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Diet
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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.
Audit support
Audit support provides ready-to-use criteria, including exceptions, definitions, suggested data sources and a data collection tool.
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.
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.
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.
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.
Slide sets
Slide sets provide a framework for discussion and assist in local dissemination of the guidance. The slides contain the key messages from NICE guidance and can be tailored for local presentations.
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.
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.
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
Training recommendations
Recommendations about training
Training for health professionals
Training for health professionals
Training for health professionals
Nutrition for young children and pregnant womenThis is part of a recommendation from 'Maternal and child nutrition' (NICE public health guidance 11).
Who should take action?
Professional bodies, skills councils and others responsible for setting competencies and developing continuing professional development programmes for health professionals, nursery nurses and support workers.
What action should they take?
Professional bodies should ensure health professionals have the appropriate knowledge and skills to give advice on the following:
- the nutritional needs of women and the importance of a balanced diet before, during and after pregnancy (including the need for suitable folic acid supplements)
- the rationale for recommending certain dietary supplements (for example, vitamin D) to pregnant and breastfeeding women
- the nutritional needs of infants and young children
- strategies for changing people's eating behaviour, particularly by offering practical, food-based advice.
Weight management before, during and after pregnancyThis recommendation is from 'Weight management before, during and after pregnancy' (NICE public health guidance 27).
Who should take action?
Professional bodies and others responsible for setting competencies and developing continuing professional development programmes for health professionals, healthcare assistants and support staff.
Training boards and organisations responsible for training health and fitness advisers and health trainers.
What action should they take?
Ensure health professionals, healthcare assistants and support workers have the skills to advise on the health benefits of weight management and risks of being overweight or obese before, during and after pregnancy, or after successive pregnancies.
Ensure they can advise women on their nutritional needs before, during and after pregnancy and can explain why it is important to have a balanced diet and to be moderately physically active.
Ensure they have behaviour change knowledge, skills and competencies. This includes being able to help people to identify how their behaviour is affecting their health, draw up an action plan, make the changes and maintain them.
Ensure they have the communication techniques needed to broach the subject of weight management in a sensitive manner. They should be able to give women practical advice on how to improve their diet and become more physically active. They should be able to tailor this advice to individual needs and know when to refer them for specialist care and support.
Ensure they have the knowledge and skills to help dispel common myths. This includes myths about what to eat and what not to eat during pregnancy and about weight loss in relation to breastfeeding.
Ensure they have knowledge, skills and competencies in group facilitation, are aware of the needs of minority ethnic groups and have knowledge of local services.
Ensure their training is regularly monitored and updated.
Training for primary care workers in preventing and managing obesity
All primary care settings shouldThis is part of a recommendation from 'Obesity' (NICE clinical guideline 43).:
- address the training needs of staff involved in preventing and managing obesity.
Local health agencies should identify appropriate health professionals and ensure that they receive training inThis recommendation is from 'Obesity' (NICE clinical guideline 43).:
- the health benefits and the potential effectiveness of interventions to prevent obesity, increase activity levels and improve diet (and reduce energy intake)
- the best practice approaches in delivering such interventions, including tailoring support to meet people's needs over the long term
- the use of motivational and counselling techniques.
Training will need to address barriers to health professionals providing support and advice, particularly concerns about the effectiveness of interventions, people's receptiveness and ability to change and the impact of advice on relationships with patients.
See also the recommendations for primary care and community health services 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).
Training by health professionals
Training by health professionals
Training by health professionals
Vitamin DThis is part of a recommendation from 'Maternal and child nutrition' (NICE public health guidance 11).
Dietitians and public health nutritionists should educate health professionals about the importance of vitamin D supplements for all pregnant and breastfeeding women.
See also recommendations for primary care and community health services in this pathway, and advice about diet and nutritional supplements in the antenatal care pathway.
Training for breastfeeding peer supporters
Who should take action?
Commissioners and managers of maternity and children's services.
What action should they take?
Consider training peer supporters and link workers to help mothers, parents and carers follow professional advice on feeding infants aged 6 months and over. The advice should promote an increasingly varied diet using food of different textures in appropriate amounts (in addition to milk), in response to the baby's needs.
Implementation tools
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Training for public sector catering staff
Training for public sector catering staff
Who should take action?
Caterers.
Chartered Institute of Environmental Health (CIEH).
Local authorities.
Providers of hygiene training.
The food and farming network (Feast).
What action should they take?
Ensure the links between nutrition and health are an integral part of training for catering managers. In particular, they should be made aware of the adverse effect that frying practices and the use of salt, industrial trans fats and saturated fats can have on health.
Ensure they are aware of the healthy alternatives to frying and to using salt and sugar excessively, based on the 'eatwell plate'Food Standards Agency (2007) Eatwell plate. .
See also the recommendations on public sector catering 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
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Training for teaching, support and catering staff in schools
Training teaching, support and catering staff in schools
Head teachers and chairs of governors should ensure that teaching, support and catering staff receive training on the importance of healthy-school policies and how to support their implementation.
See also recommendations on schools, early years education and childcare 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-nodePaths in this pathway
- Strategy, policy and commissioning for diet
- National policy on diet
- Training on diet
- Lifestyle advice on diet and physical activity
- Recommendations about diet for primary care and community health services
- Dietary interventions and advice for adults
- Dietary interventions and advice for children and young people
- Community and leisure services and weight management programmes
- Diet in schools, early years education and childcare
Pathway created: May 2011 Last updated: November 2012
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