organisations to identify if they are in line with practice recommended in NICE guidance and to help them plan activity that will help them meet the recommendations.
Weight management before, during and after pregnancy: self-assessment tool
Prevention of cardiovascular disease: self-assessment tool

Audit support

Audit support provides ready-to-use criteria, including exceptions, definitions, suggested data sources and a data collection tool.
Obesity: audit criteria
Weight management before, during and after pregnancy: audit support
Maternal and child nutrition: audit support

Commissioning guides

Commissioning guides provide information on key clinical and service-related issues to consider during the commissioning process. Each guide contains a commissioning and benchmarking tool, which is a resource that can be used to estimate and inform the level of service needed locally as well as the cost of local commissioning decisions.
Weight management before, during and after pregnancy: commissioning guide
A peer-support programme for women who breastfeed: commissioning guide

Costing support

Costing support includes national cost impact reports that summarise the national costs and savings and discuss the assumptions used; costing templates to assess the impact on local budgets; and costing statements when the impact is not significant or impossible to quantify at a national level.
Obesity: costing report
Obesity: costing template
Weight management before, during and after pregnancy: costing report
Weight management before, during and after pregnancy: financial planning tool
Prevention of cardiovascular disease: costing report
Prevention of cardiovascular disease: costing template
Maternal and child nutrition: costing statement

Education tools

NICE has developed online learning modules, in collaboration with a range of providers, including BMJ Learning, to update knowledge on evidence and NICE guidance.
Obesity: online education tool

Information resources and templates

These include key points for scrutiny or compliance assessment, signposting to resources, checklists and case studies. They are designed to offer practical help in putting NICE guidance into practice and the format depends on the specific topic.
Obesity: guide to resources
Weight management before, during and after pregnancy: questionnaire
Prevention of cardiovascular disease: checklist

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.

Information for patients and the public

NICE produces booklets for patients and the public, called 'Understanding NICE guidance'. They summarise, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written a booklet for patients and the public explaining its guidance on each of the following topics.
Treatment for people who are overweight or obese
Preventing obesity and staying a healthy weight
25 October 2011 Minor maintenance updates
25 May 2012 Minor maintenance updates
10 August 2012 Minor maintenance updates
28 November 2012 Information about obesity prevention added to Training for health professionals, Training for public sector catering staff, Training for teaching, support and catering staff in schools, Workplaces, including the NHS and local authorities, Health professionals working in the wider community, Local and regional health impact assessments and evaluation, Strategy for local authorities and partners in the community, Developing a regional cardiovascular disease prevention programme, and Standards for take-aways and other food outlets.

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 NICE's guidance on behaviour change.

Glossary

Strategy and policy for diet

Recommendations on strategy, policy and commissioning for diet

National policy

View the 'National policy on diet' path

Local strategy and policy

Local and regional strategy and policy on diet

Primary care

View the 'Recommendations about diet for primary care and community health services' path

Local health impact assessments

Local and regional health impact assessments and evaluation

Local and regional health impact assessments and evaluation

Health impact assessments of regional and local plans and policies

Use a variety of methods to assess the potential impact (positive and negative) that all local and regional policies and plans may have on rates of cardiovascular disease (CVD) and related chronic diseases. Take account of any potential impact on health inequalities.
Identify those policies and plans that are likely to have a significant impact on CVD rates. This can be achieved by using screening questions that cover the social, economic and environmental determinants of CVD.
Monitor the outcomes following an assessment and use this to follow up and amend plans.
Identify where expertise is required to carry out assessments and where this is available locally.
Identify the training and support needs of staff involved in carrying out assessments and provide the necessary resources.

Evaluation

Establish baseline measures before the CVD programme begins. These should include lifestyle and other factors that influence cardiovascular risk, as well as figures on CVD prevalence and mortality. The establishment of such measures should be budgeted for as part of the programme.
Ensure evaluation is built in (in line with 'Behaviour change' [NICE public health guidance 6]). It should include the policies and activities of partner organisations which are likely to influence CVD prevalence.
Ensure appropriate methods (using multiple approaches and measures) are used to evaluate the programme's processes, outcomes and measures or indicators. Evaluation should include determining how acceptable the programme is to the local community or the groups targeted.
Ensure the results of evaluation are freely available and shared with partner organisations. Use the findings to inform future activities.
See also the recommendations on developing a regional CVD prevention programme in this 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).

Implementation tools

Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/implementation-node-single
Prevention of cardiovascular disease: self-assessment tool

Source guidance

Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-node
PH25

Strategy for local authorities

Strategy for local authorities and partners in the community

Strategy for local authorities and partners in the community

Overarching recommendationThis recommendation is from 'Obesity' (NICE clinical guideline 43).

