Excerpt

NICE issued guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children in 2006 (CG43). This was a joint clinical and public health guideline developed by the National Collaborating Centre for Primary Care (now merged as part of the National Clinical Guidelines Centre) and NICE’s Centre for Public Health Excellence. Despite the guidance, there remain significant variations in existing service provision for people with obesity and, in many places, the multicomponent programmes that are required for both prevention and treatment are limited. The 2013 Royal College of Physicians report ‘Action on obesity: comprehensive care for all’ reported that access to surgery for obesity in some areas of the UK did not reflect the guideline recommendations.

The 2006 guideline was reviewed for update in 2011, leading to this partial update. This guideline addresses 3 main areas - follow-up care packages after bariatric surgery; the role of bariatric surgery in the management of recent-onset type 2 diabetes; very-low-calorie diets including their effectiveness, safety and effective management strategies for maintaining weight loss after such diets.

Contents

• National Clinical Guideline Centre
• Acknowledgements
• Guideline update
• 1. Introduction
• 2. Development of the guideline
  • 2.1. What is a NICE clinical guideline?
  • 2.2. Remit
  • 2.3. Who developed this guideline?
• 3. Methods
  • 3.1. Amendments to 2006 text
  • 3.2. Developing the review questions and outcomes
  • 3.3. Searching for evidence
  • 3.4. Evidence of effectiveness
  • 3.5. Evidence of cost effectiveness
  • 3.6. Developing recommendations
• 4. Guideline summary
  • 4.1. Algorithm
• 5. Full list of recommendations
  • 5.1. Generic principles of care
  • 5.2. Identification and classification of overweight and obesity
  • 5.3. Measures of overweight and obesity
  • 5.4. Classification of overweight and obesity
  • 5.5. Assessment
  • 5.6. Lifestyle interventions
  • 5.7. Behavioural interventions
  • 5.8. Physical activity
  • 5.9. Dietary
  • 5.10. Pharmacological interventions
  • 5.11. Continued prescribing and withdrawal
  • 5.12. Surgical interventions
  • 5.13. Bariatric surgery in people with recent onset type 2 diabetes
  • 5.14. Follow up care
  • 5.15. Key research recommendations
  • 5.16. How this clinical guideline was updated
• 6. Very-low-calorie diets
  • 6.1. Introduction
  • 6.2. Review question: In people who are overweight or obese, what is the clinical and cost effectiveness of very-low-calorie diets in reducing weight?
• 7. Bariatric surgery in people with recent-onset type 2 diabetes
  • 7.1. Introduction
• 8. Follow-up care packages
  • 8.1. Introduction
  • 8.2. Evidence statements
• 9. Reference list
• 10. Acronyms and abbreviations
• 11. Glossary
• Appendices
  • Appendix A. Scope
  • Appendix B. Declarations of interest
  • Appendix C. Review protocols
  • Appendix D. Clinical article selection
  • Appendix E. Economic article selection
  • Appendix F. Literature search strategies
  • Appendix G. Clinical evidence tables
  • Appendix H. Economic evidence tables
  • Appendix I. Forest plots
  • Appendix J. Excluded clinical studies
  • Appendix K. Excluded economic studies
  • Appendix L. Research recommendations
  • Appendix M. Obesity 2006 Full Guideline
  • Appendix N. Obesity 2006 Appendices
  • Appendix O. GRADE tables
  • Appendix P. Obesity 2006 Short Guideline
  • Appendix Q. Recommendations from NICE clinical guideline 43 (2006) that have been deleted or changed

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.