NICE Overweight and Obesity Management Guidelines – A Step in the Right Direction
Dr Sean Wheatley, MSc, PhD. Science and Research Lead
In last month’s blog, I took a look at the new Dietary Guidelines for Americans, concluding that their shift towards a focus on minimising the intake of ultra-processed foods was a good thing.
I also referenced how I believe they are an improvement on the current UK guidelines (the Eatwell Guide), because they provide more scope for helping people to adopt a dietary approach that meets their own needs and preferences.
What I didn’t mention, is that there are actually some guidelines for people in England and Wales that support dietary flexibility: the National Institute for Health and Care Excellence (NICE) Overweight and Obesity Management Guidelines (NG246). These guidelines are the focus of this month’s blog.
When were these guidelines published?
These updated recommendations, which superseded a number of previous guidelines, were published in January 2025, so it is hard to claim they are hot off the presses!
I did allude to them in a series of blogs about the NICE Type 2 Diabetes Management guidelines (the most recent of which can be found here), but never actually covered them directly. Given their significance, that is a fairly glaring omission!
What do they say?
The most significant change is in the “Dietary approaches for all ages” sub-section, where recommendation 1.16.1 says:
“Use a flexible and individualised approach to tailor dietary interventions to achieve nutritional balance while reducing energy intake, taking into account:
– food preferences (including cultural preferences)
– personal circumstances (such as home environment and family finances)
– any comorbidities (such as eating disorders or disordered eating, type 1 diabetes, inflammatory bowel disease or non-alcoholic fatty liver disease)
– any restrictions in the range of foods they eat (for example because of neurodiversity, sensory problems, or coeliac disease) that in many cases weight regain may happen.”
Recommendation 1.16.3 is also important, as it explicitly states that dietary approaches to support weight management can include eating patterns based on “lowering specific macronutrient content (for example, low-fat or low carbohydrate diets)”. *
How is this different to previous guidelines?
Previous guidelines revolved around the use of a low-fat diet, taking what was largely a “one size fits all” approach. They therefore provided limited scope for adapting things to meet the needs and preferences of different people. The current Eatwell guide and NICE guidelines for people with type 2 diabetes are still like this!
Such guidelines are unnecessarily restrictive. They are also inconsistent with the available evidence, which shows that a range of different approaches (including low carb and Mediterranean-style eating patterns) are safe and can be effective. This is true in relation to general health, for weight management, and for the management of a range of different conditions (including type 2 diabetes).
As alluded to before, the significance of these “new” guidelines is that they address these issues, and so support people to experiment with different options in a way that previous recommendations did not (and, at risk of labouring the point, that some current recommendations still don’t).
Why is this important?
When dietary guidelines do not support a range of options, patients may be put off trying different things. This reduces the chances of them finding an approach that is right for them. We have even seen cases where people have been discouraged from continuing with certain eating patterns despite seeing significant benefits, purely because they have been told what they are doing is not what the guidelines recommend.
Similar is true with healthcare professionals, who in many cases are not comfortable with supporting their patients in adopting, or continuing with, approaches that are not explicitly supported by the guidelines.
Ensuring guidelines are supportive of different approaches (within the bounds of what the available evidence supports) helps to ensure patients and professionals can work together to find the best option(s). Crucially, it also helps patients feel empowered and can significantly increase their hope for their future.
But surely there’s now a conflict between different UK guidelines?!
Absolutely there is, which is far from ideal!
These contradictions create confusion amongst healthcare professionals and members of the public. They also risk undermining confidence in what options are worthwhile trying, and in healthcare professionals (and bodies) more generally.
The reason for the conflicts here is, frankly, that some of the existing guidelines are outdated. The conflict between the NICE weight management guidelines and the NICE type 2 diabetes management guidelines is difficult to justify, particularly when evidence around the benefits of certain dietary approaches (e.g., low carb) for the management of type 2 diabetes is stronger than the corresponding evidence for weight management. That the NICE weight management guidelines and the dietary recommendations for the general public (the Eatwell Guide) are different is also a little bizarre, given two out of every three people in the UK is overweight or obese.
As noted before, the available evidence is clear that different dietary approaches can be safe and effective for the management of weight and a range of different long-term conditions. There is also little to no evidence that any particular dietary approach is universally “better”. Dietary guidelines that do not promote a range of approaches should therefore be updated to reflect this, and to better support people in finding an option that works for them.
So, what’s the bottom line?
The 2025 update to the NICE weight management guidelines represented a significant shift compared to previous UK guidelines, with flexible and individualised approaches being promoted and a range of different dietary approaches being supported. This is a fantastic step in the right direction, but there is still work to be done to ensure other prominent guidelines (such as the Eatwell Guide and the NICE type 2 diabetes management guidelines) follow suit.
Only by fully supporting a range of approaches can guidelines help patients and healthcare professionals feel fully comfortable with, and empowered to, explore different options to find an approach that is right for the individual. Without finding an approach that fits someone’s needs and preferences it is unlikely that they will be able to meet their health goals, and even more unlikely they will be able to maintain these changes (and any health benefits) long-term.
Whilst we wait for other guidelines to catch up, basing dietary advice on the recommendations of the NICE Weight Management Guidelines rather than the outdated alternatives would be a good choice**.
* That these guidelines explicitly reference low carbohydrate dietary approaches is significant in itself. This marks another step towards this eating pattern being widely accepted as a suitable option.
** Where they are relevant, which will be a lot of the time given the prevalence of overweight and obesity in the UK.
