NICE says GPs 'should be nicer' to fat people

"Don't be nasty to fat people," is the front page headline in the Daily Mail. The paper reports on new draft guidelines that encourage doctors to be "respectful and non-blaming" when discussing people's weight problems.

The headlines stem from new draft guidelines published by the National Institute for Health and Care Excellence (NICE) for the management of overweight and obese adults, focusing on lifestyle weight management services.

Despite the media's focus on the commonsense recommendation that obese people should be treated with respect, the draft guidelines offer a host of other useful recommendations.

These include promoting the message that even minimal weight loss can bring significant health benefits, and that there is no "magic bullet" for weight loss. People may have to try a number of approaches before they find what works for them, the guidance says.

The NICE guidelines are in the draft stage, so the recommendations are currently provisional and may undergo some changes after consultation with stakeholders. Final guidance is likely to be published some time next year, when the recommendations come into effect for health professionals.


What is the purpose of the draft guidelines?

NICE produces guidance on promoting good health and preventing, diagnosing and treating illness for healthcare professionals and other organisations with a role in healthcare, such as councils.

The organisation aims to ensure that people receive the best quality care possible at the best value for money. It produces its guidance using transparent methods based on the best available evidence.

The current draft guideline, "Managing overweight and obesity and adults: lifestyle weight management services", is public health guidance. NICE public health guidance makes recommendations to the NHS, local authorities and other organisations in the public, private, voluntary and community sectors on how to improve people's health and prevent illness and disease.

What recommendations do NICE's overweight and obesity guidelines make?

The NICE draft guidelines make 14 recommendations, mainly for the organisations that decide how to run local health services.

These recommendations include:

Minimising harm

NICE recommends that professionals should be aware of the effort needed to lose weight and avoid further weight gain, as well as the stigma adults who are overweight or obese may feel or experience.

It says professionals should ensure the tone and content of all communication or dialogue is "respectful" and "non-blaming". It also says that equipment and facilities should meet the needs of most adults who are overweight or obese.

Addressing adults' expectations of a lifestyle weight management programme

NICE says healthcare professionals need to ensure that adults who aim to lose weight are made aware of how much motivation and commitment is needed to lose weight and maintain weight loss, and that there is no "magic bullet" that can guarantee success.

NICE also advises on the need to convey to overweight or obese patients that they should make gradual long-term changes to their eating habits and physical activity, and tell them how much weight they might realistically expect to lose in total and on a weekly basis if they adhere to the programme.

Providing information for adults considering a lifestyle weight management programme

NICE wants healthcare professionals to ensure that adults are fully informed of the pros – such as the benefits of preventing further weight gain – and cons – such as potential financial costs – of  lifestyle weight management, if they are considering this. 

Lifestyle weight management services: weight loss and maintaining weight loss

NICE sets out what it expects lifestyle weight management services should offer for helping people lose weight. For example, this could be done by:

  • focusing on long-term lifestyle change (weight loss maintained over the long term or the prevention of further weight gain) rather than temporary weight loss
  • setting achievable goals for weight loss over the course of the programme, including within the first few weeks, after 12 weeks and at one year
  • ensuring staff are trained by a multidisciplinary team, including input from a registered dietitian, clinical psychologist and a qualified physical activity instructor
  • encouraging people to reduce their sedentary behaviour and adopt physical activities that can be easily continued after the programme has ended, such as walking

NICE also wants lifestyle weight management services to only be commissioned or recommended if they provide advice and support for the maintenance of weight loss (or continued weight loss), for example by:

  • fostering independence and self-management
  • providing information or opportunities for ongoing support once the programme has ended
  • stressing the impact of both healthy eating and physical activity on long-term weight loss maintenance
  • encouraging healthy eating behaviours that are sustainable in the long term and emphasise the wider benefits of eating a healthy, low-fat diet
  • encouraging ways of being more physically active and less sedentary that can be easily continued after the programme has ended, such as walking – the wider benefits should also be emphasised  

Referrals to lifestyle weight management programmes

NICE says that GPs and other health professionals should:

  • identify patients eligible for referral to lifestyle weight management services by measuring their body mass index (BMI) and any other "locally agreed risk factors"
  • focus mainly on adults with a BMI over 30 kg/m² (no upper BMI or upper age limit for referral)
  • take people's preferences into account, if possible – for example, they may prefer an individual rather than a group weight management programme
  • refer people who have no preference to a group programme because, on average, these tend to be more cost effective

How fair is the media's reporting of the guidelines?

The media's reporting is generally representative of this guidance. However, some of the headlines, such as "Don't blame patients for being overweight" and "Being fat not your fault", could give a slightly skewed idea of what this draft guidance recommends.

This guidance essentially centres upon ensuring that people who are overweight or obese are referred for the help and support that they need. It is intended to help provide services to meet overweight or obese patients' needs, ensure that they are treated with full respect, and receive all the support they need to achieve their weight loss goals.

The guideline recommendations do not state that being overweight or obese is not your fault. The guidelines do not say, for example, that being overweight or obese has nothing to do with your health behaviour (such as a high calorie diet and low physical activity) and that it is all down to your genetics. These headlines purely reflect the fact that the guidance recommends that people with weight issues should be treated with more respect.

Headlines suggesting that people will no longer be told they are "fat" should not be wrongly interpreted as meaning that people who are overweight or obese will now just be "left to get on with it" and no longer guided towards weight loss advice and support when necessary. Being overweight or obese is associated with many chronic diseases. Therefore, decreasing prevalence rates is key to improving the health of the population.

NHS Attribution