Nurses working in primary care settings could in future be required to carry out body mass measurements annually, to head off weight gain and obesity in patients with certain conditions.
Patients with long-term conditions such as diabetes and heart disease should have their body mass index (BMI) and waist-to-height ratio recorded at least once a year, according to draft guidance.
“These simple annual measurements create opportunities for early intervention and conversations”
Jonathan Benger
The recommendation comes in a draft quality standard on overweight and obesity management, which was published by the National Institute for Health and Care Excellence (NICE) on Tuesday.
Among the ideas under consideration are that adults with long-term conditions should have their BMI recorded annually, with additional waist-to-height measurements for those with a BMI under 35.
Such a move would help identify people at risk of weight-related complications so they can be offered appropriate support to prevent future ill-health, said NICE in its daft document.
It noted that, while annual physical checks already take place for those with long term conditions, the recording of BMI and waist-to-height ratio is not always taking place or added to a health record.
The draft quality standard does not provide a definitive list of long-term conditions, the institute acknowledged, but NICE did flag a wide range of examples where it felt it would be appropriate.
These were chronic obstructive pulmonary disease, diabetes, dyslipidaemia, heart failure, learning disability, obstructive sleep apnoea, peripheral arterial disease, polycystic ovary syndrome, rheumatoid arthritis, schizophrenia, bipolar disorder or other psychoses, stroke or transient ischemic attack.
NICE said in the document that regular measurement and recording of BMI during a consultation for a long-term condition allows for “prediction or identification” of weight-related conditions.
It can also be used to identify changes in weight and central adiposity – an accumulation of fat in the abdominal area – and can help in the “assessment and management” of a long-term condition, according to the draft quality standard.
As well as discussing the rational for the measurements, NICE offered advice for nurses and other staff on how to broach the subject with patients.
It said: “Healthcare professionals should seek permission in a sensitive, non-judgmental way before discussing weight, because people may then be more receptive to offers of support that could have a positive impact on their health.
“Healthcare professionals should avoid attributing all symptoms to weight (diagnostic overshadowing) and the purpose of the appointment should always be prioritised,” it added.
Commenting, Professor Jonathan Benger, NICE deputy chief executive and chief medical officer, said: “These simple annual measurements create opportunities for early intervention and conversations.
“By identifying trends before they become problems, clinical practitioners can help people prevent more serious health complications down the line,” he said.
He added: “Annual monitoring of BMI and waist-to-height ratio is a powerful tool to help prevent problems developing such as the onset of diabetes, heart disease or other obesity-related conditions.
“Once implemented, these proposed quality standards could significantly improve health outcomes for people with long-term conditions by ensuring consistent, timely support for weight management across all healthcare settings.”
The draft quality standard on overweight and obesity management is open for public consultation from 18 March to 15 April, with the final version expected to be published in August this year.
It follows the recent publication of an updated NICE guideline on overweight and obesity management in January.
Dr Rebecca Payne, chair of the quality standards advisory committee, called on nurses and other staff to share their views on the practicality of the recommendations in the NICE quality standard.
“We want to hear from healthcare professionals and commissioners during the consultation period to understand whether the proposals we have made can be implemented in the NHS,” she said.
“NICE must focus on what matters most,” she said. “We expect these changes to demonstrate the impact we are having on the lives of people with weight related conditions.
“Once the consultation period closes, the committee will meet again to discuss the responses, and if necessary, amend the statements.”
The draft quality standard also recommended a number of other related measures, including supporting people with learning disabilities to access overweight and obesity management services.
“We want to hear from healthcare professionals and commissioners during the consultation period”
Rebecca Payne
In addition, it encouraged providing up-to-date information on local interventions and national programmes, as well as annual follow-up for adults discharged from bariatric surgery services.
Giving advice for maintaining changes and support for improving health and wellbeing after completing a behavioural intervention, was also recommend by NICE.
Meanwhile, it called on services to ensure wraparound care focusing on diet, nutrition and physical activity for adults prescribed medicines for weight management.
NICE quality standards apply in England and Wales, with decisions on their application in Scotland and Northern Ireland made by the respective national governments.
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