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Diet

About

What is covered

Having a healthy balanced diet helps prevent obesity, cardiovascular and many other conditions. This NICE 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.
It also includes recommendations on local and national strategy for diet to prevent cardiovascular disease, and recommendations for schools, and the leisure and weight management industries.
It also includes recommendations about dietary supplements for children and women before, during and after pregnancy. For recommendations on breastfeeding see what NICE says on postnatal care.
Align actions to improve diet with strategies to prevent obesity at a community level to ensure a coherent, integrated approach (see what NICE says on obesity: working with local communities).

Updates

Updates to this NICE Pathway

20 April 2021 Postnatal care (NICE quality standard 37) added.
18 January 2016 Obesity in adults: prevention and lifestyle weight management programmes (NICE quality standard 111) added.
29 July 2015 Maternal and child nutrition (NICE quality standard 98) added.
22 July 2015 Obesity in children and young people: prevention and lifestyle weight management programmes (NICE quality standard 94) added.
12 March 2015 Update to lifestyle advice on diet and physical activity on publication of maintaining a healthy weight and preventing excess weight gain among adults and children (NICE guideline NG7).
12 December 2014 NICE recommendations on vitamin D (PH56) and updated guidance on antenatal care (recommendation 1.3.2.4 from CG62) added to advice on diet and use of supplements before and during pregnancy and nutrition in pregnancy and while breastfeeding. Links to increasing vitamin D supplement use among at-risk groups added.
26 November 2014 Update to reducing calorie intake for adults who are obese and dietary strategies for children who are obese on publication of obesity (NICE guideline CG189).
22 July 2014 Links to the NICE recommendations on cardiovascular disease prevention and constipation added.
11 March 2014 Link to the NICE recommendations on community engagement added.
17 October 2013 Link to the NICE recommendations on obesity: working with local communities added.

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.

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 promoting a healthy diet in an interactive flowchart

What is covered

Having a healthy balanced diet helps prevent obesity, cardiovascular and many other conditions. This NICE 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.
It also includes recommendations on local and national strategy for diet to prevent cardiovascular disease, and recommendations for schools, and the leisure and weight management industries.
It also includes recommendations about dietary supplements for children and women before, during and after pregnancy. For recommendations on breastfeeding see what NICE says on postnatal care.
Align actions to improve diet with strategies to prevent obesity at a community level to ensure a coherent, integrated approach (see what NICE says on obesity: working with local communities).

Updates

Updates to this NICE Pathway

20 April 2021 Postnatal care (NICE quality standard 37) added.
18 January 2016 Obesity in adults: prevention and lifestyle weight management programmes (NICE quality standard 111) added.
29 July 2015 Maternal and child nutrition (NICE quality standard 98) added.
22 July 2015 Obesity in children and young people: prevention and lifestyle weight management programmes (NICE quality standard 94) added.
12 March 2015 Update to lifestyle advice on diet and physical activity on publication of maintaining a healthy weight and preventing excess weight gain among adults and children (NICE guideline NG7).
12 December 2014 NICE recommendations on vitamin D (PH56) and updated guidance on antenatal care (recommendation 1.3.2.4 from CG62) added to advice on diet and use of supplements before and during pregnancy and nutrition in pregnancy and while breastfeeding. Links to increasing vitamin D supplement use among at-risk groups added.
26 November 2014 Update to reducing calorie intake for adults who are obese and dietary strategies for children who are obese on publication of obesity (NICE guideline CG189).
22 July 2014 Links to the NICE recommendations on cardiovascular disease prevention and constipation added.
11 March 2014 Link to the NICE recommendations on community engagement added.
17 October 2013 Link to the NICE recommendations on obesity: working with local communities added.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Preventing excess weight gain (2015) NICE guideline NG7
Antenatal care for uncomplicated pregnancies (2008, updated 2016) NICE guideline CG62
Obesity prevention (2006, updated 2015) NICE guideline CG43
Cardiovascular disease prevention (2010) NICE guideline PH25
Maternal and child nutrition (2008) NICE guideline PH11
Maternal and child nutrition (2015) NICE quality standard 98
Postnatal care (2013, updated 2021) NICE quality standard 37

Quality standards

Maternal and child nutrition

These quality statements are taken from the maternal and child nutrition quality standard. The quality standard defines clinical best practice for maternal and child nutrition and should be read in full.

Quality statements

Continuity of care

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

This statement has been removed. For full details, see update information in the NICE quality standard.

Maternal health – potentially serious conditions

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

Women are advised, at the first postnatal midwife contact, of the symptoms and signs of potentially serious conditions that require them to seek medical advice without delay.

Rationale

Women are at an increased risk of experiencing serious health events in the immediate hours, days and weeks following the birth, some of which could lead to maternal death or severe morbidity. Providing women with information about the symptoms and signs that may indicate a serious physical illness or mental health condition may prompt them to seek medical advice without delay and avoid unnecessary deaths and severe morbidity.

Quality measures

Structure
Evidence of local arrangements to ensure that women are advised, at the first postnatal midwife contact, of the symptoms and signs of potentially serious conditions that require them to seek medical advice without delay.
Data source: Local data collection.
Process
The proportion of women who are advised, at the first postnatal midwife contact, of the symptoms and signs of potentially serious conditions that require them to seek medical advice without delay.
Numerator – the number in the denominator who are advised, at the first postnatal midwife contact, of the symptoms and signs of potentially serious conditions that require them to seek medical advice without delay.
Denominator – the number of women who have given birth.
Data source: Local data collection.
Outcome
a) Incidence of potentially avoidable maternal morbidity and mortality.
Data source: Local data collection. The Healthcare Quality Improvement Partnership’s Maternal, Newborn and Infant Clinical Outcome Review Programme (undertaken by MBRRACE-UK) reports on rates of maternal death and severe maternal morbidity.
b) Women who have given birth feel informed about symptoms and signs of potentially serious postnatal conditions.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that systems are in place for women to be advised, at the first postnatal midwife contact, of the symptoms and signs of potentially serious conditions that require them to seek medical advice without delay.
Midwives advise women, at the first postnatal contact, of the symptoms and signs of potentially serious conditions that require them to seek medical advice without delay.
Commissioners ensure that they commission services that advise women, at the first postnatal midwife contact, of the symptoms and signs of potentially serious conditions that require them to seek medical advice without delay.
Women are given advice by their midwife at their first postnatal contact about the symptoms and signs of potentially serious conditions that should prompt them to seek medical advice without delay.

Source guidance

Definitions of terms used in this quality statement

First postnatal midwife contact
The first postnatal midwife contact should take place within 36 hours after transfer of care from the place of birth or after a home birth. [NICE’s guideline on postnatal care, recommendation 1.1.14]
Symptoms and signs of potentially serious conditions
The following symptoms and signs are suggestive of potentially serious physical conditions in the woman:
  • sudden or very heavy vaginal bleeding, or persistent or increased vaginal bleeding, which could indicate retained placental tissue or endometritis
  • abdominal, pelvic or perineal pain, fever, shivering, or vaginal discharge with an unpleasant smell, which could indicate infection
  • leg swelling and tenderness, or shortness of breath, which could indicate venous thromboembolism
  • chest pain, which could indicate venous thromboembolism or cardiac problems
  • persistent or severe headache, which could indicate hypertension, pre-eclampsia, postdural-puncture headache, migraine, intracranial pathology or infection
  • worsening reddening and swelling of breasts persisting for more than 24 hours despite self-management, which could indicate mastitis
  • symptoms or signs of potentially serious conditions that do not respond to treatment.
[NICE’s guideline on postnatal care, recommendation 1.2.4]
The following symptoms and signs are suggestive of potentially serious mental health conditions in the woman:
  • severe depression, such as feeling extreme unnecessary worry, being unable to concentrate due to distraction from depressive feelings
  • severe anxiety, such as uncontrollable feeling of panic, being unable to cope or becoming obsessive
  • the desire to hurt others or yourself, including thoughts about taking your own life
  • confused and disturbed thoughts, which could include other people telling you that you are imagining things (hallucinations and delusions).

Equality and diversity considerations

Communication and information-giving between women (and their families) and members of the maternity team is a key aspect of this statement. Relevant adjustments will need to be in place for anyone who has communication difficulties, and for those who do not speak or read English. Written and verbal information should be appropriate for the woman’s level of literacy, culture and language.

Infant health – serious illness

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

Women or main carers of babies are advised, within 24 hours of the birth, of the symptoms and signs of serious illness in the baby that require them to contact emergency services.

Rationale

Babies may experience serious health conditions in the immediate hours, days and weeks following the birth, which can lead to severe illness or in rare cases, death. Providing the mother or main carer with verbal and written information about the symptoms and signs that might indicate their baby has a serious health problem may result in them contacting emergency services more promptly. This information should be provided within 24 hours of the birth.

