Although body weight and weight gain are influenced by many factors, including people’s genetic makeup and the environment in which they live, the individual decisions people make also affect whether they maintain a healthy weight. A person needs to be in ‘energy balance’ to maintain a healthy weight – that is, their energy intake (from food) should not exceed the energy expended through everyday activities and exercise. People tend to gain weight gradually, and may not notice this happening. Many people accept weight gain with age as inevitable but the main cause is gradual changes in their everyday lives, such as a tendency to being less active, or small changes to diet. People also often gain weight during particular stages of their life, such as during and after pregnancy, the menopause or while stopping smoking. Small, sustained improvements to daily habits help people maintain a healthy weight and have wider health benefits – such as reducing the risk of coronary heart disease, type 2 diabetes and some cancers. But making changes can be difficult and is often hindered by conflicting advice on what changes to make.
Everyone should aim to maintain or achieve a healthy weight, to improve their health and reduce the risk of diseases associated with overweight and obesity, such as coronary heart disease, type 2 diabetes, osteoarthritis and some cancers.
188.8.131.52 People should follow the strategies listed in box 1, which may make it easier to maintain a healthy weight by balancing ‘calories in’ (from food and drink) and ‘calories out’ (from being physically active). Sources of advice and information are listed in appendix D.
Box 1 Strategies to help people achieve and maintain a healthy weight
Base meals on starchy foods such as potatoes, bread, rice and pasta, choosing wholegrain where possible.
Eat plenty of fibre-rich foods – such as oats, beans, peas, lentils, grains, seeds, fruit and vegetables, as well as wholegrain bread, and brown rice and pasta.
Eat at least five portions of a variety of fruit and vegetables each day, in place of foods higher in fat and calories.
Eat a low-fat diet and avoid increasing your fat and/or calorie intake.
Eat as little as possible of:
-Drinks and confectionery high in added sugars
-Other food and drinks high in fat and sugar, such as some take-away and fast foods.
Watch the portion size of meals and snacks, and how often you are eating.
For adults, minimise the calories you take in from alcohol.
Make enjoyable activities – such as walking, cycling, swimming, aerobics and gardening – part of everyday life.
Minimise sedentary activities, such as sitting for long periods watching television, at a computer or playing video games.
Build activity into the working day – for example, take the stairs instead of the lift, take a walk at lunchtime.
184.108.40.206 All adults should be encouraged to periodically check their weight, waist measurement or a simple alternative, such as the fit of their clothes.
220.127.116.11 People who have any queries or concerns about their – or their family’s – diet, activity levels or weight should discuss these with a health professional such as a nurse, GP, pharmacist, health visitor or school nurse. They could also consult reliable sources of information, such as those listed in appendix D.
The following recommendation applies to adults only. Children and young people concerned about their weight should speak to a nurse or their GP.
Weight loss programmes (including commercial or self-help groups, slimming books or websites) are recommended only if they:
-Are based on a balanced healthy diet
-Encourage regular physical activity
-Expect people to lose no more than 0.5–1 kg (1–2 lb) a week.
Programmes that do not meet these criteria are unlikely to help people maintain a healthy weight in the long term.
People with certain medical conditions – such as type 2 diabetes, heart failure or uncontrolled hypertension or angina – should check with their general practice or hospital specialist before starting a weight loss programme.
18.104.22.168 In addition to the recommendations in box 1, parents and carers should consider following the advice in box to help children establish healthy behaviours and maintain or work towards a healthy weight. These strategies may have other benefits – for example, monitoring the amount of time children spend watching television may help reduce their exposure to inappropriate programmes or advertisements.
Box 2 Helping children and young people maintain or work towards a healthy weight
Children and young adults should eat regular meals, including breakfast, in a pleasant, sociable environment without distractions (such as watching television).
Parents and carers should eat with children – with all family members eating the same foods.
-Encourage active play – for example, dancing and skipping.
Try to be more active as a family – for example, walking and cycling to school and shops, going to the park or swimming.
-Gradually reduce sedentary activities – such as watching television or playing video games – and consider active alternatives such as dance, football or walking.
-Encourage children to participate in sport or other active recreation, and make the most of opportunities for exercise at school.
The following recommendations are made specifically for health professionals and managers in the NHS, but may also be relevant to health professionals in other organisations. Recommendations in other sections may also be relevant for NHS health professionals working with local authorities and other organisations.
These recommendations are for:
senior managers, GPs, commissioners of care and directors of public health
staff in primary and secondary care, particularly those providing interventions, including public health practitioners, nurses, behavioural psychologists, physiotherapists, GPs, pharmacists, trained counsellors, registered dietitians, public health nutritionists and specifically trained exercise specialists.
With specific training, staff such as pharmacy assistants or support staff in general practices may also be able to give advice and support.
Implementing these recommendations will contribute to the English target to halt the annual rise in obesity in children younger than 11 years by 2010, and similar initiatives in Wales. Recommendations can be delivered through local strategic partnerships and other local agreements and partnerships.
Section 3 has links to tools to help with implementing the recommendations and meeting training needs. In many cases, implementation will involve organisations working together in partnership.
Primary care staff should engage with target communities, consult on how and where to deliver interventions and form key partnerships and ensure that interventions are person centred.
Tailoring advice to address potential barriers (such as cost, personal tastes, availability, time, views of family and community members) is particularly important for people from black and minority ethnic groups, people in vulnerable groups (such as those on low incomes) and people at life stages with increased risk for weight gain (such as during and after pregnancy, menopause or smoking cessation). Many of the recommendations below also highlight the need to provide ongoing support – this can be in person, or by phone, mail or internet as appropriate.