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Lifestyle weight management services for overweight or obese adults

About

What is covered

This pathway covers lifestyle and weight management services for overweight or obese adults. It includes weight management programmes, courses, clubs or groups that aim to change someone's behaviour to reduce their energy intake and encourage them to be physically active. The pathway is for commissioners, health professionals and providers of lifestyle weight management programmes. It may also be of interest to adults who are overweight or obese, their families and other members of the public.
The focus is on lifestyle weight management programmes that:
  • accept self-referrals or referrals from health or social care practitioners
  • are provided by the public, private or voluntary sector
  • are based in the community, workplaces, primary care or online.

Updates

Updates to this pathway

18 January 2016 Obesity in adults: prevention and lifestyle weight management programmes (NICE quality standard 111) added to this pathway.

Adults who are overweight or obese

Adults are assessed to see if they are overweight or obese using their BMI. The following table shows the cut-off points for a healthy weight or being overweight or obese:
Classification
BMI (kg/m2)
Healthy weight
18.5–24.9
Overweight
25–29.9
Obesity I
30–34.9
Obesity II
35–39.9
Obesity III
40 or more
BMI is a less accurate indicator of adiposity in adults who are highly muscular, so it should be interpreted with caution in this group.
Waist circumference can also be used to assess whether someone is at risk of health problems because they are overweight or obese (up to a BMI of 35, see levels of intervention in NICE's pathway on obesity). For men, a waist circumference of less than 94 cm is low risk, 94-102 cm is high and more than 102 cm is very high risk. For women, a waist circumference of less than 80 cm is low risk, 80-88 cm is high and more than 88 cm is very high risk.
The use of lower BMI thresholds to trigger action to reduce the risk of conditions such as type 2 diabetes has been recommended for black African, African-Caribbean and Asian groups. The lower thresholds are 23 kg/m2 to indicate increased risk and 27.5 kg/m2 to indicate high risk.(See Asian, black African and African-Caribbean adults in NICE's pathway on obesity.)

Lifestyle weight management programmes

Lifestyle weight management programmes for overweight or obese adults are multi-component programmes that aim to reduce a person's energy intake and help them to be more physically active by changing their behaviour. They may include weight management programmes, courses or clubs that:
  • accept adults through self-referral or referral from a health or social care practitioner
  • are provided by the public, private or voluntary sector
  • are based in the community, workplaces, primary care or online.
Although local definitions vary, these are usually called tier 2 services and are just one part of a comprehensive approach to preventing and treating obesity.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on lifestyle weight management services for overweight or obese adults in an interactive flowchart

What is covered

This pathway covers lifestyle and weight management services for overweight or obese adults. It includes weight management programmes, courses, clubs or groups that aim to change someone's behaviour to reduce their energy intake and encourage them to be physically active. The pathway is for commissioners, health professionals and providers of lifestyle weight management programmes. It may also be of interest to adults who are overweight or obese, their families and other members of the public.
The focus is on lifestyle weight management programmes that:
  • accept self-referrals or referrals from health or social care practitioners
  • are provided by the public, private or voluntary sector
  • are based in the community, workplaces, primary care or online.

Updates

Updates to this pathway

18 January 2016 Obesity in adults: prevention and lifestyle weight management programmes (NICE quality standard 111) added to this pathway.

Sources

NICE guidance and other sources used to create this interactive flowchart.

Quality standards

Quality statements

Vending machines

This quality statement is taken from the obesity in adults: prevention and lifestyle weight management programmes quality standard. The quality standard defines clinical best practice in obesity prevention in adults and should be read in full.

Quality statement

Adults using vending machines in local authority and NHS venues can buy healthy food and drink options.

Rationale

The environment in which people live influences their ability to achieve and maintain a healthy weight. Local authorities and NHS organisations can set an example by providing healthy food and drink choices at their venues. They can influence venues in the community (such as leisure centres) and services provided by commercial organisations to have a positive impact on the diet of adults using them.

