At-a-glance (what to do in clinic)
- Measure and frame risk: BMI plus a measure of central adiposity (waist/waist-to-height ratio) gives better cardiometabolic signal than BMI alone.
- Offer tiered support: brief intervention → structured programme → specialist weight management service depending on severity, comorbidity, and prior attempts.
- Focus on outcomes that matter: glycaemic control, BP, OSAHS symptoms, fatty liver markers, mobility, and quality of life—not just weight.
- Medications/surgery: follow local commissioning + relevant NICE technology appraisals; NG246 provides the overarching management framework.
Practical tiering (simplified)
- Tier 0–1 (brief intervention): opportunistic advice, agreed goals, and signposting (food environment, activity, sleep, alcohol, stress).
- Tier 2 (structured programme): multicomponent behavioural intervention (diet + activity + behaviour change) with measurable follow-up.
- Tier 3 (specialist weight management): for higher BMI and/or significant comorbidity, where more intensive interventions, medication pathways, and MDT support are available.
- Tier 4 (surgery pathway): consider referral for bariatric surgery assessment where criteria are met and patient preference aligns; ensure long-term follow-up plan.
Follow-up cadence (GP-friendly)
- First review: 4–6 weeks (momentum matters). Check adherence, barriers, and early wins (sleep, energy, BP, glucose).
- Ongoing: 8–12 weekly reviews during active weight loss; then 3–6 monthly weight maintenance reviews.
- Always screen for: OSAHS, depression/anxiety, disordered eating, and obesity-related complications (T2DM, NAFLD, hypertension, OA).
- Document: patient goals, agreed plan, and escalation triggers (when to step up intensity/referral).
Frequently asked questions
Do I need waist measurements if I already have BMI?
Central adiposity is strongly linked to cardiometabolic risk; using BMI plus waist/waist-to-height ratio generally improves risk communication and prioritisation.
When should I refer to a specialist weight management service?
When BMI is high and/or there are significant complications (OSAHS, T2DM, NAFLD, resistant hypertension), when prior lower-intensity attempts have not worked, or when medication/surgical pathways need specialist oversight.
Where do GLP-1/dual agonists fit?
These are typically governed by local commissioning and relevant NICE technology appraisals; NG246 provides the overarching pathway and the “when to escalate” logic.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.