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Evidence of what works

Background papers: Lifestyle and wider determinants :: Healthy weight [Update in progress] :: Obesity :: Evidence of what works

It is very difficult to estimate cost effectiveness, as the effect of interventions is difficult to measure over long-term scales. However, given the high costs of managing obesity and related health conditions and the high and rising prevalence it is likely that the return on investment is high. At present a small fraction of expenditure is on prevention compared with dealing with the consequences of obesity.

The National Institute of Clinical Excellence (NICE) (2006) Guidelines recommends that community weight loss programmes should meet best practice standards by:
• Helping people decide on a realistic healthy target weight (usually to lose 5–10% of their weight)
• Aiming at a maximum weekly weight loss of 0.5–1.0 kg
• Focusing on long term lifestyle changes
• Addressing both diet and activity, and offering a variety of approaches
• Using a balanced, healthy eating approach
• Offering practical, safe advice about being more active
• Including some behaviour change techniques, such as keeping a food diary and advice on how to cope with 'lapses' and 'high risk' situations
• Recommending and/or providing on-going support

The following documents contain evidence of what works: Healthy Lives, Healthy People (2011): A Call to Action on Obesity in England
NICE (2006) CG43 Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children
NICE (2010) PH27 Weight management before, during and after pregnancy
National Obesity Observatory (2009) Preventing childhood obesity through lifestyle change interventions. A briefing paper for commissioners
Sacher PM, Chadwick P, Kolotourou M et al, Poster Presentation: From clinical trial to large-scale community implementation: evaluation of the Mend child weight management programme in the UK
Foresight Report (2007) Tackling Obesities: Future Choices
Healthy Weight, Healthy Lives (2008) A Cross Government Strategy for England
Healthy Weight, Healthy Lives (2008) A Toolkit for Developing Local Strategies

NICE are currently developing a number of pieces of Public Health guidance related to obesity. Updates can be found by following the links below: Obesity - working with local communities
Overweight and obese adults - lifestyle weight management
Overweight and obese children - lifestyle weight management
Physical activity advice in primary care
Walking and cycling

Other relevant evidence and guidance would be:

NICE (2008) PH11 Guidance for midwives, health visitors, pharmacists and other primary care services to improve the nutrition of pregnant and breastfeeding mothers and children in low income households
Start Active, Stay Active: a report on physical activity for health from the four home countries' Chief Medical Officers (DH, 2011)
Royal College of Obstetricians and Gynaecologists: Management of women with obesity in pregnancy (March 2010)