NICE Recommends Annual BMI Checks for Long-Term Conditions

The National Institute for Health and Care Excellence (NICE) has proposed annual body mass index (BMI) checks for patients in England with long-term conditions. In draft guidance, the regulator also suggested measuring waist-to-height ratios for those with a BMI below 35.

Identifying Risks and Improving Care

NICE said the new approach would help identify people at risk of weight-related complications. This would allow healthcare professionals to offer appropriate support and prevent future ill-health.

While annual physical checks are standard for people with long term conditions, NICE noted that a person’s BMI and waist-to-height ratio was not always being measured or recorded. The regulator hopes its new standards would “reduce this inequality in care”.

Opportunities for Early Intervention

“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,” said Professor Jonathan Benger, deputy chief executive and chief medical officer at NICE, in a statement. 

He added: “These simple annual measurements create opportunities for early intervention and conversations about long-term health and wellbeing. By identifying trends before they become problems, clinical practitioners can help people prevent more serious health complications down the line.”

NICE also recommended that people with a learning disability should be supported to access overweight and obesity management services. People with learning disabilities were at greater risk of obesity than the general population and might need tailored support to access information and services that could help them achieve or maintain a healthy lifestyle and manage their weight, it explained.

New Quality Standards Proposed

NICE’s draft recommendations include three additional quality statements:

• Up-to-date information on available local interventions and national programmes should be provided.
• Patients should receive support to maintain health improvements after completing a behavioural intervention.
• Adults prescribed weight management medications should receive wraparound care focusing on diet, nutrition, and physical activity.

The regulator also proposed an update to an existing standard, recommending annual follow-ups for adults discharged from bariatric surgery services.

Reassessing BMI as a Measure of Health

Earlier this year, a Lancet commission of 58 international experts representing multiple medical specialties questioned the accuracy of BMI as an individual health measure. The commission stated that current BMI-based measures of obesity could both “underestimate and overestimate adiposity and provide inadequate information about health at the individual level”. 

The experts recommended using BMI only for population-level studies or screening. They advised confirming excess adiposity with direct body fat measurement or at least one additional anthropometric criterion, such as waist circumference or waist-to-hip ratio. It added that in people with very high BMI – over 40 – excess adiposity could pragmatically be assumed, with no further confirmation required.

The latest NICE draft quality standard does not specify a definitive list of long-term conditions. However, it suggested focusing on conditions such as chronic obstructive pulmonary disease (COPD), dyslipidaemia, heart failure, type 1 and type 2 diabetes, and individuals at high risk of developing type 2 diabetes.

“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,” Benger underlined. 

The final quality standard is expected to be published in August 2025.

Dr Rob Hicks is a retired NHS doctor. A well-known TV and radio broadcaster, he has written three books and has regularly contributed to national newspapers, magazines, and online. He is based in the UK.