People with long-term conditions such as COPD, diabetes and heart disease should have their BMI checked and recorded ‘at least once a year’, NICE has said.
In draft guidance published today, NICE said that adults with long-term conditions should have their BMI recorded ‘annually’, with additional waist-to-height measurements for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.
‘The new approach will help identify people at risk of weight-related complications so they can be offered appropriate support to prevent future ill-health,’ it added.
The quality standard published today does not provide a definitive list of long-term conditions, but suggests a focus on patients with:
- COPD
- diabetes (type 1 or type 2 diabetes or at high risk of developing type 2 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.
The guidance said that service providers, including primary care, should ensure that adults with a long-term condition ‘can have their BMI and waist-to-height ratio recorded at least annually’.
It said: ‘Regular measurement and recording of BMI during a consultation for a long-term condition allows for definition of overweight, obesity and central adiposity, prediction or identification of weight-related conditions, and identifying changes in weight and central adiposity.
‘It can also help in assessment and management of a long-term condition. 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.’
It follows the publication of updated NICE guidelines on overweight and obesity management in January, which encouraged clinicians to take into account the wider determinants and context of overweight and obesity and to ask patients permission to discuss their weight and respect their choice if they decline.
NICE added that while annual physical checks already take place for people with long term conditions, the recording of someone’s BMI and waist-to-height ratio is ‘not always taking place or added to a health record’, and it hopes to ‘reduce this inequality in care’.
However, RCGP chair Professor Kamila Hawthorne said that there is ‘no one-size fits all’ approach to weight management, and that GPs hear ‘first-hand’ how hard it can be for some patients to maintain a healthy weight.
She added that measuring BMI will not be ‘appropriate’ for everyone and will need to sit alongside ‘other support’.
She said: ‘Supporting our patients to understand the benefits that come with being a healthier weight and ways to achieve this is something GPs and our teams already do on a daily basis.
‘Measuring BMI can be a useful tool and help people to understand their weight – and GPs will already measure BMI annually for patients with chronic conditions as part of QOF requirements, but we need to ensure wider roll out of this is evidence based, and properly resourced as part of wider efforts to support patients to maintain a healthy weight.
‘Measuring BMI also won’t be appropriate for everyone and will need to sit alongside other support such as focused health education, counselling, and advice around specific lifestyle factors including diet, nutrition and exercise. We also need to consider the potential for overdiagnosis.’
Professor Hawthorne added that it is important to also consider how this would impact workload in general practice, which is already ‘severely overstretched’.
‘We will be considering this draft standard carefully before we respond to the consultation and look forward to working with NICE to find the best answer for our patients,’ she added.
NICE’s deputy chief executive and chief medical officer Professor Jonathan Benger explained that the measurements create opportunities for ‘early intervention and conversations’ about long-term health.
He said: ‘By identifying trends before they become problems, clinical practitioners can help people prevent more serious health complications down the line.
‘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 guidance also includes an updated quality statement on the monitoring after discharge from bariatric surgery, saying that adults discharged from the bariatric surgery service should have follow up ‘at least annually’.
‘After discharge from the bariatric surgery service an agreed shared-care model of management should be in place with collaboration between specialist weight management services and primary care as well as locally agreed monitoring arrangements and responsibilities,’ it added.
The draft is up for public consultation until 15 April, with the final quality standard expected to be published in August.
Chair of the quality standards advisory committee Dr Rebecca Payne, who is a GP, said NICE wants to hear from healthcare professionals and commissioners during the consultation period to understand whether the proposals can be implemented in the NHS.
She added: ‘NICE must focus on what matters most and in areas where it can make the biggest difference. 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. Our final quality statements will be published on the NICE website at the conclusion of this process.’
Last week, NICE approved a daily pill for treating some women with endometriosis after initially rejecting it.
