Overweight and Obesity Management

Discussion, communication and follow up
1.1.1
Before or during any discussions, think about the wider determinants and the context of overweight and obesity. These include:

• general health and current comorbidities
• weight-related comorbidities, including family history of weight-related comorbidities
• weight history and previous experiences of managing overweight or obesity
• experiences of weight stigma
• impact of bullying and adverse childhood experiences
• practicality of addressing weight and readiness to engage with change
• developmental stage (for children and young people)
• ethnicity
• language
• socioeconomic status and financial constraints
• personal and family circumstances, including living arrangements and major life events
• recent pregnancy
• how any medicines the person is taking may affect their weight or appetite
• current or previous experiences of eating disorders or disordered eating
• psychosocial considerations (for example, depression, anxiety or sense of self-esteem or self-perception)
• physical disabilities
• neurodevelopmental conditions and special educational needs and disabilities (SEND). [2025]

1.1.2
Before discussing overweight, obesity or central adiposity, take into account:

• the context of the discussion or appointment and whether it is appropriate or important to discuss weight or take measurements on this occasion
• that the subject of weight may have been raised many times before
• your own feelings and sensitivities about weight
• that people can be affected by an eating disorder at any weight (see NICE's guideline on eating disorders)
• cultural factors that may be relevant.
• For discussions with children and their families or carers, also:
• think about the vulnerability of young people to eating disorders, and the impact of measuring their weight
• tailor conversations with the child or young person to their age, maturity and level of understanding, so that they are able to engage with the discussion and be involved with the decisions about their healthcare. [2025]

1.1.3
Ask permission to discuss overweight, obesity or central adiposity. If they do not wish to discuss it further on this occasion, respect the person's choice (and that of their family or carer, if relevant) and either explore the reason sensitively or delay discussion until an appropriate time. [2025]

1.1.4
Record the outcome of the discussion to ensure that subsequent healthcare professionals are aware that the matter has been raised, and know about the person's views and any actions already taken to manage overweight or obesity. [2025]

1.1.5
Ensure that all discussions linked to overweight, obesity and central adiposity are conducted in a sensitive, non-judgemental and person-centred manner by:

• using non-stigmatising language (for example, 'living with overweight')
• identifying and exploring the person's own preferred terms (and those of their family or carers, if relevant)
• focusing on improvements in health and wellbeing rather than simply talking about weight (for example, using terms like 'healthier weight' and 'improved health' may be more acceptable than 'preventing obesity' for some people)
• staying positive, supportive and solution-based
• taking into account the person's thoughts, views and cultural, religious or spiritual beliefs (and those of their family or carers, if relevant) about overweight and obesity management
• being mindful of the factors that prevent or restrict weight loss (for example, some medicines)
• taking into account the determinants and context of overweight and obesity (see recommendation 1.1.1)
• for children and young people, using accurate facts and figures, for example growth charts, to visually show their weight and BMI centile. [2025]

1.1.6
Ensure that all written, visual and verbal communications with people living with overweight and obesity use non-stigmatising language and images and is tailored to any particular needs, such as Easy Read literature. Resources and advice that could help conduct conversations in a sensitive and positive way include:

• NHS England's healthier weight competency framework
• Office for Health Improvement and Disparities' healthy weight coaching on how to have sensitive conversations about weight and health with adults
• Public Health England's guide to brief interventions with adults: let's talk about weight (which provides practical advice and tools to support health and care professionals make brief interventions in weight management for adults)
• Public Health England's guide to conversations about weight management with children and families: let's talk about weight (which highlights a focus for many children and young people on weight maintenance and growing into a healthier weight, rather than weight loss)
• National Child Measurement Programme conversation framework for talking to parents (which can also be used for discussions about weight outside the programme)
• obesity image banks [2025]

Equipment
1.1.7
Equip specialist settings for treating people who are living with obesity with, for example, suitable seating and adequate weighing and monitoring equipment. [2006]

1.1.8
Ensure hospitals have access to suitable equipment – such as larger scanners and beds – when providing general care for people who are living with severe obesity. [2006]

See also the sections on identification, assessment and referral in children and young people and behavioural overweight and obesity management interventions for children and young people.

1.2.1
Aim to create a supportive environment at home and in other settings, such as schools, that helps a child or young person and their family or carers make behavioural changes. [2006, amended 2014]

1.2.2
Ensure that interventions for children and young people address behaviours within the family and in social settings that affect weight, including the wider determinants and context of overweight and obesity (see recommendation 1.1.1 in the section on discussion, communication and follow up). [2006, amended 2014]

1.2.3
Encourage families or carers to take the main responsibility for behavioural changes in children and young people, especially children under 12. Take into account the age and maturity of the child or young person, and their preferences and those of their families or carers. [2025]

1.2.4
If there is concern that obesity or weight or weight-related comorbidities pose a significant threat to the child or young person's health and wellbeing (see the section in this guideline on classifying overweight, obesity and central adiposity in children and young people):

• refer to emotional health and wellbeing support and services
• refer to specialist management for any other comorbidities.

Use clinical judgement to decide when it is necessary to intervene as part of the duty of care to the child or young person. See the recommendations on advocacy and support in NICE's guideline on babies, children and young people's experience of healthcare and our information on making decisions using NICE guidelines for more information about safeguarding. [2025]

Encouraging people to make changes
See also the sections on physical activity approaches, dietary approaches and raising public awareness, NICE's guidelines on walking and cycling and eating disorders, and NHS advice on meat in your diet, recommended levels of alcohol consumption and calories in alcohol.

1.3.1
Advise people to avoid extreme physical activity or dietary behaviours (such as obsessively exercising or cutting out all carbohydrates in the long term) that are difficult to sustain and may not be accompanied by wider health benefits. [2015]

1.3.2
Encourage everyone to identify perceptions, behaviours or situations that may undermine their efforts to maintain a healthier weight or prevent excess weight gain in the long term. These may include:

• drinking sugary or alcoholic drinks
• limiting fruit and vegetable intake
• underestimating how much food is consumed
• overestimating how much physical activity is being done
• overeating after being physically active
• planning and taking part in social events that focus on food
• using 'sweet treats' as a reward or emotional comfort or giving them regularly as gifts
• difficulties with consistently following physical activity and healthy eating plans during weekends and holidays, or after illness. [2015, amended 2025]

1.3.3
Encourage behaviours that may help people to keep an eye on their weight or associated behaviours, but be aware of risks for people who have or might develop disordered eating. For adults, behaviours may include:

• Checking their measurements regularly, for example weighing themselves once a week and being aware of their waist circumference (see the section on how to take measurements in adults).
• Checking their physical activity level (for example, by making a note of activities, or using an activity tracker or an app to track physical activity). (See recommendation 7 on walking: individual support, in NICE's guideline on walking and cycling.)
• Checking their food and drink intake (for example, by making a note of meals and snacks, using an app to track intake, or checking food and drink labels). For apps that may be helpful, see NHS better health advice. [2015, amended 2025]

1.3.4
Give sources of accurate information (such as the NHS Better Health) and details of local services to people who have any concerns about their – or their family's – diet, activity levels or weight. [2015, amended 2025]

Communicating the benefits of healthy behaviours and gradual improvements
1.3.5
Explain that the physical and mental health benefits of being more physically active and improving dietary behaviours are not limited to maintaining a healthier weight. They also include, for example:

• improved mental wellbeing
• enjoyment from physical activities, including the social aspects of shared activities
• reduced risk of developing diseases associated with excess weight such as heart disease, hypertension, liver disease, osteoarthritis, stroke, type 2 diabetes, some cancers, and reduced risk of poor COVID-19 outcomes
• the health benefits of losing weight before pregnancy
• reduced breathlessness, improved fitness and other benefits from increased physical activity that are independent of weight
• lower blood cholesterol, improved oral health and other benefits from improved dietary behaviours that are independent of weight. [2015]

1.3.6
Explain that even small, gradual improvements to physical activity and dietary intake are likely to be helpful. Emphasise that:

• Improving dietary intake and being physically active are as important for people who are currently a healthy weight as for people who are living with overweight.
• Weight gain in adulthood is not inevitable. It is possible to avoid gaining weight with age by being physically active and eating a diet based on foods and drinks with a lower energy density.
• No single physical activity, food or drink will maintain a healthy weight – a combination of actions is needed. [2015]

Advice for family and carers of children and young people
1.3.7
Encourage family, carers and others regularly caring for children and young people to:

• Encourage and support them to be active at every opportunity (such as active play, travel, sport or leisure activities).
• Eat meals with them and act as a positive role model.
• Avoid using food as a reward or to manage behaviour.
• Encourage repeated exposure to vegetables to increase consumption.
• Maintain good oral health, see NHS information on taking care of your teeth and gums.
• Help and encourage them to get enough sleep. Explain that lack of sleep may increase the risk of excess weight gain in children and young people. Give information on age-specific recommendations on sleep (see NHS information on sleep and on sleep problems in children).

(See also the Department of Health and Social Care's physical activity guidelines for disabled children and disabled young people, NICE's guideline on physical activity for children and young people, NHS advice on fussy eaters and the Scientific Advisory Committee on Nutrition report on feeding young children aged 1 to 5 years.) [2015, amended 2025]

Tailoring messages for specific groups
1.3.8
Ensure information is clear, consistent, specific, non-judgemental to avoid weight stigma and tailored to the person's needs. See also the recommendations on discussion, communication and follow up in this guideline and the recommendation on conveying messages to the local population in NICE's guideline on type 2 diabetes prevention. [2015]

All settings
1.4.1
Focus interventions to increase physical activity on activities that:

• fit easily into people's everyday life (such as walking)
• are tailored to people's individual preferences and circumstances
• aim to improve people's belief in their ability to change (for example, by motivational interviewing and discussing positive effects).
• Give ongoing support (including appropriate written materials) in person or by phone, letter, email or online and social media resources. [2006]

1.4.2
Offer individually tailored, multicomponent interventions and ongoing support to improve diet (and reduce energy intake). For example, interventions that include dietary modification, targeted advice, family involvement and goal setting. [2006]

1.4.3
Ensure that interventions to prevent obesity, including promotional, awareness-raising activities, are part of a long-term, multicomponent intervention rather than one-off activities, and are accompanied by targeted follow up with different population groups. [2006]

1.4.4
At times when weight gain is more likely, such as after pregnancy, around menopause and when stopping smoking, ask permission to discuss weight, dietary intake and activity. If they agree, give them:

