New NICE guidance for obesity

Adults who are overweight or obese can improve their health by losing even a small amount of weight if they keep it off, according to health watchdog NICE.

Obesity increases the risk of serious conditions including diabetes, heart disease and some cancers, although the greater the weight loss, the greater the benefit, even a modest weight loss of 3% kept off for life may improve or prevent health problems.

New guidance published by NICE looks at how lifestyle weight management programmes focusing on diet, activity and the way people live their lives (behaviour change) can help people who are overweight or obese to lose weight and to keep it off.

Professor Mike Kelly, director of the Centre for Public Health at NICE, said: “The number of people who are overweight or obese in England is rising. More than a quarter of adults are now classified as obese and a further 42% of men and a third of women are overweight. It not only damages their health but dealing with the long-term consequences of obesity costs the NHS around £5.1 billion each year. It is a huge cost to the health service. Lifestyle programmes are one part of the solution. An environment that makes it easier for people to be active and eat well is also crucial, as are services for people with other issues that affect their health and wellbeing. The guidance isn’t about quick fixes. There is no ‘magic bullet’. It is about ensuring effective services are there to support people in the long term.”

Gill Fine, independent public health nutritionist and chair of the group which developed the NICE guidance, said: “Obesity is one of the biggest health issues facing the UK. It’s a complex problem with no single solution, but programmes which aim to help people manage their weight can make a difference. What we have done in this new guidance is to identify the key components that need to be included in these programmes for them to be effective. These include setting realistic weight loss and weight maintenance goals, ensuring the programme is at least 12 weeks long and making sure the people running the programme are properly trained. We hope that these practical recommendations will help people make life-long lifestyle changes so they lose weight and most importantly help prevent those pounds from coming back.”

Recommendations included in the new guidance

Ensure services cause no harm: Health professionals and providers should be aware of the effort needed to lose weight, prevent weight regain or avoid any further weight gain. Also be aware of the stigma adults who are overweight or obese may feel or experience. Ensure the tone and content of all communications is respectful and non-judgemental. They should also ensure equipment and facilities meet the needs of most adults who are overweight or obese.

Address the expectations and information needs of adults thinking about joining a lifestyle weight management programme: GPs and providers of weight management programmes should discuss the importance and wider benefits of making gradual, long-term changes to dietary habits and physical activity levels. They should also explain the more weight lost, the greater the health benefits, particularly if someone loses more than 5% of their body weight and maintains this for life and although it varies on average, people attending a lifestyle weight management programme lose around 3% of their body weight.

Improve programme uptake, adherence and outcomes: Providers of weight management programmes should explain to adults who are considering a lifestyle weight management programme: what the programme does and does not involve, realistic goals they might hope or expect to achieve and the wider benefits of the programme and other local services that may provide additional support (for example, local walking or gardening groups).

Commission programmes that include the core components for effective weight loss and prevent weight regain: Commissioners of lifestyle weight management services should commission or recommend lifestyle weight management programmes that:
•Address dietary intake, physical activity levels and behaviour change
•Are developed by a multidisciplinary team. This includes input from a registered dietitian, registered practitioner psychologist and a qualified physical activity instructor
•Ensure staff are trained to deliver them and they receive regular professional development sessions
•Focus on life-long lifestyle change and the prevention of future weight gain
•Last at least 3 months, and that sessions are offered at least weekly or fortnightly and include a ‘weigh-in’ at each session
•Discuss sources of on-going support once the programme has ended
•Discuss strategies to overcome any difficulties in maintaining new behaviours.

Refer overweight and obese adults to a lifestyle weight management programme: GP practices and other health or social care professionals who give advice about, or refer people to, lifestyle weight management programmes should be clear that no programme holds the ‘magic bullet’ or can guarantee long-term success. For funded referrals, it should be noted that: programmes may particularly benefit adults who are obese (that is, with a BMI over 30 kg/m2, or lower for those from black and minority ethnic groups) or with other risk factors (comorbidities such as type 2 diabetes).

Carol Weir, head of service for nutrition and dietetics at Leeds Community Healthcare NHS Trust and NICE guidance developer, said: “Programmes focusing on diet, activity and making changes to behaviour really are effective in helping people lose weight, and this guidance will help ensure that these programmes are commissioned and run in the best possible way. We are recommending a number of elements to support people in making changes that they can stick to. We need to focus on more than just diet and being more active. Using tools such as weight monitoring and setting realistic personal goals are really important. We also found that a lot of overweight or obese people were put off seeking help because they felt that they were being blamed for being unable to lose weight and the position they have found themselves in. Therefore the guidance also recommends that doctors and other health professionals should ensure the tone they use when communicating with people who need help with their weight is respectful and non-judgemental.”

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