Quality measures

Structure
Evidence that local authorities and NHS organisations provide, or make contractual arrangements for the provision of, healthy food and drink options in any vending machines in their venues.
Data source: Local data collection.
Process
Proportion of local authority and NHS venues with vending machines that contain healthy food and drink options.
Numerator – the number in the denominator that have vending machines that contain healthy food and drink options.
Denominator – the number of local authority and NHS venues with vending machines.
Data source: Local data collection.

What the quality statement means for local authorities and NHS organisations

Local authorities and NHS organisations ensure that any vending machines in their venues offer healthy food and drink options.

What the quality statement means for adults

Adults have a choice of healthy food and drink options available from vending machines in local authority and NHS venues such as hospitals, clinics and leisure centres.

Source guidance

Definitions of terms used in this quality statement

Healthy food and drink
Food and drink that helps people to follow Public Health England’s eatwell plate advice, and that does not contain high levels of salt, fat, saturated fat or sugar. Public Health England’s Healthier, more sustainable catering: information for those involved in purchasing food and drink provides definitions for low, medium and high levels of fat, saturates, sugars and salt per portion/serving size for food and drink. The Change4Life website gives suggestions for healthy food and drink alternatives.
[Expert consensus]

Nutritional information at the point of choosing food and drink options

This quality statement is taken from the obesity in adults: prevention and lifestyle weight management programmes quality standard. The quality standard defines clinical best practice in obesity prevention in adults and should be read in full.

Quality statement

Adults see details of nutritional information on menus at local authority and NHS venues.

Rationale

Providing details about the nutritional content of food will allow people to make an informed choice when choosing meals. This information will help people achieve or maintain a healthy weight by enabling them to manage their daily nutritional intake.

Quality measures

Structure
Evidence that local authorities and NHS organisations ensure that information on the nutritional content of meals is included on menus at venues.
Data source: Local data collection.

What the quality statement means for local authorities and NHS organisations

Local authorities and NHS organisations ensure that their venues provide details about the nutritional content of menu items.

What the quality statement means for adults

Adults selecting meals in catering facilities in local authority and NHS venues such as hospitals, clinics and leisure centres have information on the nutritional content of meals to help them choose.

Source guidance

Definitions of terms used in this quality statement

Nutritional information
This includes details on the calorie content of meals as well as information on the fat, saturated fat, salt and sugar content. If the nutritional value of recipes is not known, ingredients should be listed and cooking methods described.
[Adapted from expert consensus and Type 2 diabetes prevention (NICE guideline PH35), recommendation 8]

Equality and diversity considerations

Information needs to be available in a variety of languages and formats to ensure that it is accessible to people of all ages and meets the needs of the community. Nutritional information should be available in a variety of formats appropriate to the target audience. The format of this information should be suitable for people with sensory impairment.

Prominent placement of healthy options

This quality statement is taken from the obesity in adults: prevention and lifestyle weight management programmes quality standard. The quality standard defines clinical best practice in obesity prevention in adults and should be read in full.

Quality statement

Adults see healthy food and drink choices displayed prominently in local authority and NHS venues.

Rationale

Local authorities and NHS organisations can set an example by ensuring that healthy food and drink choices are promoted in their venues. Prominent positioning will help to ensure that people will consider healthier options when they are choosing food and drink.

Quality measures

Structure
Evidence that local authority and NHS venues make arrangements to display healthy food and drink options in prominent positions.
Data source: Local data collection.
Outcome
Sales of healthy food and drink options.
Data source: Local data collection.

What the quality statement means for local authorities and NHS organisations

Local authorities and NHS organisations ensure that healthy food and drink choices are displayed in prominent positions in their venues.

What the quality statement means for adults

Adults can easily find healthy foods and drinks when using catering facilities in local authority or NHS venues such as hospitals, clinics and leisure centres.

Source guidance

Definitions of terms used in this quality statement

Healthy food and drink choices
Food and drink that helps people to meet Public Health England’s eatwell plate advice, and that does not contain high levels of salt, fat, saturated fat or sugar. Public Health England’s Healthier, more sustainable catering: information for those involved in purchasing food and drink provides definitions for low, medium and high levels of fat, saturates, sugars and salt per portion/serving size for food and drink. The Change4Life website gives suggestions for healthy food and drink alternatives.
[Expert consensus] 

Maintaining details of local lifestyle weight management programmes

This quality statement is taken from the obesity in adults: prevention and lifestyle weight management programmes quality standard. The quality standard defines clinical best practice in obesity prevention in adults and should be read in full.