• information on services that provide advice on prevention and management of overweight and obesity
• general advice on long-term overweight and obesity management, in particular encouraging increased physical activity. [2006]

1.4.5
Actively involve family and carers in all actions aimed at preventing excess weight gain, optimising nutritional intake and increasing activity levels in children and young people. [2006]

Community settings
1.4.6
Support and promote community schemes and facilities that improve access to physical activity, such as walking or cycling routes, combined with tailored information, based on an audit of local needs. [2006]

1.4.7
Support and promote behavioural change programmes along with tailored advice to help people become more active, for example by walking or cycling instead of driving or taking the bus. [2006]

1.4.8
Offer ongoing support from an appropriately trained healthcare professional to families of children and young people identified as being at high risk of obesity, such as children with at least 1 parent living with obesity. Think about individual as well as family-based interventions, depending on the age and maturity of the child. [2006]

Preschool, childcare and family settings
1.4.9
Ensure that any programme offered to prevent obesity in preschool, childcare or family settings includes a range of components (rather than focusing on parental education alone) to promote healthy eating and physical activity. These could include:

• interactive cookery demonstrations
• videos and group discussions on practical issues such as meal planning and shopping for food and drink
• interactive physical activity sessions
• videos and group discussions on practical issues such as ideas for physical activities opportunities for active play, safety and local facilities. [2006]

1.4.10
Ensure that family programmes offered to prevent obesity, improve dietary intake or increase physical activity levels provide ongoing, tailored support, incorporate a range of behaviour-change techniques and use non-stigmatising language and images (see NICE's guidance on behaviour change: individual approaches), and have a clear aim to improve health. [2006, amended 2025]

Managers and budget holders in local or regional strategic partnerships
1.5.1
Ensure a whole-systems approach to preventing and managing obesity is a priority at both strategic and delivery levels in all health and social care and community settings. Facilitate links between organisations to ensure that local public policies improve access to healthy foods and opportunities for physical activity and allocate dedicated resources for action to activities that:

• address both physical activity and diet
• use effective methods for encouraging and enabling behaviour change
• be targeted and tailored, using local knowledge (such as the Joint Strategic Needs Assessment or local surveys) to meet the needs of the population, recognising that some groups may need more support than others. [2006 and 2015]

1.5.2
Set an example as employers by developing policies to prevent and manage obesity in line with existing guidance and (in England) the local overweight and obesity strategy. In particular:

• promote healthy food and drink choices in on-site catering (for example by signs, posters, pricing and positioning of products)
• establish policies, facilities and information to promote physical activity, for example, through travel plans, by providing showers and secure cycle parking and by using signposting and improved décor to encourage stair use. [2006]

1.5.3
Ensure that systems are in place in primary care to implement the local overweight and obesity strategy. Enable health professionals with specific training, including public health practitioners working on their own or as part of multidisciplinary teams, to provide interventions to prevent and manage obesity. [2006]

1.5.4
Address barriers to healthcare professionals providing support and advice (such as internalised and societal weight stigma), particularly their concerns about the effectiveness of interventions, people's receptiveness and ability to change, and the impact of advice on relationships with the person. [2006, amended 2025]

1.5.5
Engage with the local community to identify environmental barriers to physical activity and healthy eating. This includes planning, transport and leisure services and should involve:

• an audit, with the full range of partners including local or regional strategic partnerships, residents, businesses and institutions
• assessing (ideally by doing a health impact assessment):
• how policies affect local people's opportunities to be physically active and eat a healthy diet
  • any barriers that may affect some groups of people differently, for example, because of their age, sex, socioeconomic status, ethnicity, religion, disability or weight stigma.
  • Address any barriers identified in this way. [2006, amended 2025]

1.5.6
Work with all parts of local or regional strategic partnerships to create and manage more safe spaces for incidental and planned physical activity. Address as a priority any concerns about safety, crime and inclusion, by:

• providing facilities such as cycling and walking routes, cycle parking, area maps and safe play areas
• making streets safer and reducing pollution, through measures such as traffic calming, congestion charging, pedestrian crossings, cycle routes, lighting and walking schemes
• ensuring buildings and spaces are designed to encourage people to be more physically active (for example, through positioning and signing of stairs, entrances and walkways)
• considering in particular people who need tailored information and support, especially groups who are vulnerable, or less likely to be active (this could include people with neurodevelopmental conditions or learning disabilities). [2006]

1.5.7
Provide tailored advice from local and transport authorities, such as personalised travel plans, to increase active travel. [2006]

1.5.8
Encourage, through the whole-systems approach, all local shops, supermarkets and caterers to promote healthy food and drink choices, for example by signs, posters, pricing and positioning of products, in line with existing good practice guidance and (in England) with the local overweight and obesity strategy. [2006]

1.5.9
Ensure that all community programmes to prevent overweight and obesity, increase activity levels and improve diet (and reduce energy intake) address the concerns of participants from the outset. These might include the availability of services and the cost of changing behaviour, an expectation that healthier foods do not taste as good, dangers associated with walking and cycling and confusion over mixed messages in the media about weight, diet and activity. Tailor messages to any local concerns and involve those with lived experience of overweight or obesity in developing and updating programmes. [2006, amended 2025]

1.5.10
Include awareness-raising promotional activities in community-based interventions, but ensure they are part of a longer-term, multicomponent intervention rather than one-off activities. [2006]

All early-years settings, nurseries, other childcare facilities and schools
1.6.1
Ensure that improving the nutrition and activity levels of children and young people is a priority for action in all early-years settings, nurseries, other childcare facilities and schools to help prevent excess weight gain. Use a whole-school approach to develop lifelong healthy eating, physical activity practices, emotional wellbeing, self-esteem and positive body image. [2025]

1.6.2
Involve families and carers in any action aimed at preventing excess weight gain, optimising nutritional intake or increasing activity levels in children in early-years settings, nurseries, other childcare facilities and schools. For example, through newsletters, and information about lunch menus and after-school activities. [2025]

1.6.3
Nurseries and other childcare facilities should:

• minimise sedentary activities during play time and provide regular opportunities for enjoyable active play and structured physical activity sessions
• adapt activities for children with special educational needs and disabilities (SEND)
• implement the Department for Education's Early years foundation stage statutory framework and Public Health England's guidance on early years: supporting healthy weight and nutrition
• follow government guidance on healthier food and drink provision
• follow advice in the Scientific Advisory Committee on Nutrition report: feeding young children aged 1 to 5 years, including being aware that larger portion sizes of snacks and meals are associated with higher food and energy intakes
• adapt catering choices to accommodate individual dietary needs, cultural preferences and beliefs (for examples, see the culturally adapted African and Caribbean Eatwell guide and South Asian Eatwell guide) while maintaining nutritional standards
• encourage the use of non-food-based rewards. [2025]

1.6.4
Ensure that children and young people in early-years settings, nurseries, other childcare facilities and schools eat regular, healthy meals (including packed lunches), drinks and snacks in a pleasant, sociable and inclusive environment free from other distractions (such as screens). Ensure that children and young people are given adequate time to finish their meals. [2025]

1.6.5
Supervise children at mealtimes and have staff eat with the children, if possible. For early-years settings, see the Department for Education's early-years foundation stage statutory framework. [2025]

1.6.6
Implement the Department for Education's school food standards practical guide and Public Health England's example menus for early years settings in England. [2025]

1.6.7
When planning school-based interventions to prevent overweight and obesity, take into account:

• the evidence for the intervention
• the views of children and young people
• any differences in preferences because of sex, culture or belief
• sensory needs
• ways to overcome potential barriers (such as cost or possible preconceptions children may have about the taste of healthier foods)
• the child or young person's school healthcare plan (if they have one). [2025]

1.6.8
Staff delivering physical education, sport and other physical activity in schools should:

• promote a range of activities that children and young people enjoy and can take part in outside school and into adulthood
• give children and young people the motivation and confidence to take part in physical activities and understand their value (sometimes called physical literacy)
• follow the UK Chief Medical Officers' physical activity guidelines and the Department of Health and Social Care's physical activity guidelines for disabled children and disabled young people
• adapt activities for children and young people with SEND. [2025]

Headteachers and chairs of governors of schools
1.6.9
In collaboration with parents and pupils, assess the whole school environment and ensure that the ethos of all school policies helps children and young people to maintain a healthier weight, eat a healthy diet and be physically active, in line with existing standards and guidance. This includes policies relating to:

• building layout and recreational spaces
• catering (including vending machines) and the food and drink pupils bring into school for themselves or others
• rewards or incentives (policies should cover avoiding ones based on food)
• the taught curriculum (including PE)
• school travel plans and provision for cycling
• bullying (including addressing bullying related to weight). [2006]

1.6.10
Ensure that teaching, support and catering staff understand the importance of healthy-school policies and how to support their implementation. [2006]

1.6.11
Ensure interventions are sustained, multicomponent and address the whole school, including after-school clubs and other activities. Short-term interventions and one-off events are insufficient on their own and should be part of a long-term integrated programme. [2006]

1.7.1
Occupational health staff and public health practitioners in workplaces should establish partnerships with local businesses to support the implementation of workplace programmes to prevent and manage overweight and obesity. [2006]

1.7.2
All workplaces, particularly large organisations such as the NHS and local authorities, should address preventing and managing overweight and obesity, because of the considerable impact on the health of the workforce and associated costs to business. Collaborate with local or regional strategic partnerships and ensure that action is in line with the local overweight and obesity strategy (in England). [2006]

1.7.3
Provide opportunities for staff to eat a healthy diet and be more physically active, through:

• active and continuous promotion of healthy choices in restaurants, hospitality, vending machines and shops for staff and clients, in line with Public Health England guidance on healthier and more sustainable catering; use tailored educational and promotional programmes to support this, which could include behavioural intervention or environmental changes (for example, food labelling or changes to availability)
• 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. [2006]

1.7.4
Ensure incentive schemes (such as policies on travel expenses, the price of food and drinks sold in the workplace and contributions to gym membership) that are used in a workplace are sustained and part of a wider programme to support staff in managing weight, improving dietary intake and increasing activity levels. [2006]

1.7.5
Ensure that any health checks provided for staff offer an opportunity to discuss weight, dietary intake and activity, and provide appropriate ongoing support. [2006]

1.8.1
Ensure healthcare professionals are aware that people from some ethnic minority backgrounds are prone to central adiposity and so are at an increased risk of chronic weight-related health conditions at a lower BMI. [2025]

1.8.2
Ensure people from these ethnic minority backgrounds (and the families and carers of children and young people from these backgrounds) are aware that they are prone to central adiposity and so are at an increased risk of chronic weight-related health conditions at a lower BMI. Explain these risks in an inclusive and non-stigmatising way. [2025]

1.8.3
Use existing community networks for people from ethnic minority backgrounds to share information on the increased risks these groups face at a lower BMI. See recommendation 1.9.11 for information about these risks. See NICE's guideline on community engagement: improving health and wellbeing and reducing health inequalities. [2025]

See also the section on classifying overweight, obesity and central adiposity in adults.

