Slide1: Obesity
Implementing NICE guidance December 2006 NICE clinical guideline 43
What this presentation covers:: What this presentation covers:
background
the guidance
key recommendations for prevention
key recommendations for assessment and
management
costs and savings
tools that can help
Background: changing practice : Background: changing practice NICE guidance is based on the best available evidence.
The Department of Health asks NHS organisations to work towards implementing NICE guidance, and compliance will be monitored by the Healthcare Commission.
Other organisations will want to use the guidance to implement best practice.
Who the guidance is aimed at: Who the guidance is aimed at local authorities and partners in the community
early years providers
schools
workplaces
self-help, commercial and community programmes
the public
the NHS
Need for this guidance: Need for this guidance Rising prevalence of obesity in England
Over 50% of all adults are overweight or obese
Estimated current cost of obesity and overweight is between £6.6 and £7.4 billion annually
Associated comorbidities: Associated comorbidities Children and teenagers
hypertension
hyperinsulinaemia
dyslipidaemia
type 2 diabetes
psychosocial dysfunction
exacerbation of existing conditions
orthopaedic problems Adults
type 2 diabetes
coronary heart disease (CHD)
hypertension
various cancers
osteoarthritis
What the guidance covers: What the guidance covers
Prevention of overweight and obesity in adults and children
Identification and assessment
Management of overweight and obesity in adults
and children:
lifestyle changes
drug treatment
surgery
Prevention and management of obesity is a priority for all : Prevention and management of obesity is a priority for all Ensure that preventing and managing obesity is a priority, at both strategic and delivery levels
Dedicate resources for action and training
Key recommendations for local authorities: Key recommendations for local authorities Work with local partners to create and manage more safe spaces for incidental and planned physical activity
Address as a priority any concerns around safety, crime and inclusion
Provide facilities and schemes such as cycling and walking routes, cycle parking, area maps and safe play areas
Make streets cleaner and safer, through measures such as traffic calming, congestion charging, pedestrian crossings, cycle routes, lighting and walking schemes
Recommended actions for local authorities: Recommended actions for local authorities All relevant workplace policies should support the local obesity strategy
Work with the local community to identify environmental barriers to eating healthily and being physically active
Ensure building designs encourage the use of stairs and walkways
Encourage local shops and caterers to promote healthy food and drink choices
Key recommendations for early years settings: Key recommendations for early years settings Minimise sedentary activities during play time
Provide regular opportunities for enjoyable
active play and structured physical activity sessions
Implement Department for Education and Skills, Food
Standards Agency and Caroline Walker Trust (see
www.cwt.org.uk) guidance on food procurement and
healthy catering
Involve parents and carers
Key recommendations for schools : Key recommendations for schools Head teachers and chairs of governors, in collaboration with parents and pupils, should:
assess the whole school environment
ensure school policies help children to eat a
healthy diet, be physically active and maintain a
healthy weight
use a whole-school approach to develop life-long
healthy eating and physical activity
practices
Recommended actions for schools: Recommended actions for schools
Ensure school policies and the school’s environment encourage physical activity and a healthy diet
Teaching, support and catering staff should have training on how to implement healthy school policies
Establish links with health professionals
Key recommendation for self-help, commercial and community settings: Key recommendation for self-help, commercial and community settings Primary care organisations and local authorities should recommend to patients, or consider endorsing, self-help, commercial and community weight management programmes only if they follow best practice
Principles of best practice : Principles of best practice Endorse programmes only if they meet best practice standards by:
helping people decide on a realistic healthy target weight
focusing on long-term lifestyle changes
addressing both diet and activity, and offering a variety of approaches
using a balanced, healthy-eating approach
offering practical, safe advice about being more active
including some behaviour-change techniques
recommending and/or providing ongoing support
Key recommendations for workplaces: Key recommendations for workplaces Ensure policies encourage activity and healthy eating
Provide opportunities for staff to eat a healthy diet through promotion of healthy choices in restaurants, hospitality, vending machines and shops, in line with Food Standards Agency guidance
Key recommendations for workplaces: Key recommendations for workplaces Provide opportunities for staff to be physically active through:
working practices and policies, such as active travel policies for staff and visitors
a supportive physical environment, such as improvements to stairwells and providing showers and secure cycle parking
recreational opportunities, such as supporting out-of-hours social activities, lunchtime walks and use of local leisure facilities
Key recommendations for the NHS: Key recommendations for the NHS Managers and health professionals in all primary care settings should:
ensure that preventing and managing obesity is a priority, at both strategic and delivery levels
dedicate resources for action and training
consider endorsing, self-help, commercial and community weight management programmes
if they follow best practice
Recommended actions for the NHS as an employer: Recommended actions for the NHS as an employer Ensure policies encourage activity and healthy eating among staff
Provide showers and secure cycle parking to encourage active travel
Actively promote healthy choices in restaurants
Improve stairwells to encourage use of stairs
Recommended actions for all health professionals: Recommended actions for all health professionals Offer tailored advice based on individual preferences and needs
Involve parents and carers in actions aimed at children and young adults
Discuss weight, diet and activity at times when weight gain is more likely
Focus interventions on activities that fit easily into everyday life
Use multicomponent interventions
Recommended actions for health professionals in community settings: Recommended actions for health professionals in community settings Support and promote healthy eating and physical activity through retail and catering schemes, schemes and facilities to encourage physical activity, and behavioural change programmes