Quality statement

Adults have access to a publicly available, up-to-date list of local lifestyle weight management programmes.

Rationale

Effective lifestyle weight management programmes for adults can be delivered by a range of organisations and in different locations. The local authority should maintain an up-to-date list of local lifestyle weight management programmes and make it available to the public. Raising awareness of locally provided programmes is important to ensure that the public know about the programmes in their area and how to enrol in them. Increased public awareness may lead to more self-referrals to these programmes.

Quality measures

Structure
Evidence that an up-to-date list of local lifestyle weight management programmes for adults is publicly available.
Data source: Local data collection.
Outcome
Number of self-referrals of overweight or obese adults to locally commissioned lifestyle weight management programmes.
Data source: Local data collection.

What the quality statement means for providers of lifestyle weight management programmes, commissioners and local authorities

Providers of lifestyle weight management programmes ensure that they provide local authorities with up-to-date information about local lifestyle weight management programmes for overweight and obese adults.
Commissioners (such as NHS England, clinical commissioning groups and local authorities) ensure that information about lifestyle weight management programmes is available across all health and care services.
Local authorities ensure that they maintain a publicly available, up-to-date list of local lifestyle weight management programmes for overweight and obese adults.

What the quality statement means for adults

Adults can easily find information about lifestyle weight management programmes in their area and how to enrol in them.

Source guidance

Definitions of terms used in this quality statement

Lifestyle weight management programmes
Lifestyle weight management programmes for overweight or obese adults are multicomponent programmes that aim to reduce a person’s energy intake and help them to be more physically active by changing their behaviour and working towards achievable goals. They should last for at least 3 months, with sessions that are offered at least weekly or fortnightly and include a ‘weigh-in’ at each session. They may include weight management programmes, courses or clubs that:
  • accept adults through self-referral or referral from a health or social care practitioner
  • are provided by the public, private or voluntary sector
  • are based in the community, workplaces, primary care or online.
Although local definitions vary, these are usually called tier 2 services and form part of a comprehensive approach to preventing and treating obesity.
[Adapted from Weight management: lifestyle services for overweight or obese adults (NICE guideline PH53) recommendation 9, glossary and expert opinion]
List of local lifestyle weight management programmes
The list should include details of programmes that have been commissioned by the local authority or clinical commissioning group and other public, private or voluntary evidence-based programmes.
[Adapted from Weight management: lifestyle services for overweight or obese adults (NICE guideline PH53) recommendation 9, glossary and expert opinion]

Equality and diversity considerations

Local authorities should take into account the cultural and communication needs of the local population when providing a publicly accessible list of local lifestyle weight management programmes.

Publishing performance data on local lifestyle weight management programmes

This quality statement is taken from the obesity in adults: prevention and lifestyle weight management programmes quality standard. The quality standard defines clinical best practice in obesity prevention in adults and should be read in full.

Quality statement

Adults can access data on attendance, outcomes and views of participants and staff from locally commissioned lifestyle weight management programmes.

Rationale

It is important that providers of lifestyle weight management programmes measure outcomes of the programmes and make the results available. This will allow commissioners and the general public to monitor and evaluate particular programmes to assess whether they are meeting their objectives and providing value for money. This ensures that any issues with the programmes are identified as early as possible, so that the programmes can be improved, leading to better outcomes for adults using the programmes. It will also help adults to select lifestyle weight management programmes.