Quality measures

Structure
Evidence of local arrangements to ensure that women or main carers of babies are advised, within 24 hours of the birth, of the symptoms and signs of serious illness in the baby that require them to contact emergency services.
Data source: Local data collection.
Process
The proportion of women or main carers of babies who are advised, within 24 hours of the birth, of the symptoms and signs of serious illness in the baby that require them to contact emergency services.
Numerator – the number in the denominator who are advised, within 24 hours of the birth, of the symptoms and signs of serious illness in the baby that require them to contact emergency services.
Denominator – the number of mothers or main carers of babies.
Data source: Local data collection.
Outcome
a) Incidence of potentially avoidable infant morbidity and mortality.
Data source: Local data collection. The NHS Digital Maternity Services Data Set collects data on neonatal deaths. The Healthcare Quality Improvement Partnership’s perinatal mortality surveillance report (MBRRACE-UK) reports on rates of perinatal death.
b) Women and main carers feel informed about symptoms and signs of serious illness in the baby.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that systems are in place for women or main carers of babies to be advised, within 24 hours of the birth, of the symptoms and signs of serious illness in the baby that require them to contact emergency services.
Healthcare practitioners advise women or main carers of babies, within 24 hours of the birth, of the symptoms and signs of serious illness in the baby that require them to contact emergency services.
Commissioners ensure that they commission services that advise women or main carers of babies, within 24 hours of the birth, of the symptoms and signs of serious illness in the baby that require them to contact emergency services.
Women or the main carer of the baby are given advice within 24 hours of the birth about symptoms and signs of serious illness in the baby, for which they need to contact emergency services.

Source guidance

Definitions of terms used in this quality statement

Symptoms and signs of serious illness in the baby
The following symptoms and signs are suggestive of serious illness in a baby:
  • appearing pale, ashen, mottled or blue (cyanosis)
  • unresponsive or unrousable
  • having a weak, abnormally high-pitched or continuous cry
  • abnormal breathing pattern, such as:
    • grunting respirations
    • increased respiratory rate (over 60 breaths/minute)
    • chest indrawing
  • temperature of 38°C or over or under 36°C
  • non-blanching rash
  • bulging fontanelle
  • neck stiffness
  • seizures
  • focal neurological signs
  • diarrhoea associated with dehydration
  • frequent forceful (projectile) vomiting
  • bilious vomiting (green or yellow-green vomit).
  • within the first 24 hours after the birth:
    • has not passed urine
    • has not passed faeces (meconium)
    • develops a yellow skin colour (jaundice).
[NICE’s guideline on postnatal care, recommendations 1.3.2 and 1.4.9, NICE’s guideline on jaundice in newborn babies under 28 days, recommendation 1.1.1 and expert opinion]
Main carers of babies
For the majority of babies, the main carer will be the mother. For some babies, the main carer could be a close relative, for example, the baby’s father or grandparent, or for looked-after babies, this could be a foster parent. [Expert opinion]

Equality and diversity considerations

Communication and information-giving between women or main carers of babies (and their families) and members of the maternity team is a key aspect of this statement. Relevant adjustments will need to be in place for anyone who has communication difficulties, and for those who do not speak or read English.

Infant health – bed sharing

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

Women, their partner or main carers of babies have discussions with their healthcare professional about safer bed-sharing practices.

Rationale

There are risk factors associated with sudden unexpected death in infancy when bed sharing. Discussing safer bed-sharing practices and the circumstances in which bed sharing with a baby is strongly advised against with women, their partner or main carers of babies will support them to establish safer infant sleeping habits.

Quality measures

Structure
Evidence of local arrangements to ensure that women, their partner or main carers of babies have discussions with their healthcare professional about safer bed-sharing practices.
Data source: Local data collection.
Process
Proportion of postnatal contacts in which women, their partner or main carers of babies have discussions with their healthcare professional about safer bed-sharing practices.
Numerator – the number in the denominator in which women, their partner or main carers of babies have discussions with their healthcare professional about safer bed-sharing practices.
Denominator – the number of postnatal contacts.
Data source: Local data collection.
Outcome
a) Incidence of sudden infant death syndrome (SIDS).
b) Women, their partner and main carers of babies know about safer bed-sharing practices.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that information about safer bed-sharing practices is available, and that healthcare professionals are trained to discuss safer bed-sharing practices with women, their partner or main carers of babies.
Healthcare practitioners ensure that they understand and can explain safer bed-sharing practices, and that they have discussions about this with women, their partner or the main carers of babies.
Commissioners ensure that they commission services that provide information about safer bed-sharing practices, and that train healthcare professionals to discuss this with women, their partner or main carers of babies.
Women, their partner or main carers of babies have discussions about safer bed-sharing practices with their healthcare professional. This should include how to keep their baby safe if they share a bed with their baby and when they should not share a bed with their baby.

Source guidance

Postnatal care. NICE guideline NG194 (2021), recommendations 1.3.13 and 1.3.14

Definitions of terms used in this quality statement

Main carers of babies
For the majority of babies, the main carer will be the mother. For some babies, the main carer could be a close relative, for example, the baby’s father or grandparent, or for looked-after babies, this could be a foster parent. [Expert opinion]
Safer bed-sharing practices
Discussions about bed sharing should include:
  • safer practices for bed sharing, including:
    • making sure the baby sleeps on a firm, flat mattress, lying face up (rather than face down or on their side)
    • not sleeping on a sofa or chair with the baby
    • not having pillows or duvets near the baby
    • not having other children or pets in the bed when sharing a bed with a baby
  • advice not to share a bed with their baby if their baby was low birth weight or if either parent:
    • has had 2 or more units of alcohol
    • smokes
    • has taken medicine that causes drowsiness
    • has used recreational drugs.
[NICE’s guideline on postnatal care, recommendations 1.3.13 and 1.3.14]

Equality and diversity considerations

Communication and information-giving between women, their partners or main carers of babies (and their families), and members of the maternity team are key aspects of this statement. Relevant adjustments should be in place for people with communication difficulties, and those who do not speak or read English. Verbal and written information should be appropriate for the person’s level of literacy, culture, language and family circumstances. Bed sharing can be intentional or a necessity, but all women, their partners or main carers of babies should be given information in a format they can understand, irrespective of their culture.

Breastfeeding

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

Women receive breastfeeding support from a service that uses an evaluated, structured programme.

Rationale

Breastfeeding contributes to the health of both the mother and child in the short and longer term. Women should be made aware of these benefits and those who choose to breastfeed should be supported by a service that is evidence-based and delivers an externally audited, structured programme. Delivery of breastfeeding support should be coordinated across the different sectors.

Quality measures

Structure
Evidence of local arrangements for breastfeeding support to be provided through a service that uses an evaluated, structured programme.
Data source: Local data collection.
Process
a) Proportion of women who receive breastfeeding support through a service that uses an evaluated, structured programme.
Numerator – the number in the denominator who receive breastfeeding support through a service that uses an evaluated, structured programme.
Denominator – the number of women who breastfeed (exclusively or partially).
Data source: Local data collection.
b) Proportion of women who wanted to continue breastfeeding but stopped before they had planned to.
Numerator – the number in the denominator who wanted to continue breastfeeding but stopped before they had planned to.
Denominator – the number of women who breastfed (exclusively or partially).
Data source: Local data collection.
Outcome
a) Rates of breastfeeding initiation.
Data source: The NHS Digital Maternity Services Data Set reports percentage of babies receiving breast milk as first feed.
b) Rates of exclusive or partial breastfeeding on discharge from hospital and at 6 to 8 weeks after the birth.
c) Women’s satisfaction with breastfeeding support.
Data source: The Care Quality Commission maternity services survey collects information about women’s experiences of maternity care and this includes a section on infant feeding.

What the quality statement means for different audiences

Service providers ensure that women receive breastfeeding support through a service that uses an evaluated, structured programme.
Healthcare practitioners ensure that women receive breastfeeding support through an integrated service that uses an evaluated, structured programme.
Commissioners ensure that they commission a service that delivers breastfeeding support through an evaluated, structured programme.
Women receive breastfeeding support through a service that uses an evaluated, structured programme.

Source guidance

Maternal and child nutrition. NICE guideline PH11 (2008, updated 2014), recommendations 1 and 7

Definitions of terms used in this quality statement

Structured programme
All maternity care providers (whether working in hospital or in primary care) should implement an externally evaluated, structured programme that encourages breastfeeding, using the UNICEF Baby Friendly Initiative as a minimum standard. If providers implement a locally developed programme, this should be evidence-based, structured, and undergo external evaluation. The structured programme should be delivered and coordinated across all providers, including hospital, primary, community and children’s centre settings. Breastfeeding outcomes should be monitored across all services. [Adapted from NICE’s guideline on maternal and child nutrition, recommendation 7]
Breastfeeding support
All people involved in delivering breastfeeding support should receive the approriate training and undergo assessment of competencies for their role. This includes employed staff and volunteer workers in all sectors, for example, hospitals, community settings, children’s centres and peer supporter services.

