Healthy Weight

Excess weight and obesity remain a serious public health concern, being directly associated with many long-term illnesses, including type 2 diabetes, fatty-liver-disease, heart disease and some cancers (NICE 2025), as well as with musculoskeletal and mental health problems. Obesity (i.e., a BMI of 30-35 kg/m) causes a 2–4-year reduction in life expectancy (ibid). In children, obesity can have long-term effects on physical, social, educational and mental health outcomes, and tends to persist across the life-course, with overweight and obese children likely to remain so in adulthood (OHID 2022). Obesity has a major impact on the NHS, with 1.2 million people admitted to hospital with obesity as a primary or secondary factor in 2022/23 (NICE 2025). Being underweight affects far fewer people than excess weight, both nationally and locally, but is also linked to an increased risk of ill-health.   

Whilst obesity can be the result of an underlying health condition or the side effects of certain drugs, the vast majority of cases arise from poor dietary and lifestyle behaviours, through which energy intake (food and drink) exceeds energy used (metabolic processes and physical activity). The causes of these unhealthy behaviours are complex, encompassing individual choice as well as cultural, societal and economic elements. The Foresight Report (2007) identified over 100 such factors that may contribute to population-level weight gain; for example, technological changes that have led to an increase in sedentary jobs and leisure activities, the mass ownership of cars and labour-saving domestic devices, and easy access to high-calorie convenience foods.  

Excess weight and obesity have traditionally been addressed through group-based or individual behaviour change programmes that focus on diet and physical activity. However, there is an increasing emphasis on pharmacological approaches to weight-loss, particularly through the use of GLP-1 inhibitors such as Tirzepatide and Semaglutide. GLP-1s are estimated to be used privately by over 1.5 million people in the UK (NESTA). Originally used for treating type 2 diabetes, in 2024 they were approved for prescription on the NHS for obesity. It is estimated that 3.4 million people meet the NICE eligibility criteria; however, roll-out will be gradual over the next 12 years, with 220,000 people who meet additional eligibility requirements expected to receive this treatment over the first three years (NICE TA1026).  

Obesity is not evenly spread across the whole population, with year 6 children in the most deprived IMD decile being more than twice as likely as those in the least deprived to be obese. Similarly, adult obesity is nearly twice as high in the most deprived compared to the least deprived decile. However, the relationship between deprivation and adult obesity is far clearer amongst women than men, with men showing no statistical difference in prevalence when the data are broken down by household income. Differences also exist between populations with respect to ethnicity; black and white British adults are most likely to be obese, with prevalence amongst all other ethnic groups being below the England average. Amongst year 6 children, the highest obesity levels are across all black populations and the lowest amongst Chinese and mixed white and Asian groups. Disability is also a significant indicator of obesity, with disabled people 1.8 times more likely to be obese than non-disabled (DHSC).  

The current healthy weight policy is set within the context of rebalancing health services away from treatment towards prevention. Policies build on changes made since 2010, including Healthy Lives, Healthy People (2010), the Childhood obesity strategy (2016 and 2018) (COS) and the 2020 ‘Tackling Obesity’ strategy. The aim is to engage all sectors with a particular emphasis on the role of the food and drink industry. Key national policies, plans and aspirations are included in The NHS 10 Year Plan for England: fit for the future, which outlines a cross-sector ‘coalition’ approach to tackling prevention that will involve industry, employers, local government, individuals and the NHS all working in partnership. It supports the use of GLP-1 inhibitors, which are described as having ‘outstanding promise’ with respect to tackling obesity. The plan outlines the following actions: 

• The Advertising (Less Healthy Food Definitions and Exemptions) Regulations 2024, also known as the ‘junk food advertising ban,’ came into force in January 2026 and prohibit the advertising of 13 categories of high-fat, salt and sugar foods online and on television before 9pm. In addition, the regulations banned the sale of high-caffeine ‘energy’ drinks to children under 16, and the updated National Planning Policy Framework will give councils stronger powers to block new fast food outlets near schools.  
• The School Food Standards are compulsory requirements for all local authority and state-funded schools to ensure the nutritional quality of school meals. They are currently under consultation to improve nutritional quality and compliance. In 2025, the Department for Education issued new Early Years Foundation Stage Nutrition Guidance to promote healthy eating habits from an early age. Additionally, eligibility for free school meals is being expanded to include all families in receipt of Universal Credit. Although not included in the 10 Year Plan, in April 2025, the roll-out of universal free breakfast clubs for all primary schools began a pilot phase. As part of the NHS 10-year plan, the government has enacted various measures and regulations on the food industry, including the expansion of the Soft Drinks Industry Levy (‘sugar tax’), which began in 2016 as part of the COS and has since resulted in a 46% decrease in total sugar sold in soft drinks. In 2025, a consultation informed the reduction of the sugar content threshold at which the levy applies from 5 to 4.5g/100ml, as well as the removal of the exemption for milk (and milk substitute)-based drinks. To set a basis for mandatory targets, the government has also introduced mandatory reporting on healthy food sales by all major companies. The 10 year plan also sets out the vision for the future of weight management services. Although the plan mentions the possibility of delivery in local communities, the main emphasis is on the expanding and enhancing digital services and the use of pharmaceuticals. 