Quality measures

Structure
a) Evidence that commissioners and providers of lifestyle weight management programmes jointly agree the key performance indicators to be collected for monitoring and evaluation.
Data source: Local data collection.
b) Evidence that commissioners and providers of lifestyle weight management programmes have used data from monitoring and evaluation to amend and improve programmes.
Data source: Local data collection.
Process
a) Proportion of adults recruited to a locally commissioned lifestyle weight management programme who have information on attendance, outcomes and views of participants and staff collected at recruitment and completion.
Numerator – the number in the denominator who have information on attendance, outcomes and views of participants and staff collected at recruitment and completion.
Denominator – the number of adults recruited to a locally commissioned lifestyle weight management programme.
Data source: Local data collection.
b) Proportion of adults who complete a lifestyle weight management programme who have data on outcomes collected 6 months after completion of the programme.
Numerator – the number in the denominator who have data on outcomes collected 6 months after completion of the programme.
Denominator – the number of adults who complete a lifestyle weight management programme.
Data source: Local data collection.
c) Proportion of adults who complete a lifestyle weight management programme who have data on outcomes collected 1 year after completion of the programme.
Numerator – the number in the denominator who have data on outcomes collected 1 year after completion of the programme.
Denominator – the number of adults who complete a lifestyle weight management programme.
Data source: Local data collection.
Outcome
Improved performance of local lifestyle weight management programmes.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as local authorities and providers of lifestyle weight management programmes) ensure that they publish data on attendance, outcomes and views of participants and staff. Providers of lifestyle weight management programmes should use the data to monitor and evaluate their programmes. Data sharing should be in line with the Department of Health’s information governance and data protection requirements.
Healthcare professionals (such as GPs, dietitians and practice nurses) consider data on attendance, outcomes and views of participants and staff for local lifestyle weight management programmes before offering information or a referral.
Commissioners (such as NHS England, clinical commissioning groups and local authorities) agree key performance indicators for lifestyle weight management programmes providers, and ensure the data are published. Commissioners use the data on attendance, outcomes and views of participants and staff to improve local provision of lifestyle weight management services.

What the quality statement means for adults

Adults can find published information about their local lifestyle weight management programmes, including how many people enrol in them, how much weight people lose and how good people think the programme is.

Source guidance

Definitions of terms used in this quality statement

Lifestyle weight management programmes
Lifestyle weight management programmes for overweight or obese adults are multicomponent programmes that aim to reduce a person’s energy intake and help them to be more physically active by changing their behaviour and working towards achievable goals. They should last for at least 3 months, with sessions that are offered at least weekly or fortnightly and include a ‘weigh-in’ at each session. They may include weight management programmes, courses or clubs that:
  • accept adults through self-referral or referral from a health or social care practitioner
  • are provided by the public, private or voluntary sector
  • are based in the community, workplaces, primary care or online.
Although local definitions vary, these are usually called tier 2 services and form part of a comprehensive approach to preventing and treating obesity.
[Adapted from Weight management: lifestyle services for overweight or obese adults (NICE guideline PH53) recommendation 9, glossary and expert opinion]
Data on attendance, outcomes and views of participants and staff
Providers of lifestyle weight management programmes should use the standard evaluation framework for weight management programmes and validated tools to monitor interventions.
As a minimum, information on participants at the end of the programme should be collected and assessed, in line with the Department of Health's Best practice criteria for weight management services. Details of how each participant’s weight has changed 12 months after the programme is completed should also be collected.
[Weight management: lifestyle services for overweight or obese adults (2014) NICE guideline PH53, recommendation 17]

Equality and diversity considerations

When monitoring and evaluating lifestyle weight management programmes, information also needs to be collected on the programmes’ suitability for minority groups, for example groups with different family origins or religions and groups with disabilities. Reasonable adaptations should be made to the programmes to make them accessible to these groups and to assess their impact on health inequalities.

Raising awareness of lifestyle weight management programmes

This quality statement is taken from the obesity in adults: prevention and lifestyle weight management programmes quality standard. The quality standard defines clinical best practice in obesity prevention in adults and should be read in full.

Quality statement

Adults identified as being overweight or obese are given information about local lifestyle weight management programmes.

Rationale

When adults are identified as being overweight or obese it is important that they are given information about local lifestyle weight management programmes. Actively raising the possibility of participation in one of these programmes will support people who choose to take positive action to lose weight by self-referring to a suitable programme.

