Excerpt

This is the first national guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children in England and Wales. The guidance aims to: stem the rising prevalence of obesity and diseases associated with it; increase the effectiveness of interventions to prevent overweight and obesity; improve the care provided to adults and children with obesity, particularly in primary care.

The recommendations are based on the best available evidence of effectiveness, including cost effectiveness. They include recommendations on the clinical management of overweight and obesity in the NHS, and advice on the prevention of overweight and obesity that applies in both NHS and non-NHS settings.

Contents

• Sibutramine (Reductil): marketing authorisation suspended
• Foreword
• Acknowledgements
• Abbreviations and glossary of terms
• Guidance Development Groups
• Registered stakeholder organisations
• Working with people to prevent and manage overweight and obesity: the issues
• Person-centred care: principles for health professionals
• Training
• Section 1. Executive summary, introduction and methods
  • 1. Executive summary and recommendations
    • 1.1 Aims of the guidance
    • 1.2 Key priorities for implementation
    • 1.3 Clinical care pathways
    • 1.4 Public health map
    • 1.5 Links between public health and clinical care
    • 1.6 Public health recommendations
    • 1.7 Clinical recommendations
  • 2. Development of the guidance
    • 2.1 Public health and clinical context
    • 2.2 Who is the guidance for?
    • 2.3 Structure of the guidance documentation
    • 2.4 Scope
    • 2.5 Plans for guidance revision
  • 3. Obesity
    • 3.1 Introduction
    • 3.2 Prevalence
    • 3.3 Existing service provision
    • 3.4 Key public health audiences and settings
    • 3.5 Key clinical audiences and settings
    • 3.6 Addressing inequalities in health
    • 3.7 Assessment of the evidence base
  • 4. Methodology
    • 4.1 Introduction
    • 4.2 The developers
    • 4.3 Developing key questions
    • 4.4 Identifying the evidence
    • 4.5 Reviewing and grading the evidence
    • 4.6 Developing recommendations
    • 4.7 Relation between the guidance and technology appraisals
    • 4.8 Relation between the guidance and national service frameworks
    • 4.9 Relation between the guidance and ‘Choosing health’
    • 4.10 External review
  • References
• Section 2. Identification and classification
  • 5. Identification and classification
    • 5.1 A: Clinical
    • 5.2 B: Public health
    • 5.3 Review limitations
  • Reference List
• Section 3. Prevention
  • 6. Prevention evidence summary: determinants of weight gain and weight maintenance (‘energy balance’)
    • 6.1 Evidence statements
    • 6.2 Methodology
    • 6.3 Weight outcomes: children
    • 6.4 Weight outcomes: adults
    • 6.5 Sub questions
    • 6.6 Limitations of the review
  • 7. Prevention evidence summary: interventions to raise awareness
    • 7.1 Evidence statements
    • 7.2 Methodology
    • 7.3 Weight outcomes
    • 7.4 Diet and activity outcomes
    • 7.5 Knowledge, attitudes and awareness
    • 7.6 Sub questions
    • 7.7 Limitations of the review
  • 8. Prevention evidence summary: interventions for pre-school children and family-based interventions (‘early years’)
    • 8.1 Evidence statements
    • 8.2 Methodology
    • 8.3 Weight outcomes
    • 8.4 Diet and activity outcomes
    • 8.5 Sub questions
    • 8.6 Limitations of the review
  • 9. Prevention evidence summary: school-based interventions
    • 9.1 Evidence statements
    • 9.2 Methodology
    • 9.3 Weight outcomes
    • 9.4 Diet and activity outcomes
    • 9.5 Essential elements of a ‘whole-school’ approach
    • 9.6 Sub questions
    • 9.7 Limitations of the review
  • 10. Prevention evidence summary: workplace interventions
    • 10.1 Evidence statements
    • 10.2 Methodology
    • 10.3 Weight outcomes
    • 10.4 Diet and activity outcomes
    • 10.5 Sub questions
    • 10.6 Limitations of the review
  • 11. Prevention evidence summary: interventions led by health professionals (‘Community 1’)
    • 11.1 Evidence statements
    • 11.2 Methodology for review
    • 11.3 Weight outcomes
    • 11.4 Diet and activity outcomes
    • 11.5 Sub questions
    • 11.6 Limitations of the review
  • 12. Prevention evidence summary: broader community interventions (‘Community 2’)
    • 12.1 Evidence statements
    • 12.2 Methodology for review
    • 12.3 Weight outcomes
    • 12.4 Diet and activity outcomes
    • 12.5 Sub questions
    • 12.6 Limitations of the review
  • 13. Prevention evidence summary: interventions aimed at black, minority ethnic groups, vulnerable groups and vulnerable life stages (‘BMEGs’)
    • 13.1 Evidence statements
    • 13.2 Methodology
    • 13.3 Weight outcomes
    • 13.4 Diet and activity outcomes
    • 13.5 Sub questions
    • 13.6 Limitations of the review
  • Reference List
• Section 4. Management of obesity 1
  • 14. Management of obesity in non-clinical settings
    • 14.1 Evidence statements
    • 14.2 Methodology
    • 14.3 Weight outcomes
    • 14.4 Dietary and activity outcomes
    • 14.5 Maintenance of weight loss
    • 14.6 Sub questions
    • 14.7 Review limitations
  • Reference List
• Section 5. Management of obesity 2
  • 15. Management of obesity in clinical settings
    • 15.1 General introduction to clinical management
    • 15.2 Children
    • 15.3 Adults
  • Reference List
• Section 6. Health economics
  • 16. Cost effectiveness of clinical interventions
    • 16.1 Introduction
    • 16.2 Methods
    • 16.3 Cost effectiveness of non-pharmacological interventions
    • 16.4 Cost effectiveness of sibutramine
    • 16.5 Cost effectiveness of orlistat
    • 16.6 Cost effectiveness of surgery
  • 17. Cost effectiveness of public health interventions
    • 17.1 Introduction
    • 17.2 Evidence review
    • 17.3 Economic modelling
  • Reference List
• Section 7. Research recommendations
  • 18. Research recommendations
    • 18.1 Introduction
    • 18.2 Research recommendations
    • 18.3 Evaluation and monitoring
• Appendices
  • Appendix 1 Scope of work
  • Appendix 2 Key questions & review parameters
  • Appendix 3 The effectiveness of public health interventions to identify individuals who would benefit
  • Appendix 4 Determinants of weight gain and weight maintenance
  • Appendix 5 Raising awareness of what constitutes a healthy weight range
  • Appendix 6 The effectiveness of interventions to prevent weight gain or maintain a healthy weight in children aged between 2 and 5 years
  • Appendix 7 School based interventions to prevent obesity
  • Appendix 8 Workplace interventions to prevent obesity
  • Appendix 9 Community-based interventions to prevent obesity
  • Appendix 10 The effectiveness of broader community-based interventions to prevent obesity
  • Appendix 11 The effectiveness of interventions to prevent weight gain targeted at black and minority ethnic groups, at vulnerable groups and at individuals at vulnerable life stages
  • Appendix 12 Treatment of overweight and obesity in non clinical settings
  • Appendix 13 Management of child obesity in clinical settings evidence tables
  • Appendix 14 Management of child obesity in clinical settings excluded studies
  • Appendix 15 Management of adult obesity in clinical settings evidence tables
  • Appendix 16 Management of adult obesity in clinical settings excluded studies
  • Appendix 17 Summary estimates for interventions
  • Appendix 18 Health Economics: Public Health