In addition to the food industry requirements outlined in the NHS 10 Year Plan, the government has issued voluntary industry guidelines (2025) to improve the nutritional quality, labelling and marketing of commercial baby food.   

NICE Overweight and Obesity Management (NG246, 2025) provides guidelines on the prevention and management of overweight, obesity and central adiposity in children and adults. It brings together and updates all previous NICE guidance on overweight and obesity. It does not include pregnancy, which is covered in Maternity and Child Nutrition: Nutrition and Weight Management in Pregnancy and Nutrition in Children up to 5 Years (NICE 247, 2025).  

The Lincolnshire Joint Health and Wellbeing Strategy includes adult and childhood obesity amongst its priorities. The strategy emphasises the need for a ‘whole system’ approach, which, as well as supporting individuals, encourages the development of ‘healthy places’ by engaging with planning and environmental agencies.  

Prevalence of obesity amongst adults in Lincolnshire has generally been significantly above that of England as a whole over recent years and has seen a gradual increase since 2017. Childhood obesity prevalence, in both Reception and year 6, with the exception of a few years, has largely risen in line with national trends.  

Annual OHID data frequently show significant divergence in prevalence across the county, and trend data since 2015-16 indicate that some areas may have persistently higher rates. Lincoln has consistently had the lowest adult obesity levels, which may reflect its younger age profile and high student population. South Kesteven has been significantly higher than the national average only twice over this period. East Lindsey, West Lindsey and North Kesteven have fluctuated between being in line with and significantly above the national rate and South Holland has shown a similarly mixed picture until 2020, since when it has significantly exceeded the national average. Prevalence in Boston, except one year, has consistently been significantly higher than that of England as a whole.  

Similar patterns can be seen in the prevalence of childhood obesity. In Boston, obesity rates have been significantly above the national average in 12 out of 18 years of reporting from the National Child Measurement Programme and consistently so since 2016. South Holland has shown a similar pattern, with 11 out of 18 years above the national level. Lincoln and East Lindsey have a fluctuating picture, with eight and six years above the national average, respectively. South Kesteven and West Lindsey have generally been in line with, and occasionally better than, the England average. North Kesteven is the only district that has regularly been below the national rate.  

Given the number of interacting factors that influence obesity levels, coupled with demographic differences within, and between districts, no simple explanation for the variation in obesity rates at the district level is possible. 

Overweight and obesity data are not broken down by demographic characteristics, for example, ethnicity or deprivation, at the county or district level; however, there is no reason to suppose that national patterns, discussed in the Background section, would not be reflected locally.  

Weight management services are broadly divided into ‘tiers’ that describe the intensity and nature of the intervention. Tier 1 includes widely or universally accessible preventative strategies such as health promotion campaigns, brief advice and signposting. Tier 2 provides online or in-person structured interventions that usually include nutrition, physical activity and behaviour change elements. Tier 3 involves intensive, multidisciplinary support that may include pharmacological treatments. Tier 4 services, for severely obese patients, entail additional specialist multidisciplinary support and can include bariatric surgery.   

The Healthy Weight Partnership (HWP) supports system-wide collaboration to maximise healthy weight across Lincolnshire. It oversees the implementation of the Joint Health and Wellbeing Healthy Weight priority delivery plan and its alignment to the local NHS weight management delivery plan. It includes members from Public Health, Children’s Services, Lincolnshire Integrated Care Board (ICB), Voluntary Centre Services (VCS), district councils and service providers. 

Sport England funds Active Lincolnshire to coordinate the place-based programme of physical activity in East Lindsey, Boston, South Holland and Spalding. They also provide the ‘Activity Finder’ platform, through which stakeholders and the public can access information about physical activity opportunities across the county. Further details about Active Lincolnshire can be found in the JSNA Physical Activity topic.  

