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Diet
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Introduction
Having a healthy balanced diet helps prevent obesity, cardiovascular and many other conditions. This pathway covers recommendations for everyone about diet and lifestyle, and recommendations for health professionals on interventions to encourage people to follow a healthy diet. It is for mothers and children, particularly those from low-income households, and on weight management before and during pregnancy.
The pathway also includes NICE's recommendations on local and national strategy for diet to prevent cardiovascular disease, and recommendations for schools, and the leisure and weight management industries.
The pathway also includes recommendations about dietary supplements for children and women before, during and after pregnancy. It does not cover breastfeeding. Recommendations on breastfeeding are in the postnatal care pathway.
Align actions to improve diet with strategies to prevent obesity at a community level to ensure a coherent, integrated approach (see the obesity: working with local communities pathway).
Source guidance
The NICE guidance that was used to create the pathway.
Obesity. NICE clinical guidance 43 (2006)
Weight management before, during and after pregnancy. NICE public health guidance 27 (2010)
Prevention of cardiovascular disease. NICE public health guidance 25 (2010)
Maternal and child nutrition. NICE public health guidance 11 (2008)
Quality standards
Quality statements
Effective interventions library
Successful effective interventions library details
Implementation
Assessment tools
The baseline and self-assessment tools are Excel spreadsheets that can be used by organisations to identify if they are in line with practice recommended in NICE guidance and to help them plan activity that will help them meet the recommendations.
Audit support
Audit support provides ready-to-use criteria, including exceptions, definitions, suggested data sources and a data collection tool.
Commissioning guides
Commissioning guides provide information on key clinical and service-related issues to consider during the commissioning process. Each guide contains a commissioning and benchmarking tool, which is a resource that can be used to estimate and inform the level of service needed locally as well as the cost of local commissioning decisions.
Costing support
Costing support includes national cost impact reports that summarise the national costs and savings and discuss the assumptions used; costing templates to assess the impact on local budgets; and costing statements when the impact is not significant or impossible to quantify at a national level.
Education tools
NICE has developed online learning modules, in collaboration with a range of providers, including BMJ Learning, to update knowledge on evidence and NICE guidance.
Information resources and templates
These include key points for scrutiny or compliance assessment, signposting to resources, checklists and case studies. They are designed to offer practical help in putting NICE guidance into practice and the format depends on the specific topic.
Slide sets
Slide sets provide a framework for discussion and assist in local dissemination of the guidance. The slides contain the key messages from NICE guidance and can be tailored for local presentations.
Pathway information
Diet and obesity
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.
Women and children from disadvantaged groups
Women from disadvantaged groups have a poorer diet and are less likely to take folic acid or other supplements than those who are better off. They are more likely to be overweight or show low weight gain during pregnancy and their babies are more likely to have a low birth weight.
Mothers from these groups are also less likely to breastfeed and more likely to introduce solid foods earlier than recommended. As a result of many of these factors, their children are more likely to be underweight as infants while also being more prone to obesity later in childhood.
Cardiovascular disease: a national framework for action
Cardiovascular disease (CVD) is a major public health problem. Changes in the risk factors can be brought about by intervening at the population and individual level. Government has addressed – and continues to address – the risk factors at both levels.
Interventions focused on changing an individual's behaviour are important. But changes at the population level could lead to further substantial benefits.
Population-level changes may be achieved in a number of ways but national or regional policy and legislation are particularly powerful levers.
The national framework would be established through policy, led by the Department of Health. It would involve government, government agencies, industry and key, non-governmental organisations working together.
The final decision on whether these policy options are adopted – and how they are prioritised – will be determined by government through normal political processes.
Schools
Improving diet and physical activity levels helps children develop a healthy lifestyle that will prevent them becoming overweight or obese in adulthood. Other benefits may include higher motivation and achievement at school, and better health in childhood and later life.
Workplaces
An organisation's policies and incentive schemes can help to create a culture that supports healthy eating and physical activity. Action will have an impact, not only on the health of the workforce but also in savings to industry.
Information for patients and the public
NICE produces booklets for patients and the public, called 'Understanding NICE guidance'. They summarise, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written a booklet for patients and the public explaining its guidance on each of the following topics.
25 October 2011 Minor maintenance updates
25 May 2012 Minor maintenance updates
10 August 2012 Minor maintenance updates
28 November 2012 Information about obesity prevention added to Training for health professionals, Training for public sector catering staff, Training for teaching, support and catering staff in schools, Workplaces, including the NHS and local authorities, Health professionals working in the wider community, Local and regional health impact assessments and evaluation, Strategy for local authorities and partners in the community, Developing a regional cardiovascular disease prevention programme, and Standards for take-aways and other food outlets.