Quality measures

Structure
Evidence of local arrangements to give adults who are identified as being overweight or obese information about local lifestyle weight management programmes.
Data source: Local data collection.
Process
Proportion of adults identified as being overweight or obese who are given information about local lifestyle weight management programmes.
Numerator – the number in the denominator who are given information about local weight management programmes.
Denominator – the number of adults identified as being overweight or obese.
Data source: Local data collection. Data on BMI values are included in the Health and Social Care Information Centre care.data extract.
Outcome
a) Number of self-referrals of overweight or obese adults to lifestyle weight management programmes.
Data source: Local data collection.
b) Obesity prevalence.
Data source: Local data collection.
c) Prevalence of obesity-related comorbidities.
Data source: Local data collection. The numbers of people with type 2 diabetes, hypertension and coronary heart disease are shown in the Quality and outcomes framework indicators DM001, HYP001 and CHD001.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers provide information about local lifestyle weight management programmes to adults identified as being overweight or obese.
Healthcare professionals (such as GPs, practice nurses, secondary healthcare professionals, dietitians and community pharmacists) ensure that they provide information about local lifestyle weight management programmes to adults identified as being overweight or obese.
Commissioners (such as NHS England, clinical commissioning groups and local authorities) ensure that they commission services that provide information about local lifestyle weight management programmes to adults identified as being overweight or obese.

What the quality statement means for adults

Adults who are overweight or obese are given information about local lifestyle weight management programmes, including what the programmes involve and how to take part.

Source guidance

Definitions of terms used in this quality statement

Adults who are overweight or obese
Adults are assessed to see if they are overweight or obese using their body mass index (BMI). The following table shows the cut-off points for a healthy weight or being overweight or obese.
Classification
BMI (kg/m2)
Healthy weight
18.5–24.9
Overweight
25.0–29.9
Obesity I
30.0–34.9
Obesity II
35.0–39.9
Obesity III
40.0 or more
BMI is a less accurate indicator of adiposity in adults who are highly muscular, so it should be interpreted with caution in this group.
Waist circumference can also be used to assess whether someone is at risk of health problems because they are overweight or obese (up to a BMI of 35 kg/m2). For men, a waist circumference of less than 94 cm is low risk, 94–102 cm is high risk and more than 102 cm is very high risk. For women, a waist circumference of less than 80 cm is low risk, 80–88 cm is high risk and more than 88 cm is very high risk.
Using lower BMI thresholds to trigger action to reduce the risk of conditions such as type 2 diabetes has been recommended for adults of black African, African-Caribbean or Asian family origin. The lower thresholds are 23 kg/m2 to indicate increased risk and 27.5 kg/m2 to indicate high risk.

Equality and diversity considerations

Service providers and healthcare professionals should take into account the cultural and communication needs of people who are overweight or obese when giving information about lifestyle weight management programmes.
Healthcare professionals should ensure that people of black African, African-Caribbean or Asian family origin who have higher comorbidity risk factors are given information about lifestyle weight management programmes if they have a BMI of 23 kg/m2 or more.
Providers of lifestyle weight management programmes should have an inclusive approach that encourages people from all backgrounds to participate. This includes using a respectful and non-judgemental approach to engage people. Particular attention should be given to people who may be less likely to participate, such as people with learning difficulties or mental health problems and those from lower socioeconomic groups.
Providers of lifestyle weight management programmes should be able to meet the specific needs of women who are pregnant, planning to become pregnant or are trying to lose weight after pregnancy.

Referral to a lifestyle weight management programme for people with comorbidities

This quality statement is taken from the obesity in adults: prevention and lifestyle weight management programmes quality standard. The quality standard defines clinical best practice in obesity prevention in adults and should be read in full.

Quality statement

Adults identified as overweight or obese with comorbidities are offered a referral to a lifestyle weight management programme.

Rationale

It is important for general practice teams and other healthcare professionals to offer a referral to a local lifestyle weight management programme to adults who are overweight or obese with comorbidities in order to improve their health outcomes.

