Managing obesity in adults and children
Your essential guide to the latest NICE standards
According to the Health Survey for England, in 2013 around a quarter of adults were obese, while 41% of men and 33% of women were overweight.
In addition, 30% of boys and 29% of girls aged two to 15 were either overweight or obese. A Department of Health report in 2011, Healthy lives, healthy people: a call to action on obesity in England estimated that costs of obesity and being overweight to society and the economy were almost £16 billion in 2007. This could reach £50 billion by 2050, if obesity rates continue to rise.
In August, the National Institute for Health and Care Excellence (NICE) published new quality standards on clinically assessing and managing obesity in adults and children. It includes recommendations on informing people about their body mass index (BMI), any associated risks to health and how to get help; discussing interventions; referring children for specialist care; and bariatric surgery, including referral, follow-up care and monitoring.
For most adults, a BMI of between 18.5 to 24.9 means a healthy weight; 25 to 29.9 is overweight; 30 to 39.9 is obese; and 40 or more is severely obese. Waist circumference is also used as an additional measure in those who are overweight. Men with a waist measurement of 94 centimetres or more and women who measure 80 centimetres or more are believed to be at greater risk of developing obesity-related health problems.
Being obese raises the risk of developing many potentially serious health conditions, including: type 2 diabetes; hypertension; atherosclerosis; coronary heart disease; several types of cancer, including bowel and breast; gallstones, osteoarthritis; sleep apnoea; liver and kidney disease; and complications in pregnancy, including gestational diabetes and pre-eclampsia.
How you can help your patient
Nurses can play a key role in weight loss programmes, whether provided in hospitals or the community. A study published by BMJ Open in November 2013 showed that those who received advice from healthcare professionals on losing weight were three times more likely to say they wanted to lose weight and be trying to do it.
Lisa Rickers, bariatric advanced nurse practitioner, Oxford University Hospitals NHS Foundation Trust
‘These standards are very welcome. There are a lot of key points that will help nurses to improve the care they offer, giving them a framework to support their patients.
'Nurses are often the first port of call and people feel they can talk to us because we have the time.
‘I especially like the emphasis on the shared care model and joined up pathway that runs from clinical commissioning groups right through to bariatric surgery. NICE also talks about discussing BMI and the associated health risks with patients, but this is a very sensitive topic and can be done badly.
'I’d suggest putting the emphasis on asking how the patient feels about their weight and whether it concerns them. I also like the fact that the standards talk about the failure of an intervention, rather than a person – so in other words, try something else. Some people want a very straightforward approach while others need something different. It can be trial and error.’
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