The January 2025 update from NICE (National Institute for Health and Care Excellence) marks a significant advancement in the clinical management of overweight and obesity. This updated guidance reflects the growing understanding of obesity as a complex, chronic condition requiring a long-term, multifaceted care strategy—particularly within primary care settings where early intervention and sustained support are critical.

Key to this update is a shift toward a more holistic approach that integrates biological, psychological, and socio-environmental determinants of obesity. The guidance underscores the need for personalized care pathways, recognizing how factors such as sex-specific physiology, comorbidities, behavioral influences, and social determinants can shape individual risk profiles and treatment outcomes.

Notably, the guidance introduces gender-sensitive strategies, with tailored interventions for women that address under-recognized drivers of obesity. It also reinforces the role of psychological and behavioral therapies, especially in children and adolescents, highlighting the importance of involving families and communities in interventions.

General principles for all ages

Sensitive Discussion & Communication Principles

Aspect	Key Points for Consultation
Context Matters	Consider health, comorbidities, weight history, stigma, eating disorders, neurodevelopmental conditions, socioeconomic status, recent pregnancy, family dynamics, etc.
Before Talking About Weight	Reflect on setting, cultural sensitivities, your own biases, and patient's prior experiences with weight discussions. Tailor approach to age/maturity (esp. children).
Ask Permission	Always seek consent before initiating conversations on weight. Respect a refusal and document the outcome.
Record & Communicate	Note in records: the discussion occurred, patient’s perspective, and any next steps for continuity.
Language Use	Avoid stigma: use phrases like “living with overweight.” Focus on health, not just weight. Explore preferred terms.
Tone	Be non-judgmental, supportive, and patient-centred. Acknowledge cultural and personal beliefs.
Resources	Use guidance and frameworks: NHS healthier weight competencies, PHE weight conversation guides, and image banks. Tailor to literacy/communication needs.

Principles for Children & Young People

Focus Area	Practical Application
Supportive Environments	Promote health behaviours at home, school, and community settings.
Family-Centred Approach	Address behaviours within family and social settings. Involve families directly, especially under 12s.
Tailored Interventions	Adapt discussions and plans to the child’s age, maturity, and preferences.
Safeguarding & Duty of Care	If obesity threatens health/wellbeing: refer to emotional and specialist support. Use clinical judgement on urgency.
Communication Style	Avoid triggering language. Be clear, visual (e.g. growth charts), and developmentally appropriate. Emphasize health, not weight.

Supporting Healthy Weight Maintenance

Focus Area	Summary of Key Points
Avoid Extreme Behaviours	Discourage unsustainable actions like cutting all carbs or obsessive exercise. ⚠️
Identify Risk Behaviours	Discuss triggers for weight gain: sugary drinks, portion distortion, reward eating, holiday habits, etc.
Encourage Monitoring (with caution)	Weekly self-weighing, tracking activity or intake (apps/tools). ⚖️ Watch for disordered eating signs.
Provide Reliable Info	Signpost to NHS Better Health and local services for diet, activity, or weight concerns.
Promote Broader Benefits	Explain non-weight benefits: better mental health, social enjoyment, reduced disease risks, pre-pregnancy health.
Gradual Change is Powerful	Emphasize: small steps matter, weight gain isn’t inevitable, multiple behaviours together lead to results. ⬆️⬇️
Advice for Families & Carers	Encourage active play, shared meals, avoiding food as a reward, repeated veg exposure, sleep hygiene. 🧒🛌🍽️
Tailor Communication	Make it specific, non-judgemental, and clear. Avoid stigma; personalise the message.
Routine Opportunities	Use key life stages (e.g. post-pregnancy, menopause, smoking cessation) to raise weight topics—only with consent. 🕰️
Healthcare Professional Role	Offer multicomponent, tailored, long-term support. Combine dietary, physical, behavioural components. 📋🤝

📌 Specific Advice for People from Ethnic Minority Backgrounds

Focus Area	Specific Guidance
Healthcare Professional Awareness	Clinicians should recognise increased risk of central adiposity and chronic disease in some ethnic groups at lower BMI thresholds. 👩‍⚕️📏
Patient & Family Education	Inform patients and families from ethnic minority backgrounds about their increased risk in an inclusive, non-stigmatising way. 👪🧠
Community Engagement	Utilise community networks to communicate tailored health messages about BMI-related risks. Link with community engagement and health inequality reduction efforts. 🌍📣