A tier 2 adult weight management service is delivered by One You Lincolnshire (OYL) as part of the Integrated Lifestyle Service delivered by Thrive Tribe and commissioned by LCC and NHS Lincolnshire ICB until March 2027. OYL provides a range of interventions, including 12-week, group-based, in-person courses; the ‘Man V Fat’ football programme; and Gloji-Digital, a 12-week online service. Access is via health professional or self-referral for people aged 18+ with a BMI of ≥30 (≥27.5 for ethnic groups other than white, due to the risk of obesity-related conditions, such as type 2 diabetes, occurring at a lower BMI than in white people).  

The tier 2 Digital Weight Management Programme funded by NHSE, is a free 12-week, online programme that provides structured support for diet, physical activity and healthy habits delivered via smartphone, tablet, or computer. The programme is available to adults aged 18+ with a BMI of ≥30 (≥27.5 for ethnic groups other than white) who also have a diagnosis of hypertension and/or diabetes and is accessed via referral by a GP.  

Lincolnshire does not currently have a local tier 3 weight management service, with patients having to access services delivered in Derby; however, consideration is being given to the commissioning of a local tier 3 service in 2026. 

A tier 4 service for Lincolnshire residents is currently provided mainly by University Hospitals of Derby and Burton, with a very small number, living close to the border, accessing the service via Cambridge University Hospitals.  

In line with NICE guidance (TA1026), the injectable weight-loss drug, Tirzepatide will be rolled out in Lincolnshire over an initial three-year implementation period, after which NICE and NHSE will evaluate the outcomes of the programme to determine future commissioning arrangements. Lincolnshire has been allocated funding for a limited number of patients in the initial cohort. Eligibility for cohort 1 is a BMI of 40+ in addition to the diagnosis of at least four of the following comorbidities: hypertension, dyslipidaemia, obstructive sleep apnoea, cardiovascular disease and type 2 diabetes.  

The NHS Health Check programme supports adults aged 40-74 by promoting early awareness and management of lifestyle risk factors, including overweight and obesity, for cardiovascular disease. People without diagnoses of certain conditions, such as hypertension and diabetes, are eligible to attend every five years. The service is commissioned by LCC and delivered by GP practices.  

The NHS Diabetes Prevention Programme (NDPP) is commissioned by NHS England and delivered by Xyla. It provides an in-person, group-based programme and a tailored digital service, and a remote service for specialist groups. The NDPP is available countywide and accessed through GP referral or self-referral. It provides support around healthy eating, weight and physical activity for people who have been identified as being at high risk of developing type 2 diabetes or have a history or diagnosis of gestational diabetes. Xyla also delivers the NHS Type 2 Diabetes Path to Remission programme (T2DR) to people who are overweight or obese and have been diagnosed with type 2 diabetes. T2DR entails a low-calorie total diet replacement for three months followed by a further nine months of support, available in person or online, to promote weight loss and, where possible, remission. Referral into T2DR is via GP or specialist.  

A variety of private sector organisations, such as Slimming World and Weight Watchers, provide in-person groups across Lincolnshire as well as digital services. GLP-1 inhibitors such as Semaglutide and Tirzepatide are available privately from online pharmacies.  

The Lincolnshire County Council Children’s Health 0-19 service (Health Visiting and Children and Young People’s Nurses) offers an Antenatal Education package. The service provides either an online or face-to-face programme with families, including offering support around healthy eating and healthy weight. An Infant Feeding Strategy is also due to be published in early 2026, aiming to support healthy weight by increasing breastfeeding rates.  

The Health Visitor services include individual antenatal contacts, providing support around diet, nutrition and healthy lifestyles to parents, as well as help with breastfeeding. A First Bites and Baby Life group for babies aged 3-6 months provides advice on weaning and baby nutrition. Babies are weighed and measured according to national guidance, and parents are given appropriate advice depending on the results.  

The 0-19s team also leads the delivery of the nationally mandated National Child Measurement Programme (NCMP), a health surveillance programme that provides data for DHSC. It is delivered in primary schools and involves weighing and measuring all Reception and Year 6 children. Results are sent to all parents, including advice, guidance and signposting. Children and Young People’s Nurses follow up on all underweight children.   

Gloji Energy is the child and family weight management component of the OYL integrated lifestyle service, delivered by Thrive Tribe and commissioned by LCC until March 2027. The service provides 6 or 12-week in-person group-based interventions that include physical activity sessions for children and educational workshops on nutrition and physical activity for parents; it is open to primary-school-aged children. Gloji Energy is closely aligned with the NCMP. Families of children whose BMI falls between the 91st and 99.6th centile will be contacted directly by the service; access can also be obtained through health or education professionals or through self-referral.  