When to take and record measurements in adults
1.9.1
Avoid attributing all symptoms to overweight or obesity (diagnostic overshadowing). If the person is presenting with another health problem or condition (such as hip pain), address this problem or condition first before deciding whether it is appropriate to ask permission to discuss weight. [2025]

1.9.2
Ask for permission each time before discussing overweight, obesity or central adiposity and before taking measurements. See the section on discussion, communication and follow up for steps to think about before discussing overweight, obesity and central adiposity and how to ensure discussions are sensitive and non-judgemental. [2025]

1.9.3
If permission is given, use suitable opportunities to measure and record a person's:

• height
• weight
• waist circumference in people with BMI below 35 kg/m2 so that waist-to-height ratio can be calculated.

Opportunities could include registration with a GP, routine consultation for long-term conditions, and other routine health checks. [2025]

1.9.4
Ensure that records are kept up to date and shared between providers, if possible and with permission, for people who have self-referred to overweight and obesity management interventions. [2025]

How to take measurements in adults
1.9.5
Encourage adults with a BMI below 35 kg/m² to:

• measure their own waist-to-height ratio to assess central adiposity
• seek advice and further clinical assessments (such as a cardiometabolic risk factor assessment) from a healthcare professional if the measurement indicates an increased health risk.

Explain to people that to accurately measure their waist and calculate their own waist-to-height ratio, they should follow the advice in box 1. [2022]

1.9.6
Direct people to resources that give advice on how to measure waist circumference and waist-to-height ratio, such as the video guide on the NHS obesity page. See recommendations 1.9.10 and 1.9.11 in the section on classifying overweight, obesity and central adiposity in adults for how to interpret waist-to-height ratio. [2022]

Measures of overweight, obesity and central adiposity in adults
1.9.7
Use BMI as a practical measure of overweight and obesity (see the NHS BMI calculator for adults). Interpret it with caution because it is not a direct measure of central adiposity. [2022]

1.9.8
In adults with BMI below 35 kg/m2, measure and use their waist-to-height ratio, as well as their BMI, as a practical estimate of central adiposity and use these measurements to help to assess and predict health risks (for example, type 2 diabetes, hypertension or cardiovascular disease). [2022]

1.9.9
Do not use bioimpedance as a substitute for BMI as a measure of general adiposity in adults. [2006, amended 2014]

Classifying overweight, obesity and central adiposity in adults
1.9.10
Classify the degree of overweight or obesity in adults as follows, if they are not in the groups covered by recommendation 1.9.11:

• healthy weight: BMI 18.5 kg/m2 to 24.9 kg/m2
• overweight: BMI 25 kg/m2 to 29.9 kg/m2
• obesity class 1: BMI 30 kg/m2 to 34.9 kg/m2
• obesity class 2: BMI 35 kg/m2 to 39.9 kg/m2
• obesity class 3: BMI 40 kg/m2 or more.

Use clinical judgement when interpreting the healthy weight category because a person in this category may nevertheless have central adiposity. See Public Health England's guidance on obesity and weight management for people with learning disabilities for information on reasonable adjustments that may need to be made. [2022]

1.9.11
People with a South Asian, Chinese, other Asian, Middle Eastern, Black African or African–Caribbean background are prone to central adiposity and their cardiometabolic risk occurs at lower BMI, so use lower BMI thresholds as a practical measure of overweight and obesity:

• overweight: BMI 23 kg/m2 to 27.4 kg/m2
• obesity: BMI 27.5 kg/m2 or above.

For people in these groups, obesity classes 2 and 3 are usually identified by reducing the thresholds highlighted in recommendation 1.9.10 by 2.5 kg/m2. [2022]

1.9.12
Interpret BMI with caution in adults with high muscle mass because it may be a less accurate measure of central adiposity in this group. [2022]

1.9.13
Interpret BMI with caution in people aged 65 and over, taking into account comorbidities, conditions that may affect functional capacity and the possible protective effect of having a slightly higher BMI when older. [2022]

1.9.14
Classify the degree of central adiposity based on waist-to-height ratio as follows:

• healthy central adiposity: waist-to-height ratio 0.4 to 0.49, indicating no increased health risks
• increased central adiposity: waist-to-height ratio 0.5 to 0.59, indicating increased health risks
• high central adiposity: waist-to-height ratio 0.6 or more, indicating further increased health risks.

These classifications can be used for people with a BMI under 35 kg/m2 of both sexes and all ethnicities, including adults with high muscle mass.

The health risks associated with higher levels of central adiposity include type 2 diabetes, hypertension and cardiovascular disease. [2022]

1.9.15
When talking to a person about their waist-to-height ratio, explain that they should try and keep their waist to less than half their height (so a waist-to-height ratio of under 0.5). [2022]

Assessing and managing comorbidities in adults
1.9.16
After the initial assessment of overweight or obesity, identify any comorbidities and other factors that may affect or be affected by the person's weight. Take into account the timing of the assessment, the degree of overweight or obesity, and the results of previous assessments. [2006]

1.9.17
Start managing comorbidities as soon as they are identified; do not wait until the person has lost weight. [2006]

When to take and record measurements in children and young people
1.10.1
Ensure there are processes to identify children and young people with overweight and obesity in addition to the National Child Measurement Programme and the Healthy Child Programme, particularly for children and young people outside the age groups covered by these programmes, and children not in mainstream state education. [2025]

1.10.2
Avoid attributing all symptoms to overweight or obesity (diagnostic overshadowing). If the child or young person is presenting with another health problem or condition (such as asthma) address this problem or condition first before deciding whether it is appropriate to ask permission to discuss weight. [2025]

1.10.3
Ask the family or carer and the child or young person for permission before discussing overweight, obesity or central adiposity and before taking measurements. (Also see NICE's guideline on babies, children and young people's experiences of healthcare.) [2025]

1.10.4
If there is a suitable opportunity, ask permission to record an up-to-date measure of a child or young person's height and weight. Potentially suitable opportunities could include routine health checks and non-urgent appointments (such as immunisation appointments). See the section on general principles of care for steps to take before discussing overweight and obesity and on ensuring discussions are sensitive and non-judgemental. [2025]

1.10.5
Consider measuring a child or young person's waist circumference and calculating waist-to-height ratio to predict health risks associated with central adiposity. See recommendation 1.10.10 on using waist-to height ratio in children and young people and defining the degree of central adiposity, and see box 1 for how to measure waist-to-height ratio. [2025]

1.10.6
Ensure that records are kept up to date, if possible, for children and young people and their family and carers who have self-referred to overweight and obesity management interventions. [2025]

Measures of overweight, obesity and central adiposity in children and young people
1.10.7
Use BMI as a practical estimate of overweight and obesity in children and young people, and ensure that charts used are:

• appropriate for children and young people and
• adjusted for age and sex.

Interpret BMI with caution because it is not a direct measure of central adiposity. Use the NHS BMI healthy weight calculator, Royal College of Paediatrics and Child Health UK-World Health Organization (WHO) growth charts and BMI charts to plot and classify BMI centile. The childhood and puberty close monitoring (CPCM) form can also be used for continued BMI monitoring in children aged 2 and over, especially if puberty is either premature or delayed. Refer to special BMI growth charts for children and young people with Down's syndrome, if needed. [2022, amended 2025]

1.10.8
Do not use bioimpedance as a substitute for BMI as a measure of general adiposity in children and young people. [2006, amended 2014]

Classifying overweight, obesity and central adiposity in children and young people
1.10.9
Classify the degree of overweight or obesity in children and young people using the following classifications:

• overweight: BMI 91st centile + 1.34 standard deviations (SDs)
• clinical obesity: BMI 98th centile + 2.05 SDs
• severe obesity: BMI 99.6th centile + 2.68 SDs.

Use clinical judgement when interpreting BMI below the 91st centile, especially the healthy weight category in BMI charts because a child or young person in this category may nevertheless have central adiposity. [2022]

1.10.10
Classify the degree of central adiposity based on waist-to-height ratio in children and young people aged 5 years and over as follows:

• healthy central adiposity: waist-to-height ratio 0.4 to 0.49, indicating no increased health risk
• increased central adiposity: waist-to-height ratio 0.5 to 0.59, indicating increased health risk
• high central adiposity: waist-to-height ratio 0.6 or more, indicating further increased health risk.

These classifications can be used for children and young people aged 5 years and over of both sexes and all ethnicities.

The health risks associated with higher central adiposity levels include type 2 diabetes, hypertension and cardiovascular disease. [2022, amended 2026]


1.10.11
When talking to a child or young person aged 5 years or over, and their families and carers, explain that they should try and keep their waist to less than half their height (so a waist-to-height-ratio of under 0.5). [2022, amended 2026]

Assessing and managing comorbidities in children and young people
1.10.12
After the initial assessment of overweight or obesity, identify any comorbidities and other factors that may affect or be affected by the person's weight. Take into account the timing of the assessment, the degree of overweight or obesity, and the results of previous assessments. [2006]

1.10.13
Consider assessing comorbidities for children with a BMI at or above the 98th centile. [2006]

1.10.14
Start managing comorbidities as soon as they are identified; do not wait until the child or young person has lost weight. [2006]

Discussing the results with adults
1.11.1
Give adults information about the severity of their overweight or obesity and central adiposity and the impact this has on their risk of developing other long-term conditions (such as type 2 diabetes, cardiovascular disease, hypertension, dyslipidaemia, certain cancers and respiratory, musculoskeletal and other metabolic conditions such as non-alcoholic fatty liver disease). [2006, amended 2022]

1.11.2
Offer advice and discuss the possibility of referral to an overweight and obesity management service with the person, taking into account their individual needs and preferences (see also recommendation 1.11.6). [2025]

1.11.3
Address the drivers of overweight and obesity (for example, social context, mental health and wellbeing, and stigma) if possible. Refer as needed for assessment for any comorbidities, or to other services such as social care, physiotherapy, eating disorder services or the NHS diabetes prevention programme. [2025]

1.11.4
Discuss and agree realistic, personalised health goals (and any other related goals such as clothes fitting better, taking part in active play with children or grandchildren, finding it easier to breathe when walking or climbing stairs, being able to tie shoelaces or fasten a standard-length seatbelt). Include the importance and wider benefits of making sustainable, long-term changes to dietary behaviours and increasing physical activity levels. [2025]

Choosing interventions with adults
1.11.5
Ensure that healthcare professionals involved in identifying overweight, obesity and central adiposity are familiar with the local overweight and obesity management pathway, including:

• local and national behavioural overweight and obesity management interventions and what these may involve
• links to support services, such as mental health support
• referral criteria and process for funded referrals
• the capacity of services
• and are aware of services that are available locally and nationally. [2025]

1.11.6
Discuss and agree the type and level of intervention with adults who:

• are living with overweight or obesity or
• have increased health risk based on their waist-to-height ratio.