📏 Key Messages: Taking Anthropometric Measurements in Adults

Focus Area	Key Messages
Encourage Self-Measurement	Adults with BMI <35 kg/m² should assess central adiposity using waist-to-height ratio. Seek clinical advice if ratio indicates increased health risk. 📏⚠️
How to Measure (Box 1)	Locate midpoint between bottom of ribs and top of hips (above navel). Wrap tape, exhale naturally, measure. Use same units for waist and height. Divide waist by height (e.g. 96.5 cm / 170 cm = 0.57).
Trusted Resources	Refer patients to NHS video guides and online calculators for accurate waist-to-height measurement. 📹🌐
Using BMI & WHtR in Practice	Use BMI cautiously—it's not a direct adiposity measure. For BMI <35, include waist-to-height ratio to assess health risks. Avoid substituting bioimpedance for BMI. ⚖️🚫

⚖️ Classification of Overweight, Obesity, and Central Adiposity (Adults)

Focus Area	Key Classification or Advice
Standard BMI Categories	- Healthy weight: 18.5–24.9 kg/m² - Overweight: 25–29.9 kg/m² - Obesity Class 1: 30–34.9 kg/m² - Obesity Class 2: 35–39.9 kg/m² - Obesity Class 3: ≥40 kg/m²
Ethnicity-Based Adjustments	For South Asian, Chinese, other Asian, Middle Eastern, Black African, African-Caribbean: - Overweight: 23–27.4 kg/m² - Obesity: ≥27.5 kg/m² - Obesity Classes 2 & 3: reduce thresholds by 2.5 kg/m²
Caution: High Muscle Mass	BMI may be inaccurate in muscular adults—use clinical judgement when assessing adiposity.
Caution: Age 65+	Interpret BMI carefully in older adults. Consider comorbidities and possible protective effects of slightly higher BMI.
Waist-to-Height Ratio (WHtR)	- Healthy: 0.4–0.49 (no increased risk) - Increased: 0.5–0.59 (increased risk) - High: ≥0.6 (further increased risk) Use for BMI <35 kg/m², any ethnicity or sex, including muscular adults.
Advice for Patients	Encourage people to keep their waist measurement under half their height (WHtR <0.5).

🧒 Classification in Children & Young People

Focus Area	Key Classification or Advice
BMI Centile-Based Categories	- Overweight: ≥91st centile (+1.34 SDs) - Clinical Obesity: ≥98th centile (+2.05 SDs) - Severe Obesity: ≥99.6th centile (+2.68 SDs) Use clinical judgement for BMI below 91st centile—central adiposity may still be present.
Waist-to-Height Ratio (WHtR)	- Healthy: 0.4–0.49 (no increased risk) - Increased: 0.5–0.59 (increased risk) - High: ≥0.6 (further increased risk) Applies to all ethnicities and sexes.
Advice for Families	Encourage children to keep waist measurement under half their height (WHtR <0.5). Explain in age-appropriate and supportive language. 👪📏

⚖️ Management & Referral Principles for Adults

Focus Area	Key Messages
Discussing Results	Inform patients about severity of overweight/obesity and central adiposity and their long-term health risks (e.g. diabetes, CVD, NAFLD, cancer).
Initial Advice & Options	Offer tailored referrals to weight management services. Consider individual needs, stigma, mental health, and social context.
Goal Setting	Agree on realistic, personalised goals (e.g. increased mobility, social activity, breathing ease). Emphasise sustainable lifestyle changes.
Clinician Preparedness	Ensure familiarity with local/national pathways, referral criteria, support links, and service capacity.
Choosing Interventions	Align intervention format with patient needs/preferences. Factor in comorbidities, ethnicity, disabilities, and SEND. Options include behavioural, digital, or physical approaches.
Past Experience	Acknowledge past attempts, successes, challenges, and cultural factors influencing engagement with previous interventions.
Culturally Appropriate Interventions	Recommend tailored or culturally adapted services, such as peer-based or age-/gender-specific groups. Explain the benefits clearly.
Cost Transparency	Clearly inform patients of any costs during or after the intervention, particularly if funding ends.
Long-Term Support	Refer to community and health services (e.g. health coaches, social prescribers, online groups, support apps) for ongoing help.
Specialist Referral	Offer higher-intensity or specialist services for complex needs, high BMI (≥35 with diabetes, ≥50), or if standard care has failed.
If Referral Declined	Respect decision. Revisit later if appropriate. Share other support options and encourage future re-referral if needed.

