Intended for healthcare professionals

Practice Guidelines

Identification, assessment, and management of overweight and obesity: summary of updated NICE guidance

BMJ 2014; 349 doi: (Published 27 November 2014) Cite this as: BMJ 2014;349:g6608
  1. Heather Stegenga, systematic reviewer1,
  2. Alexander Haines, health economist2,
  3. Katie Jones, senior project manager2,
  4. John Wilding, professor of medicine and honorary consultant physician3
  5. On behalf of the Guideline Development Group
  1. 1National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
  2. 2National Clinical Guideline Centre, Royal College of Physicians of London, London NW1 4LE, UK
  3. 3University of Liverpool and University Hospital Aintree, Liverpool, UK
  1. Correspondence to: A Haines Alexander.Haines{at}

The bottom line

  • Obesity is a chronic condition that causes serious disease and disability

  • Management should include diet, physical activity, and behaviour change components. Long term follow-up is needed

  • Bariatric surgery is a treatment option for some patients with severe obesity, particularly those with type 2 diabetes. Such patients should be assessed for their suitability for this treatment

  • Follow-up after bariatric surgery should be comprehensive. After discharge from a surgical service, follow-up should be annual and lifelong

Overweight and obesity lead to serious health and social difficulties. In the United Kingdom, the prevalence of obesity rose from 6% of men and 8% of women in 1980 to 24% of men and 25% of women in 2012.1 2 Severe obesity (body mass index (BMI) >40), which was rare in 1980, now affects 2.4% of the population.2 In 2012, about three in 10 children aged 2-15 years were overweight or obese. Obesity related illnesses include type 2 diabetes, hypertension, obstructive sleep apnoea, and gastro-oesophageal reflux disease.3 Obesity also increases the risk for many common cancers3 and contributes to psychological and psychiatric morbidity.4 The treatment of obesity can be challenging and requires multicomponent weight management programmes; however, existing service provision is varied and often limited.5

Newly available evidence on very low calorie diets and on the effectiveness of bariatric surgery in people with recent onset type 2 diabetes and a lack of clear guidance on follow-up after bariatric surgery have led to the need to revise the original National Institute for Health and Care Excellence (NICE) guideline from 2006.6 This article summarises the most recent recommendations from NICE (CG189).7


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development …

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