An Overview of Overweight and Obesity Management, NICE NG246

Obesity is a significant public health concern, affecting millions of individuals worldwide. In this post, we provide an overview of the latest NICE guideline on Overweight and Obesity Management, [NG246]. It was published on 14 January 2025. We will return to specific aspects of the guideline in future. You can also check out our Podcast for the associated podcast review by Adam and Amanda.

General Principles of Care

The NICE guideline emphasizes that individuals have the right to be involved in discussions. They should make informed decisions regarding their care. Healthcare professionals should ensure that their communication is non-stigmatizing and tailored to individual needs. Key considerations include:

• Addressing wider determinants of obesity, such as mental health, socioeconomic status, and lifestyle factors.
• Following general healthcare guidelines, including shared decision-making, patient experience, and multimorbidity management.
• Utilizing appropriate tools and resources, such as the NHS Eatwell Guide and UK Chief Medical Officers’ physical activity guidelines.
• Creating a supportive and inclusive environment for individuals of all ages and backgrounds to access weight management services.
• Ensuring proper training for healthcare professionals in discussing weight-related concerns sensitively.

Preventing Overweight, Obesity, and Central Adiposity

Prevention plays a crucial role in reducing obesity rates. The guideline recommends:

• Encouraging gradual changes in diet and physical activity to prevent excessive weight gain.
• Providing clear communication on the benefits of healthy behaviors in maintaining an appropriate weight.
• Tailoring messages for different demographics, including children, ethnic minorities, and those with specific medical conditions.
• Promoting healthy environments in schools, workplaces, and community settings to support weight management efforts.
• Encouraging local authorities to create public health campaigns targeting dietary and physical activity improvements.

Identifying and Assessing Overweight, Obesity, and Central Adiposity

Identification and assessment should be conducted sensitively and consistently. The NICE guideline suggests:

• Using BMI as a practical measure but interpreting results carefully, especially in different ethnic groups.
• Measuring waist-to-height ratio as an additional indicator of central adiposity.
• BMI thresholds need adjustment for individuals from South Asian, Chinese, Middle Eastern, Black African, or African-Caribbean backgrounds. This is because their cardiometabolic risks occur at lower BMI levels.
• Regularly monitoring weight and other health indicators in primary care and community settings.
• Implementing standardized screening measures across healthcare settings to ensure early identification.

Discussing Results and Referral

When discussing assessment results with individuals, healthcare professionals should:

• Explain the severity of overweight or obesity and associated health risks, including diabetes, cardiovascular disease, and metabolic syndrome.
• Address underlying causes such as social and psychological factors that contribute to obesity.
• Offer appropriate referrals to weight management services, social care, or mental health support based on individual needs.
• Respect individuals’ decisions while providing opportunities for follow-up discussions and re-referral if necessary.
• Encourage shared decision-making to help individuals take ownership of their weight management journey.

Behavioural Overweight and Obesity Management Interventions

Behavioral interventions form the foundation of weight management strategies. Key recommendations include:

• Encouraging goal-setting and self-monitoring to track progress and maintain motivation.
• Providing structured support through behavioral therapy and lifestyle modification programs.
• Addressing barriers to lifestyle changes, including socioeconomic and psychological challenges.
• Engaging family members and carers in weight management programs for children and young people to promote long-term success.
• Implementing digital health interventions, such as apps and online coaching, for additional support.

Physical Activity and Diet

Diet and exercise are critical components of obesity management. The NICE guideline recommends:

• Promoting physical activity through structured programs and everyday activities, including walking, cycling, and strength training.
• Encouraging dietary changes that are sustainable and nutritionally balanced, emphasizing whole foods, fiber, and lean protein.
• Avoiding very low-calorie diets unless medically supervised, as they may lead to nutrient deficiencies and muscle loss.
• Supporting individuals in making long-term dietary adjustments rather than short-term restrictive plans that may be difficult to maintain.
• Implementing community-based initiatives to promote accessible and affordable healthy eating options.

Medicines and Surgery

For some individuals, pharmacological or surgical interventions may be necessary:

• Medicines for Weight Management: NICE recommends certain medications for weight management in individuals where lifestyle interventions alone are insufficient. BMI thresholds for treatment are outlined in the guidance.
• The medications include:
  • Orlistat: A lipase inhibitor that reduces fat absorption in the intestines. It is recommended for adults with a BMI ≥30 and those with a BMI ≥28 with weight-related comorbidities.
  • Liraglutide (Saxenda): A GLP-1 receptor agonist that regulates appetite and promotes satiety. It is initiated in secondary care
  • Semaglutide (Wegovy): Another GLP-1 receptor agonist that has shown significant weight loss results in clinical trials. It is recommended for individuals at high risk of obesity-related health conditions.
  • Tirzepatide: A newer drug that is both a GLP-1 and GIP agonist. It may be initiated in primary care subject to the patient meeting specified criteria.
  • Setmelanotide: Recommended for rare genetic disorders of obesity, such as POMC deficiency, as part of specialist care. There are specific commercial arrangements under which this is provided.
• Bariatric Surgery:
  • Surgical interventions may be considered for individuals with a BMI ≥40 or those with a BMI ≥35 with significant comorbidities.
  • Common procedures include gastric bypass, sleeve gastrectomy, and adjustable gastric banding.
  • Surgery should be performed in specialized centers with a multidisciplinary team providing preoperative and postoperative care.
  • Patients undergoing surgery require long-term follow-up, including nutritional supplementation and psychological support.
• Post-Surgery Considerations:
  • Lifelong lifestyle modifications are necessary to maintain weight loss and prevent complications.
  • Regular monitoring of vitamin and mineral levels to prevent deficiencies.
  • Behavioral counseling to address psychological aspects of weight management.

The Role of Prescribing Professionals in Primary Care

Primary care professionals play a pivotal role in obesity management by:

• Identifying and assessing individuals at risk of obesity-related health conditions through routine screenings.
• Offering brief interventions and referrals to specialized services, including weight management programs and bariatric surgery.
• Monitoring the effectiveness of prescribed treatments, including medications and surgical interventions.
• Encouraging adherence to lifestyle modifications and supporting long-term weight maintenance strategies.
• Addressing psychological and social factors that may impact weight management efforts.

Conclusion

NG246 highlights the necessity of personalized, evidence-based interventions. These interventions incorporate behavioral strategies, physical activity, and dietary modifications. When necessary, medical or surgical treatment is also included. Healthcare professionals must work collaboratively with individuals to support sustainable weight management and improve overall health outcomes. Ongoing research and public health initiatives are essential to enhancing obesity management strategies and reducing its burden on society.