Equality and diversity considerations

Breastfeeding support should be culturally appropriate and accessible to people with additional needs, such as physical, sensory or learning disabilities, and to people who do not speak or read English. Women should have access to an interpreter or advocate if needed. Special consideration will be needed if the mother and baby have been separated for any reason, for example, if the baby has been admitted to neonatal care or the baby has been taken into care.

Formula feeding

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

Information about bottle feeding is discussed with women or main carers of formula-fed babies.

Rationale

Babies who are fully or partially formula-fed can develop infections and illnesses if their formula milk is not prepared safely. In a small number of babies these cause serious harm and are life threatening and require the baby to be admitted to hospital. The mother or main carer of the baby needs consistent, evidence-based advice about how to sterilise feeding equipment and safely prepare formula milk.

Quality measures

Structure
Evidence of local arrangements to ensure that information about bottle feeding is discussed with women or main carers of formula-fed babies.
Data source: Local data collection.
Process
The proportion of women or main carers of formula-fed babies who have information about bottle feeding discussed with them.
Numerator – the number in the denominator who have information about bottle feeding discussed with them.
Denominator – the number of women or main carers of formula-fed babies.
Data source: Local data collection.
Outcome
a) Rates of hospital admissions for formula feeding-related conditions.
Data source: Local data collection.
b) Women’s and main carers’ knowledge of how to sterilise feeding equipment and safely prepare formula milk.
Data source: Local data collection, for example, use of patient surveys.
c) Women’s and main carers’ satisfaction with feeding support.
Data source: The Care Quality Commission maternity services survey collects information about women’s experiences of maternity care and this includes a section on infant feeding.

What the quality statement means for different audiences

Service providers ensure that information about bottle feeding is discussed with women or main carers of formula-fed babies.
Healthcare practitioners discuss information about bottle feeding with women or main carers of formula-fed babies.
Commissioners ensure that they commission services in which information about bottle feeding is discussed with women or main carers of formula-fed babies.
Women or main carers of formula-fed babies have the opportunity to discuss information about bottle feeding.

Source guidance

Postnatal care. NICE guideline NG194 (2021), recommendations 1.5.18 and 1.5.19

Definitions of terms used in this quality statement

Formula-fed baby
This statement relates to mothers and main carers who totally or partially formula feed their baby, and breastfeeding mothers who plan to formula feed their baby. [Expert opinion]
Information about bottle feeding
The woman or main carer of the baby should have a one-to-one discussion about safe formula feeding and face-to face support supplemented with written, digital or telephone information.
Face-to-face formula feeding support should include:
  • advice about responsive bottle feeding and help to recognise feeding cues
  • offering to observe a feed
  • positions for holding a baby for bottle feeding and the dangers of ‘prop’ feeding
  • advice about how to pace bottle feeding and how to recognise signs that a baby has had enough milk (because it is possible to overfeed a formula-fed baby), and advice about other ways than feeding that can comfort and soothe the baby
  • how to bond with the baby when bottle feeding, through skin-to-skin contact, eye contact and the potential benefit of minimising the number of people regularly feeding the baby.
[NICE’s guideline on postnatal care, recommendations 1.5.18 and 1.5.19]
Main carers of babies
For the majority of babies, the main carer will be the mother. For some babies, the main carer could be a close relative, for example, the baby’s father or grandparent, or for looked-after babies, this could be a foster parent. [Expert opinion]

Equality and diversity considerations

Communication and information-giving between women or main carers of babies (and their families), and members of the maternity team is a key aspect of this statement. Relevant adjustments will need to be in place for anyone who has communication difficulties, and for those who do not speak or read English. Verbal and written information should be appropriate in terms of women’s (and their families) level of literacy, culture, language and family circumstances.

Infant health – physical examination

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

Babies have a complete 6- to 8-week physical examination.

Rationale

The purpose of the examination is to identify babies more likely to have conditions that would benefit from further investigation and management. This includes an overall physical examination as well as screening for eye problems, congenital heart defects, developmental dysplasia of the hip and undescended testicles. Most babies will be healthy, but the small number of babies who do have serious problems will benefit from prompt identification. Early treatment can improve the health of the baby and prevent or reduce disability.

Quality measures

Structure
a) Evidence of local arrangements to ensure that parents or main carers of babies are offered an appointment for the baby to attend for a 6- to 8-week physical examination.
Data source: Local data collection.
b) Evidence of local arrangements to ensure that a system is in place to monitor the competency of practitioners undertaking a 6- to 8-week physical examination.
Data source: Local data collection.
Process
Proportion of babies who had a 6- to 8-week physical examination.
Numerator – the number in the denominator who had a 6- to 8-week physical examination.
Denominator – the number of babies aged 8 weeks.
Data source: Local data collection could include data collected for the Public Health England newborn and infant physical examination (NIPE) screening programme.
Outcomes
a) Incidence of physical abnormalities in babies.
Data source: Local data collection.
b) Health outcomes associated with early intervention for babies with physical abnormalities.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that babies are offered a complete 6- to 8-week physical examination.
Healthcare practitioners ensure that they perform a complete 6- to 8-week physical examination of babies and that they maintain the necessary competencies for this role.
Commissioners ensure that they commission services that offer a complete 6- to 8-week physical examination for babies, which is carried out in a timely manner and by a competent practitioner.
The mother or main carer of the baby is given the opportunity for their baby to have a complete 6- to 8-week physical examination, which is carried out in a timely manner and by a competent practitioner.

Source guidance

Postnatal care. NICE guideline NG194 (2021), recommendations 1.3.3, 1.3.4 and 1.3.5

Definitions of terms used in this quality statement

6- to 8-week physical examination
The 6- to 8-week physical examination should include:
  • checking the baby’s:
    • appearance, including colour, breathing, behaviour, activity and posture
    • head (including fontanelles), face, nose, mouth (including palate), ears, neck and general symmetry of head and facial features
    • eyes: opacities, red reflex and colour of sclera
    • neck and clavicles, limbs, hands, feet and digits; assess proportions and symmetry
    • heart: position, heart rate, rhythm and sounds, murmurs and femoral pulse volume
    • lungs: respiratory effort, rate and lung sounds
    • abdomen: assess shape and palpate to identify any organomegaly; check condition of umbilical cord
    • genitalia and anus: completeness and patency and undescended testes in boys
    • spine: inspect and palpate bony structures and check integrity of the skin
    • skin: colour and texture as well as any birthmarks or rashes
    • central nervous system: tone, behaviour, movements and posture; check newborn reflexes only if concerned
    • hips: symmetry of the limbs, Barlow and Ortolani's manoeuvres
    • cry: assess sound
    • social smiling and visual fixing and following
  • measuring the baby’s weight and head circumference and plotting the results on a growth chart.
[NICE’s guideline on postnatal care, recommendations 1.3.3, 1.3.4 and 1.3.5]

Maternal health – weight management

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

Women with a body mass index (BMI) of 30 kg/m2 or more at the 6- to 8-week postnatal check are offered a referral for advice on healthy eating and physical activity.

Rationale

The woman’s eating habits and physical activity levels could influence the health behaviour of the wider family, including children who are developing habits that may remain with them for life. Supporting the woman in the postnatal period to change her eating habits and physical activity levels may improve her health, her infant’s health and the health of the wider family. It may also improve the outcomes of future pregnancies.
Women who are obese during pregnancy face increased risks of complications that include gestational diabetes, miscarriage, pre-eclampsia, thromboembolism and maternal death. Risks for the infant include fetal death, stillbirth, shoulder dystocia, and macrosomia. Infants of obese women face health risks in childhood including diabetes and obesity in later life.

