Discussing results and referral

1.11 Discussing results and referral for adults

Discussing the results with adults

1.11.1

Give adults information about the severity of their overweight or obesity and central adiposity and the impact this has on their risk of developing other long-term conditions (such as type 2 diabetes, cardiovascular disease, hypertension, dyslipidaemia, certain cancers and respiratory, musculoskeletal and other metabolic conditions such as non-alcoholic fatty liver disease). [2006, amended 2022]

1.11.2

Offer advice and discuss the possibility of referral to an overweight and obesity management service with the person, taking into account their individual needs and preferences (see also recommendation 1.11.6). [2025]

1.11.3

Address the drivers of overweight and obesity (for example, social context, mental health and wellbeing, and stigma) if possible. Refer as needed for assessment for any comorbidities, or to other services such as social care, physiotherapy, eating disorder services or the NHS diabetes prevention programme. [2025]

1.11.4

Discuss and agree realistic, personalised health goals (and any other related goals such as clothes fitting better, taking part in active play with children or grandchildren, finding it easier to breathe when walking or climbing stairs, being able to tie shoelaces or fasten a standard-length seatbelt). Include the importance and wider benefits of making sustainable, long-term changes to dietary behaviours and increasing physical activity levels. [2025]

Choosing interventions with adults

1.11.5

Ensure that healthcare professionals involved in identifying overweight, obesity and central adiposity are familiar with the local overweight and obesity management pathway, including:

  • local and national behavioural overweight and obesity management interventions and what these may involve

  • links to support services, such as mental health support

  • referral criteria and process for funded referrals

  • the capacity of services

    and are aware of services that are available locally and nationally. [2025]

1.11.6

Discuss and agree the type and level of intervention with adults who:

1.11.7

Discuss any previous or ongoing overweight and obesity management interventions or attempts, including:

  • acknowledging any progress the person has already made

  • their positive or negative experiences with interventions

  • any barriers, or concerns, they may have about making changes and meeting their personal goals

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

1.11.8

Identify available behavioural overweight and obesity management interventions that are:

  • appropriate for the person, taking their preferences and previous experiences into account if possible

  • culturally appropriate or have been adapted for different cultural communities and dietary practices

  • tailored to specific demographic groups, such as men only or for older adults.

    Explain how these may be beneficial (for example, peer support). [2025]

1.11.9

Inform people if there are any known costs associated with taking part in the intervention or continuing it after a funded referral period has ended. [2025]

1.11.10

Emphasise the person's choice in the referral. Refer them to an in-person individual or group intervention, or digital services according to preference and availability. [2025]

1.11.11

Give people information about more sources of long-term community or healthcare support (for example, provided by social prescribers, health coaches, pharmacists, local support groups, online groups or networks, friends and family, Talking Therapies, free healthcare-endorsed apps, national campaigns, and local community groups such as walking or gardening groups). These can be used while waiting for and alongside an overweight and obesity management intervention. See NICE's guideline on behaviour change: digital and mobile health interventions. [2025]

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

Full details of the evidence and the committee's discussion for the 2025 recommendations are in evidence review D: identifying overweight and obesity in children, young people and adults.

Referring adults to specialist services

1.11.12

Offer a higher level of intervention to people with weight-related comorbidities (see the section on assessing and managing comorbidities in adults). Adjust the approach depending on the person's clinical needs, for example for people with a BMI over 35 kg/m2 who have recently developed diabetes or for people with a BMI of 50. [2022]

1.11.13

Consider referral to specialist overweight and obesity management services if:

  • the underlying causes of overweight or obesity need to be assessed

  • the person has complex disease states or needs that cannot be managed adequately in behavioural overweight and obesity management services (for example, the extra support needs of people with learning disabilities)

  • less intensive management has been unsuccessful

  • specialist interventions (such as a very-low-calorie diet) may be needed

  • surgery or certain medicines is being considered.

    For more information see specialist overweight and obesity services. [2006, amended 2025]

For a short explanation of why the committee made the 2022 recommendation and how it might affect practice, see the .

Full details of the evidence and the committee's discussion are in evidence review A: accuracy of anthropometric measures in assessing health risks associated with overweight and obesity in adults.

If an adult declines referral

1.11.14

If the person declines a referral to an intervention:

  • acknowledge and respect their choice, being aware that a person's decision to accept referral may be temporarily or permanently influenced by many factors, including the wider determinants of overweight and obesity

  • either explore the reason sensitively or delay discussion until an appropriate time

  • ensure they have the opportunity to discuss referral again in future

  • give them information about other ways to make sustainable, long-term changes to their dietary behaviours and physical activity levels. [2025]

1.11.15

Give people the opportunity for a re-referral, as needed, taking into account that overweight and obesity management is a long-term process. [2025]

For a short explanation of why the committee made the 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.

1.12 Discussing results and referral for children and young people

Asking permission from children and young people, and their families and carers

1.12.1

Ask permission from children, young people, and their families and carers, before talking about the degree of overweight, obesity and central adiposity, and discuss it in a sensitive and age-appropriate manner. [2022]

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

Full details of the evidence and the committee's discussion are in evidence review B: accuracy of anthropometric measures in assessing health risks associated with overweight and obesity in children and young people.