As part of their roles in regulation, enforcement and promoting wellbeing, local authorities, other commissioners of public health services and partners in the community should ensure that preventing and managing obesity is a priority for action – at both strategic and delivery levels – through community interventions, policies and objectives. Dedicated resources should be allocated for action.

Strategy for senior managers and budget holders

Local authorities should set an example in developing policies to prevent obesity in their role as employers, by following existing guidance and (in England) the local obesity strategy.
  • On-site catering should promote healthy food and drink choices (for example by signs, posters, pricing and positioning of products)This is part of a recommendation from 'Obesity' (NICE clinical guideline 43)..
Local authorities (including planning, transport and leisure services) should engage with the local community, to identify environmental barriers to physical activity and healthy eating. This should involve:
  • an audit, with the full range of partners including commissioners of health services, residents, businesses and institutions
  • assessing (ideally by doing a health impact assessment) the affect of their policies on the ability of their communities to be physically active and eat a healthy diet; the needs of subgroups should be considered because barriers may vary by, for example, age, gender, social status, ethnicity, religion and whether an individual has a disability.
Barriers identified in this way should be addressed.
Local authorities should facilitate links between health professionals and other organisations to ensure that local public policies improve access to healthy foods and opportunities for physical activity.
Local authorities, through local partnerships, should encourage all local shops, supermarkets and caterers to promote healthy food and drink, for example by signs, posters, pricing and positioning of products, in line with existing guidance and (in England) with the local obesity strategy.

Use of public money to buy food and drink in private sector venuesThis recommendation is from 'Prevention of cardiovascular disease' (NICE public health guidance 25).

When public money is used to procure food and drink in venues outside the direct control of the public sector, ensure those venues provide a range of affordable healthier options (including from vending machines). Ideally, the healthier options should be cheaper than the less healthy alternatives. For instance, carbonated or sweetened drinks should not be the only options and fruit and water should be available at an affordable price. (Examples of when public money is used in this way include school visits to museums, sports centres, cinemas and fun parks.)

Sponsorship in private and public sector venues

Encourage venues frequented by children and young people and supported by public money to resist sponsorship or product placement from companies associated with foods high in fat, sugar or salt. (This includes fun parks and museums.)
Organisations in the public sector should avoid sponsorship from companies associated with foods high in fat, sugar or salt.
See also the recommendations on community programmes, diet in schools and childcare and health professionals working in the wider community in this pathway, and the physical activity 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).

Implementation tools

Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/implementation-node-single
Obesity: slide set for all settings

Source guidance

Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-node
CG43
PH25

Regional CVD prevention programme

Developing a regional cardiovascular disease prevention programme

Developing a regional cardiovascular disease prevention programme

The recommendations below provide for a comprehensive regional and local cardiovascular disease (CVD) prevention programme. They should all be implemented, following the order set out below and in conjunction with the recommendations for national policy, which they support. The aim is to plan, develop and maintain effective programmes.

Good practice principles

Ensure a CVD prevention programme comprises intense, multi-component interventions.
Ensure it takes into account issues identified in the recommendations for national policy.
Ensure it includes initiatives aimed at the whole population (such as local policy and regulatory initiatives) which complement existing programmes aimed at individuals at high risk of CVD.
Ensure it is sustainable for a minimum of 5 years.
Ensure appropriate time and resources are allocated for all stages, including planning and evaluation.

Preparation

Gain a good understanding of the prevalence and incidence of CVD in the community. Find out about any previous CVD prevention initiatives that have been run (including any positive or negative experiences).
Consider how existing policies relating to food, tobacco control and physical activity, including those developed by the local authority, may impact on the prevalence of CVD locally.
Gauge the community's level of knowledge of, and beliefs about, CVD risk factors. This includes beliefs that smoking is the only solace in life for people with little money, or that only people who have a lot of money eat salad.
Gauge how confident people in the community are that they can change their behaviour to reduce the risks of CVD. (See 'Behaviour change' [NICE public health guidance 6].)
Identify groups of the population who are disproportionately affected by CVD and develop strategies with them to address their needs.
Take into account the community's exposure to risk factors (factors currently facing adults and those emerging for children and younger people).