Quality measures

Structure
a) Evidence of local arrangements to ensure that women have their BMI assessed and recorded at the 6- to 8-week postnatal check.
Data source: Local data collection.
b) Evidence of local arrangements to ensure that women with a BMI of 30 kg/m2 or more at the 6- to 8-week postnatal check are offered a referral for advice on healthy eating and physical activity.
Data source: Local data collection.
c) Evidence of local arrangements to ensure that the local workforce has appropriate numbers of staff trained to deliver healthy eating and physical activity services to postnatal women.
Data source: Local data collection.
Process
a) The proportion of women who have their BMI recorded at the 6- to 8-week postnatal check.
Numerator – the number in the denominator who have their BMI recorded.
Denominator – the number of women who attend a 6- to 8-week postnatal check.
Data source: Local data collection.
b) The proportion of women with a BMI of 30 kg/m2 or more at the 6- to 8-week postnatal check who are offered a referral for advice on healthy eating and physical activity.
Numerator – the number in the denominator who are offered a referral for advice on healthy eating and physical activity.
Denominator – the number of women with a BMI of 30 kg/m2 or more who attend a 6- to 8-week postnatal check.
Data source: Local data collection.
c) The proportion of women with a BMI of 30 kg/m2 or more at the 6- to 8-week postnatal check who accept a referral for advice on healthy eating and physical activity.
Numerator – the number in the denominator who accept a referral for advice on healthy eating and physical activity.
Denominator – the number of women with a BMI of 30 kg/m2 or more who attend a 6- to 8-week postnatal check.
Data source: Local data collection.
Outcome
Women feel able to make informed decisions about healthy eating, physical activity and weight management for themselves and their family.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that systems are in place for women with a BMI of 30 kg/m2 or more at the 6- to 8-week postnatal check to be offered a referral for advice on healthy eating and physical activity.
Healthcare practitioners offer women with a BMI of 30 kg/m2 or more at the 6- to 8-week postnatal check a referral for advice on healthy eating and physical activity.
Commissioners ensure that they commission services that offer women with a BMI of 30 kg/m2 or more at the 6- to 8-week postnatal check a referral for advice on healthy eating and physical activity.
Women who have a body mass index of 30 kg/m2 or more at the 6- to 8-week postnatal check are offered a referral for advice on healthy eating and physical activity.

Source guidance

Definitions of terms used in this quality statement

Structured programme
Women should be offered a referral to an individual or group-based service that uses a structured programme. Services should deliver a structured programme that:
  • addresses the reasons why women may find it difficult to lose weight, particularly after pregnancy
  • is tailored to the needs of an individual or group
  • combines advice on healthy eating and physical exercise (advising them to take a brisk walk or other moderate exercise for at least 30 minutes on at least 5 days of the week)
  • identifies and addresses individual barriers to change
  • provides ongoing support over a sufficient period of time to allow for sustained lifestyle changes.
Services should be delivered by an appropriately trained person. This is someone who can demonstrate expertise and competencies in healthy eating and/or physical activity, including weight management for women in the postnatal period. This may include midwives, health visitors, obstetricians, dietitians, GPs, nurses, midwifery assistants, support workers and those working in weight management programmes (commercial or voluntary).
Women who choose not to accept a referral should be given information about where they can get support on healthy eating and physical activity in future.
[Adapted with expert group consensus from NICE’s guideline on weight management before, during and after pregnancy, recommendations 3 and 4, and NICE’s guideline on maternal and child nutrition, recommendation 6]

Equality and diversity considerations

Women should be able to access services that are appropriate to their cultural and religious beliefs, and that make relevant adjustments for anyone who has communication difficulties, and for those who do not speak or read English.

Emotional wellbeing and bonding with the baby

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

Women have an assessment of their emotional wellbeing, including bonding with their baby, at each postnatal contact.

Rationale

The baby’s relationship with the mother has a significant impact on the baby’s social and emotional development. In turn, the woman's ability to provide a nurturing relationship is partly dependent on her own emotional wellbeing. Regular assessment of the woman’s emotional wellbeing, including bonding with her baby, may lead to earlier detection of problems.

Quality measures

Structure
Evidence of local arrangements that women have an assessment of their emotional wellbeing, including bonding with their baby, at each postnatal contact.
Data source: Local data collection.
Process
Proportion of postnatal contacts that include an assessment of the woman’s emotional wellbeing, including bonding with their baby.
Numerator – the number in the denominator that include an assessment of the woman’s emotional wellbeing, including bonding with their baby.
Denominator – the number of postnatal contacts.
Data source: Local data collection.
Outcome
a) Incidence of postnatal mental health problems.
Data source: Local data collection.
b) Incidence of baby-to-mother emotional attachment problems.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that systems are in place so that women have an assessment of their emotional wellbeing, including bonding with their baby, at each postnatal contact.
Healthcare practitioners ensure that they assess women’s emotional wellbeing, including bonding with their baby, at each postnatal contact.
Commissioners ensure that they commission services that have local agreements to ensure women have an assessment of their emotional wellbeing, including bonding with their baby, at each postnatal contact.
Women have an assessment of their emotional wellbeing, including bonding with their baby, at each postnatal contact.

Source guidance

Postnatal care. NICE guideline NG194 (2021), recommendations 1.2.2, 1.3.15 and 1.3.17

Definitions of terms used in this quality statement

Postnatal contacts
Women and their babies should receive the number of postnatal contacts that are appropriate to their care needs. A postnatal contact is a scheduled postnatal appointment that may occur in the woman or baby’s home or another setting such as a GP practice, children’s centre or this could be a hospital setting where women and/or the baby requires extended inpatient care. [Expert opinion]
Emotional wellbeing
Being happy and confident and not anxious or depressed. [NICE’s guideline on social and emotional wellbeing: early years, glossary]
Bonding
Bonding is the positive emotional and psychological connection that the parent develops with the baby [NICE’s guideline on postnatal care, terms used in this guideline section]

Equality and diversity considerations

Communication between women (and their families) and members of the maternity team is a key aspect of this statement. Relevant adjustments will need to be in place for anyone who has communication difficulties, and for those who do not speak or read English.

Maternal health – mental wellbeing

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

This statement has been removed. In 2016, NICE published a separate quality standard on antenatal and postnatal mental health, which focuses on this area of care in more detail. For more details, see update information in the NICE quality standard.

Parent–baby attachment

This quality statement is taken from the postnatal care quality standard. The quality standard defines clinical best practice for postnatal care and should be read in full.

Quality statement

This statement has been removed. For full details, see update information in the NICE quality standard.

Vending machines

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

Quality statement

Children and young people, and their parents or carers, 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 children and young people using them. Legal requirements govern the provision of food in local authority-maintained schools (see the Department of Education’s Standards for school food in England for further details). Schools are therefore not covered by this quality statement.

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 that are used by children and young people.
Data source: Local data collection.
Process
Proportion of local authority and NHS venues used by children and young people with vending machines that have 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 used by children and young people 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 that are used by children and young people offer healthy food and drink options.

What the quality statement means for children and young people and their parents or carers

Children and young people (and their parents or carers) have a choice of healthy food and drink options available from vending machines in local authority and NHS venues (for example 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 meet the eatwell plate guidance recommendations, and which 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 children and young people: prevention and lifestyle weight management programmes quality standard. The quality standard defines clinical best practice in obesity prevention and lifestyle weight management in children and young people and should be read in full.

Quality statement

Children and young people, and their parents or carers, see details of nutritional information on menus at local authority and NHS venues.

Rationale

Providing details about the nutritional content of food will allow children and young people (and their parents or carers) 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 that are used by children and young people.
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 used by children and young people provide details about the nutritional content of menu items.

What the quality statement means for children and young people and their parents or carers

Children and young people (and their parents or carers) selecting meals in catering facilities in local authority and NHS venues 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 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 children and young people with sensory impairment.

Prominent placement of healthy options

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

Quality statement

Children and young people, and their parents or carers, 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 children and young people (and their parents or carers) will consider healthier options when they are choosing food and drink.

Quality measures

Structure
Evidence that local authority and NHS venues used by children and young people 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 children and young people and their parents or carers

Children and young people (and their parents or carers) can easily find healthy foods and drinks when using catering facilities in local authority or NHS venues.

Source guidance

Definitions of terms used in this quality statement

Healthy food and drink choices
Food and drink that helps people to meet the eatwell plate guidance recommendations, and which 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 children and young people: prevention and lifestyle weight management programmes quality standard. The quality standard defines clinical best practice in obesity prevention and lifestyle weight management in children and young people and should be read in full.

Quality statement

Children and young people, and their parents or carers, have access to a publicly available up to date list of local lifestyle weight management programmes.

Rationale

Effective lifestyle weight management programmes for children and young people can be delivered by a range of organisations, in different locations, covering different age groups. 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 these locally provided programmes is important to ensure that the public, healthcare professionals and other professionals who work with children and young people are aware of the programmes that exist in their area and how to access them. Increased public awareness may lead to more self referrals to the programmes, either by children and young people themselves or their parents or carers. In addition, raised awareness among healthcare professionals such as GPs, school nurses, health visitors and staff involved in the National Child Measurement Programme and the Healthy Child Programme may lead to more direct referrals.

Quality measures

Structure
Evidence that an up to date list of local lifestyle weight management programmes for children and young people is made publically available by the local authority.
Data source: Local data collection.
Outcome
Number of referrals (including self referrals, by children and young people or their parents or carers) to lifestyle weight management programmes.
Data source: Local data collection.

