Behavioural overweight and obesity management interventions

1.13 Behavioural overweight and obesity management interventions for adults

Encouraging adherence to behavioural overweight and obesity management interventions for adults

These recommendations are for providers of behavioural overweight and obesity management services.

1.13.1

Discuss with the person any concerns or barriers that may affect their attendance and participation in the intervention (such as personal circumstances, cultural barriers, physical health needs, or neurodevelopmental or psychological factors), including those that affect their ability to make changes and their progress towards meeting their goals. Repeat these discussions during the course of the intervention if needed and acknowledge:

  • any progress the person has made

  • any positive or negative experiences with the intervention

  • any cultural and social context or assumptions about health and diet, and the impact of deviating from these to improve their health. [2025]

1.13.2

If the person is facing difficulties that affect their attendance and participation in the intervention:

  • discuss whether the programme is suitable for them at this time

  • if it has not been possible to resolve their difficulties with the intervention agree what should happen next (for example, referral to another service, leave the intervention at an agreed time, or think about a re-referral at a later date). [2025]

1.13.3

Discuss with the person the importance of support from any other members of their household and others such as friends, family, and the other participants in group interventions. With their permission, talk to relevant household members about the intervention and how they can help. [2025]

1.13.4

Regularly review the person's health and progress they have made towards meeting their goals (including weight loss) and send feedback to the person's referring GP or healthcare professional (for adults who self-refer, ask permission before sending feedback to their GP). [2025]

For a short explanation of why the committee made the 2025 recommendations and how they might affect practice, see the .

Full details of the evidence and the committee's discussion are in evidence review E: increasing uptake of weight management services in children, young people and adults.

Submitting audit data for adults

1.13.5

Submit data on results of behavioural overweight and obesity management interventions for a national audit scheme such as the National Obesity Audit (see the sections on reviewing success and data to collect). [2025]

For a short explanation of why the committee made the 2025 recommendation and how it might affect practice, see the .

Full details of the evidence and the committee's discussion are in evidence review E: increasing uptake of weight management services in children, young people and adults.

1.14 Behavioural overweight and obesity management interventions for children and young people

Core components of behavioural overweight and obesity management interventions for children and young people

These recommendations are for providers of overweight and obesity management interventions.

1.14.1

Ensure behavioural overweight and obesity management interventions for children and young people include maintenance advice for those who have completed the intervention. [2025]

1.14.3

Ensure interventions focus on:

  • targeted diet modifications and

  • healthy and nutritious eating habits (see the section on dietary approaches) and

  • effective behaviour-change strategies to help the child, young person, their families and carers modify their behaviours, such as:

    • motivational techniques

    • setting goals and planning how to achieve them

    • giving feedback or rewards for progress

    • encouraging self-monitoring and building on success

    • teaching people strategies to implement changes

    • making it easier to make changes by reducing barriers and building life skills. [2025]

1.14.4

Consider including a physical activity component in interventions. This can focus on:

  • reducing the amount of time spent being sedentary

  • increasing physical activity, for example by taking part in active games, dancing and exercise (see the section on physical activity approaches). [2025]

1.14.5

Ensure behavioural overweight and obesity management interventions encourage all family members to eat healthily and to be physically active, regardless of their weight. [2025]

1.14.6

Maintain consistency of staff if possible throughout each cycle of the intervention. [2025]

For a short explanation of why the committee made the 2025 recommendations and how they might affect practice, see the .

Full details of the evidence and the committee's discussion are in:

Developing a tailored plan to meet individual needs

These recommendations are for providers of behavioural overweight and obesity management interventions.

1.14.7

Assess and record the child or young person's degree of overweight, obesity or central adiposity, obesity-associated comorbidities and mental health and wellbeing (including whether their weight is a consequence of circumstances that have affected their mental wellbeing), in particular for those who:

1.14.8

Inform the child or young person's GP if any concerns are identified (for example, obesity-related comorbidities or mental wellbeing). [2025]

1.14.9

Refer to the local mental health pathway if there are concerns at any stage of the intervention that the child or young person's mental wellbeing is affected by their weight, that mental health is affecting their weight or the circumstances that influence their weight, or an eating disorder is suspected. [2025]

1.14.10

Give children and young people opportunities to discuss issues such as self-esteem, self-perception (including any history of bullying or teasing) and any previous attempts to manage their weight, either in a group or one-to-one setting. [2025]

1.14.11

Agree goals that can be realistically achieved over the duration of the intervention. [2025]

1.14.12

Include families and carers as well as children and young people (depending on their ability and stage of development), in discussions about situations in which it would be possible to:

  • improve dietary intake and eating patterns and behaviours

  • reduce sedentary behaviour. [2025]

1.14.13

Agree dietary changes that are age appropriate, affordable, culturally sensitive and consistent with healthy eating advice, and take into account the child or young person's preferences. [2025]

1.14.14

Ensure nutrient needs for growth and development are met by including healthier choices, in appropriate amounts, from each of the food groups. [2025]

1.14.15

Consider increasing the amount and types of moderate-to-vigorous-intensity physical activity during the intervention. [2025]

1.14.16

Engage with families and carers as well as children and young people (depending on their ability and stage of development), to regularly compare progress against their goals and provide feedback. [2025]

1.14.17

Praise progress and achievements and update goals as the child or young person progresses throughout the intervention. [2025]

1.14.18

If the child or young person is not meeting their goals, discuss the possible reasons for this and modify the goals if necessary. [2025]

1.14.19

Stress the importance of maintaining changes, no matter how small, over the longer term. [2025]

For a short explanation of why the committee made the 2025 recommendations and how they might affect practice, see the .