Programme development

Develop a population-based approach.
Ensure a 'programme theory' is developed and used to underpin the programmePawson R (2001) Evidence based policy: 2. The promise of 'realist synthesis'. . This should cover the reasons why particular actions are expected to have particular outcomes.
Ensure the programme helps address local targets and tackles health inequalities.
Link the programme with existing strategies for targeting people at particularly high risk of CVD and take account of ongoing, accredited screening activities by GPs and other healthcare professionals. This includes the NHS Health Checks programmeSee NHS health checks programme..
Work closely with regional and local authorities and other organisations to promote policies which are likely to encourage healthier eating, tobacco control and increased physical activity. Policies may cover spatial planning, transport, food retailing and procurement. Organisations that may get involved could include statutory, public sector and civil society groups (examples of the latter are charities, clubs, self-help and community groups).
When developing CVD programmes, take account of relevant recommendations made within the following NICE guidance:
Only develop, plan and implement a strategic, integrated media campaign as part of a wider package of interventions to address CVD risk factors. Media campaigns should be based on an acknowledged theoretical framework.

Resources

Ensure the programme lasts a minimum of 5 years (while subject to annual evaluation reports) to maximise its potential impact.
Produce a long-term plan – and gain political commitment – for funding to ensure the programme has adequate resources and is sustainable beyond the end of the research or evaluation period.
Ensure the programme is adequately staffed. Avoid adding CVD prevention to the workload of existing staff without relieving them of other tasks.
Ensure volunteers are an additional (rather than a core) resource and that their training and support is adequately resourced.
Ensure steps are taken to retain staff.
Where staff are recruited from the local community ensure, as far as possible, that they reflect the local culture and ethnic mix.
Ensure there are effective links with other existing and relevant community initiatives.

Leadership

Act as leader and governor of CVD prevention. Identify and articulate local community needs and aspirations and how these may impact on the community's risk of CVD. Reconcile these needs and aspirations or arbitrate on them to help prevent CVDHM Government; Communities and Local Government (2008) Creating strong, safe and prosperous communities. Statutory guidance. London: Community and Local Government Publications..
Identify senior figures in health services and local authorities as champions for CVD prevention.
Identify people to lead the CVD programme, including members of the local community. Identify in advance – and provide for – the training and other needs of these potential leaders.
Develop systems within local, subregional or regional partnerships for agreeing shared priorities with other organisations involved in CVD prevention. Ensure senior staff are involved, as appropriate.
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).

Implementation tools

Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/implementation-node-single
Prevention of cardiovascular disease: self-assessment tool

Source guidance

Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-node
PH25

Strategy on catering and take-aways

Catering

Public sector catering

Public sector catering

Public sector catering

NHS and local authority catering for employees

NHS employersThis is part of a recommendation from 'Obesity' (NICE clinical guideline 43).

In their role as employers, NHS organisations should set an example in developing public health policies to prevent and manage obesity by following existing guidance and (in England) the local obesity strategy. In particular:
  • on-site catering should promote healthy food and drink choices (for example by signs, posters, pricing and positioning of products).

Local authorities

Local authorities should set an example in developing policies to prevent obesity in their role as employers, by following existing guidance and (in England) the local obesity strategy. In particular:
  • on-site catering should promote healthy food and drink choices (for example by signs, posters, pricing and positioning of products).

Public sector food provision generallyThis recommendation is from 'Prevention of cardiovascular disease' (NICE public health guidance 25).

Ensure all food procured by, and provided for, people working in the public sector and all food provided for people who use public services:
  • is low in salt and saturated fats
  • is nutritionally balanced and varied, in line with recommendations made in the 'eatwell plate'Food Standards Agency (2007) Eatwell plate.
  • does not contain industrially produced trans fatty acids (IPTFAs).
See also the recommendations on nutrition training for public sector catering staff and schools staff, and on diet in schools and childcare in this pathway.

Implementation tools

Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/implementation-node-multiple
Obesity: audit criteria
Obesity: costing report
Obesity: costing template
Obesity: slide set for all settings

Source guidance

Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-node
CG43
PH25

Standards for take-aways and food outlets

Standards for take-aways and other food outlets

Standards for take-aways and other food outlets

Who should take action?

Environmental health officers.
Local government planning departments.
Public health nutritionists.
Trading standards officers.

What action should they take?

Use bye-laws to regulate the opening hours of take-aways and other food outlets, particularly those near schools that specialise in foods high in fat, salt or sugar.
Use existing powers to set limits for the number of take-aways and other food outlets in a given area. Directives should specify the distance from schools and the maximum number that can be located in certain areas.
Help owners and managers of take-aways and other food outlets to improve the nutritional quality of the food they provide. This could include monitoring the type of food for sale and advice on content and preparation techniques.
For recommendations on strategies for local authorities, see strategy for local authorities and partners in the community in this 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).