What the quality statement means for providers of lifestyle weight management programmes, healthcare professionals, other professionals who work with children and young people, and local authorities

Providers of lifestyle weight management programmes ensure that they provide local authorities with up to date lists of local lifestyle weight management programmes for children and young people.
Healthcare professionals (such as GPs, dietitians, pharmacists, health visitors, school nurses and staff involved in the National Child Measurement Programme) and other professionals who work with children and young people (such as youth workers, social workers and pastoral care workers, and those who work in schools, colleges, early years organisations, children’s centres and looked-after children’s teams) ensure that they are aware of the lifestyle weight management programmes for children and young people in their area and how to enrol people on them.
Local authorities ensure that they maintain a publicly available up-to-date list of local lifestyle weight management programmes for children and young people.

What the quality statement means for children and young people and their parents or carers

Children and young people (and their parents or carers) are aware of the lifestyle weight management programmes in their area and how they can enrol on them.

Source guidance

Definitions of terms used in this quality statement

Lifestyle weight management programme
Lifestyle weight management programmes focus on diet, physical activity and behaviour change to help people who are overweight or obese. They are usually based in the community and may be run by the public, private or voluntary sector. [Adapted from NICE guideline PH47]

Raising awareness of lifestyle weight management programmes

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

Quality statement

Children and young people identified as being overweight or obese, and their parents or carers as appropriate, are given information about local lifestyle weight management programmes.

Rationale

Actively raising the possibility of participation in a local lifestyle weight management programme will help to increase the use of these programmes by children and young people identified as being overweight or obese.

Quality measures

Structure
Evidence of written protocols and local arrangements for healthcare professionals and other professionals to give information about local lifestyle weight management programmes to children and young people identified as being overweight or obese, and their parents or carers (as appropriate).
Data source: Local data collection.
Process
Proportion of children and young people identified as being overweight or obese, and their parents or carers as appropriate, who are given information about local lifestyle weight management programmes.
Numerator – the number in the denominator who are given information about local lifestyle weight management programmes.
Denominator – the number of children and young people identified as being overweight or obese, and their parents or carers as appropriate.
Data source: Local data collection.
Outcome
Number of children and young people enrolling in lifestyle weight management programmes.
Data source: Local data collection.

What the quality statement means for healthcare professionals, other professionals who work with children and young people, and commissioners

Healthcare professionals (such as GPs, dietitians, pharmacists, health visitors, school nurses and staff involved in the National Child Measurement Programme) and other professionals who work with children and young people (such as youth workers, social workers and pastoral care workers, and those who work in schools, colleges, early years organisations, children’s centres and looked after children’s teams) ensure that they provide information about local lifestyle weight management programmes to children and young people identified as being overweight or obese, and their parents or carers (as appropriate).
Commissioners (such as NHS England, clinical commissioning groups and local authorities) ensure that healthcare professionals, and other professionals who work with children and young people, provide information about local lifestyle weight management programmes to children and young people identified as being overweight or obese, and their parents or carers (as appropriate).

What the quality statement means for children and young people and their parents or carers

Children and young people identified as being overweight or obese (and their parents or carers, as appropriate) are given information about local lifestyle weight management programmes, including an explanation of what the programmes involve and how to take part.

Source guidance

Definitions of terms used in this quality statement

Information about local lifestyle weight management programmes
This information should explain what these programmes involve and how people can take part (including whether or not they can self refer). [Adapted from NICE guideline PH47, recommendation 7]
Lifestyle weight management programme
Lifestyle weight management programmes focus on diet, physical activity and behaviour change to help people who are overweight or obese. They are usually based in the community and may be run by the public, private or voluntary sector. [Adapted from NICE guideline PH47]
Other professionals who work with children and young people
These professionals include youth workers, social workers and pastoral care workers, as well as those who work in schools, colleges, early years organisations, children’s centres and looked after children’s teams. [NICE guideline PH47, recommendation 7] 

Family involvement in lifestyle weight management programmes

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

Quality statement

Family members or carers of children and young people are invited to attend lifestyle weight management programmes, regardless of their weight.

Rationale

Family members and carers have an important role and responsibility in influencing the environment in which children and young people live. Therefore, actively involving family members and carers in the programme is important to ensure that children and young people receive positive reinforcement and support away from the programme. Involving the family and carers is also likely to make the programme more successful, change behaviour and lifestyle choices and improve BMI over time in children and young people. It may also benefit family members because they may have the same genetic and/or lifestyle risk factors for weight.

Quality measures

Structure
Evidence that providers of lifestyle weight management programmes for children and young people invite family members or carers to attend, regardless of their weight.
Data source: Local data collection.
Process
Proportion of children and young people who attend a lifestyle weight management programme whose family members or carers have been invited to attend.
Numerator – the number in the denominator whose family members or carers have been invited to attend.
Denominator – the number of children and young people who attend a lifestyle weight management programme.
Data source: Local data collection.

Outcome

Family member attendance and involvement in lifestyle weight management programmes.
Data source: Local data collection.

What the quality statement means for providers of lifestyle weight management programmes, healthcare professionals and public health practitioners, and local authorities

Providers of lifestyle weight management programmes for children and young people ensure that they involve family members and carers in the programme and provide services that include the appropriate core components. Weight management programmes should emphasise the importance, and highlight the benefit, of family member involvement and encouragement.
Healthcare professionals and public health practitioners who deliver lifestyle weight management programmes for children and young people encourage the involvement of family members or carers.
Local authorities ensure that they commission lifestyle weight management programmes for children and young people that encourage family members and carers to be actively involved and contain the core components to involve family members. Local authorities require providers to report on how they have engaged family members and carers in the programme as part of their performance management and contract monitoring.

What the quality statement means for families or carers

Family members or carers of children and young people identified as being overweight or obese are encouraged to be involved in the child’s lifestyle weight management programme, regardless of their own weight. This may include receiving training and resources to support changes in behaviour or, if this is not possible, being provided with information on the aims of the programme. Family members are also encouraged to eat healthily and to be physically active, regardless of their weight.

Source guidance

Definitions of terms used in this quality statement

Lifestyle weight management programme
Lifestyle weight management programmes focus on diet, physical activity and behaviour change to help people who are overweight or obese. They are usually based in the community and may be run by the public, private or voluntary sector. [Adapted from NICE guideline PH47]

Equality and diversity considerations

Particular consideration needs to be given when engaging adult men in the programmes because they are often harder to involve than other family members. Consideration also needs to be given to the language needs of the child or young person accessing the programme, as well as their family members or carers. For some families, the child or young person may be the only English speaker in the family.

Evaluating lifestyle weight management programmes

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

Quality statement

Children and young people, and their parents or carers, can access data on attendance, outcomes and the views of participants and staff from lifestyle weight management programmes.

Rationale

It’s important that providers of lifestyle weight management programmes for children and young people 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 children and young people using the programmes. It will also help children and young people, and their parents or carers, to select lifestyle weight management programmes.

Quality measures

Structure
a) Evidence that commissioners and providers of lifestyle weight management programmes for children and young people 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 for children and young people have used data from monitoring and evaluation to amend and improve programmes.
Data source: Local data collection.
Process
a) Proportion of children and young people recruited to a lifestyle weight management programme that has data on attendance, outcomes and the views of participants and staff collected at recruitment and completion.
Numerator – the number in the denominator that has data on attendance, outcomes and the views of participants and staff collected at recruitment and completion.
Denominator – the number of children and young people recruited to a lifestyle weight management programme.
Data source: Local data collection.
b) Proportion of children and young people who complete a lifestyle weight management programme that has data on outcomes collected at 6 months after completion of the programme.
Numerator – the number in the denominator that has data on outcomes collected at 6 months after completion of the programme.
Denominator – the number of children and young people who complete a lifestyle weight management programme.
Data source: Local data collection.
c) Proportion of children and young people who complete a lifestyle weight management programme that has data on outcomes collected at 1 year after completion of the programme.
Numerator – the number in the denominator that has data on outcomes collected at 1 year after completion of the programme.
Denominator – the number of children and young people who complete a lifestyle weight management programme.
Data source: Local data collection.

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

Providers of lifestyle weight management programmes for children and young people ensure that they collect and report data to monitor and evaluate the programme.
Commissioners (including directors of public health, public health teams, local authority commissioners and clinical commissioning groups) ensure that sufficient resources are dedicated to monitoring and evaluation, that they evaluate lifestyle weight management programmes for children and young people using data on outcomes, and use the data to amend and improve the programme.

What the quality statement means for children and young people and their parents or carers

Children and young people (and their parents or carers) attend lifestyle weight management programmes that are regularly monitored and evaluated so that the programmes can be improved.

