overview bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see: http://pathways.nice.org.uk/pathways/diet NICE Pathway last updated: 30 August 2017 This document contains a single flowchart and uses numbering to link the boxes to the associated recommendations. Page 1 of 10
overview Page 2 of 10
overview 1 Improving people's diet No additional information 2 Strategy, policy and commissioning See / Strategy, policy and commissioning for diet 3 Training See / Training on diet 4 Areas of work (settings) No additional information 5 Lifestyle advice on diet and physical activity See / Lifestyle advice on diet and physical activity 6 Primary care and community health services See / Recommendations about diet for primary care and community health services 7 Community programmes including leisure and weight management See / Community and leisure services and weight management programmes Page 3 of 10
overview 8 Commercial organisations, including manufacturing, retailing, catering and weight management Manufacturers of products for women Folic acid 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 For advice for manufacturers on vitamin D supplements, see NICE's recommendations on vitamin D: supplement use in specific population groups. Take-aways and other food outlets See recommendations on standards for take-aways and other food outlets. Providers of weight management programmes See recommendations on weight management programmes. 9 Schools, early years education and childcare See / in schools, early years education and childcare 10 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). Page 4 of 10
overview 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, and recommendations for workplaces in NICE's recommendations on physical activity. Align actions to improve diet with strategies to prevent obesity at a community level to ensure a coherent, integrated approach (see what NICE says on obesity: working with local communities). Page 5 of 10
overview 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. Quality standards The following quality statements are relevant to this part of the interactive flowchart. Obesity in adults: prevention and lifestyle weight management programmes quality standard 2. Nutritional information at the point of choosing food and drink options Obesity in children and young people: prevention and lifestyle weight management programmes quality standard 2. Nutritional information at the point of choosing food and drink options obesity prevention and lifestyle weight management in children and young people Page 6 of 10
overview Reference nutrient intake is the amount of a nutrient needed to meet the needs of 97.5% of individuals in a group. Reference nutrient intake for a given nutrient may vary by gender, age and physiological status (for example during pregnancy and lactation). The reference nutrient intake is not a minimum target that all people need to achieve, but the risk of deficiency is minimised if the average population intake exceeds it. The current reference nutrient intakes (µg/day) for vitamin D are: 10 micrograms of vitamin D per day, throughout the year, for everyone in the general population aged 4 years and older 10 micrograms of vitamin D per day for pregnant and lactating women and population groups at increased risk of vitamin D deficiency. Although the entire population of the UK are at risk of having a low vitamin D status, evidence was only considered in regard to increasing the supplement use for these specific population groups: All pregnant and breastfeeding women, particularly teenagers and young women. Infants and children under 4 years (breast fed, non-breast fed and mixed fed). People over 65. People who have low or no exposure to the sun. For example, those who cover their skin for cultural reasons, who are housebound or confined indoors for long periods. People who have darker skin, for example, people of African, African Caribbean and South Asian origin. All population groups are currently advised to take a supplement that meets 100% of the reference nutrient intake for their age group. All infants and young children aged 6 months to 3 years are advised to take a daily supplement containing vitamin D in the form of vitamin drops. But infants who are fed infant formula will not need them until they have less than 500 ml of infant formula a day, because these products are fortified with vitamin D. Breastfed infants may need drops containing vitamin D from 1 month of age if their mother has not taken vitamin D supplements throughout pregnancy. ('Vitamin D advice for supplements for at risk groups letter from the UK Chief Medical Officers' Department of Health). BMI body mass index Page 7 of 10
overview CVD cardiovascular disease IPTFAs industrially-produced trans fatty acids Sources Obesity prevention (2006 updated 2015) NICE guideline CG43 Maternal and child nutrition (2008) NICE guideline PH11 Your responsibility Guidelines The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Page 8 of 10
overview Technology appraisals The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian. Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Medical technologies guidance, diagnostics guidance and interventional procedures guidance The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties. Page 9 of 10
overview Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Page 10 of 10