Quality standard

Quality statement 2: Structured weight-loss programme

Quality statement 2: Structured weight-loss programme

Quality statement

Women with a BMI of 30 or more after childbirth are offered a structured weight-loss programme.

Rationale

Attendance on a structured weight-loss programme for women who have a BMI of 30 or more after childbirth can improve the woman's health. If they become pregnant again, the programme can help to ensure that their nutritional status at conception is adequate to support optimal fetal growth. By losing weight the woman would reduce their risk of complications during pregnancy and childbirth, including gestational diabetes, pre-eclampsia and postpartum haemorrhage, if they subsequently became pregnant. In addition, their baby's risk of still birth, high birthweight and subsequent obesity and diabetes would be reduced.

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

Evidence of local arrangements to ensure that women with a BMI of 30 or more after childbirth are offered a structured weight-loss programme.

Data source: Local data collection.

Process

Proportion of women with a BMI of 30 or more after childbirth attending their baby's 6‑ to 8‑week health visitor appointment who receive a structured weight-loss programme.

Numerator – the number in the denominator who receive a structured weight-loss programme.

Denominator – the number of women with a BMI of 30 or more after childbirth attending their baby's 6‑ to 8‑week health visitor appointment.

Data source: Local data collection.

Outcome

a) Obesity rates in pregnancy.

Data source: Local data collection. The Maternity Services Data Set collects data on maternal height, weight and BMI during pregnancy. The Office for Health Improvement and Disparities' Obesity Profile presents data on obesity in early pregnancy in an online tool to show patterns and trends at local authority level.

b) Attendance at a weight‑loss programme.

Data source: Local data collection.

c) Pregnancy morbidity.

Data source: Local data collection.

d) Infant morbidity.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as primary and secondary care including maternity services) ensure that processes are in place for women with a BMI of 30 or more after childbirth to be offered a structured weight-loss programme.

Healthcare professionals ensure that they offer women with a BMI of 30 or more after childbirth a structured weight-loss programme.

Commissioners (clinical commissioning groups or integrated care systems, NHS England and local authority commissioners) ensure that the services they commission have processes in place to offer women with a BMI of 30 or more after childbirth a structured weight-loss programme.

Women who are overweight after having a baby (with a BMI of 30 or more) are offered support to lose weight. This should include a personal assessment and advice on diet, exercise and how to set and achieve weight-loss goals.

Definitions of terms used in this quality statement

BMI (body mass index)

BMI is a measure used to see if people are a healthy weight for their height.

For most adults, an ideal BMI is in the 18.5 to 24.9 range. A BMI in the range of 25 to 29.9 is overweight, 30 to 39.9 is obese and 40 or more is very obese.

These ranges are only for adults. BMI is interpreted differently for children. [Adapted from the NHS website]

Structured weight-loss programme

A structured weight-loss programme provides a personalised assessment, advice about diet and physical activity and advice on behaviour change strategies such as goal setting. [NICE's guideline on weight management before, during and after pregnancy, recommendation 4]

Equality and diversity considerations

Women from some ethnic groups may have an increased risk of obesity at a lower BMI, for example, women of South Asian or East Asian family origin, and this should be considered by their healthcare professionals.

Care and support, and the information given about it, should be both age-appropriate and culturally appropriate. It should also be accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. Women should have access to an interpreter or advocate if needed.

For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.