Source guidance

Definitions of terms used in this quality statement

Data on attendance, outcomes and the views of participants and staff
The data to be collected include:
  • Numbers recruited, percentage completing the programme and percentage followed up at 6 months and at 1 year after completing the programme.
  • For all those recruited, BMI and BMI z score measured at:
    • recruitment
    • completion of the programme
    • 6 months after completing the programme
    • 1 year after completing the programme.
  • referral routes
  • outcomes related to the aim of the programme and related to factors that can support or contribute to a reduction in BMI, for example:
    • improvements in diet
    • improvements in physical activity
    • reduction in sedentary behaviour
    • improvements in self-esteem.
  • variations in outcomes, according to age, gender, ethnicity and socioeconomic status
  • views of participants (including children, young people and their families and/or carers who have participated in the programme, as well as those who did not complete the programme)
  • views of staff delivering the programme. [Adapted from (NICE guideline PH47, recommendations 2 and 15]
(See Public Health England’s Standard evaluation framework for weight management interventions for examples of other possible outcome measures.)

Lifestyle weight management programme

Lifestyle weight management programmes focus on diet, physical activity and behaviour change to help people who are overweight or obese. They are usually based in the community and may be run by the public, private or voluntary sector. [Adapted from NICE guideline PH47]

Equality and diversity considerations

When monitoring and evaluating lifestyle weight management programmes, information also needs to be captured to ensure that the programmes are suitable for minority groups, for example, by family origin, religion and disability, and that reasonable adaptations are being made to the programmes to make them accessible to these groups and to assess their impact on health inequalities.

Reducing sedentary behaviour: placeholder statement

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

What is a placeholder statement?

A placeholder statement is an area of care that has been prioritised by the Quality Standards Advisory Committee but for which no source guidance is currently available. A placeholder statement indicates the need for evidence based guidance to be developed in this area.

Rationale

Decreasing the levels of sedentary behaviour in children and young people is a different issue to increasing physical activity in this group, as noted in Start active, stay active: a report on physical activity from the four home countries' Chief Medical Officers. There is a need to specify interventions and actions that can be carried out to achieve a reduction in sedentary behaviour in children and young people and also methods that can be used to easily and successfully measure sedentary activity.

Healthy eating in pregnancy

This quality statement is taken from the nutrition: improving maternal and child nutrition quality standard. The quality standard defines clinical best practice in improving maternal and child nutrition and should be read in full.

Quality statement

Pregnant women attending antenatal and health visitor appointments are given advice on how to eat healthily in pregnancy.

Rationale

A healthy diet is important for both mother and baby throughout pregnancy because this will help them to get the nutrients they need to stay healthy and for the baby to develop and grow. Advice on how to eat healthily and foods which should be avoided will enable pregnant women to make informed choices about their diet while pregnant.

Quality measures

Structure
Evidence of local arrangements for midwives and health visitors to advise pregnant women how to eat healthily in pregnancy.
Data source: Local data collection.
Process
a) Proportion of pregnant women attending their antenatal booking appointment who receive advice on how to eat healthily during pregnancy from a midwife.
Numerator – the number in the denominator who receive advice on how to eat healthily during pregnancy from a midwife.
Denominator – the number of pregnant women attending their antenatal booking appointment.
Data source: Local data collection.
b) Proportion of pregnant women attending their health visitor appointment who receive advice on how to eat healthily during pregnancy.
Numerator – the number in the denominator who receive advice on how to eat healthily during pregnancy from a health visitor.
Denominator – the number of pregnant women attending their health visitor appointment.
Data source: Local data collection.
Outcome
Healthy eating in pregnancy.
Data source: Local data collection.

What the quality statement means for service providers, health and public health practitioners, and commissioners

Service providers (such as primary and secondary care including maternity services, community and public health providers) ensure that systems are in place for midwives and health visitors to advise pregnant women how to eat healthily during pregnancy.
Midwives and health visitors ensure that they give advice to pregnant women on how to eat healthily during pregnancy at their antenatal booking appointment and their health visitor appointment.
Commissioners (such as clinical commissioning groups, NHS England and local authorities) specify that providers give advice to pregnant women on how to eat healthily during pregnancy at the antenatal booking appointment and the health visitor appointment.

What the quality statement means for service users and carers

Pregnant women are offered advice on how to eat healthily and which foods to avoid during pregnancy. This should happen when they have their first appointment with their midwife and when they have an appointment with their health visitor.

Source guidance

Definitions of terms used in this quality statement

Healthy eating in pregnancy
Where appropriate, the advice should include: eating 5 portions of fruit and vegetables a day and 1 portion of oily fish (for example, mackerel, sardines, pilchards, herring, trout or salmon) a week. If there are special dietary considerations then advice should be tailored to the woman’s needs and additional advice sought from a dietitian.
[Adapted from Maternal and child nutrition (NICE guideline PH11) recommendation 5]
Foods which should be avoided or limited in pregnancy
There are some foods that a pregnant woman should avoid eating because they could make her ill or harm her baby. These include raw or undercooked meat, liver, raw shellfish, some types of cheese, raw or partly cooked eggs. A detailed list of foods to limit or avoid can be found on the NHS Choices website.
[Adapted from the NHS Choices website and expert consensus]

Structured weight-loss programme

This quality statement is taken from the nutrition: improving maternal and child nutrition quality standard. The quality standard defines clinical best practice in improving maternal and child nutrition and should be read in full.

Quality statement

Women with a BMI of 30 or more after childbirth are offered a structured weight-loss programme.

Rationale

Attendance on a structured weight-loss programme for women who have a BMI of 30 or more after childbirth can improve the woman’s health. If they become pregnant again, the programme can help to ensure that their nutritional status at conception is adequate to support optimal fetal growth. By losing weight the women would reduce their risk of complications during pregnancy and childbirth, including gestational diabetes, pre-eclampsia and postpartum haemorrhage, if they subsequently became pregnant. In addition, their baby’s risk of still birth, high birthweight and subsequent obesity and diabetes would be reduced.

Quality measures

Structure
Evidence of local arrangements to ensure that women with a BMI of 30 or more after childbirth are offered a structured weight-loss programme.
Data source: Local data collection.
Process
Proportion of women with a BMI of 30 or more after childbirth attending their baby’s 6–8 week health visitor appointment who receive a structured weight-loss programme.
Numerator – the number in the denominator who receive a structured weight-loss programme.
Denominator – the number of women with a BMI of 30 or more after childbirth attending their baby’s 6–8 week health visitor appointment.
Data source: Local data collection.
Outcome
a) Obesity rates in pregnancy.
Data source: Local data collection.
b) Attendance at a weight-loss programme.
Data source: Local data collection.
c) Pregnancy morbidity.
Data source: Local data collection.
d) Infant morbidity.
Data source: Local data collection.

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

Service providers (such as primary and secondary care including maternity services) ensure that processes are in place for women with a BMI of 30 or more after childbirth to be offered a structured weight-loss programme.
Healthcare professionals ensure that they offer women with a BMI of 30 or more after childbirth a structured weight-loss programme.
Commissioners (clinical commissioning groups, NHS England and local authority commissioners) ensure that the services they commission have processes in place to offer women with a BMI of 30 or more after childbirth a structured weight-loss programme.

What the quality statement means for service users and carers

Women who are overweight after having a baby (with a BMI of 30 or more) are offered support to lose weight. This should include a personal assessment and advice on diet, exercise and how to set and achieve weight-loss goals.

Source guidance

Definitions of terms used in this quality statement

Structured weight-loss programme
A structured weight-loss programme provides a personalised assessment, advice about diet and physical activity and advice on behaviour change strategies such as goal setting.
[Adapted from Weight management before, during and after pregnancy (NICE guideline PH27), recommendation 4]
BMI (body mass index)
BMI is a measure used to see if people are a healthy weight for their height.
For most adults, an ideal BMI is in the 18.5–24.9 range. A BMI in the range of 25–29.9 is overweight, 30–39.9 is obese and 40 or more is very obese.
These ranges are only for adults. BMI is interpreted differently for children.
[Adapted from NHS Choices]

Equality and diversity considerations

Women from some ethnic groups may have an increased risk of obesity at a lower BMI, for example, women of South Asian or East Asian family origin, and this should be considered by their healthcare professionals.
Care and support, and the information given about it, should be both age-appropriate and culturally appropriate. It should also be accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. Women should have access to an interpreter or advocate if needed.

Healthy Start scheme

This quality statement is taken from the nutrition: improving maternal and child nutrition quality standard. The quality standard defines clinical best practice in improving maternal and child nutrition and should be read in full.

Quality statement

Pregnant women and the parents and carers of children under 4 years who may be eligible for the Healthy Start scheme are given information and support to apply.

