This pathway covers the prevention, identification, assessment and management of obesity in adults and children. The pathway aims to:

• stem the rising prevalence of obesity and diseases associated with it

• increase the effectiveness of interventions to prevent people becoming overweight and obese

• improve the care provided to adults and children with obesity, particularly in primary care.

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals.

Guiding principles

The recommendations in this pathway should be undertaken in parallel, wherever possible as part of a system-wide approach to preventing obesity. Ideally, to be as cost effective as possible, they should be implemented as part of integrated programmes that address the whole population, but with a scale and intensity that is proportionate to addressing locally identified inequalities in obesity and associated diseases and conditions.

Community engagement

The prerequisites for effective community engagement are covered in NICE's pathway on community engagement. These include:

• coordinated implementation of the relevant policy initiatives

• a commitment to long-term investment ​

• openness to organisational and cultural change

• a willingness to share 'power', as appropriate, between statutory and community organisations

• the development of trust and respect among all those involved.

The guidance states that the following should also be in place to ensure effective local practice:

• support to ensure those working with the community – including members of that community – receive appropriate training and development opportunities​

• formal mechanisms that endorse partnership working​

• support for effective implementation of area-based initiatives.​

Behaviour change

The prerequisites for effective interventions and programmes aimed at changing behaviour are covered in NICE's pathway on behaviour change. In summary, NICE recommends that interventions and programmes should be based on:

• careful planning, taking into account the local and national context and working in partnership with recipients​

• a sound knowledge of community needs

• existing skills and resources, by identifying and building on the strengths of individuals and communities and the relationships within communities.

In addition, interventions and programmes should be evaluated, either locally or as part of a larger project, and practitioners should be equipped with the necessary competencies and skills to support behaviour change. This includes knowing how to use evidence-based tools. (NICE recommends that courses for practitioners should be based on theoretically informed, evidence-based best practice.)

Cultural appropriateness

The prerequisites for culturally appropriate action are outlined in the NICE pathway on preventing type 2 diabetes. The guidance emphasises that culturally appropriate action takes account of the community's cultural or religious beliefs and language and literacy skills by:

• Using community resources to improve awareness of, and increase access to, interventions. For example, they involve community organisations and leaders early on in the development stage, use media, plan events or make use of festivals specific to black and minority ethnic groups.​

• Understanding the target community and the messages that resonate with them.
  Identifying and addressing barriers to access and participation, for example, by keeping costs low to ensure affordability, and by taking account of different working patterns and education levels.​

• Developing communication strategies that are sensitive to language use and information requirements. For example, they involve staff who can speak the languages used by the community. In addition, they may provide information in different languages and for varying levels of literacy (for example, by using colour-coded visual aids and the spoken rather than the written word).​

• Taking account of cultural or religious values, for example, the need for separate physical activity sessions for men and women, or in relation to body image, or beliefs and practices about hospitality and food. They also take account of religious and cultural practices that may mean certain times of the year, days of the week, settings, or timings are not suitable for community events or interventions. In addition, they provide opportunities to discuss how interventions would work in the context of people's lives.​

• Considering how closely aligned people are to their ethnic group or religion and whether they are exposed to influences from both the mainstream and their community in relation to diet and physical activity.

Physical activity and sedentary behaviour

• Physical activity includes the full range of human movement. It includes everyday activities such as walking or cycling for everyday journeys, active play, work-related activity, active recreation (such as working out in a gym), dancing, gardening or playing active games, as well as organised and competitive sport.​

• Sedentary behaviour describes activities that do not increase energy expenditure much above resting levels. Sedentary activities include sitting, lying down and sleeping. Associated activities, such as watching television, are also sedentary.