Source guidance

Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-node
PH25

Diet advice for women

Services offering dietary advice for women before, during and after pregnancy

Services offering dietary advice for women before, during and after pregnancy

Folic acidThis is part of a recommendation from 'Maternal and child nutrition' (NICE public health guidance 11).

Public health commissioners and managers should ensure local education initiatives aimed at health professionals include information on the importance of folic acid supplements. They should provide the maternal Healthy Start vitamin supplements (folic acid, vitamins C and D) for eligible women. They should also ensure women who are not eligible for Healthy Start can obtain the supplements from their local pharmacy.

Healthy Start

Public health commissioners and managers should promote the Healthy Start scheme.
Public health commissioners and managers should ensure an adequate supply of both types of Healthy Start vitamin supplements (for women and for children from 6 months to 4 years) is available for distribution by health professionals when they see pregnant women and parents of children under 4 years.
Public health commissioners and managers should ensure an adequate supply of Healthy Start application forms is available and that the uptake of Healthy Start benefits is regularly audited.
Commissioners should consider distributing the maternal Healthy Start vitamin supplement (folic acid, vitamins C and D) to all women who receive Healthy Start benefit for children aged 1–4 years, particularly those who may become pregnant.

Family nutritionThis recommendation is from 'Maternal and child nutrition' (NICE public health guidance 11).

Public health nutritionists and dietitians should offer parents in receipt of Healthy Start benefit practical support and advice on how to use the Healthy Start vouchers to increase their intake of fruit and vegetables.
Provide support (both practical and financial) to develop and maintain community-based initiatives which aim to make a balanced diet more accessible to people on a low income. Examples include: food cooperatives, 'cook and eat' clubs, 'weaning parties' and 'baby cafes'.
Work with local retailers to improve the way fresh fruit and vegetables are displayed and promoted.

Preparing for pregnancy: women with a BMI of 30 or moreThis is part of a recommendation from 'Weight management before, during and after pregnancy' (NICE public health guidance 27).

NHS and other commissioners and managers, directors of public health and planners and organisers of public health campaigns should ensure health professionals understand the importance of achieving a healthy weight before pregnancy. Local education initiatives should also stress the health risks of being obese, including during pregnancy.
For recommendations for staff working in services, see dietary interventions and advice for adults in this pathway.

Implementation tools

Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/implementation-node-multiple
Weight management before, during and after pregnancy: self-assessment tool
Weight management before, during and after pregnancy: audit support
Weight management before, during and after pregnancy: commissioning guide
Weight management before, during and after pregnancy: questionnaire
Weight management before, during and after pregnancy: financial planning tool
Weight management before, during and after pregnancy: slide set
Maternal and child nutrition: audit support
Maternal and child nutrition: costing statement
Maternal and child nutrition: slide set

Source guidance

Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-node
PH27
PH11

Diet advice for children

Services offering dietary advice for children

Services offering dietary advice for children

Healthy StartThis is part of a recommendation from 'Maternal and child nutrition' (NICE public health guidance 11).

Public health commissioners and managers should promote the Healthy Start scheme.
Public health commissioners and managers should ensure an adequate supply of both types of Healthy Start vitamin supplements (for women and for children from 6 months to 4 years) is available for distribution by health professionals when they see pregnant women and parents of children under 4 years.
Public health commissioners and managers should ensure an adequate supply of Healthy Start application forms is available and that the uptake of Healthy Start benefits is regularly audited.

Family nutritionThis recommendation is from 'Maternal and child nutrition' (NICE public health guidance 11).

Who should take action?

  • Commissioning agencies, local authorities, local strategic partnerships, voluntary agencies and local businesses that fund or provide community projects.
  • Public health nutritionists and dietitians.

What action should they take?

Public health nutritionists and dietitians should offer parents in receipt of Healthy Start benefit practical support and advice on how to use the Healthy Start vouchers to increase their intake of fruit and vegetables.
Provide support (both practical and financial) to develop and maintain community-based initiatives which aim to make a balanced diet more accessible to people on a low income. Examples include: food cooperatives, 'cook and eat' clubs, 'weaning parties' and 'baby cafes'.
Work with local retailers to improve the way fresh fruit and vegetables are displayed and promoted.
For recommendations for staff working in services, see dietary interventions and advice for children and young people in this pathway.

Implementation tools

Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/implementation-node-multiple
Maternal and child nutrition: audit support
Maternal and child nutrition: costing statement
Maternal and child nutrition: slide set

Source guidance

Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-node
PH11

Paths in this pathway

Pathway created: May 2011 Last updated: November 2012

Copyright © 2013 National Institute for Health and Care Excellence. All Rights Reserved.



Recently viewed

(Clear all)