Quality measures

Structure
Evidence of local arrangements to ensure that adults who are identified as overweight or obese with comorbidities are offered a referral to a lifestyle weight management programme.
Data source: Local data collection.
Process
Proportion of adults who are identified as overweight or obese with comorbidities who are referred to a lifestyle weight management programme.
Numerator – the number in the denominator who are referred to a lifestyle weight management programme.
Denominator – the number of adults who are identified as overweight or obese with comorbidities.
Data source: Local data collection.
Outcome
a) Number of adults who are identified as overweight or obese with comorbidities enrolling in lifestyle weight management services.
Data source: Local data collection.
b) Obesity prevalence among adults with comorbidities.
Data source: Local data collection.
c) Obesity-related comorbidities
Data source: Local data collection. The number of people with type 2 diabetes, hypertension and coronary heart disease is shown in the Quality and outcomes framework indicators DM001, HYP001 and CHD001.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as local authorities and providers of lifestyle weight management programmes) ensure that a referral to a locally commissioned suitable lifestyle weight management programme is offered to adults who are identified as overweight or obese and who have comorbidities.
Healthcare professionals (such as GPs, practice nurses and dietitians) offer a referral to a locally commissioned lifestyle weight management programme to adults who are identified as overweight or obese and who have comorbidities.
Commissioners (such as NHS England, clinical commissioning groups and local authorities) ensure that adults who are identified as overweight or obese and who have comorbidities are offered a referral to a locally commissioned lifestyle weight management programme and that there is sufficient capacity to meet demand.

What the quality statement means for adults

Adults who are overweight or obese and have other conditions such as type 2 diabetes, high blood pressure, high cholesterol, arthritis, heart disease or sleep apnoea are offered a referral to a local lifestyle weight management programme to help them improve their overall health.

Source guidance

Definitions of terms used in this quality statement

Adults who are overweight or obese
Adults are assessed to see if they are overweight or obese using their body mass index (BMI). The following table shows the cut-off points for a healthy weight or being overweight or obese.
Classification
BMI (kg/m2)
Healthy weight
18.5–24.9
Overweight
25.0–29.9
Obesity I
30.0–34.9
Obesity II
35.0–39.9
Obesity III
40.0 or more
BMI is a less accurate indicator in adults who are highly muscular, so it should be interpreted with caution in this group.
Waist circumference can also be used to assess whether someone is at risk of health problems because they are overweight or obese (up to a BMI of 35 kg/m2). For men, a waist circumference of less than 94 cm is low risk, 94–102 cm is high risk and more than 102 cm is very high risk. For women, a waist circumference of less than 80 cm is low risk, 80–88 cm is high risk and more than 88 cm is very high risk.
Using lower BMI thresholds to trigger action to reduce the risk of conditions such as type 2 diabetes has been recommended for adults of black African, African–Caribbean and Asian family origin. The lower thresholds are 23 kg/m2 to indicate increased risk and 27.5 kg/m2 to indicate high risk.
Adults with comorbidities
Adults with any other comorbidities in addition to being overweight or obese, such as type 2 diabetes, hypertension, cardiovascular disease, osteoarthritis, dyslipidaemia and sleep apnoea.
[Adapted from Obesity: identification, assessment and management (2014) NICE guideline CG189]

Equality and diversity considerations

Healthcare professionals should take into account the cultural and communication needs of adults who are overweight or obese with comorbidities when making a referral to a lifestyle weight management programme.
Healthcare professionals should ensure that people of black African, African-Caribbean or Asian family origin are offered a referral to a lifestyle weight management programme if they have a BMI of 23 kg/m2 or more because of their increased health risk.
Providers of lifestyle weight management programmes should have an inclusive approach that encourages people from all backgrounds to participate. This includes using a respectful and non-judgemental approach. Particular attention should be given to engaging people who may be less likely to participate, such as people with learning difficulties or mental health problems and those from lower socioeconomic groups.
Providers of lifestyle weight management programmes should be able to meet the specific needs of women who are pregnant, planning to become pregnant or are trying to lose weight after pregnancy.

Preventing weight regain

This quality statement is taken from the obesity in adults: prevention and lifestyle weight management programmes quality standard. The quality standard defines clinical best practice in obesity prevention in adults and should be read in full.

Quality statement

Adults about to complete a lifestyle weight management programme agree a plan to prevent weight regain.

