Poobalan et al. BMC Public Health 2010, 10:17 http://www.biomedcentral.com/1471-2458/10/17 Page 4 of 7 Table 1 Results of the analysis of recommendations. Analysis of essential elements within the recommendations using the Implementation framework Implementation Number out of 21 set of framework elements recommendations Target population 21 out of 21 14 = Both adults and children; [12-16,19,23,25-29,31,32] 4 = Children and young adults (up to 18 years) only;[17,18,24,30] 3 = Obese adults [20-22] Responsible agency 20 out of 21[12-26,28-32] Monitoring and Evaluation 16 out of 21 [12-16,19-23,25,26,28,30-32] Time-frame for the implementation Prioritisation Cost and resources 4 out of 21[13,14,23,31] 21 out of 21 4 had treatment as priority [20-23] 2 had treatment and prevention [27,32] 15 had prevention only as priority [12-19,24-26,28-31] 7 out of 21[14,20-23,28,32] Details Children and adults, obese adults, children of obese parents and with a family history, people with diabetes and coronary heart disease, low income groups, pregnant women, smokers, disabled people and ethnic groups Government, Department of Health for overall development and implementation of strategies NHS for management within NHS and training of GPs and nurses GPs for implementation of clinical guidelines and maintaining the audit for compliance Local authorities for local implementation of recommendations (i.e safe routes) Food Standard Agency for Nutrition Department of Sports, Sports England and Sports Scotland for Physical activity One third of the articles did not report on how the implementation progress would be monitored or evaluated. The Government, Department of Health, cabinet task force, NHS and physicians were implied for the monitoring of implementation. Achieving the set milestones, conducting regular audits and maintaining databases on progress were few of the tools suggested for monitoring progress of implementation. Very few set out specific time-frame for implementation. Two studies[12,24] stressed implementation was urgent and some studies anticipated problems in implementing the recommendations Although the recommendations was separated out broadly into ‘Treatment’ and ‘Prevention’, in many there was a long list of recommendations without any priority for specific components Seven studies estimated the costs to the NHS for implementation of their recommendations. 11 did not mention cost or funding and the rest only recognised cost as an issue for successful implementation within 3 years of their report with goals set for the 1st, 2nd and 3rd year whereas the Tayside report [14] set a 10 year timeframe with goals set at the 1st and 5th year. The other two reports mentioning timeframes gave no details. Two reports by NICE [20,21] predicted the uncertainty in implementation due to lack of expertise and resources plus training of doctors. Two other reports [12,24] merely stated that the implementation of recommendations was urgent. Seven reports gave estimated implementation costs [14,20-23,28,32]. NICE gave NHS estimated costs for orlistat, sibutramine and bariatric surgery recommenda- tions [15-17]. The Tayside local strategy for obesity report [14] gave costing for the extension of their weight management service to all Tayside GP practices, child obesity services and their food “dudes” programme [14]. One report [28] identified resources along with skills required for interventions. Of the remaining, eleven gave no costing, two others [13,19] suggested that their recommendations should be implemented after consid- ering the available resources and the “Toolkit for obe- sity” by the Public Health Faculty [31] recommended that the NICE costing templates [32] for adult and childhood obesity management should be used. Cross-country applicability of the developed framework The Swedish action plan [9] has been identified as one of the most detailed documents [10] addressing obesity as part of the action plan for healthy dietary habits and increased physical activity. It has 79 proposals (called measures) in 12 specified policy areas (see Additional file 3) with detailed descriptions of the justification for each measure. It clearly identifies the people responsible for implementing all the 79 proposals highlighted. Only 20 out of the 79 proposals gave cost estimates, with one proposal indicating the split between development and implementation. However, the action plan did not pro- vide adequate information in terms of monitoring, eva- luation and time frames. Some of the proposals highlight the importance of evaluation but details of how this might be achieved or who would be responsi- ble for the evaluation was not clear. The breakdown of the costing in 4 of the proposals gave an indication of time frame (e.g. EUR 8.5 million over 7 yr period or EUR 210.000 per year for 3 years and EUR 53.000 per