🏃 Key Points: Physical Activity Approaches

Focus Area	Summary of Recommendations
Staff Qualifications	Ensure sessions are led by qualified, insured professionals (e.g. physiotherapists or CIMSPA members). Children's activity leaders should have paediatric CPR training. 🎓🏥
Adults – Benefits Beyond Weight Loss	Encourage physical activity for broader health gains (mental, cardiovascular, metabolic), even without weight change. Follow UK CMO guidelines. 🧠💪
Adults – Intensity & Duration	To prevent obesity: 45–60 mins/day. To maintain weight loss: 60–90 mins/day. Recommend consistent, moderate-intensity activity. ⏱️🚶
Adults – Building Activity	Support gradual progress with goal-setting. Suggest daily-life activities (walking, gardening), structured programs, or step targets. Reduce screen time. Tailor to fitness level. 🌿📉
Children – Encourage Activity	Promote regular movement regardless of weight changes. Use UK guidelines for age-appropriate targets, including for disabled children. ⚽🧒
Children – Higher Needs	Those with overweight/obesity may require more activity than general recommendations. Consider additional support. 📈🏃
Children – Support & Accessibility	Support active routines (play, walking) and structured exercise (sports, dance). Let the child help choose activities that match their interests and are affordable. 🤸‍♂️💬

🍽️ Key Points: Dietary Approaches for Overweight and Obesity Management

Focus Area	Detailed Recommendations
Tailored, Individual Approach	Design flexible plans to reduce energy intake and support nutritional balance. Consider cultural food preferences, household context, comorbidities (e.g. eating disorders, IBD), neurodiversity, and food limitations. Be mindful of potential weight regain. 🍛🏡
Health Benefits Beyond Weight	Encourage dietary improvements even without weight loss to support lipid health, T2DM prevention, and cardiovascular outcomes. 🫀🥦
Adults – Energy Deficit	Create a calorie deficit using approaches like low-fat, low-carb, or total intake reduction. 🧮🔥
Children – Calorie Control	Keep intake within age/sex recommendations. Focus on healthy eating habits over restriction. Refer to SACN guidance for under-5s. 👶📏
Professional Support Required	Only offer energy-reducing diets with support from trained dietitians or UKVRN-registered nutritionists. Ensure follow-up for weight maintenance. 🧑‍⚕️📋
Balanced Long-Term Eating	Encourage long-term healthy eating aligned with the NHS Eatwell Guide. Avoid nutritionally unbalanced restrictive diets. 🥗⛔
Low-/Very-Low-Energy Diets (LED/VLED)	Use only in specialist settings as part of a multicomponent plan for: - Obesity (with/without T2DM) - Overweight + T2DM (LED) - Rapid weight loss need (e.g. pre-surgery, VLED) 🧪🏥
LED/VLED Use Requirements	Must be: - Nutritionally complete - Supervised by qualified professionals - Limited to 12 weeks - Followed by structured food reintroduction and maintenance strategy 🕒📦
Before Starting LED/VLED	Explain: - Short-term goal focus (e.g. diabetes improvement) - Risks: weight cycling, constipation, fatigue, hair loss (esp. VLED) - Need for lifelong energy control & physical activity - Regain is common, not failure - Discuss support (diet/activity/meds/surgery) - Assess mental health and eating disorders - Review and adjust medications as needed 🧠💊

💊 Medicines for Weight Management – Adults

Focus Area	Key Points
When to Use	Initiate after trying and evaluating diet, activity, and behavioural strategies. 💬🍽️
Always Combined With	Prescribe alongside reduced-calorie diet and increased physical activity. 🔁🏃‍♂️
Shared Decision-Making	Discuss pros/cons, motivation, support needs, and patient programmes before starting medication. 🤝📋
Available Medicines	- Tirzepatide: Weekly injection; BMI ≥35 with comorbidity or high-risk groups. - Semaglutide: Weekly injection; BMI ≥35 or ≥30 + comorbidity (specialist only). - Liraglutide: Daily injection; BMI ≥35 + non-diabetic hyperglycaemia + high CVD risk. - Orlistat: Oral; BMI ≥30 or ≥28 + risk factors (widely available). 💉💊
Prescribing Settings	- Tirzepatide/Semaglutide: Primary or specialist care. - Liraglutide: Secondary care only. - Orlistat: Any setting, incl. OTC in pharmacy (low dose). 🏥🛒
Contraindications	Not for use in pregnancy. Require contraception. Orlistat may affect oral contraceptive reliability due to diarrhoea. ⚠️🚫
When to Stop	- Tirzepatide/Semaglutide: Stop if <5% weight loss after 6 months. - Liraglutide/Orlistat: Stop if <5% loss after 12 weeks at full dose. ⏳🧪
Ethnicity Adjustments	Use BMI thresholds reduced by 2.5 kg/m² for high-risk ethnicities (e.g. South Asian, Black African, Middle Eastern). 🌍📉
Support on Withdrawal	Provide guidance to maintain weight loss after stopping medication. 🤗📉
Monitoring	Review treatment effectiveness and reinforce behaviour change. Adjust expectations for people with type 2 diabetes. 📈🔁
Micronutrient Caution	Consider supplements for older adults or young people at risk of deficiency. 💊🧓👶