Rationale

It is important to ensure that adults who are about to complete a lifestyle weight management programme have a plan to help them maintain a healthy weight and avoid weight regain. This will enable them to self-manage their weight and make it less likely that they will need further lifestyle weight management interventions in the future.

Quality measures

Structure
Evidence of local arrangements to ensure that adults about to complete a lifestyle weight management programme agree a plan to prevent weight regain.
Data source: Local data collection.
Process
Proportion of adults completing a lifestyle weight management programme who agree a plan to prevent weight regain.
Numerator – the number in the denominator who agree a plan to prevent weight regain.
Denominator – the number of adults about to complete a lifestyle weight management programme.
Data source: Local data collection.
Outcome
a) Obesity prevalence.
Data source: Local data collection.
b) Prevalence of obesity-related comorbidities.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (providers of lifestyle weight management programmes) ensure that adults about to complete a lifestyle weight management programme agree a plan to prevent weight regain.
Healthcare professionals (such as GPs, dietitians and practice nurses) ensure that they make referrals to and promote lifestyle weight management programmes that include agreeing a plan to prevent weight regain on completion.
Commissioners (such as NHS England, clinical commissioning groups and local authorities) ensure that a plan to prevent weight regain is agreed with adults who are about to complete a lifestyle weight management programme. This could be provided by the lifestyle weight management programme provider or commissioned separately.

What the quality statement means for adults

Adults who are about to finish a lifestyle weight management programme agree a plan to help them avoid putting weight back on.

Source guidance

Definitions of terms used in this quality statement

Lifestyle weight management programmes
Lifestyle weight management programmes for overweight or obese adults are multicomponent programmes that aim to reduce a person’s energy intake and help them to be more physically active by changing their behaviour and working towards achievable goals. They should last for at least 3 months, with sessions that are offered at least weekly or fortnightly and include a ‘weigh-in’ at each session. They may include weight management programmes, courses or clubs that:
  • accept adults through self-referral or referral from a health or social care practitioner
  • are provided by the public, private or voluntary sector
  • are based in the community, workplaces, primary care or online.
Although local definitions vary, these are usually called tier 2 services and form part of a comprehensive approach to preventing and treating obesity.
[Adapted from Weight management: lifestyle services for overweight or obese adults (NICE guideline PH53) recommendation 9, glossary and expert opinion]
Plan to prevent weight regain
A plan to prevent weight regain should:
• encourage independence and self-management (including self-monitoring)
• identify a suitable weight target that is sustainable in the long term
• identify sources of ongoing support once the programme has ended, such as online resources, support groups, other local services or activities, and family and friends
• include goals to maintain new dietary habits and increased physical activity levels and strategies to overcome any difficulties encountered
• identify dietary habits that will support weight maintenance and are sustainable in the long term
• promote ways of being more physically active and less sedentary which are sustainable in the long term.
[Adapted from Weight management: lifestyle services for overweight or obese adults (NICE guideline PH53) recommendations 9 and 10]

Equality and diversity considerations

Providers of lifestyle weight management programmes should take into account the cultural and communication needs of people who are completing a lifestyle weight management programme when agreeing a plan to prevent weight regain.
Providers of lifestyle weight management programmes should have an inclusive approach that encourages people from all backgrounds to agree a plan to prevent weight regain. This includes using a respectful and non-judgemental approach. Particular attention should be given to engaging people with learning difficulties or mental health issues and those from lower socioeconomic groups.
Providers of lifestyle weight management programmes should be able to meet the specific needs of women who are pregnant, planning to become pregnant or are trying to lose weight after pregnancy when developing a plan to prevent weight regain.