Take into account people's individual needs and preferences, and factors such as weight-related comorbidities, ethnicity, socioeconomic status, family medical history, eating disorders, disabilities including learning disabilities, neurodevelopmental conditions, and special educational needs and disabilities (SEND). See the sections on behavioural interventions, physical activity approaches, dietary approaches, medicines for overweight and obesity and surgical interventions. [2022, amended 2025]

1.11.7
Discuss any previous or ongoing overweight and obesity management interventions or attempts, including:

• acknowledging any progress the person has already made
• their positive or negative experiences with interventions
• any barriers, or concerns, they may have about making changes and meeting their personal goals
• any cultural and social context or assumptions about health and diet, and the impact of deviating from these to improve their health. [2025]

1.11.8
Identify available behavioural overweight and obesity management interventions that are:

• appropriate for the person, taking their preferences and previous experiences into account if possible
• culturally appropriate or have been adapted for different cultural communities and dietary practices
• tailored to specific demographic groups, such as men only or for older adults.
• Explain how these may be beneficial (for example, peer support). [2025]

1.11.9
Inform people if there are any known costs associated with taking part in the intervention or continuing it after a funded referral period has ended. [2025]

1.11.10
Emphasise the person's choice in the referral. Refer them to an in-person individual or group intervention, or digital services according to preference and availability. [2025]

1.11.11
Give people information about more sources of long-term community or healthcare support (for example, provided by social prescribers, health coaches, pharmacists, local support groups, online groups or networks, friends and family, Talking Therapies, free healthcare-endorsed apps, national campaigns, and local community groups such as walking or gardening groups). These can be used while waiting for and alongside an overweight and obesity management intervention. See NICE's guideline on behaviour change: digital and mobile health interventions. [2025]

Referring adults to specialist services
1.11.12
Offer a higher level of intervention to people with weight-related comorbidities (see the section on assessing and managing comorbidities in adults). Adjust the approach depending on the person's clinical needs, for example for people with a BMI over 35 kg/m2 who have recently developed diabetes or for people with a BMI of 50. [2022]

1.11.13
Consider referral to specialist overweight and obesity management services if:

• the underlying causes of overweight or obesity need to be assessed
• the person has complex disease states or needs that cannot be managed adequately in behavioural overweight and obesity management services (for example, the extra support needs of people with learning disabilities)
• less intensive management has been unsuccessful
• specialist interventions (such as a very-low-calorie diet) may be needed
• surgery or certain medicines is being considered.

For more information see specialist overweight and obesity services. [2006, amended 2025]

If an adult declines referral
1.11.14
If the person declines a referral to an intervention:

• acknowledge and respect their choice, being aware that a person's decision to accept referral may be temporarily or permanently influenced by many factors, including the wider determinants of overweight and obesity
• either explore the reason sensitively or delay discussion until an appropriate time
• ensure they have the opportunity to discuss referral again in future
• give them information about other ways to make sustainable, long-term changes to their dietary behaviours and physical activity levels. [2025]

1.11.15
Give people the opportunity for a re-referral, as needed, taking into account that overweight and obesity management is a long-term process. [2025]

Asking permission from children and young people, and their families and carers
1.12.1
Ask permission from children, young people, and their families and carers, before talking about the degree of overweight, obesity and central adiposity, and discuss it in a sensitive and age-appropriate manner. [2022]

Discussing the results with children and young people, and their families and carers
1.12.2
During discussions with a child or young person living with overweight or obesity, and their family or carers:

• explain the degree of overweight or obesity, and the health risks associated with a higher BMI
• encourage them to engage with overweight and obesity management
• advocate for the child's health proportionately to the degree of health risk. [2025]

1.12.3
Before deciding on behavioural overweight and obesity management interventions, address the drivers of overweight and obesity (for example, social context, mental health and wellbeing, and stigma) if possible. Refer as needed for assessment for any comorbidities, or to other services such as social care, physiotherapy, eating disorder services, or other physical or mental health and wellbeing support and early help services (for example youth work or parenting). [2025]

1.12.4
Discuss personalised goals and the importance and wider potential benefits of making sustainable, long-term changes to dietary behaviours and physical activity levels with children and young people (and their families and carers). Changes or goals could include:

• for children who are growing taller, avoidance of further weight gain and maintenance of weight whilst continuing to grow to reduce BMI centile is a realistic and appropriate goal
• for young people who have reached their near-final height, long-term behavioural changes that can help them reduce their weight (and explain that this can be a way to sustain a lower BMI)
• changes to diet and physical activity that can have positive health benefits, independent of any effect on weight or BMI
• improvements in psychosocial outcomes (such as sense of wellbeing, self-efficacy, self-esteem and self-perception) which are important health benefits
• personal goals such as feeling less breathless when playing with friends. [2025]

1.12.5
Use the local mental health pathway to access support if there are concerns about the child or young person's mental health and wellbeing. [2025]

Choosing interventions with children and young people, and their families and carers
1.12.6
Ensure you are familiar with the local overweight and obesity management pathway for children and young people, including:

• local and national behavioural overweight and obesity management interventions and what these may involve
• links to support services
• the referral criteria and the process for funded referrals
• the capacity of services. [2025]

1.12.7
Discuss any previous or ongoing overweight and obesity management interventions or attempts, including:

• acknowledging any progress the child or young person and their family have already made
• their positive or negative experiences with interventions
• barriers to or concerns they may have about:
  • joining an intervention
  • making changes
• how the child or young person feels about overweight and obesity management and common fears they may have (for example, about having changes in diet and activity imposed, or about being stigmatised)
• how the family or carers feel about overweight and obesity management
• any cultural and social context or assumptions about health and diet, and the impact of deviating from these to achieve better health. [2025]

1.12.8
Identify behavioural overweight and obesity management interventions that are:

• appropriate for the child or young person, taking the family's and carers preferences and previous experiences into account if possible
• culturally appropriate or have been adapted for different cultural communities and dietary practices
• tailored to particular demographic groups, such as specific age groups, to encourage peer support.
• Explain how these may be beneficial to the child, young person and their family. [2025]

1.12.9
Encourage children and young people and their families and carers to take part in decision making by discussing what the interventions involve and what to expect. This could include:

• giving information about the intervention, or about where they can get this information
• explaining that the more sessions they attend, the greater the likelihood of success
• explaining how they can take part, including whether or not they can self-refer
• giving information about any known costs associated with taking part in the intervention or continuing it after a funded referral period has ended
• understanding that their decision to accept the referral may be influenced temporarily or permanently by the wider determinants and the context of overweight and obesity.

Emphasise to the child, young person and families or carers that it is their choice whether to accept a referral. [2025]

1.12.10
Advise children, young people and their families and carers that behavioural overweight and obesity management interventions:

• may not reduce BMI in the long term without sustained behavioural changes, but that even a short-term reduction in BMI can improve health and wellbeing and reduce the risk of long-term conditions and comorbidities
• may focus on weight maintenance and growing into a healthier weight, rather than weight loss, depending on the age of the child or young person, their stage of growth and degree of overweight or obesity
• need to provide support for weight maintenance after the intervention, because overweight and obesity can be a long-term health issue and relapses are normal. [2025]

1.12.11
Refer only to behavioural overweight and obesity management interventions that offer longer-term support and maintenance advice to improve health and wellbeing if these are available locally. Make the referral alongside referral to other health and social care services that can help address the drivers of obesity. [2025]

1.12.12
Consider tailored interventions for children and young people:

• who are living with overweight or obesity or
• have increased health risk based on their waist-to-height ratio.

Take into account their individual needs and preferences, and factors such as weight-related comorbidities, ethnicity, socioeconomic status, social complexity (for example, looked-after children and young people), family medical history, mental and emotional health and wellbeing, developmental age, and SEND. See the sections on behavioural overweight and obesity management interventions, physical activity approaches, dietary approaches, medicines for overweight and obesity and surgical interventions. [2022]

Specialist services
1.12.13
Offer a higher level of intervention such as referral to specialist overweight and obesity management services, for example complications from excess weight clinics (CEW) (if available) or paediatric services to children and young people with weight-related comorbidities or who need specialist support. Adjust the approach depending on the child's clinical needs. see also the sections on medicines for children and young people and surgery for children and young people. [2022]

1.12.14
In specialist overweight and obesity management services, assess associated comorbidities and possible causes for children and young people who are living with overweight or obesity. Include investigations of:

• blood pressure
• lipid profile, preferably while fasting
• fasting insulin
• fasting glucose levels and oral glucose tolerance
• liver function
• endocrine function.
• Interpret the results of any tests used in the context of:
• the level of the child or young person's overweight or obesity
• the child's age
• any history of comorbidities
• possible genetic causes
• any family history of metabolic disease related to overweight or obesity. [2014]

1.12.15
Consider referral to an appropriate specialist for children and young people who are living with overweight or obesity and have significant comorbidities or complex needs (for example, SEND, physical disabilities or other extra support needs). [2006, amended 2014]

If a child or young person declines referral
1.12.16
If the child or young person and their family or carer are not ready or able to accept referral to a behavioural overweight and obesity management intervention:

• either explore the reason sensitively or delay discussion until an appropriate time
• ensure they have opportunities to discuss referral in the future and offer a follow-up appointment to monitor the child or young person's weight and reassess readiness and other options
• give them sources of information about how to make sustainable, long-term changes to their dietary behaviours and physical activity levels outside an intervention (see NHS Better Health advice)
• offer alternative interventions that include opportunities to be involved in healthy eating and physical activities such as walking or cycling groups, youth groups, cooking sessions and other children's and young people's activities (these may be delivered by community organisations or other local support). [2025]

Encouraging adherence to behavioural overweight and obesity management interventions for adults
These recommendations are for providers of behavioural overweight and obesity management services.

