Shutterstock.com
Adults with a long-term health condition should have their BMI recorded at least once per year, the National Institute for Health and Care Excellence (NICE) has recommended.
The draft quality standard on overweight and obesity management, published on 18 March 2025, also states that patients should have an annual recording of their waist-to-height ratio if they have a BMI lower than 35kg/m2.
The draft standard will replace the existing quality standards, published in 2015 and 2016, on obesity in children and young people; obesity in adults; and obesity’s clinical assessment and management.
The new quality standard says the regular measurement and recording of BMI, or BMI and waist-to-height ratio, “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,” it adds.
NICE advises healthcare professionals to seek permission in a sensitive, non-judgemental way before discussing weight, “because people may then be more receptive to offers of support that could have a positive impact on their health”.
The draft standard also says that healthcare professionals should avoid attributing all symptoms to weight and the purpose of the appointment should always be prioritised. They are also advised to identify when it is appropriate to take measurements, ask for permission before discussing weight and respect the person’s choice if they do not wish to discuss their weight.
While it does not provide a definitive list of long-term conditions, the standard suggests services could focus on specific conditions, including diabetes, heart failure, COPD, dyslipidaemia and learning disabilities.
Douglas Twenefour, head of clinical at Diabetes UK, commented: “People with diabetes should have their BMI measured as part of their vital annual health checks, and so we are pleased to see these measures recognised in the draft standards. But while BMI can be a useful tool, it is not perfect, and so the inclusion of additional waist-to-height measurement is encouraging.”
However, Rachel Morman, chair of Verity (PCOS UK), said the quality standard “risks further alienating those who need support”.
“For many people with PCOS [polycystic ovary syndrome], BMI is often a barrier to receiving symptom-based treatment rather than a tool for improving health. From restrictions on contraceptive prescriptions to fertility treatments and even weight management support, many have been told to ‘just lose weight’ without proper guidance or medical support,” she said.
“Weight stigma and medical bias already deter many from seeking care, fearing dismissal or fat-shaming instead of being heard and helped.”
Andy Whittamore, clinical lead at Asthma + Lung UK, said: “Regular checks of BMI and waist-to-height ratio could help to manage lung conditions, but it’s important that alongside these checks, people are supported to make the necessary lifestyle changes to diet and exercise habits to help them reach a healthier weight.
“However, this can be difficult for people with lung conditions that can impact the ability to be active and can have different nutritional needs.”
The draft standard also states that adults living with overweight or obesity who are prescribed medicines for weight management should receive wrap-around care focusing on diet, nutrition and increasing physical activity — guidance that is already in place for prescribing glucagon-like peptide 1 receptor agonists (GLP-1 RA)s.
GLP-1 RA treatment semaglutide was made available for weight management in the UK in September 2023.
In October 2024, NHS England said the GLP-1 RA tirzepatide could be used to treat 1.6 million people for obesity by 2036.
The draft quality standard is out for consultation until 15 April 2025. The final quality standard is expected to be published in August 2025.
