Quality statement 1: Recording BMI and waist-to-height ratio in adults
Quality statement
Adults with a long-term condition have at least annual recording of their BMI and, if they have a BMI lower than 35 kg/m2, recording of waist-to-height ratio. [new 2025]
Rationale
Regular measurement and recording of BMI, or BMI and waist-to-height ratio if somebody has a BMI lower than 35 kg/m2 (taking into account increased risks based on ethnic background), during a consultation for a long-term condition allows all of the following:
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definition of overweight, obesity and central adiposity
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prediction or identification of weight-related conditions
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identification of changes in weight and central adiposity.
It can also help in assessment and management of a long-term condition. Healthcare professionals should seek permission in a sensitive, non-judgmental way before discussing and measuring weight, because people may then be more receptive to offers of support that could have a positive impact on their health. Healthcare professionals should avoid attributing all symptoms to weight (diagnostic overshadowing) and the purpose of the appointment should always be prioritised.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Process
a) Proportion of adults with a long-term condition who have a recorded BMI in the last 12 months.
Numerator – the number in the denominator who have a recorded BMI in the last 12 months.
Denominator – the number of adults with a long-term condition.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from the electronic medical record. For some long-term conditions, national data collection and reporting are already in place:
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Quality and Outcomes Framework indicator MH006 reports the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of BMI in the preceding 12 months.
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The National Diabetes Audit reports the percentage of people with type 1 and type 2 diabetes who have a record of BMI in the preceding 12 months.
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CVDPREVENT indicator CVDP001BMI reports the percentage of patients aged 18 and over, with GP recorded coronary heart disease, stroke or transient ischaemic attack, peripheral arterial disease, heart failure, diabetes mellitus, non-diabetic hyperglycaemia, familial hypercholesterolaemia, chronic kidney disease, hypertension or atrial fibrillation whose notes record BMI status in the preceding 12 months.
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NHS Digital Health and Care of People with Learning Disabilities includes data on the percentage of registered patients on the learning disability register who have had a health check annually.
b) Proportion of adults with a long-term condition whose most recent BMI was lower than 35 kg/m2 who have a recorded waist-to-height ratio in the last 12 months.
Numerator – the number in the denominator with a recorded waist-to-height ratio in the last 12 months.
Denominator – the number of adults with a long-term condition whose most recent BMI was lower than 35 kg/m2.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from the electronic medical record.
What the quality statement means for different audiences
Service providers (such as primary care services and secondary care services) ensure that adults with a long-term condition can have their BMI and, if needed, waist-to-height ratio recorded at least annually. They ensure that healthcare professionals have appropriate equipment to measure height, weight and waist circumference and systems to record BMI and waist-to-height ratio.
Healthcare professionals (such as doctors, nurses and allied health professionals) accurately measure and record height and weight of adults with a long-term condition at least annually, and if they have a BMI of under 35 kg/m2 also record waist circumference. They are able to identify when it is appropriate to take measurements and ask for permission before discussing weight. They approach conversations in a sensitive, non-judgemental way and respect the person's choice (and that of their family or carer, if relevant) if they do not wish to discuss their weight.
Commissioners ensure that they commission services in which adults with a long-term condition can have their BMI and, if needed, waist-to-height ratio recorded at least annually.
Adults with a long-term condition have their BMI (weight and height), and their waist-to-height ratio (waist measurement and height) if they have a BMI lower than 35 kg/m2, recorded at least annually by healthcare professionals if they consent to this.
Source guidance
Overweight and obesity management. NICE guideline NG246 (2025), recommendations 1.9.2, 1.9.3, 1.9.7 and 1.9.8
The 12-month timeframe in the quality statement is based on advice from the NICE quality standards advisory committee. The timeframe is not derived from the NICE guideline on overweight and obesity management. It is considered a practical timeframe to enable stakeholders to measure performance.
Definitions of terms used in this quality statement
Long-term condition
There is no definitive list of long-term conditions. For quality improvement purposes, services could focus on conditions such as:
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chronic obstructive pulmonary disease
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coronary heart disease
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hypertension
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diabetes: type 1 or type 2 diabetes or at high risk of developing type 2 diabetes (a high-risk score and a fasting plasma glucose of 5.5 to 6.9 mmol/litre, or HbA1c of 42 to 47 mmol/mol)
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dyslipidaemia
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heart failure
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learning disability
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obstructive sleep apnoea
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peripheral arterial disease
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polycystic ovary syndrome
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rheumatoid arthritis
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schizophrenia, bipolar disorder or other psychoses
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stroke or transient ischemic attack.
[NICE's guideline on chronic obstructive pulmonary disease in over 16s, recommendation 1.2.103; NICE's guideline on psychosis and schizophrenia in adults, recommendation 1.1.2.5; NICE's guideline on bipolar disorder, recommendation 1.2.12; NICE's guideline on type 2 diabetes: prevention in people at high risk, recommendation 1.6.5; NICE's CKS on polycystic ovarian syndrome, NICE's indicator on learning disabilities, NICE's technology appraisal guidance on tirzepatide for managing overweight and obesity and expert opinion]
Equality and diversity considerations
Reasonable adjustments should be considered when measuring height and weight in adults with a learning or physical disability. This may include use of seated or hoisted scales, or scales that will accept a wheelchair, measuring height with a tape measure, rollameter, or with the person lying down. Measurements may need to be modified for example using sitting height or demi-span (the distance between the mid-point of the sternal notch and the finger roots with the arms outstretched laterally) instead of overall height, meaning specialist assessment may be needed. [NICE's guideline on overweight and obesity, rationale and impact section for classifying overweight, obesity and central adiposity in adults and Public Health England's guidance on obesity and weight measurement for people with learning disabilities].
People with a South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean background are prone to central adiposity and so are at an increased risk of chronic weight-related conditions at a lower BMI. For people in these groups, obesity class 3 (BMI 35 kg/m2 to 39.9 kg/m2) is usually identified by reducing the threshold by 2.5 kg/m2.
BMI should be interpreted with caution in people aged 65 and over, taking into account comorbidities, conditions that may affect functional capacity and the possible protective effect of having a slightly higher BMI when older.