Rationale

Pregnant women and the parents and carers of children under 4 years who are eligible for the Healthy Start scheme can apply to receive coupons for vitamin supplements and food vouchers. It aims to improve health and access to a healthy diet for families on low incomes across the UK.

Quality measures

Structure
Evidence of local arrangements to ensure that pregnant women and the parents and carers of children under 4 years who may be eligible for the Healthy Start scheme receive information and support to apply.
Data source: Local data collection.
Process
a) Proportion of pregnant women who may be eligible for the Healthy Start scheme receive information and support to apply when they attend their antenatal booking appointment.
Numerator – the number in the denominator who receive advice and support to apply.
Denominator – the number of pregnant women who may be eligible for the Healthy Start scheme attending their antenatal booking appointment.
Data source: Local data collection.
b) Proportion of 6–8 week health visitor appointments where parents and carers who may be eligible for the Healthy Start scheme receive information and support to apply.
Numerator – the number in the denominator where advice and support to apply is given.
Denominator – the number of 6–8 week health visitor appointments where parents and carers may be eligible for the Healthy Start scheme.
Data source: Local data collection.
c) Proportion of 8–12 month developmental reviews where parents and carers who may be eligible for the Healthy Start scheme receive information and support to apply.
Numerator – the number in the denominator where advice and support to apply is given.
Denominator – the number of 8–12 month developmental reviews where parents and carers may be eligible for the Healthy Start scheme.
Data source: Local data collection.
d) Proportion of 2- to 2-and-a-half-year health reviews where parents and carers who may be eligible for the Healthy Start scheme receive information and support to apply.
Numerator – the number in the denominator where advice and support to apply is given.
Denominator – the number of 2- to 2-and-a-half-year health reviews where parents and carers may be eligible for the Healthy Start scheme.
Data source: Local data collection.
e) Proportion of vaccination appointments at age 3 years 5 months to 4 years where parents and carers who may be eligible for the Healthy Start scheme receive information and support to apply.
Numerator – the number in the denominator where advice and support to apply is given.
Denominator – the number of vaccination appointments at age 3 years 5 months to 4 years where parents and carers may be eligible for the Healthy Start scheme.
Data source: Local data collection
Outcome
a) Vitamin D deficiency.
Data source: Local data collection.
Outcome
b) Neural tube defects.
Data source: Local data collection.
Outcome
c) Iron and calcium absorption.
Data source: Local data collection.

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

Service providers (such as primary, secondary, community care and public health providers) ensure that systems are in place to ensure that pregnant women and the parents and carers of children under 4 years who may be eligible are given information about the Healthy Start scheme and that an adequate supply of application forms is available for distribution by healthcare professionals.
Healthcare professionals ensure that they give information to pregnant women and the parents and carers of children under 4 years who may be eligible about the Healthy Start scheme, and provide them with support to apply, such as giving them a signed application form.
Commissioners (clinical commissioning groups, NHS England and local authorities) ensure that providers give information to pregnant women and the parents and carers of children under 4 years who may be eligible about the Healthy Start scheme and provide them with support to apply, including having enough application forms for distribution by healthcare professionals.

What the quality statement means for service users and carers

Pregnant women and the parents and carers of children under 4 years who may be eligible for the Healthy Start scheme are given information about it and help to apply (including a signed application form from their healthcare professional). The Healthy Start scheme provides free vitamins and food vouchers to people on low incomes.

Source guidance

Definitions of terms used in this quality statement

Pregnant women and the parents and carers who may be eligible
Pregnant women and the parents and carers of children under 4 years of age, who are in receipt of certain benefits, may be eligible for the Healthy Start scheme. All pregnant women under the age of 18 years are eligible.
Please see the Government’s Healthy Start webpage for up-to-date information on eligibility criteria.
[Expert consensus]
Healthy Start scheme
The Healthy Start scheme provides food vouchers and coupons for vitamin supplements to pregnant women, new mothers and parents and carers with young children (under 4 years) who are on low incomes and to all pregnant women aged under 18 years. It aims to improve health and access to a healthy diet for families on low incomes across the UK.
Healthy Start maternal vitamin supplements
The Healthy Start vitamin supplement for pregnant and breastfeeding women contains folic acid to help reduce the baby’s risk of neural tube defects, vitamin C to maintain healthy body tissue, and vitamin D to help iron and calcium absorption to keep bones healthy and ensure that the baby’s bones and teeth grow strong.
Women who are eligible for the Healthy Start scheme receive coupons to obtain these vitamin supplements free of charge. Women who are not eligible for the Healthy Start scheme may be able to buy the supplements from community pharmacies and should ask their midwife or health visitor where to access the vitamins in their local area.
[Adapted from the Healthy Start website and expert consensus]
Healthy Start children’s vitamin supplements
The Healthy Start supplement for children contains vitamins A, C and D, which help to strengthen the immune system, maintain healthy skin, and help with absorbing iron and calcium; keeping their bones and teeth healthy.
[Adapted from the Healthy Start website]
Healthy Start food vouchers
The Healthy Start food vouchers scheme is for families eligible for other means-tested benefits and provides food vouchers to spend with local retailers. Pregnant women and parents and carers of children over 1 year and under 4 years get 1 voucher per week. Parents and carers of babies under 1 year get 2 vouchers per week. (See the Healthy Start website for more information).
The vouchers can be spent on:
  • pasteurised cow’s milk
  • fresh or frozen fruit and vegetables (with no added ingredients), which can be whole or chopped, packaged or loose
  • cow’s milk based infant formula milk suitable from birth.
[Adapted from the Healthy Start website and expert consensus]

Equality and diversity considerations

The risk of vitamin D deficiency can be increased in people with darker skin, for example, people who are black or of Asian family origin, or people who wear clothing that covers their entire body, and this should be considered by their healthcare professionals.
Care and support, and the information given about it, should be both age-appropriate and culturally appropriate. It should also be accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. Pregnant women, parents and carers should have access to an interpreter or advocate if needed.

Breastfeeding

This quality statement is taken from the nutrition: improving maternal and child nutrition quality standard. The quality standard defines clinical best practice in improving maternal and child nutrition and should be read in full.

Quality statement

Women receive breastfeeding support from a service that uses an evaluated, structured programme.
This statement has been incorporated from NICE’s quality standard for postnatal care. For the rationale, quality measures, what the quality statement means, source guidance and definitions please see statement 5 of the quality standard for postnatal care.

Advice on introducing solid food

This quality statement is taken from the nutrition: improving maternal and child nutrition quality standard. The quality standard defines clinical best practice in improving maternal and child nutrition and should be read in full.

Quality statement

Parents and carers are given advice on introducing their baby to a variety of nutritious foods to complement breastmilk or formula milk.

Rationale

It is important that babies aged around 6 months are started on solid food, with the introduction of suitable foods in addition to breastmilk or formula milk to establish a healthy and varied diet. This ensures that a varied and nutritionally adequate diet is already in place when breastmilk or formula milk are no longer given. Involving parents and carers in discussions about starting solid food when they attend the 6–8 week health visitor appointment with their baby helps them to introduce solid food when their baby is around 6 months, minimising poor infant outcomes associated with starting solid food earlier or later.

Quality measures

Structure
a) Evidence of local arrangements to advise parents and carers how to introduce a variety of nutritious foods to their baby to complement breastmilk or formula milk.
b) Evidence of local arrangements to advise parents and carers when to introduce a variety of nutritious foods to their baby to complement breastmilk or formula milk.
Data source: Local data collection.
Process
a) Proportion of 6–8 week health visitor appointments where parents and carers receive advice on how to introduce their baby to a variety of nutritious foods to complement breastmilk or formula milk.
Numerator – the number in the denominator where the parents and carers receive advice on how to introduce their baby to a variety of nutritious foods to complement breastmilk or formula milk.
Denominator – the number of 6–8 week health visitor appointments.
Data source: Local data collection.
b) Proportion of 6–8 week health visitor appointments where parents and carers receive advice on when to introduce their baby to a variety of nutritious foods to complement breastmilk or formula milk.
Numerator – the number in the denominator where the parents and carers receive advice on when to introduce their baby to a variety of nutritious foods to complement breastmilk or formula milk.
Denominator – the number of 6–8 week health visitor appointments.
Data source: Local data collection.
Outcome
a) Introduction of solid food at around 6 months.
Data source: Local data collection.
b) Infant obesity rates.
Data source: Local data collection.
c) Faltering infant growth.
Data source: Local data collection.

What the quality statement means for service providers, health and public health practitioners, and commissioners

Service providers (community providers) ensure that systems are in place for parents and carers to be advised on how and when to introduce their baby to a variety of nutritious foods to complement breastmilk or formula milk.
Health visitors ensure that they work with parents and carers, advising them at the 6–8 week appointment on how and when to introduce their baby to a variety of nutritious foods to complement breastmilk or formula milk.
Commissioners (such as clinical commissioning groups, NHS England and local authorities) specify that providers advise parents and carers how and when to introduce their baby to a variety of nutritious foods to complement breastmilk or formula milk.

