Poobalan et al. BMC Public Health 2010, 10:17 http://www.biomedcentral.com/1471-2458/10/17 year for 5 years), but was otherwise not clearly stated. Within the proposals, gaps and limitations which need to be addressed were identified, for example the lack of health information to ethnic minorities, lack of evalua- tion of organisational measures, and shortage of inter- vention research in Sweden. Discussion Main findings of this review This critical appraisal of obesity prevention/treatment recommendations in the UK using implementation cri- teria indicates that some aspects such as priorities and target populations are generally well laid out. However, important factors such as timeframes and cost estima- tions are not adequately addressed. The responsible organisations are often identified but actual ownership of the recommendations is unclear. Treatment recom- mendations for drugs and surgery were more specific with projections of cost and future eligible populations. However, prevention recommendations tended to lack clarity for timeframes and costings. What is known and what this review adds There is considerable expertise in the process of identi- fying, critically appraising, and synthesising the evidence to develop guidelines and recommendations for obesity policy and practice. However, there are indications that these recommendations are failing to be implemented despite being evidence based, which may be due to their formulation and presentation. This assessment is the first to systematically appraise recommendations for obesity treatment/prevention in terms of the criteria for their implementation. All the recommendations within UK and one action plan from Sweden were appraised using an implementation frame- work. Another framework recently proposed by Sacks et al [33] has analysis grids for a comprehensive policy approach to reducing obesity hence identify areas for obesity policy action. Our review leads on from this by proposing criteria within such policies to be addressed for easier implementation. Recommendations need to be framed in a manner to facilitate their implementation and this includes target- ing, ownership, monitoring and evaluation, time frame and resource implications. This approach is generalisa- ble and can be used to assess other strategy documents and their recommendations. It is worth noting that evi- dence based guidelines/action plans do not always give the essential elements for implementation at the initial stage but may be extended as formal implementation plans at a later date. The NHS Modernisation Agency [34] with 24 Primary Care Trusts (PCTs) conducted a review to identify obe- sity strategies developed by the Trusts as a response to recommendations issued by the Faculty of Public Health Page 5 of 7 [13]. This review found that the Trusts were at the early stages of development and implementation, and high- lighted the evidence of current best practices by various Trusts. Since this review, two strategies have been pub- lished in England [35] and Scotland [36] which move away from focusing on the individual and instead con- sider broader holistic integrated approaches to obesity prevention such as healthy lifestyle adoption at all levels of society, but these still do not address the issues if implementation highlighted in this paper. The Swedish action plan identified as one of the most complete docu- ments [9] provides detailed descriptions of 79 proposals and addresses most of the criteria identified in this fra- mework but it does not address the issues of monitor- ing, evaluation or the setting of time frames. The essential elements identified in this proposed framework encompass issues at the level of recommendation/guide- line formation that will facilitate implementation. Suc- cessful implementation of guidelines (in whole or in part) will result in various interventions being developed which can be assessed using a Health Impact Assess- ment [37] which reflects some of the broader issues cov- ered by the proposed framework. The literature search used a comprehensive strategy but many of the recommendation documents were not electronically indexed in databases and available only on websites. Efforts were made to identify all documents from various sources but recommendations by various groups, charities and local authorities may not be readily in the public domain. The implementation framework was developed through a scoping exercise and was based on the recur- ring themes within guidelines and may require modifica- tion in light of experience with its use. The proposed framework thus provides a first step in assessing the obesity guidelines to emphasise the importance of addressing the essential elements contained within them for successful implementation. Conclusion Obesity recommendations in UK clearly define the tar- get population and are well prioritized in terms of either prevention and/or treatment. Sub-groups of the commu- nity vulnerable to obesity are specifically targeted within recommendations with most identifying the organisa- tions responsible for implementation. However, for recommendations to be successfully implemented, it is essential that they also have clear timeframes, costings and identify ownership, training and coordination within local organisations. Clinicians and academics involved in producing recommendations and policies should consult public health professionals who are more familiar with actual implementation of the proposed actions to ensure that their proposals are realistic for successful