Evidence
How we made the decision
How we made the decision
We check our guidelines regularly to ensure they remain up to date. We based the decision on surveillance 4 years after the publication of weight management: lifestyle services for overweight or obese children and young people (2013) NICE guideline PH47.
For details of the process and update decisions that are available, see ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual.
Surveillance update decisions for the guideline are on our website.
New evidence from 4 year surveillance review on PH47
A forward citation search on all studies included in the effectiveness review and barriers and facilitators review that informed PH47 and a literature search (re-run of the original search strategy for the effectiveness and barriers and facilitators reviews that informed PH47) were undertaken to identify systematic reviews, randomised controlled trials and qualitative research papers from May 2012 (the end of the search period for the guideline) to June 2016 on the effectiveness of lifestyle weight management programmes (LWMPs) for children and young people, and the barriers and facilitators to implementation of LWMPs, uptake and adherence.
All relevant abstracts were assessed for their impact on the recommendations within PH47.
We reviewed studies highlighted by topic experts for any potential impact on the guideline scope and remit, these are summarised in the evidence summary (appendix 1).
We checked for ongoing and newly published research from the National Institute for Health Research and Cochrane as well as new policy developments. One report and 2 published studies were included as evidence, and 5 pieces of ongoing research were identified.
See appendix 1: evidence summary for references and assessment of the abstracts for all new evidence considered.
Consideration of the evidence
We found 70 new studies, 1 report and 5 pieces of ongoing research. This evidence indicates that new evidence is available that impacts directly on:
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Recommendation 3 'Lifestyle weight management programmes: core components' and Recommendation 4 'Developing a tailored plan to meet individual needs' may both benefit from an update providing further details on effective behaviour change techniques and specific activities that are deemed enjoyable/ associated with effectiveness.
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Recommendation 5 'Encouraging adherence to lifestyle weight management programmes'. Evidence indicates that the recommendation to offer programmes to both children and their families may need to be re-considered for overweight and obese children aged ≤12 years old, for whom parent-only interventions may be as effective at managing weight as parent-child interventions.
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Recommendation for research 3 'Barriers and facilitators': there was new evidence identified on themes concerning barriers and facilitators to participating in a LWMP.
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Recommendation for research 4 'Weight management programmes': there appears to be new evidence that could contribute to an up-date of the original evidence review meta-analysis on the effects of weight management programmes in the long-term. Overall, the findings of studies reporting at least 12 months follow-up data indicate that LWMPs can be effective at weight management in the long-term.
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Evidence gap 3 'Effective and cost effective approaches to weight management for children younger than 6 years': 15 studies (7 of which are systematic reviews) were identified which assess the effectiveness of weight management interventions for overweight or obese children aged under 6 years old, indicating that there is now a substantial body of evidence for this age group which assesses the effectiveness of parent-only interventions, parent and child-based interventions, multicomponent interventions, motivational interviews, and other types of intervention, provided across various settings. It should however be noted that many studies included children aged 6 years old and over as well as under.
New evidence was identified for the following guideline recommendations, but it has been concluded that it does not have an impact on the content of the recommendations:
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Recommendation 2 Commissioning lifestyle weight management programmes for children and young people.
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Recommendation 6 Raising awareness of lifestyle weight management programmes: commissioners and programme providers.
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Recommendation 8 Formal referrals to lifestyle weight management programmes.
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Recommendation 9 Providing ongoing support: health professionals.
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Recommendation 10 Providing ongoing support: lifestyle weight management programmes.
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Recommendation 15 Monitoring and evaluating programmes.
See appendix 1 for details of the evidence reviewed.
We did not find any new evidence related to Recommendation 1 'Planning lifestyle weight management services for children and young people', Recommendation 7 'Raising awareness of lifestyle weight management programmes: health professionals, other professionals and voluntary organisations', Recommendation 11 'Lifestyle weight management programme staff: training', Recommendation 12 'Lifestyle weight management programme staff: knowledge and skills', Recommendation 13 'Training in how to make referrals to a lifestyle weight management programme', or Recommendation 14 'Supporting lifestyle weight management programme staff and those making programme referrals'.
Implementation
Data were obtained from The Health Improvement Network database (Copyright © 2016, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved) on the percentage of patients aged under 18 years old recorded by GPs as either overweight or obese and the proportion of whom were offered or referred to a weight management programme for the years 2011 to 2015. Between 2011 and 2014 0.5% of patients aged less than 18 years old had a record indicating they were 'overweight' or 'obese', and in 2015 this was 0.4%. Less than five children/young people classified as overweight were offered or referred to a weight management programme by their GP in 2011 and 2013, and none in 2012, 2014 or 2015. The percentage of obese children/young people referred to, or offered a weight management programme has remained at a consistently low rate: 1.4% in 2014, 1.5% in 2012, 2013 and 2015 and 1.6% in 2011.
Equalities
No evidence has been found to indicate that the guideline does not comply with anti-discrimination and equalities legislation.
Implications for other NICE programmes
The surveillance review recommendation to partially update weight management: lifestyle services for overweight or obese children and young people (PH47) may lead to one of the quality statements being affected by the proposed areas for update, specifically statement 6 in the NICE quality standard on obesity in children and young people: prevention and lifestyle weight management programmes.
Work that was undertaken in the mapping of the diet management guidelines and for the public health catalogue themes Senior Management Team paper indicated that there are some gaps concerning the coverage of 'promotion of health and wellbeing in schools' within the public health guideline portfolio. The areas requiring update within obesity prevention (NICE guideline CG43) covers early years settings and schools and weight management: lifestyle services for overweight or obese children and young people (NICE guideline PH47) covers school-aged children and young people, but is a service(s) provided outside of school. Given that the same populations are covered within CG43 (update areas) and PH47, It is proposed that these guidelines are amalgamated to cover the 'promotion of health and wellbeing in children and young people'.
Overall decision
Weight management: lifestyle services for overweight or obese children and young people (PH47) should have a partial update taking into account new evidence on:
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Effectiveness of LWMPs for overweight and obese children aged ≤ 5 years old.
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Effectiveness of parent-only LWMP interventions for overweight and obese children aged ≤ 12 years old.
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Long-term effectiveness of LWMPs.
An update may also wish to consider evidence in the following areas:
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Behaviour change techniques associated with effective (and non-effective) LWMPs.
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The role of new technologies (SMS, Apps, etc) in LWMPs and on-going support.
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Intervention content detail (such as which activities are both associated with effectiveness and deemed 'enjoyable').
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Issue of costs impacting on enrolment and participation on a LWMP and remuneration encouraging adherence to a LWMP.
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