1.13.1
Discuss with the person any concerns or barriers that may affect their attendance and participation in the intervention (such as personal circumstances, cultural barriers, physical health needs, or neurodevelopmental or psychological factors), including those that affect their ability to make changes and their progress towards meeting their goals. Repeat these discussions during the course of the intervention if needed and acknowledge:

• any progress the person has made
• any positive or negative experiences with the intervention
• any cultural and social context or assumptions about health and diet, and the impact of deviating from these to improve their health. [2025]

1.13.2
If the person is facing difficulties that affect their attendance and participation in the intervention:

• discuss whether the programme is suitable for them at this time
• if it has not been possible to resolve their difficulties with the intervention agree what should happen next (for example, referral to another service, leave the intervention at an agreed time, or think about a re-referral at a later date). [2025]

1.13.3
Discuss with the person the importance of support from any other members of their household and others such as friends, family, and the other participants in group interventions. With their permission, talk to relevant household members about the intervention and how they can help. [2025]

1.13.4
Regularly review the person's health and progress they have made towards meeting their goals (including weight loss) and send feedback to the person's referring GP or healthcare professional (for adults who self-refer, ask permission before sending feedback to their GP). [2025]


Submitting audit data for adults
1.13.5
Submit data on results of behavioural overweight and obesity management interventions for a national audit scheme such as the National Obesity Audit (see the sections on reviewing success and data to collect). [2025]

Core components of behavioural overweight and obesity management interventions for children and young people
These recommendations are for providers of overweight and obesity management interventions.

1.14.1
Ensure behavioural overweight and obesity management interventions for children and young people include maintenance advice for those who have completed the intervention. [2025]

1.14.2
Ensure interventions are multicomponent, tailored to meet individual needs, and take into account the wider determinants and context of overweight and obesity (see recommendation 1.1.1 in the section on discussion, communication and follow up). [2025]

1.14.3

• Ensure interventions focus on:
• targeted diet modifications and
• healthy and nutritious eating habits (see the section on dietary approaches) and
• effective behaviour-change strategies to help the child, young person, their families and carers modify their behaviours, such as:
  • motivational techniques
  • setting goals and planning how to achieve them
  • giving feedback or rewards for progress
  • encouraging self-monitoring and building on success
  • teaching people strategies to implement changes
  • making it easier to make changes by reducing barriers and building life skills. [2025]

1.14.4
Consider including a physical activity component in interventions. This can focus on:

• reducing the amount of time spent being sedentary
• increasing physical activity, for example by taking part in active games, dancing and exercise (see the section on physical activity approaches). [2025]

1.14.5
Ensure behavioural overweight and obesity management interventions encourage all family members to eat healthily and to be physically active, regardless of their weight. [2025]

1.14.6
Maintain consistency of staff if possible throughout each cycle of the intervention. [2025]

Developing a tailored plan to meet individual needs
These recommendations are for providers of behavioural overweight and obesity management interventions.

1.14.7
Assess and record the child or young person's degree of overweight, obesity or central adiposity, obesity-associated comorbidities and mental health and wellbeing (including whether their weight is a consequence of circumstances that have affected their mental wellbeing), in particular for those who:

• have self-referred to the intervention
• have not been assessed by a healthcare professional.

See the section on measures of overweight, obesity and central adiposity in children and young people. [2025]

1.14.8
Inform the child or young person's GP if any concerns are identified (for example, obesity-related comorbidities or mental wellbeing). [2025]

1.14.9
Refer to the local mental health pathway if there are concerns at any stage of the intervention that the child or young person's mental wellbeing is affected by their weight, that mental health is affecting their weight or the circumstances that influence their weight, or an eating disorder is suspected. [2025]

1.14.10
Give children and young people opportunities to discuss issues such as self-esteem, self-perception (including any history of bullying or teasing) and any previous attempts to manage their weight, either in a group or one-to-one setting. [2025]

1.14.11
Agree goals that can be realistically achieved over the duration of the intervention. [2025]

1.14.12
Include families and carers as well as children and young people (depending on their ability and stage of development), in discussions about situations in which it would be possible to:

• improve dietary intake and eating patterns and behaviours
• reduce sedentary behaviour. [2025]

1.14.13
Agree dietary changes that are age appropriate, affordable, culturally sensitive and consistent with healthy eating advice, and take into account the child or young person's preferences. [2025]

1.14.14
Ensure nutrient needs for growth and development are met by including healthier choices, in appropriate amounts, from each of the food groups. [2025]

1.14.15
Consider increasing the amount and types of moderate-to-vigorous-intensity physical activity during the intervention. [2025]

1.14.16
Engage with families and carers as well as children and young people (depending on their ability and stage of development), to regularly compare progress against their goals and provide feedback. [2025]

1.14.17
Praise progress and achievements and update goals as the child or young person progresses throughout the intervention. [2025]

1.14.18
If the child or young person is not meeting their goals, discuss the possible reasons for this and modify the goals if necessary. [2025]

1.14.19
Stress the importance of maintaining changes, no matter how small, over the longer term. [2025]

1.14.20
Encourage the family and carers, and the child or young person (depending on their ability and stage of development), to take up offers of ongoing support (see the sections on ongoing support from providers of overweight and obesity management interventions and ongoing support from healthcare and other professionals). [2025]

Care for the wider family
1.14.21
Offer assessment of overweight, obesity or central adiposity to families and carers. [2013]

1.14.22
Emphasise that the behavioural overweight and obesity management intervention may benefit the whole family. [2013]

1.14.23
Offer information about local and national behavioural overweight and obesity management interventions to family members and carers who are living with overweight or obesity. [2013]

Also see the sections on dietary approaches and physical activity approaches for children and young people.

Encouraging adherence to behavioural overweight and obesity management interventions for children and young people
These recommendations are for providers of overweight and obesity management interventions.

1.14.24
Consider both individual and group interventions, based on the child or young person's needs and those of their family and carers. For example, some families may prefer to attend individual sessions initially and then group sessions as the child or young person's confidence and self-esteem grows. Think about whether a young person may respond better if their sessions are separate from those for their family and carers. [2025]

1.14.25
Offer interventions that are accessible and convenient by:

• using venues that have the necessary facilities, are easily accessible by public transport, and where the child or young person and their family or carers feel comfortable
• offering times that are convenient for families with children of different ages, working family members and carers
• adopting a flexible approach so that participants can accommodate other commitments. [2025]

1.14.26
Maintain regular contact with families and carers, and review progress towards meeting individual goals (including weight). [2025]

1.14.27
Promptly follow up those who miss sessions to establish why, ensure safeguarding, and encourage re-engagement. Focus on participants from groups likely to be affected by health inequalities and those who miss sessions early in the intervention. [2025]

1.14.28
Discuss with the families and carers the importance of their support and readiness to adhere to the intervention. [2025]

1.14.29
Discuss with the child or young person, and their family and carers, their views and experiences of the intervention. [2025]

1.14.30
Discuss with families and carers any issues they may be facing that may affect their attendance and participation in the intervention. Explore any reasons beyond the family's control, such as unemployment, financial difficulties or caring responsibilities. See recommendation 1.12.7 on discussing any previous or ongoing overweight and obesity management interventions or attempts. [2025]

1.14.31
If it has not been possible to resolve a child or young person's difficulties with the intervention, or those of the family or carers, (for example, their attendance or participation) agree what should happen next. For example, they could be referred to another service, leave the intervention at an agreed time, or think about a re-referral at a later date. See NICE's guidance on making decisions using NICE guidelines for more information about safeguarding. [2025]

Ongoing support from providers of overweight and obesity management interventions
These recommendations are for providers of overweight and obesity management interventions.

1.14.32
Offer a range of options for follow-up sessions after the intervention active phase has been completed. This should include at different times and in easily accessible and suitable venues. [2025]

1.14.33
Discuss with the child or young person, their family and carers any local services and activities that can provide further long-term support to help them manage their weight, for example, local leisure services and walking, cycling or youth groups. [2025]

Ongoing support from healthcare and other professionals
1.14.34
Use information from the intervention provider (such as change in weight, BMI centile or waist-to-height ratio, reported improvements to fitness and mental wellbeing) and continue to measure when appropriate to help monitor progress and give ongoing tailored support. [2025]

1.14.35
Offer support and follow-up sessions, depending on the needs of the child or young person and their family and carers. [2025]

1.14.36
Give children and young people, and their family and carers, information about any other local sources of long-term support as part of a multidisciplinary team approach. These could include support from a Registered dietitian or registered nutritionist, youth worker, school nurse, family support worker, local support group, online groups or networks, friends and family, free healthcare-endorsed apps, national programmes, charities, helplines, and community groups (such as local leisure services or sports clubs). [2025]

1.14.37
If the child or young person's BMI centile and SD (see recommendations 1.10.9 and 1.10.10 on classifying overweight, obesity and central adiposity in children and young people) begins to increase, or if they or their family or carers express concerns about their weight and health (or sustaining changes in their behaviour):

• discuss the possible reasons for these
• offer another referral to an alternative overweight and obesity management intervention that may better address the needs of the child or young person, and those of their family and carers (this could include re-referral to a service they have used before)
• if the child or young person has any comorbidities, ensure they get support from paediatric services or specialist overweight and obesity management services (if eligible). [2025]

Submitting audit data for children and young people
1.14.38
Submit data on behavioural overweight and obesity management interventions for a national audit scheme such as the National Obesity Audit (see the sections on reviewing success and on data to collect). [2025]

See also the recommendations on physical activity in the section on behavioural overweight and obesity management interventions.