Full details of the evidence and the committee's discussion are in evidence review G: effectiveness and acceptability of weight management interventions in children and young people living with overweight and obesity.

Care for the wider family

1.14.21

Offer assessment of overweight, obesity or central adiposity to families and carers. [2013]

1.14.22

Emphasise that the behavioural overweight and obesity management intervention may benefit the whole family. [2013]

1.14.23

Offer information about local and national behavioural overweight and obesity management interventions to family members and carers who are living with overweight or obesity. [2013]

Also see the sections on dietary approaches and physical activity approaches for children and young people.

Encouraging adherence to behavioural overweight and obesity management interventions for children and young people

These recommendations are for providers of overweight and obesity management interventions.

1.14.24

Consider both individual and group interventions, based on the child or young person's needs and those of their family and carers. For example, some families may prefer to attend individual sessions initially and then group sessions as the child or young person's confidence and self-esteem grows. Think about whether a young person may respond better if their sessions are separate from those for their family and carers. [2025]

1.14.25

Offer interventions that are accessible and convenient by:

  • using venues that have the necessary facilities, are easily accessible by public transport, and where the child or young person and their family or carers feel comfortable

  • offering times that are convenient for families with children of different ages, working family members and carers

  • adopting a flexible approach so that participants can accommodate other commitments. [2025]

1.14.26

Maintain regular contact with families and carers, and review progress towards meeting individual goals (including weight). [2025]

1.14.27

Promptly follow up those who miss sessions to establish why, ensure safeguarding, and encourage re-engagement. Focus on participants from groups likely to be affected by health inequalities and those who miss sessions early in the intervention. [2025]

1.14.28

Discuss with the families and carers the importance of their support and readiness to adhere to the intervention. [2025]

1.14.29

Discuss with the child or young person, and their family and carers, their views and experiences of the intervention. [2025]

1.14.31

If it has not been possible to resolve a child or young person's difficulties with the intervention, or those of the family or carers, (for example, their attendance or participation) agree what should happen next. For example, they could be referred to another service, leave the intervention at an agreed time, or think about a re-referral at a later date. See NICE's guidance on making decisions using NICE guidelines for more information about safeguarding. [2025]

For a short explanation of why the committee made the 2025 recommendations and how they might affect practice, see the .

Full details of the evidence and the committee's discussion are in evidence review E: increasing uptake of weight management services in children, young people and adults.

Ongoing support from providers of overweight and obesity management interventions

These recommendations are for providers of overweight and obesity management interventions.

1.14.32

Offer a range of options for follow-up sessions after the intervention active phase has been completed. This should include at different times and in easily accessible and suitable venues. [2025]

1.14.33

Discuss with the child or young person, their family and carers any local services and activities that can provide further long-term support to help them manage their weight, for example, local leisure services and walking, cycling or youth groups. [2025]

For a short explanation of why the committee made the 2025 recommendations and how they might affect practice, see the .

Full details of the evidence and the committee's discussion are in evidence review G: effectiveness and acceptability of weight management interventions in children and young people living with overweight and obesity.

Ongoing support from healthcare and other professionals

1.14.34

Use information from the intervention provider (such as change in weight, BMI centile or waist-to-height ratio, reported improvements to fitness and mental wellbeing) and continue to measure when appropriate to help monitor progress and give ongoing tailored support. [2025]

1.14.35

Offer support and follow-up sessions, depending on the needs of the child or young person and their family and carers. [2025]

1.14.36

Give children and young people, and their family and carers, information about any other local sources of long-term support as part of a multidisciplinary team approach. These could include support from a Registered dietitian or UK Voluntary Register of Nutritionists (UKVRN) registered nutritionist administered by the Association for Nutrition, youth worker, school nurse, family support worker, local support group, online groups or networks, friends and family, free healthcare-endorsed apps, national programmes, charities, helplines, and community groups (such as local leisure services or sports clubs). [2025]

1.14.37

If the child or young person's BMI centile and SD (see recommendations 1.10.9 and 1.10.10 on classifying overweight, obesity and central adiposity in children and young people) begins to increase, or if they or their family or carers express concerns about their weight and health (or sustaining changes in their behaviour):

  • discuss the possible reasons for these

  • offer another referral to an alternative overweight and obesity management intervention that may better address the needs of the child or young person, and those of their family and carers (this could include re-referral to a service they have used before)

  • if the child or young person has any comorbidities, ensure they get support from paediatric services or specialist overweight and obesity management services (if eligible). [2025]

For a short explanation of why the committee made the 2025 recommendations and how they might affect practice, see the .

Full details of the evidence and the committee's discussion are in evidence review G: effectiveness and acceptability of weight management interventions in children and young people living with overweight and obesity.

Submitting audit data for children and young people

For a short explanation of why the committee made the 2025 recommendation and how it might affect practice, see the .

Full details of the evidence and the committee's discussion are in evidence review G: effectiveness and acceptability of weight management interventions in children and young people living with overweight and obesity.

Psychological therapies to address the effect of weight stigma

See the NICE recommendation for research about psychological therapies to address the effect of weight stigma.