Obesity (OB) - QOF indicator

Obesity indicators for 2026/27

The obesity QOF indicators cover referrals for weight management and discussions with eligible patients about medicines alongside behavioural support. For 2026/27, inclusion in QOF means the Weight Management Enhanced Service will end on 31 March 2026; the indicators take account of ethnicity when defining eligibility.

Why obesity is included in QOF

• Around 1 in every 4 adults in England live with obesity, and prevalence has doubled over the past 30 years. Associated health risks include cardiovascular disease, type 2 diabetes, joint disorders, mental health difficulties and certain cancers. For Black, Asian and other minority groups, these risks rise at lower BMI and waist circumference measurements than in the population overall.

• Obesity can diminish quality of life and deepen health inequalities. Its prevalence is greater in areas falling within the most deprived Index of Multiple Deprivation (IMD) deciles, demonstrating a marked social gradient. The effects extend beyond individual health, with lower productivity at work and a greater likelihood of hospital admission.

• England’s 10 Year Health Plan, Fit for the Future, makes tackling obesity a priority. Its actions address prevention in children and adults as well as better treatment and ongoing management.

• With this work moving into QOF, the Weight Management Enhanced Service will be withdrawn on 31 March 2026.

OB004

Rationale

• OB004 is intended to make identification of adults with obesity more consistent and access to support fairer. Common eligibility and referral rules, including ethnicity-adjusted BMI thresholds, should reduce unjustified differences between practices and systems. Referring people early allows intervention before medicines become necessary, with the aim of improving outcomes and lowering longer-term costs to the health system.

• The indicator puts NICE obesity guidance (NG246) into practice: every adult living with obesity should be offered a structured intervention focused on behaviour. Practices should use recorded BMI to identify patients, with appropriate coding of ethnicity and comorbidity risk. Assessment and the offer of structured support should become routine, proactive treatment rather than depend on patients being identified opportunistically. OB004 also supports NICE quality standard QS212, which addresses prevention, behavioural management, assessment and treatment of overweight, obesity and central adiposity in adults.

• Decisions made with patients should draw on the whole range of weight management options. The choice offered should reflect the person’s needs and preferences and what is available locally. Clinicians and practices therefore need an accessible overview of local services, allowing them to use these alongside national provision where appropriate. Options include the NHS Digital Weight Management Programme, relevant services commissioned by local authorities, and tailored national programmes such as the NHS Diabetes Prevention Programme (DPP) and NHS Type 2 Path to Remission Programme (T2DR), where weight loss and related changes in behaviour are specified and measured as outcomes.

Reporting and verification

• Apply the requirements set out in the OB004 definition in the table above.

OB005

Rationale

• OB005 supports practices in identifying adults with obesity and giving them fair access to behavioural support and treatment choices agreed through discussion. Standardising eligibility, referral and treatment initiation is intended to limit unjustified differences across practices and systems, with particular attention to ethnicity-adjusted BMI thresholds and risks associated with comorbidities.

• Medicines used for weight management should follow NICE obesity guidance (NG246), Technology Appraisal TA1026 and the accompanying NICE Funding Variation for tirzepatide (Mounjaro®) in primary care. Both NICE guidance and the product licence position medicines as an addition to dietary changes and greater physical activity, not a replacement for them. Requiring an organised, timely referral for behavioural support alongside medication places prescribing within a complete, evidence-based care pathway. The aim is safe, clinically effective and cost-effective treatment, with fair access for eligible patients under NHS commissioning guidance.

• Evidence-based prescribing and thorough shared decision-making are central to this indicator. Recording ethnicity and comorbidities also supports population health management. The anticipated benefits are better outcomes and longer-term efficiencies through fewer obesity-related health problems and less demand on primary and secondary care.

• Medicines will not suit every patient clinically, and some people will prefer not to take them. Before initiating treatment in primary care, clinicians and patients should consider preferences, treatment goals, ability to participate in behavioural support, comorbidities, and possible benefits and harms. Any offer must be clinically appropriate, consistent with NICE guidance and the NICE Funding Variation for tirzepatide (Mounjaro®) in primary care, and reflect the patient’s informed choice. Non-drug alternatives should also be considered and discussed.

• NHS England’s interim commissioning guidance prioritises access to primary care pharmacotherapy for the highest-priority cohorts during the initial 3 years of implementation, from 2025-2028. Approximately 220,000 patients are expected to receive NICE approved medicines for obesity management in primary care during that period.

Reporting and verification

• Use the OB005 definition in the table above for the indicator requirements.

• Consult the NHS interim commissioning guidance for eligibility in full. In brief, patients must meet the minimum BMI thresholds, with adjustment for ethnicity, and have at least 4 qualifying weight-related comorbidities drawn from hypertension, dyslipidaemia, obstructive sleep apnoea, type 2 diabetes and cardiovascular disease. The applicable criteria depend on the implementation year of the funding variation.