Staff qualifications
1.15.1
Ensure staff leading supervised physical activity sessions are qualified and insured, for example, a physiotherapist or a practitioner member of the CIMSPA (Chartered Institute for the Management of Sport and Physical Activity). Ensure that people running children's sessions have a paediatric CPR qualification. [2014, amended 2025]

Physical activity approaches for adults
1.15.2
Encourage adults to increase their physical activity even if they do not lose weight as a result, because of the other health benefits it can bring. Encourage them to meet the recommendations in the UK Chief Medical Officers' physical activity guidelines for weekly activity. See NHS advice on treating obesity [2006]

1.15.3
Advise that to prevent obesity, most people may need to do 45 to 60 minutes of moderate-intensity physical activity a day, particularly if they do not reduce their energy intake. Advise people who have lived with obesity and have lost weight that they may need to do 60 to 90 minutes of activity a day to avoid regaining weight. (See NHS advice on treating obesity.) [2006]

1.15.4
Encourage adults to build up to the recommended activity levels for weight maintenance, using a managed approach with agreed goals. Recommend:

• activities as part of everyday life, such as brisk walking, gardening or cycling (see NICE's guideline on walking and cycling)
• supervised exercise programmes
• other activities, such as swimming, aiming to walk a certain number of steps each day, or stair climbing.
• Take into account the person's current physical fitness and ability for all activities. Encourage people to also reduce the amount of time they spend inactive, such as leisure-based screen time. [2006]

Physical activity approaches for children and young people
1.15.5
Encourage children and young people to increase their level of physical activity, even if they do not lose weight as a result, because of the other health benefits physical activity can bring. Encourage them to meet the recommendations in the UK Chief Medical Officers' physical activity guidelines for daily activity, NHS physical activity guidelines for children and young people and the Department of Health and Social Care's physical activity guidelines for disabled children and disabled young people. [2006, amended 2025]

1.15.6
Be aware that children who are already living with overweight or obesity may need to do more than the standard recommended amount of activity. [2006, amended 2014]

1.15.7
Give children the opportunity and support to both include more physical activity in their daily lives (for example, walking, cycling, using the stairs and active play; see also NICE's guideline on walking and cycling) and to do more regular, structured physical activity (for example football, swimming or dancing). Agree the choice of activity with the child, and ensure it is appropriate to the child's interests, ability and confidence and is affordable for the family (see the UK Chief Medical Officers' physical activity guidelines for ideas of free activities). [2006, amended 2025]

Dietary approaches for all ages
1.16.1
Use a flexible and individualised approach to tailor dietary interventions to achieve nutritional balance while reducing energy intake, taking into account:

• food preferences (including cultural preferences)
• personal circumstances (such as home environment and family finances)
• any comorbidities (such as eating disorders or disordered eating, type 1 diabetes, inflammatory bowel disease or non-alcoholic fatty liver disease)
• any restrictions in the range of foods they eat (for example because of neurodiversity, sensory problems, or coeliac disease)
• that in many cases weight regain may happen. [2025]

1.16.2
Encourage people to improve their dietary intake even if this does not result in them losing weight, because there can be other health benefits (for example, improved lipid profile and reduced risk of type 2 diabetes and cardiovascular disease). [2025]

1.16.3
Ensure that dietary approaches for adults to support overweight and obesity management keep the person's total energy intake below their energy expenditure (also called an energy deficit or calorie deficit). This could be done by lowering specific macronutrient content (for example, low-fat or low-carbohydrate diets) or using other methods to limit overall energy intake. [2025]

1.16.4
Ensure that dietary approaches for children and young people keep their total energy intake at or below the recommended daily calorie intake for their age and sex, depending on their level of overweight or obesity and any weight-related comorbidities. Focus on healthy eating rather than on overly restrictive diets. See the Scientific Advisory Committee on Nutrition guidance on feeding young children aged 1 to 5 years. [2025]

1.16.5
Ensure that any dietary approaches that maintain an energy deficit are offered with support (for example by an appropriately trained healthcare professional such as a Registered dietitian or registered nutritionist) and follow up to help people maintain any weight loss in the long term. [2025]

1.16.6
Encourage people to eat a nutritionally balanced diet in the long term, consistent with other healthy eating advice. See the NHS Eatwell guide. [2025]

1.16.7
Advise people not to use restrictive diets that are nutritionally unbalanced, because they are ineffective in the long term and can be harmful. [2025]

Intermittent fasting in adults
See the NICE recommendation for research about intermittent fasting in adults.

Low-energy and very-low-energy diets for adults
1.16.8
Consider low-energy diets (800 to 1,200 kilocalories per day, also known as low-calorie diets) only as part of a multicomponent overweight and obesity management strategy with long-term support within a specialist overweight and obesity management service (or other services for the management of long-term conditions such as type 2 diabetes) for people:

• living with obesity (with or without diabetes) or
• living with overweight and with type 2 diabetes.

See the recommendations on classifying overweight, obesity and central adiposity in adults. [2025]

1.16.9
Consider very-low-energy diets (under 800 kilocalories per day, also known as very-low-calorie diets) only as part of a multicomponent strategy within a specialist overweight and obesity management service, for people who:

• are living with obesity and
• have a clinically assessed need to lose weight rapidly (for example, to make surgery safer and more feasible). [2025]

1.16.10
Do not use low-energy diets or very-low-energy diets as a long-term strategy to manage obesity. [2025]

1.16.11
Ensure that low-energy and very-low-energy diets:

• are nutritionally complete
• last no more than 12 weeks
• include ongoing clinical support and supervision, with access to support from an appropriately trained Registered dietitian or registered nutritionist, and advice on reintroducing a wider range of foods (for example, moving on to a nutritionally balanced diet for long-term and sustainable weight loss maintenance). [2025]

1.16.12
Before starting someone on a low-energy or very-low-energy diet as part of a multicomponent overweight and obesity management strategy:

• Explain that this is a restrictive diet with a specific health goal (such as improvement in diabetes) and risks (such as weight cycling, weight regain and potential adverse events, and for very-low-energy diets also the risk of constipation, fatigue and hair loss).
• Explain that this is not a long-term overweight and obesity management strategy in its own right as it must be followed by lifelong dietary energy intake control and appropriate physical activity levels.
• Discuss:
  • that weight regain is likely to happen, and if it does it is not because they or their healthcare professional have 'failed'
  • reintroducing a wider range of foods after a low-energy or very-low-energy diet
  • the options for long-term weight loss maintenance support or therapies (including nutritional advice, physical activity, medicines or surgery) if weight regain happens.
• Offer assessment and counselling if they may have eating disorders or other mental health issues, to ensure the diet is appropriate for them.
• Review any medicines they are taking and discuss any changes that may need to be made. [2025]

Dietary approaches for children and young people
1.16.13
Avoid a dietary approach alone. Ensure dietary recommendations are part of a multicomponent intervention and are age appropriate and consistent with healthy eating advice. [2006]

Medicines for adults
This section contains a table of medicines for weight management, which includes NICE technology appraisal guidance.

1.17.1
After dietary, exercise and behavioural approaches have been started and evaluated in adults living with overweight or obesity, see the weight management medicines options listed in table 1. [2006, amended 2025]

1.17.2
All medicines for weight management should be used alongside a reduced-calorie diet and increased physical activity. [2025]

1.17.3
Make the decision to start medicines after discussing them with the person, and discussing the potential impact on their motivation. Arrange information, support and counselling on additional diet, physical activity and behavioural strategies when medicines are prescribed, and give information on patient support programmes. [2006, amended 2014]

Continued prescribing and withdrawal for adults
1.17.4
If there is concern about micronutrient intake adequacy, consider a supplement providing the reference nutrient intake for all vitamins and minerals, particularly for older people (who may be at risk of malnutrition) and young people (who need vitamins and minerals for growth and development). [2006]

1.17.5
Offer support to help maintain weight loss to people who are stopping weight management medicines. [2006]

Monitoring weight management medicines in adults
1.17.6
Monitor the effect of medicines and reinforce behavioural advice and adherence through regular review. [2006, amended 2014]

1.17.7
When agreeing goals with someone with type 2 diabetes, take into account that their weight loss may be slower than that of people without the condition. Review their goals regularly. [2006]

Medicines for children and young people
1.17.8
Weight management medicines are not generally recommended for children younger than 12 years. [2006]

1.17.9
In children younger than 12 years, medicines may be used only in exceptional circumstances, if severe comorbidities are present. Prescribing should be started and monitored only in specialist paediatric settings. See also the NICE guideline on the diagnosis and management of diabetes in children and young people. [2006, amended 2014]

1.17.10
In children aged 12 years and older, treatment with orlistat is recommended only if physical comorbidities (such as orthopaedic problems or sleep apnoea) or severe psychological comorbidities are present, and if started in a specialist paediatric setting by a multidisciplinary team with expertise in:

• prescribing in this age group
• monitoring medicines
• psychological support
• behavioural interventions
• interventions to increase physical activity
• interventions to improve dietary intake. [2006, amended 2014]

In June 2023, this was an off-label use of orlistat. See NICE's information on prescribing medicines.

1.17.11
Medicines may be continued in primary care, for example with a shared-care protocol, if local circumstances or licensing allow. [2006, amended 2014]

Continued prescribing and withdrawal for children and young people
1.17.12
Follow the recommendations on continued prescribing and withdrawal for adults. [2023]

1.17.13
If orlistat is prescribed for children and young people, a 6- to 12‑month trial is recommended, with regular review to assess effectiveness, adverse effects and adherence.

In June 2023, this was an off-label use of orlistat. See NICE's information on prescribing medicines. [2006, amended 2014]

Also see NICE's interventional procedures guidance on endoscopic sleeve gastroplasty for obesity.

When to refer adults for assessment for bariatric surgery
1.18.1
Offer adults a referral for a comprehensive assessment by specialist overweight and obesity management services providing multidisciplinary management of obesity, to see whether bariatric surgery is suitable for them if they:

• have a BMI of 40 kg/m2 or more, or between 35 kg/m2 and 39.9 kg/m2 with a significant health condition that could be improved if they lost weight (see box 2 for examples) and
• agree to the necessary long-term follow up after surgery (for example, lifelong annual reviews). [2023]

1.18.2
Consider referral for people of South Asian, Chinese, other Asian, Middle Eastern, Black African or African–Caribbean background using a lower BMI threshold (reduced by 2.5 kg/m2) than in recommendation 1.9.1, to account for the fact that these groups are prone to central adiposity and their cardiometabolic risk occurs at lower BMI. [2023]

When to offer expedited assessment
1.18.3
Offer an expedited assessment for bariatric surgery to people:

• with a BMI of 35 kg/m2 or more who have recent-onset (diagnosed within the past 10 years) type 2 diabetes and
• as long as they are also receiving, or will receive, assessment in a specialist overweight and obesity management service. [2014]

1.18.4
Consider an expedited assessment for bariatric surgery for people:

• with a BMI of 30 to 34.9 kg/m2 who have recent-onset (diagnosed within the past 10 years) type 2 diabetes and
• who are also receiving, or will receive, assessment in a specialist overweight and obesity management service. [2014]

1.18.5
Consider an expedited assessment for bariatric surgery for people of South Asian, Chinese, other Asian, Middle Eastern, Black African or African–Caribbean background using a lower BMI threshold (reduced by 2.5 kg/m2) than in recommendation 1.9.4, to account for the fact that these groups are prone to central adiposity and their cardiometabolic risk occurs at lower BMI. [2014, amended 2023]

Initial assessment and discussions with the multidisciplinary team
1.18.6
Ensure the multidisciplinary team within a specialist overweight and obesity management service includes or has access to health and social care professionals who have expertise in conducting medical, nutritional, psychological and surgical assessments in people living with obesity and are able to assess whether surgery is suitable. [2023]

1.18.7
Carry out a comprehensive, multidisciplinary assessment for bariatric surgery based on the person's needs. As part of this, assess:

• the person's medical needs (for example, existing comorbidities)
• their nutritional status (for example, dietary intake, and eating behaviours)
• any psychological needs that, if addressed, would help ensure surgery is suitable and support adherence to postoperative care requirements
• their previous attempts to manage their weight, and any past response to an overweight and obesity management intervention (such as one provided by a specialist overweight and obesity management service)
• any other factors that may affect their response after surgery (for example, language barriers, learning disabilities and neurodevelopmental conditions, deprivation and other factors related to health inequalities)
• whether any individual arrangements need to be made before the day of the surgery (for example if they need extra dietary or psychological support, or support to manage existing or new comorbidities)
• fitness for anaesthesia and surgery. [2023]

1.18.8
The hospital specialist or bariatric surgeon should discuss the following with people who are thinking about having bariatric surgery:

• the potential benefits
• plans for conception and pregnancy (for women and trans and non-binary people of childbearing age)
• the longer-term implications and requirements of surgery
• the potential risks, including perioperative mortality, and complications.

