Overweight and obesity are increasing problems that lead to significant health and social difficulties for people. Commonly defined by a measurement of Body Mass Index (BMI – calculated by dividing body weight (kilograms) by height (metres) squared), the prevalence of overweight (adult BMI of between 25 and 29.9) and obesity (BMI of 30 or over) is increasing. For children, these BMI standards require adjustments for age and gender. Overweight and obesity are global problems and the World Health Organization (WHO) predicts that by 2015 approximately 2.3 billion adults worldwide will be overweight and more than 700 million obese. In the UK, obesity rates have nearly doubled in the past 18 years from 13% of men and 16% of women in 1993, to 24% of men and 26% of women in 2011. In the same year, about 3 in 10 children aged 2-15 years were found to be overweight or obese. Ethnic differences exist in the prevalence of obesity and the related risk of ill health. For example, compared with the general population, the prevalence of obesity is lower in men of Bangladeshi and Chinese family origin, whereas it is higher for women of African, Caribbean and Pakistani family origin as reported by the National Obesity Observatory in 2011.

Obesity is directly linked to a number of different illnesses including type 2 diabetes, hypertension, gallstones and gastro-oesophageal reflux disease, as well as psychological and psychiatric morbidities. The Health and Social Care Information Centre reported that there were 11,740 inpatient admissions to hospitals in England with a primary diagnosis of obesity in 2011/2012, which is 3 times as many as 5 years earlier in 2006/2007. There were 3 times as many women admitted as men.

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The cost of overweight and obesity to society and the economy was estimated to be almost £16 billion in 2007 (over 1% of gross domestic product). The cost could increase to just under £50 billion in 2050 if obesity rates continue to rise, according to projections from the Department of Health. A simulated model reported in the Lancet predicted that there would be 11 million more obese adults in the UK by 2030, with combined medical costs for treatment of associated diseases estimated to increase by £1.9-2 billion/year.

Treatment options for obesity may include non-surgical treatment and bariatric surgery. Non-surgical treatment usually takes a multicomponent approach, involving dietary changes to reduce calorie intake, an increase in physical activity, behavioural modification, and where appropriate, psychological support or pharmacotherapy.

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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.

The public health aspects of CG43 are not addressed here, but are in the process of being updated by the Centre for Public Health Excellence. The public health recommendations that formed part of CG43 will continue to exist within the original piece of guidance. All other clinical recommendations from areas not subject to update have been reviewed to ensure that they comply with the NICE policy on non-discrimination and, where appropriate, have been amended or the wording changed in line with current NICE house style (see Section 3.1).

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