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Implementation

Pathway information

Adults who are overweight or obese

Adults are assessed to see if they are overweight or obese using their BMI. The following table shows the cut-off points for a healthy weight or being overweight or obese:
Classification
BMI (kg/m2)
Healthy weight
18.5–24.9
Overweight
25–29.9
Obesity I
30–34.9
Obesity II
35–39.9
Obesity III
40 or more
BMI is a less accurate indicator of adiposity in adults who are highly muscular, so it should be interpreted with caution in this group.
Waist circumference can also be used to assess whether someone is at risk of health problems because they are overweight or obese (up to a BMI of 35, see levels of intervention in NICE's pathway on obesity). For men, a waist circumference of less than 94 cm is low risk, 94-102 cm is high and more than 102 cm is very high risk. For women, a waist circumference of less than 80 cm is low risk, 80-88 cm is high and more than 88 cm is very high risk.
The use of lower BMI thresholds to trigger action to reduce the risk of conditions such as type 2 diabetes has been recommended for black African, African-Caribbean and Asian groups. The lower thresholds are 23 kg/m2 to indicate increased risk and 27.5 kg/m2 to indicate high risk.(See Asian, black African and African-Caribbean adults in NICE's pathway on obesity.)

Lifestyle weight management programmes

Lifestyle weight management programmes for overweight or obese adults are multi-component programmes that aim to reduce a person's energy intake and help them to be more physically active by changing their behaviour. They may include weight management programmes, courses or clubs that:
  • accept adults through self-referral or referral from a health or social care practitioner
  • are provided by the public, private or voluntary sector
  • are based in the community, workplaces, primary care or online.
Although local definitions vary, these are usually called tier 2 services and are just one part of a comprehensive approach to preventing and treating obesity.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

Glossary

body mass index is commonly used to measure whether or not adults are a healthy weight or underweight, overweight or obese. It is defined as weight in kilograms divided by the square of height in metres (kg/m2)
issues that affect a person's health and wellbeing. They might include: a behavioural issue such as substance misuse, specific conditions such as those limiting mobility or learning, mental health conditions, substantive or life-threatening comorbidities or dietary needs, and personal social circumstances, such as homelessness.
this includes a range of factors including the food and drink (including alcoholic drinks) consumed, energy and nutrient intake, portion size and the pattern and timing of eating. Population advice on food and nutrition is available on the NHS choices website
lifestyle weight management programmes for overweight or obese adults are multi-component programmes that aim to reduce a person's energy intake and help them to be more physically active by changing their behaviour. They may include weight management programmes, courses or clubs that: accept adults through self-referral or referral from a health or social care practitioner, are provided by the public, private or voluntary sector, and are based in the community, workplaces, primary care or online. Although local definitions vary, these are usually called tier 2 services and are just one part of a comprehensive approach to preventing and treating obesity
the full range of human movement, from competitive sport and exercise to active hobbies, walking, cycling and the other physical activities involved in daily living
a qualified instructor meets the fitness industry's agreed qualification standards and undertakes continued professional development. Instructors working with people referred from a GP or another health professional should hold level 3 membership of the Register of Exercise Professionals (or equivalent)
stigma in relation to someone's weight may take the form of bullying, teasing, harsh comments, discrimination or prejudice based on a person's body size
the maintenance of a specific weight (whether or not weight has been lost)
the maintenance of a specific weight (whether or not weight has been lost)
a general pattern of weight gain or weight loss over many years. Many adults gradually put on weight as they get older. This gradual increase in weight will be lower for someone who has lost weight during a lifestyle weight management programme, if they have not regained any of that lost weight
commissioners and providers of lifestyle weight management programmes, professionals who make referrals, services that help prevent weight regain, and monitoring services (such as public health teams within local authorities or other health and social care commissioners; providers [designers, developers or deliverers of lifestyle weight management programmes in private, public or voluntary sector organisations] working in the community or in [or via] primary care settings; health and social care professionals who refer people to lifestyle weight management programmes; providers of services to support the prevention of weight regain; providers of programme monitoring services)
GPs and other health or social care professionals advising or referring adults to lifestyle weight management programmes, and providers advising people who are thinking about joining programmes (designers, developers or deliverers of lifestyle weight management programmes in private, public or voluntary sector organisations) working in the community or in (or via) primary care settings
designers, developers or deliverers of lifestyle weight management programmes working in the community or in (or via) primary care settings

Paths in this pathway

Pathway created: May 2014 Last updated: November 2016

© NICE 2017. All rights reserved. Subject to Notice of rights.

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