What the quality statement means for service users and carers

Parents and carers are given advice on how and when to introduce their baby to different types of nutritious foods to complement breastmilk or formula milk. The health visitor explains that they should start their baby on solid food at around 6 months and introduce a wide variety of different foods to give their baby a healthy and varied diet in the first year, in addition to breastmilk or formula milk. This will help the baby to be healthy, support the development of motor skills and speech and language, and help the baby to stay at a healthy weight. Advice should also be given about the texture of food, the use of finger foods and how parents and carers can reduce the risk of choking.

Source guidance

Definitions of terms used in this quality statement

Advice on introducing their baby to a variety of nutritious foods
This is advice that includes, but is not limited to:
  • the reasons for starting solid food at around 6 months
  • the possible effects on the baby of starting solid food earlier or later
  • the reasons for continuing breastfeeding
  • maximising breastmilk or increasing infant formula feeds for a baby under 6 months who is feeding more frequently.
This information can be given by the health visitor at the mandated 6–8 week appointment.
[Expert consensus]

Equality and diversity considerations

This information should be culturally appropriate. It should also be accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. Parents and carers should have access to an interpreter or advocate if needed.
People from some religious groups introduce solid food to babies when they are considerably older than 6 months of age. Health visitors should be mindful of different behaviours and beliefs while highlighting the importance of introducing a range of foods at around 6 months. This requires sensitive communication to inform parents and carers of the possible impact on their baby’s health.

Advice on Healthy Start food vouchers

This quality statement is taken from the nutrition: improving maternal and child nutrition quality standard. The quality standard defines clinical best practice in improving maternal and child nutrition and should be read in full.

Quality statement

Parents and carers receiving Healthy Start food vouchers are offered advice on how to use them to increase the amount of fruit and vegetables in their family’s diet.

Rationale

Including more fruit and vegetables increases the nutrients in a diet and can help people to manage their body weight. Healthy diets rich in fruit and vegetables may also help to reduce the risk of heart disease, stroke, cancer and other chronic diseases. It is important that service providers such as local authorities, local health services and voluntary organisations provide advice to parents and carers to ensure that they use the food vouchers to increase the amount of fruit and vegetables their family eats. This may also help to reduce outcomes associated with poor nutrition.

Quality measures

Structure
Evidence of local arrangements to offer parents and carers receiving Healthy Start food vouchers advice on how to use them to increase the amount of fruit and vegetables in their family’s diet.
Data source: Local data collection.
Process
a) Proportion of 6–8 week health visitor appointments where parents and carers receiving Healthy Start food vouchers receive advice on how to use them to increase the amount of fruit and vegetables in their family’s diet.
Numerator – the number in the denominator where advice is given on how to use the vouchers to increase the amount of fruit and vegetables in their family’s diet.
Denominator – the number of 6–8 week health visitor appointments where the parents and carers are receiving Healthy Start food vouchers.
Data source: Local data collection.
b) Proportion of 8–12 month developmental reviews where parents and carers receiving Healthy Start food vouchers receive advice on how to use them to increase the amount of fruit and vegetables in their family’s diet.
Numerator – the number in the denominator where advice is given on how to use the vouchers to increase the amount of fruit and vegetables in their family’s diet.
Denominator – the number of 8–12 month developmental reviews where the parents and carers are receiving Healthy Start food vouchers.
Data source: Local data collection.
c) Proportion of 2- to 2-and-a-half–year health reviews where parents and carers receiving Healthy Start food vouchers receive advice on how to use them to increase the amount of fruit and vegetables in their family’s diet.
Numerator – the number in the denominator where advice is given on how to use the vouchers to increase the amount of fruit and vegetables in their family’s diet.
Denominator – the number of 2- to 2-and-a-half-year health reviews where the parents and carers are receiving Healthy Start food vouchers.
Data source: Local data collection.
d) Proportion of vaccination appointments at age 3 years and 5 months to 4 years where parents and carers receiving Healthy Start food vouchers receive advice on how to use them to increase the amount of fruit and vegetables in their family’s diet.
Numerator – the number in the denominator where advice is given on how to use the vouchers to increase the amount of fruit and vegetables in their family’s diet.
Denominator – the number of vaccination appointments at age 3 years and 5 months to 4 years where the parents and carers are receiving Healthy Start food vouchers.
Data source: Local data collection.
Outcome
a) Fruit and vegetable intake.
Data source: Public Health England and Food Standards Agency National diet and nutrition survey (2011–12) and local data collection.
b) Obesity.
Data source: Local data collection.

What the quality statement means for service providers, health and public health practitioners, and commissioners

Service providers (such as children’s centres, local authorities, local strategic partnerships, local health services and voluntary organisations) ensure that they offer parents and carers receiving Healthy Start food vouchers advice on how to use them to increase the amount of fruit and vegetables in their family’s diet.
Health and public health practitioners ensure that they explain to parents and carers receiving Healthy Start food vouchers how they can use them to increase the amount of fruit and vegetables in their family’s diet.
Commissioners (such as clinical commissioning groups, NHS England, local authorities and local businesses that fund or provide community projects) specify that services offer parents and carers receiving Healthy Start food vouchers advice on using them to increase the amount of fruit and vegetables in their family’s diet.

What the quality statement means for service users and carers

Parents and carers receiving Healthy Start food vouchers are offered advice on how to use their vouchers to increase the amount of fruit and vegetables in their family’s diet. Eating more fruit and vegetables will help to improve their health and help them to stay at a healthy weight, and it may reduce their family’s risk of developing some illnesses.

Source guidance

Definitions of terms used in this quality statement

Healthy Start scheme
The Healthy Start scheme provides food vouchers and coupons for vitamin supplements to pregnant women, new mothers and parents and carers with young children (under 4 years) who are on low incomes and to all pregnant women aged under 18 years. It aims to improve health and access to a healthy diet for families on low incomes across the UK.
Healthy Start food vouchers
The Healthy Start food vouchers scheme is for families eligible for other means tested benefits and provides food vouchers to spend with local retailers. Pregnant women and parents and carers of children over 1 year and under 4 years get 1 voucher per week. Parents and carers of babies under 1 year get 2 vouchers per week. (See the Healthy Start website for more information).
The vouchers can be spent on:
  • pasteurised cow’s milk
  • fresh or frozen fruit and vegetables (with no added ingredients), which can be whole or chopped, packaged or loose
  • cow’s milk-based infant formula milk suitable from birth.
[Adapted from the Healthy Start website and expert consensus]
Advice on how to use Healthy Start food vouchers
This is advice which includes, but is not limited to:
  • the shops, markets and local and community food delivery services where the vouchers can be used and how these can be accessed, for example, by public transport.
  • the types of food that the vouchers can be used to buy.
  • simple, healthy recipes using food bought with the vouchers, taking the family’s circumstances into account, for example, their religion and culture, and the size of the family.
Advice can be given by primary and secondary healthcare professionals, public health nutritionists, dietitians and at children’s centres, health centres, nursery schools and other community settings. It can be provided in a number of ways, including formal and informal group sessions and one to one discussions, and using practical cook and eat sessions, leaflets and online resources (for example, step-by-step cooking demonstrations). This advice can be given at any time, but particularly when eligibility for the Healthy Start food vouchers is established and then on an ongoing basis as needed.
[Expert consensus]

Equality and diversity considerations

The information given should be both age-appropriate and culturally appropriate and sensitive to those who may have limited cooking skills and cooking equipment. It should also be accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. Pregnant women, parents and carers should have access to an interpreter or advocate if needed.

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.

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

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.

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

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 what NICE says on [[behaviour change
Tailor dietary changes to food preferences and allow for a flexible and individual approach to reducing calorie intake.
Do not use unduly restrictive and nutritionally unbalanced diets, because they are ineffective in the long term and can be harmful.
Encourage people to improve their diet even if they do not lose weight, because there can be other health benefits.
Population groups at higher risk of having a low vitamin D status include:
  • All pregnant and breastfeeding women, particularly teenagers and young women
  • Infants and children under 5 years
  • People over 65
  • People who have low or no exposure to the sun. For example, those who cover their skin for cultural reasons, who are housebound or confined indoors for long periods
  • People who have darker skin, for example, people of African, African-Caribbean and South Asian origin.

Glossary

body mass index
cardiovascular disease
industrially-produced trans fatty acids
the amount of a nutrient needed to meet the needs of around 97% of individuals in a group

Paths in this pathway

Pathway created: May 2011 Last updated: April 2021

© NICE 2021. All rights reserved. Subject to Notice of rights.

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