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NICE issues guidance on obesity

Overweight and obese people may receive treatment undertaken and paid for by the NHS, states national healthcare watchdog

The National Institute for Health and Clinical Excellence (NICE) has called for urgent action to be taken to address the growing problem of obesity in England and Wales, and has recommended that drugs and surgery should be provided by the NHS to help certain adults and older children lose weight.

Obesity is more damaging than smoking, heavy drinking and poverty, NICE said as it issued new guidance on how to prevent and treat obesity in adults and children, and get people back into a healthier condition.

Changes to diet and exercise should be the first-line treatment for obese and overweight adults, with healthcare professionals giving advice on maintaining a healthy weight by adopting a multitude of measures, including making physical activities such as walking, cycling, swimming, aerobics or even gardening a part of everyday life. The guidance also states that eating five portions of fruit and vegetables a day and habitually avoiding foods that are high in fat and sugar will be effective.

If such lifestyle interventions in adults prove to be unsuccessful, however, the cost-effectiveness body recommends the use of anti-obesity drugs and, in cases of morbid obesity, bariatric surgery, but only as a last resort. To undergo such surgery, adults must meet strict criteria and all appropriate non-surgical measures must have been exhausted already.

In childhood obesity, lifestyle interventions within the family and social settings must be addressed first, with drug treatments to be undertaken only if there are physical comorbidities - orthopaedic problems or sleep apnoea - or severe psychological comorbidities.

Bariatric surgery may be considered in exceptional circumstances for young people who have gone through puberty, but only if they meet strict criteria, as is the case for adults.

The guidance contains wide-ranging recommendations, not just for the health service but also for schools, nurseries, local authorities, employers and town planners. It suggests means by which the population can be encouraged to be more active, including the provision of facilities and schemes such as cycling and walking routes, safe play areas, and ensuring that buildings and public spaces are designed to make people more physically active.

Multi-factorial condition
NICE's multi-faceted approach to tackling obesity highlights the complexities of changing the ingrained habits of a population that is second only to the US in terms of the number of overweight and obese people.

Healthcare professionals and policy experts, the majority of whom seemingly believe this guidance is long overdue, have welcomed the recommendations. ìTackling the obesity epidemic isn't just about treating people who are already obese, it's about helping people to avoid becoming overweight in the first place,î said Dr Ken Snider, director of County Durham and Tees Valley Public Health Network.

ìWe recommend an integrated approach to the obesity problem - action must be taken now to stop the epidemic and to ensure better health and wellbeing for us all and for our children,î he added.

Yet, while the guidance has been well received by some, to many the prospect of using drugs to treat childhood obesity is likely to cause a stir. ìSome of the treatment options we are recommending such as offering anti-obesity drugs and, in extreme cases, surgery to children will be seen as highly controversial,î said John Wilding, Professor of Medicine and Honorary consultant, University Hospital Aintree. ìBut it is right that the NHS is given the go ahead to take radical action when faced with such a major threat to the health of our children.î

It is not just these recommended treatment regimens that are likely to raise a few eyebrows: just weeks after deciding not to recommend the use of Alzheimer's drugs on the NHS for those newly diagnosed with the disease, and taking similar action on a bowel cancer treatment, NICE may attract hostility from some quarters over its obesity guidance. It is perceived by some as a time when NICE needed to make a clear-cut decision, and not provide another issue that elicits debate and controversy.

For further information on the guidance visit www.nice.org.uk

30th September 2008

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