Supporting information
Support for workplaces
Health professionals such as occupational health staff and public health practitioners should establish partnerships with local businesses and support the implementation of workplace programmes to prevent and manage obesity.
Changing behaviour
Evidence-based behaviour change advice includes:
- understanding the short, medium and longer-term consequences of people's health-related behaviour
- helping people to feel positive about the benefits of health-enhancing behaviours and changing their behaviours
- recognising how people's social contexts and relationships may affect their behaviour
- helping plan people's changes in terms of easy steps over time
- identifying and planning situations that might undermine the changes people are trying to make and plan explicit 'if–then' coping strategies to prevent relapse.
For more information see NICE's guidance on behaviour change.
Glossary
Recommendation of interest
What type of recommendation are you interested in?
Strategy and policy
View the 'Strategy, policy and commissioning for diet' pathTraining
View the 'Training on diet' pathSettings
Areas of work (settings)
Primary care
View the 'Recommendations about diet for primary care and community health services' pathCommunity and leisure services
View the 'Community and leisure services and weight management programmes' pathCommercial organisations
Commercial organisations, including manufacturing, retailing, catering and weight management
Commercial organisations, including manufacturing, retailing, catering and weight management
Manufacturers of products for women
Folic acidThis is part of a recommendation from 'Maternal and child nutrition' (NICE public health guidance 11).
Manufacturers should include information with their products on the importance of folic acid supplements before and during pregnancy. Relevant products may include pregnancy tests, sanitary products, contraceptives and ovulation predictor kits.
Vitamin D
Manufacturers should include information with their products on the importance of vitamin D supplements during pregnancy and while breastfeeding. Relevant products may include pregnancy tests and breast pumps.
Take-aways and other food outlets
See recommendations on standards for take-aways and other food outlets in this pathway.
Providers of weight management programmes
See recommendations about weight management programmes in this pathway.
Source guidance
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View the 'Diet in schools, early years education and childcare' pathAll workplaces
Workplaces, including the NHS and local authorities
Workplaces, including the NHS and local authorities
Overarching recommendation
All workplaces, particularly large organisations such as the NHS and local authorities, should address the prevention and management of obesity, because of the considerable impact on the health of the workforce and associated costs to industry. Workplaces are encouraged to collaborate with local partnerships and to ensure that action is in line with the local obesity strategy (in England).
For all workplaces
Workplaces should provide opportunities for staff to eat a healthy diet and be more physically active, through:
- active and continuous promotion of healthy choices in restaurants, hospitality, vending machines and shops for staff and clients, in line with existing Food Standards Agency guidance
- working practices and policies, such as active travel policies for staff and visitors.
Incentive schemes (such as policies on travel expenses, the price of food and drinks sold in the workplace and contributions to gym membership) that are used in a workplace should be sustained and part of a wider programme to support staff in managing weight, improving diet and increasing activity levels.
For NHS, public organisations and large commercial organisations
Workplaces providing health checks for staff should ensure that they address weight, diet and activity, and provide ongoing support.
Action to improve food and drink provision in the workplace, including restaurants, hospitality and vending machines, should be supported by tailored educational and promotional programmes, such as a behavioural intervention or environmental changes (for example, food labelling or changes to availability).
For this to be effective, commitment from senior management, enthusiastic catering management, a strong occupational health lead, links to other on-site health initiatives, supportive pricing policies and heavy promotion and advertisement at point of purchase are likely to be needed.
See also recommendations on public sector catering in this pathway, and recommendations for workplaces in the physical activity pathway.
Align actions to improve diet with strategies to prevent obesity at a community level to ensure a coherent, integrated approach (see the obesity: working with local communities pathway).
Support for workplaces from health professionals
Support for workplaces
Health professionals such as occupational health staff and public health practitioners should establish partnerships with local businesses and support the implementation of workplace programmes to prevent and manage obesity.
Implementation tools
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Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeLifestyle advice
View the 'Lifestyle advice on diet and physical activity' pathPaths in this pathway
- Strategy, policy and commissioning for diet
- National policy on diet
- Training on diet
- Lifestyle advice on diet and physical activity
- Recommendations about diet for primary care and community health services
- Dietary interventions and advice for adults
- Dietary interventions and advice for children and young people
- Community and leisure services and weight management programmes
- Diet in schools, early years education and childcare
Pathway created: May 2011 Last updated: November 2012
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