Include the person's family and carers in the discussion, if appropriate. [2006, amended 2023]

1.18.9
Choose the surgical intervention jointly with the person, taking into account:

• the severity of obesity and any comorbidities
• the best available evidence on effectiveness and long-term effects
• the facilities and equipment available
• the experience of the surgeon who would perform the operation. [2006]

1.18.10
Give the person information on:

• appropriate dietary intake after the bariatric procedure
• monitoring their macronutrient and micronutrient status
• individualised nutritional supplementation, and sources of support and guidance for long-term weight loss and weight maintenance
• patient support groups. [2006, amended 2023]

Preoperative assessment and discussions
1.18.11
Carry out a comprehensive preoperative assessment of any psychological or clinical factors that may affect adherence to postoperative care requirements (such as changes to dietary intake, eating behaviours and taking nutritional supplements) before performing surgery. [2006, amended 2014]

Medicines while waiting for surgery
1.18.12
Medicines may be used to maintain or reduce weight before surgery for people who have been recommended surgery, if the waiting time is excessive. See the section on medicines for overweight and obesity. [2006, amended 2023]

Multidisciplinary team qualifications and hospital equipment in surgical settings
1.18.13
The surgeon in the multidisciplinary team should have:

• had relevant, supervised training
• specialist experience in bariatric surgery. [2006, amended 2014]

1.18.14
Ensure the multidisciplinary team carrying out bariatric surgery can provide:

• preoperative assessment, including a risk-benefit analysis that includes preventing complications of obesity
• specialist assessment for eating disorders (and if appropriate, referral or signposting to specialist eating disorder services)
• information on the different procedures, including potential weight loss and possible risks
• regular postoperative assessment, including specialist dietetic and surgical follow up (see recommendation 1.18.17 on postoperative and longer-term follow-up care)
• management of comorbidities
• specialist psychological support before and after surgery (for example, a psychological assessment before surgery and, if appropriate, referral to specialist mental health services either before or after surgery)
• information on plastic surgery (such as apronectomy) if appropriate. [2006, amended 2023]

1.18.15
Hospitals undertaking bariatric surgery should ensure there is access to, and staff trained to use, suitable equipment, including but not limited to weighing scales, blood pressure cuffs, theatre tables, walking frames, commodes, hoists, bed frames, pressure-relieving mattresses and seating suitable for people having bariatric surgery. [2006, amended 2023]

1.18.16
Only surgeons with extensive experience should undertake revisional surgery (if the first operation has not been effective) in specialist centres because of the higher rate of complications and increased mortality of revision surgery compared with primary surgery. [2006]

Postoperative and longer-term follow-up care
1.18.17
Offer people who have had bariatric surgery a follow-up care package for a minimum of 2 years within the bariatric service. Include:

• monitoring nutritional intake, (including protein and vitamins) and mineral deficiencies
• monitoring for comorbidities
• medications review
• individualised dietary and nutritional assessment, advice and support
• advice and support on physical activity
• psychological support tailored to the person
• information about professionally led or peer-support groups. [2014]

1.18.18
After discharge from follow up by the bariatric surgery service, ensure people are offered at least annual monitoring of nutritional status and appropriate supplementation after bariatric surgery, as part of a shared-care model with primary care. [2014]

Audit of bariatric surgery
1.18.19
Arrange a prospective audit so that the outcomes and complications of different procedures, the impact on quality of life and nutritional status, and the effect on comorbidities can be monitored in both the short and the long term. (The National Bariatric Surgery Registry conducts national audits for agreed outcomes.) [2006, amended 2014]

1.18.20
The surgeon in the multidisciplinary team should submit data for a national clinical audit scheme such as the National Bariatric Surgery Registry. [2006, amended 2014]

Surgery for children and young people
1.18.21
Surgery for obesity is not generally recommended in children or young people. [2006]

1.18.22
Surgery for obesity may be considered for young people only in exceptional circumstances, and if they have achieved or nearly achieved physiological maturity. [2006]

1.18.23
Surgery for obesity should be undertaken only by a multidisciplinary team that can provide paediatric expertise in:

• preoperative assessment, including a risk-benefit analysis that includes preventing complications of obesity
• specialist assessment for eating disorders (and, if appropriate, referral or signposting to specialist eating disorder services)
• information on the different procedures, including potential weight loss and possible risks
• regular postoperative assessment, including specialist dietetic and surgical follow up (see recommendation 1.18.17 on postoperative and longer-term follow-up care)
• management of comorbidities
• specialist psychological support before and after surgery (for example, a psychological assessment before surgery and, if appropriate, referral to specialist mental health services either before or after surgery)
• information on plastic surgery (such as apronectomy) if appropriate. [2006, amended 2023]

1.18.24
Hospitals undertaking paediatric bariatric surgery should ensure there is access to, and staff trained to use suitable equipment, including scales, theatre tables, walking frames, commodes, hoists, bed frames, pressure-relieving mattresses and seating suitable for young people having bariatric surgery. [2006, amended 2023]

1.18.25
Coordinate surgical care and follow‑up around the young person and their family's needs. Follow the approaches outlined in the Department of Health's healthy lives, healthy people: a call to action on obesity in England. [2006, amended 2014]

1.18.26
Ensure all young people have had a comprehensive psychological, educational, family and social assessment before undergoing bariatric surgery. [2006, amended 2014]

1.18.27
Perform a full medical evaluation, including genetic screening or assessment before surgery to exclude rare, treatable causes of obesity. [2006]

Planning and funding services and interventions
1.19.1
Identify an obesity partnership group to work on joint approaches to reduce obesity and overweight in line with Public Health England's 'Whole systems approach to obesity', Guide to commissioning and delivering tier 2 weight management services for adults, and Guide to commissioning and delivering tier 2 weight management services for children and their families. [2012, amended 2025]

1.19.2
Ensure overweight and obesity management services are accessible, with no upper limit on either BMI or age for referral. Include services suitable for people with different degrees of obesity and complexity of needs, including people with very high BMI, those aged 65 or over, people with learning disabilities or severe mental health conditions. [2025]

Key components of interventions
1.19.3
Commission or recommend overweight and obesity management interventions for adults that focus on effective overweight and obesity management and:

• are multicomponent, covering dietary intake, physical activity and behaviour change
• adopt a respectful, non-judgemental approach
• monitor weight and participants' personal goals throughout the programme
• monitor indicators that people are engaged and meeting their goals (for example for fruit and vegetable intake or amount of physical activity) and use a variety of methods to encourage behaviour change in relation to:
  • problem solving
  • goal setting
  • how to carry out a particular task or activity
  • helping the person identify sources of support (such as friends and family or workplace programmes)
  • self-monitoring of weight and behaviours that can affect weight
  • feedback from participants on their own progress and their views of the overall programme. [2014]

1.19.4
Commission or recommend interventions for adults that:

• include achievable goals for weight loss that are agreed for different stages, including goals for the first few weeks, end of the programme or referral period (and for 1 year)
• include specific dietary goals (for example, for a clear energy intake or a specific reduction in energy intake) in line with the Department of Health and Social Care advice on weight management and tailored to the person's needs (note: the price of any recommended dietary approaches should not be prohibitive; individual advice from a Registered dietitian or registered nutritionist may be beneficial)
• help the person track their weight and the progress they have made towards individual goals throughout. [2014]

1.19.5
Ensure interventions:

• include sustainable ways the person can reduce sedentary behaviour and fit more physical activity into everyday life over the long term (for example, walking)
• take any medical conditions the person may have into account when planning any physical activity sessions
• have a qualified physical activity instructor leading any supervised activity sessions; for example, a physiotherapist or a practitioner member of the CIMSPA (Chartered Institute for the Management of Sport and Physical Activity)
• last at least 3 months, with weekly or fortnightly sessions
• monitor and review progress toward individual goals throughout the intervention
• are developed by a multidisciplinary team that includes healthcare professionals with expertise in overweight and obesity management, nutrition, psychology or physical activity
• are run by staff who are trained in delivering overweight and obesity management interventions and take part in regular professional development sessions. [2014]

1.19.6
Commission and recommend interventions for adults that encourage people to make lifelong behavioural changes and prevent future weight gain, by:

• fostering independence and self-management (including self-monitoring)
• encouraging dietary behaviours that support weight maintenance and can be sustained in the long term (for example, emphasise that national programmes that promote healthy eating like NHS Better Health can support overweight and obesity management)
• emphasising the wider benefits of keeping up levels of physical activity over the long term
• discussing strategies to overcome any difficulties in maintaining behavioural changes
• encouraging family-based changes
• discussing sources of ongoing support once the intervention or referral period has ended (opportunities could include the programme itself, online resources or support groups, other local services or activities, and help from family or friends). [2014, amended 2025]

1.19.7
Tailor interventions to support the needs of different groups. For example by holding sessions that are men- or women-only, or at different times of the day (such as interventions for children outside school hours, and ones for adults outside common working hours), and at venues that have good transport links or are used by a particular community. Think about providing childcare to support parents or carers attending sessions. [2014]

Working together on local approaches to prevent overweight and obesity
Involving local businesses and social enterprises
1.19.8
Engage local businesses in the wider approach to preventing overweight and obesity, and encourage them to promote health and wellbeing. For example:

• workplace health initiatives that support and encourage employees (and their families) to adopt a healthy diet
• developing and implementing active travel plans to encourage employees and their families to walk and cycle
• ensuring the range and content of any food and drinks they sell does not create an incentive to overeat, and gives people the opportunity to eat healthily
• actively supporting community initiatives on health and wellbeing (for example, as part of a social value approach to their business). [2012, amended 2025]

1.19.9
Encourage all local businesses and social enterprises to recognise their corporate health and wellbeing responsibilities in relation to:

• products – for example, ensuring the range and content of the food and drinks they sell does not encourage or incentivise to overeat and gives people the opportunity to eat healthily
• wider social interests – such as actively supporting wider community initiatives on health and wellbeing. [2012]

See also NICE's guidance on physical activity in the workplace, preventing cardiovascular disease, alcohol-use disorders and type 2 diabetes, and Public Health England's physical activity, healthy eating and healthier weight toolkit for employers.