🏥 Referral for Bariatric Surgery

Referral Type	Criteria
Standard Referral	Refer to specialist multidisciplinary service if: - BMI ≥40 kg/m² - Or BMI 35–39.9 kg/m² with a significant health condition (e.g. T2DM, CVD, OSA, NAFLD, HTN) - And patient agrees to lifelong follow-up (e.g. annual reviews) 🩺📉
Ethnicity-Based Adjustments	Use lower BMI threshold (↓2.5 kg/m²) for people of South Asian, Chinese, other Asian, Middle Eastern, Black African, or African-Caribbean backgrounds due to higher cardiometabolic risk at lower BMI. 🌍⚠️
Expedited Assessment – Standard	Offer expedited referral if: - BMI ≥35 kg/m² + recent-onset T2DM (diagnosed within 10 years) - Must be receiving or awaiting assessment in a specialist obesity service ⏱️🧬
Expedited Assessment – Lower BMI	Consider expedited referral if: - BMI 30–34.9 kg/m² + recent-onset T2DM - Must also be under specialist obesity service care 📋🔍
Expedited Assessment – Ethnicity-Adjusted	For high-risk ethnic groups, reduce BMI threshold by 2.5 kg/m² when considering expedited referral for recent-onset T2DM. Applies to same groups as above. 🧪📉

People who have bariatric surgery should receive structured follow-up and support to ensure nutritional adequacy, manage comorbidities, and support long-term health and wellbeing. This care should transition from specialist services to shared care with primary care, and be supported by national audit processes.

Key follow-up components:

• Minimum 2 years of follow-up in the bariatric service

• Monitor:

  • Nutritional intake (protein, vitamins, minerals)

  • Comorbidities and medication needs

• Provide:

  • Individualised dietary and nutrition support

  • Physical activity advice

  • Tailored psychological support

  • Access to peer or professionally led support groups

• After discharge:

  • Offer at least annual nutrition monitoring and supplementation in primary care

In addition to behavioural strategies, the NICE guidance has integrated recommendations related to technological innovations, underscoring the role of digital health tools in obesity management. The development of mHealth applications that involve community engagement and multidisciplinary teamwork is a critical part of the new approach (Toh, 2025). Such applications facilitate personalised care and encourage patient involvement in their treatment, which can significantly enhance compliance and outcome effectiveness.

From a clinical practice perspective, the updates advocate for comprehensive training among healthcare providers to ensure they are equipped with the latest evidence-based practices in obesity management (Cheng et al., 2025). This includes recognising obesity as a complex, chronic condition requiring sustained, long-term care rather than a one-off intervention. There is growing emphasis on a proactive, dual focus that addresses both weight and glycaemic control, especially in individuals with type 2 diabetes.

In summary, the January 2025 NICE updates on overweight and obesity management highlight a multidisciplinary, personalised, and evidence-based approach. By incorporating behavioural, psychological, cultural, and technological factors, the guidance supports a holistic model of care. This shift aims to improve clinical outcomes, promote equity, and enhance the long-term effectiveness of obesity interventions across diverse populations.

• Ayesh, H., Nasser, S., Ferdinand, K., & Leon, B. (2025). Sex-specific factors influencing obesity in women: bridging the gap between science and clinical practice. Circulation Research, 136(6), 594–605. https://doi.org/10.1161/circresaha.124.325535

• Cheng, A., Heine, R., Prato, S., Green, J., Thieu, V., & Zeytinoglu, M. (2025). Striving for early effective glycaemic and weight management in type 2 diabetes: a narrative review. Diabetes Obesity and Metabolism, 27(4), 1708–1718. https://doi.org/10.1111/dom.16206

• Davila, N. (2025). Adopting national recommendations for clinical management of pediatric obesity in primary care. The Nurse Practitioner, 50(3), 40–47. https://doi.org/10.1097/01.npr.0000000000000286

• Henderson, M., Moore, S., Harnois‐Leblanc, S., Johnston, B., Fitzpatrick‐Lewis, D., Usman, A., … & Birken, C. (2025). Effectiveness of behavioural and psychological interventions for managing obesity in children and adolescents: a systematic review and meta‐analysis framed using minimal important difference estimates based on GRADE guidance to inform a clinical practice guideline. Pediatric Obesity, 20(3). https://doi.org/10.1111/ijpo.13193

• Toh, S. (2025). Codevelopment of an mHealth app with health care providers, digital health experts, community partners, and families for childhood obesity management: protocol for a co-design process. JMIR Research Protocols, 14, e59238. https://doi.org/10.2196/59238

• National Institute for Health and Care Excellence. (2025). Obesity: identification, assessment and management (NICE Guideline NG246). https://www.nice.org.uk/guidance/ng246

•