Support implementation of workplace programmes on obesity
In community programmes, address local concerns, including the availability of services, cost and safety
Recommended actions for health professionals in early years settings: Recommended actions for health professionals in early years settings Use a range of components (not just parental education):
offer interactive cookery and physical activity demonstrations
use videos and discussions on meal planning and shopping
provide opportunities for active play
Clinical recommendations for the NHS: Clinical recommendations for the NHS
Identification and assessment
Management of overweight and obesity in adults and children:
lifestyle changes
drug treatment
surgery
Slide24: Determine degree of
overweight or obesity Management:
lifestyle changes;
drug treatment
Assessment and management: adults Assess lifestyle,
comorbidities and
willingness to change Consider referral
to specialist care Specialist assessment
and management;
surgery and follow up
Determine degree of overweight or obesity: adults: Determine degree of overweight or obesity: adults
Assess lifestyle, comorbidities and willingness to change: adults: Assess lifestyle, comorbidities and willingness to change: adults Including:
presenting symptoms and underlying causes
of overweight or obesity
willingness to change
risk factors and comorbidities
eating behaviour
lifestyle – diet and physical activity
psychosocial factors
Management: lifestyle changes for adults: Management: lifestyle changes for adults Offer multicomponent interventions, including behaviour change strategies to encourage:
increased physical activity
improved eating behaviour
healthy eating
Behavioural change strategies: adults: Behavioural change strategies: adults self monitoring of behaviour and progress
stimulus control
goal setting
slowing rate of eating
ensuring social support
Behavioural change strategies: adults: Behavioural change strategies: adults problem solving
assertiveness
cognitive restructuring (modifying thoughts)
reinforcement of changes
relapse prevention
strategies for dealing with weight regain
Referral to specialist care: adults: Referral to specialist care: adults Consider referral to specialist care if:
underlying causes of overweight and obesity need to be assessed
there are complex disease states and/or needs that cannot be managed adequately in primary or secondary care
conventional treatment has failed
specialist interventions may be needed
drug therapy is being considered for a person with a BMI of 50 kg/m2 or more
surgery is being considered
Management: drug treatment for adults: Management: drug treatment for adults Drug treatment should be considered for adults:
only after dietary and exercise advice have
been started and evaluated
for patients who have not reached their
target weight or have reached a plateau
These recommendations update the NICE
technology appraisals on orlistat and sibutramine
Surgical treatment: adults: Surgical treatment: adults Consider surgery if all of the following conditions
are met:
the person has a BMI of 40 kg/m² or more, OR
a BMI of 35 to 40 kg/m² plus other significant
disease that could be improved with weight loss
non-surgical measures have failed to achieve or
maintain clinically beneficial weight loss for at
least 6 months
the person has been receiving or will receive
intensive management in a specialist obesity
service, such as psychological support
Slide33: Consider intervention
or assessment Determine degree of
overweight or obesity Management:
lifestyle changes Consider referral
to an appropriate
specialist Assessment and management: children and young people Assess lifestyle,
comorbidities and
willingness to change Assessment in
secondary care Specialist
management:
drug treatment;
surgery
Determine degree of overweight or obesity: children and young people: Determine degree of overweight or obesity: children and young people Use clinical judgement to decide when to
measure height and weight
Use BMI – UK 1990 BMI charts
Discuss with child/young person and their family
Use clinical judgement to decide when to
measure height and weight
Use BMI – UK 1990 BMI charts
Discuss with child/young person and their family
Use clinical judgement to decide when to
measure height and weight
Use BMI – UK 1990 BMI charts
Discuss with child/young person and their family
Use clinical judgement to decide when to
measure height and weight
Use the UK 1990 BMI charts
Discuss with child/young person and their family
Consider intervention or tailored assessment: children : Consider intervention or tailored assessment: children
Assess lifestyle, comorbidities and willingness to change: children: Assess lifestyle, comorbidities and willingness to change: children Including:
presenting symptoms and underlying causes
of overweight or obesity,
willingness to change
risk factors and comorbidities
eating behaviours
lifestyle – diet and physical activity
psychosocial factors
Management: lifestyle changes for children: Management: lifestyle changes for children Offer multicomponent interventions that include behaviour change strategies to:
increase physical activity levels or decrease
inactivity
improve eating behaviour or quality of diet
Behavioural change strategies: children: Behavioural change strategies: children stimulus control
self monitoring
goal setting
rewards for reaching goals
problem solving
Giving praise and encouraging parents to role-model desired behaviours are also recommended
Referral to specialist care: children : Referral to specialist care: children
Consider referral to specialist care if the child has:
significant comorbidity or
complex needs – such as learning or educational difficulties
Management: drug treatment for children : Management: drug treatment for children
Consider drug treatment only if multicomponent dietary,
exercise and behavioural approaches have been started
and evaluated.
Children under 12: drug treatment not generally recommended.
Prescribe only in exceptional circumstances such as severe
life-threatening comorbidities Children over 12: drug treatment is recommended only if
there are severe comorbidities
Prescribing should be started by a specialist multidisciplinary
team with experience of prescribing for this age group
Surgical treatment: young people: Surgical treatment: young people
Surgery is not generally recommended
for children or young people.
However, in exceptional circumstances
it may be considered for young people.
Costs: Costs
Savings: Savings
Access tools online: Access tools online Costing tools
costing report
costing template
Guide to useful resources
Audit criteria
Available from: www.nice.org.uk/CG043
Access the guidance online: Access the guidance online Two quick reference guides –www.nice.org.uk/CG043quickrefguide
NICE guideline – all of the recommendations www.nice.org.uk/CG043niceguideline
Full guideline – all of the evidence and rationale www.nice.org.uk/CG043fullguideline
Two ‘Understanding NICE guidance’ booklets – plain English versions www.nice.org.uk/CG043publicinfo