Discussing the results with children and young people, and their families and carers

1.12.2

During discussions with a child or young person living with overweight or obesity, and their family or carers:

  • explain the degree of overweight or obesity, and the health risks associated with a higher BMI

  • encourage them to engage with overweight and obesity management

  • advocate for the child's health proportionately to the degree of health risk. [2025]

1.12.3

Before deciding on behavioural overweight and obesity management interventions, address the drivers of overweight and obesity (for example, social context, mental health and wellbeing, and stigma) if possible. Refer as needed for assessment for any comorbidities, or to other services such as social care, physiotherapy, eating disorder services, or other physical or mental health and wellbeing support and early help services (for example youth work or parenting). [2025]

1.12.4

Discuss personalised goals and the importance and wider potential benefits of making sustainable, long-term changes to dietary behaviours and physical activity levels with children and young people (and their families and carers). Changes or goals could include:

  • for children who are growing taller, avoidance of further weight gain and maintenance of weight whilst continuing to grow to reduce BMI centile is a realistic and appropriate goal

  • for young people who have reached their near-final height, long-term behavioural changes that can help them reduce their weight (and explain that this can be a way to sustain a lower BMI)

  • changes to diet and physical activity that can have positive health benefits, independent of any effect on weight or BMI

  • improvements in psychosocial outcomes (such as sense of wellbeing, self-efficacy, self-esteem and self-perception) which are important health benefits

  • personal goals such as feeling less breathless when playing with friends. [2025]

1.12.5

Use the local mental health pathway to access support if there are concerns about the child or young person's mental health and wellbeing. [2025]

For a short explanation of why the committee made these 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.

Choosing interventions with children and young people, and their families and carers

1.12.6

Ensure you are familiar with the local overweight and obesity management pathway for children and young people, including:

1.12.7

Discuss any previous or ongoing overweight and obesity management interventions or attempts, including:

  • acknowledging any progress the child or young person and their family have already made

  • their positive or negative experiences with interventions

  • barriers to or concerns they may have about:

    • joining an intervention

    • making changes

  • how the child or young person feels about overweight and obesity management and common fears they may have (for example, about having changes in diet and activity imposed, or about being stigmatised)

  • how the family or carers feel about overweight and obesity management

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

1.12.8

Identify behavioural overweight and obesity management interventions that are:

  • appropriate for the child or young person, taking the family's and carers preferences and previous experiences into account if possible

  • culturally appropriate or have been adapted for different cultural communities and dietary practices

  • tailored to particular demographic groups, such as specific age groups, to encourage peer support.

    Explain how these may be beneficial to the child, young person and their family. [2025]

1.12.9

Encourage children and young people and their families and carers to take part in decision making by discussing what the interventions involve and what to expect. This could include:

  • giving information about the intervention, or about where they can get this information

  • explaining that the more sessions they attend, the greater the likelihood of success

  • explaining how they can take part, including whether or not they can self-refer

  • giving information about any known costs associated with taking part in the intervention or continuing it after a funded referral period has ended

  • understanding that their decision to accept the referral may be influenced temporarily or permanently by the wider determinants and the context of overweight and obesity.

    Emphasise to the child, young person and families or carers that it is their choice whether to accept a referral. [2025]

1.12.10

Advise children, young people and their families and carers that behavioural overweight and obesity management interventions:

  • may not reduce BMI in the long term without sustained behavioural changes, but that even a short-term reduction in BMI can improve health and wellbeing and reduce the risk of long-term conditions and comorbidities

  • may focus on weight maintenance and growing into a healthier weight, rather than weight loss, depending on the age of the child or young person, their stage of growth and degree of overweight or obesity

  • need to provide support for weight maintenance after the intervention, because overweight and obesity can be a long-term health issue and relapses are normal. [2025]

1.12.11

Refer only to behavioural overweight and obesity management interventions that offer longer-term support and maintenance advice to improve health and wellbeing if these are available locally. Make the referral alongside referral to other health and social care services that can help address the drivers of obesity. [2025]

1.12.12

Consider tailored interventions for children and young people:

Specialist services

1.12.14

In specialist overweight and obesity management services, assess associated comorbidities and possible causes for children and young people who are living with overweight or obesity. Include investigations of:

  • blood pressure

  • lipid profile, preferably while fasting

  • fasting insulin

  • fasting glucose levels and oral glucose tolerance

  • liver function

  • endocrine function.

    Interpret the results of any tests used in the context of:

  • the level of the child or young person's overweight or obesity

  • the child's age

  • any history of comorbidities

  • possible genetic causes

  • any family history of metabolic disease related to overweight or obesity. [2014]

1.12.15

Consider referral to an appropriate specialist for children and young people who are living with overweight or obesity and have significant comorbidities or complex needs (for example, SEND, physical disabilities or other extra support needs). [2006, amended 2014]

For a short explanation of why the committee made the 2022 recommendation and how it might affect practice, see the .

Full details of the evidence and the committee's discussion are in evidence review B: accuracy of anthropometric measures in assessing health risks associated with overweight and obesity in children and young people.

If a child or young person declines referral

1.12.16

If the child or young person and their family or carer are not ready or able to accept referral to a behavioural overweight and obesity management intervention:

  • either explore the reason sensitively or delay discussion until an appropriate time

  • ensure they have opportunities to discuss referral in the future and offer a follow-up appointment to monitor the child or young person's weight and reassess readiness and other options

  • give them sources of information about how to make sustainable, long-term changes to their dietary behaviours and physical activity levels outside an intervention (see NHS Better Health advice)

  • offer alternative interventions that include opportunities to be involved in healthy eating and physical activities such as walking or cycling groups, youth groups, cooking sessions and other children's and young people's activities (these may be delivered by community organisations or other local support). [2025]

For a short explanation of why the committee made these 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.