The Complications of Excess Weight (CEW) service provides multi-disciplinary treatment for children who have significant health and/or psychological problems related to their obesity. This tier 3 service is funded until March 2027 and is delivered on a ‘hub and spoke’ model. Lincolnshire is part of the Nottinghamshire hub but delivers clinics in Boston and Lincoln. Capacity is limited, leading to extensive waiting lists for initial appointments.  

The Greater Lincolnshire Food Partnership brings together communities, public and private sector organisations to influence local food systems. Its focus is not specifically on healthy weight, but it supports several school and community projects that promote healthy eating.  

A number of programmes are delivered across Lincolnshire schools and Early Years services, that, whilst not specifically addressing healthy weight, support children and families to improve their diets and/or increase their activity levels. These include: 

The Holiday Activities and Food (HAF) programme, which is open to Lincolnshire school-age children up to year 11 who are in receive of benefits-related free-school meals, includes a focus on healthy eating and physical activity. HAF is managed by LCC Children’s Services and delivered by a variety of local community providers over the main school holidays.  

The Free Breakfast Club programme is currently delivered in 11 schools across Lincolnshire. Over the coming year, it will be rolled out across England to a further 500 schools in which at least 40% of pupils are in receipt of free school meals. The national Wraparound Childcare programme, which is also being rolled out this year, allows children to attend school from 8 am to 6 pm every day in term time. Provision of food is optional; however, many schools are expected to provide it.  

The LCC Food Education Team provides a traded service to nurseries, schools, child-minders and families, promoting healthy food provision by providing education and support on adherence to the School Food Standards and the contents of packed lunches. It also delivers several funded projects; these include ‘Defeat the Sweet’ and the Early Years Oral Health initiative, which aim to reduce children’s sugar consumption and improve their daily diets, as well as staff training in nurseries to support the Early Years Nutrition Guidance.  

The Community Dental Service (CDS) delivers a range of initiatives that can contribute to the healthy weight agenda by focusing on improving diets and reducing sugar consumption. These include support for the HAF programme and delivery of training to LCC staff and commissioned service providers.  

Key stakeholders include One You Lincolnshire, schools, GPs, Children’s Services, local healthcare trusts and the ICB, private sector weight management providers, pharmacies and frontline health and care organisations. Local services capture views about the quality of provision through regular feedback processes. Surveys conducted as part of the process of decision-making about the recommissioning of the Integrated Lifestyle Service captured public views about the One You Lincolnshire adult weight management and child and family weight management programmes. 

Group-based, tier 2, community-delivered child and adult weight management services can be infeasible in very rural or sparsely populated areas of the county, resulting in geographical gaps in provision. An offer of one-to-one or online support mitigates this.

From April 2027, when the ILS will be decommissioned, there will be no free-of-charge, in-person tier-2 weight management service available for adults who do not have type 2 diabetes or are not at risk of developing it. Likewise, from this date, there will be no free-of-charge tier 2 service (digital or in-person) available for overweight/obese adults who have neither hypertension nor diabetes.

From April 2027, when the ILS will be decommissioned, there will be no child and family weight management service available in Lincolnshire. Consequently, no support other than information and signposting will be available to families whose children are identified as overweight or obese by the NCMP.

There is currently no in-person or digital tier 2 weight management service for teenagers between the ages of 13 and 17. 

Although Health Visitors and Children’s and Young People’s Nurses will give families advice on diet and nutrition.

There is currently no dedicated weight management or healthy eating intervention for families of pre-school children.

At both national and local levels, there is a lack of robust evidence on the impact of child weight management programmes, including which aspects of multi-component interventions are effective and the of the extent to which these interventions reduce health inequalities.

Tier 3 adult weight management is not available locally, with Lincolnshire residents having to access services in Derby; however, consideration is currently being given to the development of a locally delivered tier 3 service. Tier 4 services are also currently delivered outside Lincolnshire.  

The Healthy Weight Partnership will continue to oversee the implementation of the JHW Healthy Weight delivery plan and to maximise its impact through promoting a coordinated, ‘whole system’ approach.  

Organisations will continue to commission and provide weight management, healthy eating and physical activity services to meet the needs of the population, with a particular focus on the most deprived and other underserved populations.  

Work to improve links with local communities and stakeholders will continue in order to ensure the effective dissemination of key messages, national campaigns and signposting information.