Quality standard

Quality statement 1: Informing people of their BMI

Quality statement 1: Informing people of their BMI

Quality statement

People are informed of their body mass index (BMI) when it is calculated and advised about any associated health risks.

Rationale

The increasing prevalence of overweight and obesity can make it harder for people to recognise that they or their children are (or are at risk of becoming) overweight or obese. It is therefore important that people who are identified as being overweight or obese are informed of their BMI and understand what it means, any associated risks to their health and how they can get help. Calculation of BMI is often done as part of registration with a GP, or at hospital or community outpatient appointments for related conditions such as type 2 diabetes, cardiovascular disease or osteoarthritis. BMI measurement can also take place when people are admitted to hospital as inpatients, when they are having preoperative assessments and at booking appointments during pregnancy.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

a) Evidence of local arrangements to ensure that people are informed of their BMI when it is calculated.

Data source: Evidence can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service pathways and protocols.

b) Evidence of local arrangements to ensure that people have a discussion with the healthcare professional about the associated health risks related to their BMI measurement.

Data source: Evidence can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service pathways and protocols.

Process

a) Proportion of people who are informed of their BMI when it is calculated.

Numerator – the number in the denominator who are informed of their BMI.

Denominator – the number of people who have had their BMI calculated.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

b) Proportion of people who have a discussion with their healthcare professional about their associated health risks in relation to their BMI.

Numerator – the number in the denominator who had a discussion with their healthcare professional about their associated health risks in relation to their BMI.

Denominator – the number of people informed of their BMI.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

Outcome

a) Patient awareness of their BMI measurement.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient surveys.

b) Patient understanding of the health risks associated with their weight.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

What the quality statement means for different audiences

Service providers (primary and secondary care providers) ensure that healthcare professionals are able to accurately measure and record height and weight, and are able to determine BMI centile using age- and gender-specific charts for children and young people. Service providers should also ensure that healthcare professionals inform people of their BMI when it is calculated, are able to assess the health risks associated with BMI or BMI centile scores, and are able to discuss health risks with people (and their families or carers, as appropriate) who have a BMI that shows they are overweight or obese, or who have health risks because of their weight.

Healthcare professionals (such as GPs, nurses, hospital clinicians and consultants) ensure that they inform people of their BMI when they calculate it, assess the health risks associated with the person's BMI or BMI centile score, and ensure that there is time during the consultation to answer questions.

Commissioners ensure that they commission services in which healthcare professionals inform people of their BMI when they calculate it, assess the health risks associated with BMI or BMI centile scores, and discuss these risks with people who have a BMI that identifies that they are overweight or obese, or at health risk because of their weight.

People who have their body mass index (a measure of height and weight, often shortened to BMI) measured and who may be at risk of health problems because of their weight are told what their BMI is and have a discussion with a healthcare professional about what this might mean for their health. Their family members or carers can be involved in this discussion.

Definitions of terms used in this quality statement

BMI or BMI centile

BMI is calculated by dividing weight (in kilograms) by the square of height (in metres).

Royal College of Paediatrics and Child Health UK-World Health Organization (WHO) growth charts and BMI charts should be used to plot and classify BMI centile. The childhood and puberty close monitoring (CPCM) form can also be used for continued BMI monitoring in children aged 2 and over, especially in instances where puberty is either premature or delayed. Refer to special BMI growth charts for children and young people with Down's syndrome, if needed. [Adapted from NICE's guideline on obesity: identification, assessment and management, recommendation 1.2.21]

Associated health risks

Guidance on defining the degree of overweight or obesity and assessing associated health risks can be found in section 1.2 of NICE's guideline on obesity: identification, assessment and management.

Local voluntary organisations and support groups can also provide details on the health risks associated with being overweight or obese and help with approaches to weight loss. Discussions about likely resulting health problems can also therefore include providing details of such groups and how to contact them. [NICE's guideline on obesity: identification, assessment and management, recommendation 1.4.8]

Once people are informed of their BMI, they can be made aware of local lifestyle weight management programmes, in line with statement 6 in NICE's quality standard on obesity in adults: prevention and lifestyle weight management programmes and statement 5 in NICE's quality standard on obesity in children and young people: prevention and lifestyle weight management programmes.

Equality and diversity considerations

Some population groups, such as people of Asian family origin and older people, have comorbidity risk factors that are of concern at different BMIs. Clinical judgement should be used when considering risk factors in these groups.

There are circumstances when it may not be appropriate to inform someone of their BMI measurement, such as inpatients approaching the end of life.