Service and intervention specifications and equipment
1.19.10
Follow Public Health England's guide to delivering and commissioning tier 2 adult weight management services and commission services and interventions that meet the measures set out in the National Obesity Audit advice for the Community Services Data Set, and Public Health England's 'Adult weight management: key performance indicators'. [2014, amended 2025]

1.19.11
Ensure equipment and facilities for overweight and obesity management interventions meet the needs of most people who are living with overweight or obesity. For example, providers of services and interventions should ensure there are large blood pressure cuffs and suitably sized chairs without arms. Any new scales purchased should be able to accurately weigh everybody using the service. Agree a process for using equipment from more specialist services, such as hospital weighing scales, when needed. [2014, amended 2025]

1.19.12
Ensure scales used by overweight and obesity management interventions for monitoring people's weight are regularly calibrated. [2014]

1.19.13
Equip specialist settings (including paediatric settings) for treating people who are living with severe obesity with, for example, suitable seating, suitable toilets and adequate weighing and monitoring equipment. Ensure hospitals have access to specialist equipment – such as larger scanners and beds – when providing general care for people who are living with severe obesity. [2006, amended 2025]

Raising awareness of overweight and obesity management options
Raising awareness among commissioners and providers
1.19.14
Ensure local or regional strategic partnerships are:

aware of, and committed to, the overweight and obesity strategy in the joint local health and wellbeing strategy

aware of the impact of obesity on other priorities. [2012]

1.19.15
Ensure overweight and obesity prevention interventions are highly visible and easily recognisable. To increase recognition and minimise costs, think about adapting a widely known campaign (such as NHS Healthier Families) for use locally. [2012]

1.19.16
Ensure partners have shared vision, speak with a common voice and are clearly identifiable to the community. Promote all relevant activities using the same overweight and obesity management campaign materials and use this branding consistently over the long term. [2012]

1.19.17
Work with partners and the local media to advocate for action on overweight and obesity. [2012]

1.19.18
Make the relevance of a wide range of initiatives for managing overweight and obesity clear, for example in annual reports. [2012]

1.19.19
Ensure all those commissioning overweight and obesity management services are aware of:

the number of people living with overweight or obesity locally, including any variations between different groups

the effect of the local environment and health inequalities on the prevention and management of obesity

the local overweight and obesity management pathway and the role of overweight and obesity management services in the local strategic approach to preventing and managing overweight and obesity

the range of interventions that could be commissioned locally (see the sections on service and intervention specifications and equipment and reviewing success)

opportunities to continue professional development or any training available on overweight and obesity management. [2025]

Raising awareness among health and social care professionals
1.19.20
Raise awareness of overweight and obesity management interventions among health and social care professionals who may refer people to them. This includes GPs and staff involved in the National Child Measurement Programme and the Healthy Child Programme. For example, publicise professional networks and ensure staff are familiar with the interventions available and how to make referrals (see also the National Child Measurement Programme: operational guidance). [2025]

1.19.21
Make online and social media resources available and accessible for health and social care professionals to share with adults, children, young people and their family and carers. [2025]

Raising public awareness
These recommendations are for local or regional strategic partnerships.

1.19.22
Think about the following in messages about weight and obesity:

• which media types will best reach the intended groups
• tailoring language to the situation or intended audience (for example, using 'healthier weight' rather than 'preventing obesity', talking more generally about health and wellbeing, or mentioning specific community issues)
• using non-judgemental language and non-stigmatising images
• using materials that include a variety of body shapes, disabilities and ethnicities
• using local insight to help develop communications for subgroups within a community or specific at-risk groups. [2012, amended 2025]

1.19.23
Engage with children's centres, libraries, the local media, schools and colleges, and professional and voluntary organisations working with children, young people and adults to raise awareness of behavioural overweight and obesity management services and interventions for children, young people and adults. Publicity could include:

• who the intervention is for (for interventions for children and young people this includes age range, eligibility criteria, and the level of family involvement needed)
• how to enrol (including whether participants can self-refer or need a formal referral from a healthcare professional)
• aims, and type of activities involved
• the time, location, length of each session, and the number of sessions
• general public health messages such as moving more and eating more fruit and vegetables. [2025]

1.19.24
Ensure the local population is aware of:

• the health and potential psychosocial benefits of having and maintaining a healthier weight at any age
• the range of overweight and obesity management services available locally and nationally
• local sources of information and advice such as GPs, practice nurses, health visitors and pharmacists
• national sources of accurate information and advice.

Include details of information sources in all communications about overweight and obesity. [2025]

1.19.25
Maintain an up-to-date list of local overweight and obesity management interventions for adults, children and young people. Regularly share the list, or make it accessible, to organisations in the public, community and voluntary sectors. [2025]

Reviewing interventions for adults
These recommendations are for those providing interventions.

Reviewing success
1.19.26
Collect evidence for health and wellbeing boards showing that interventions:

• are effective at 12 months or beyond (the following programmes currently available in the UK have been shown to be effective at 12 to 18 months: [in alphabetical order] Slimming World and Weight Watchers)
• continue to meet core components and best practice criteria for commissioning (see the section on key components of interventions). [2014, amended 2025]

Collecting, assessing and sharing information about participants
1.19.27
Ensure overweight and obesity management interventions contact participants 12 months after the intervention is completed. This could be done by intervention providers or an additional commissioned service. Work with all referrers and providers to develop systems to share relevant information about people referred to overweight and obesity management interventions, in line with information governance and data protection requirements. [2014]

See also the section on raising awareness of overweight and obesity management options.

1.20.1
When commissioning interventions, take into account the needs of children and young people who are living with obesity or overweight and have special needs or disabilities. This could include offering specific interventions, if available, or making reasonable adaptations to mainstream interventions (including training staff), and evaluating both. [2013]

1.20.2
Ensure those with more complex needs, their families and carers, have a contact in specialist services who can help them manage their weight. [2013]

Involving a multidisciplinary team for children and young people
1.20.3
Develop the components of behavioural overweight and obesity management interventions with the input of a multidisciplinary team. [2025]

1.20.4
The multidisciplinary team should comprise professionals who specialise in children, young people and overweight and obesity management, including:

• a Registered dietitian or registered nutritionist
• a physical activity specialist
• a behaviour-change expert, such as a health promotion specialist
• a health or clinical psychologist, or a child or adolescent psychiatrist, to provide expertise in mental wellbeing
• a paediatrician or paediatric nurse
• a community-based health professional (such as a public health nurse). [2013]

1.20.5
Ensure intervention content is regularly reviewed and updated by the multidisciplinary team. [2013]

Contracts and intervention specifications
1.20.6
Ensure the contract or intervention specification requires that height and weight are measured and that both BMI and BMI for age and sex are recorded for children and young people:

• at start and end of the intervention
• whenever an opportunity arises during the year after completion. [2013, amended 2025]

1.20.7
Specify in contracts any groups that may be at risk of health inequalities, such as children and young people from ethnic minority backgrounds, or from deprived or disadvantaged neighbourhoods. [2013]

Supporting interventions in the long term
1.20.8
Dedicate long-term, protected resources to support the development, implementation, delivery, promotion, monitoring and evaluation of overweight and obesity management interventions for children and young people. See the section on evaluating effectiveness (principle 7) in NICE's guideline on behaviour change: general approaches. [2013]

1.21.1
Measure a broad range of outcomes and use validated tools to capture the full benefits of a sustainable, integrated health and wellbeing strategy. These include:

• anthropometric measures such as BMI or waist-to-height ratio
• indicators of dietary intake (for example intake of fruit and vegetables or sugar-sweetened drinks), physical activity (for example time spent in moderately vigorous activities such as brisk walking) or sedentary behaviour (for example leisure-based screen time or car use)
• prevalence of obesity-related diseases
• wider health outcomes such as indicators of mental health and wellbeing, improvements in self-esteem and quality of life
• process outcomes such as service use, engagement of groups subject to health inequalities groups, establishment or expansion of community groups
• indicators of structural changes (such as changes to procurement contracts).

(See the UK government's standard evaluation framework for weight management interventions for other possible outcome measures.) [2014]

1.21.2
Consider collecting and assessing other outcomes at the end of the intervention, such as changes in:

• dietary habits, physical activity and sedentary behaviour
• self-esteem, depression or anxiety
• health outcomes, such as blood pressure. [2014]

1.22.1
Log data in the National Obesity Audit and ensure all monitoring and evaluation results are accessible and easy to use by all who can use them in their work, both in the local community and nationally, including those involved with obesity prevention, local groups and networks, the media and the public. [2012]

These recommendations are for commissioners and providers.

1.23.1
Ensure monitoring focuses on sustaining changes in the longer term, including reports on the following data:

• the number of children and young people taking part in the intervention
• the percentage who complete it
• the percentage followed up at 6 months and 1 year after completion
• BMI and BMI adjusted for age and sex:
• at the start and end of the intervention
• 6 months after completing the intervention and
• 1 year after completing the intervention. [2013]

1.23.2
Ensure data collection tools are validated for the age range or population group covered by the intervention and are feasible and affordable in practice settings. Do not rely on self-reported measures of height or weight, or interpretations of BMI based on them. [2013]

1.23.3
Monitor any variation in the numbers of children and young people who join and who complete the intervention, and the proportion of people retained by the intervention. Analyse this by population subgroup. [2013]