Poobalan et al. BMC Public Health 2010, 10:17 http://www.biomedcentral.com/1471-2458/10/17 country applicability of the developed framework using the Swedish action plan for healthy dietary habits and increased physical activity [9]. This document has been identified as one of the most detailed documents on obesity policies [10] and provides an opportunity to evaluate the framework. Methods An initial scoping exercise was conducted to identify any implementation framework to assess guidelines on obesity. One framework was identified for monitoring and evaluating implementation of the global strategy on diet, physical activity and health published by the WHO in 2008 [11]. This framework suggested that process, outcome and output indicators should be identified by each member state. The literature was also searched for recurrent themes within various recommendations that were relevant to implementation. The proposed frame- work with critical items was developed based on these recurrent common themes which were: specificity of the target population, responsibility for implementation, monitoring, evaluation, time frame, priorities and cost estimation. The electronic bibliographic databases, Medline and Embase, were then systematically searched for articles published from 1996 to December 2007. Mesh terms and key words for ‘obesity’, ‘obesity guidelines’, ‘recom- mendations’ were combined using Boolean operators to identify the relevant articles and reports. The search strategy used in Medline is detailed in the additional file, which was modified for use in Embase (see Addi- tional file 1). A structured search of the internet was undertaken to identify the other guidelines and recom- mendations not indexed in the electronic bibliographic databases. The sources accessed were Science Direct, Blackwell Synergy, National Electronic Library for Health (Guidelines Finder), University of York Centre for Reviews and Dissemination, Public Health Electronic Library, The National Electronic Library for Health, Scottish Intercollegiate Guidelines Network (SIGN), The National Institute of Clinical Excellence (NICE), Health Development Agency (HDA), Department of Health (DoH), and The Stationery Office site. The key words used for the website searches were ‘obesity’, ‘guidelines’ and ‘recommendations’. All the identified abstracts were scanned by two reviewers and full texts of potentially eligible documents were obtained and assessed accord- ing to the inclusion criteria. All the included UK recommendations were appraised using the proposed framework. The relevant details were extracted from all the documents included. The assessment of the obesity recommendation documents are summarised according to this framework. The Swed- ish action plan for healthy dietary habits and increased Page 2 of 7 physical activity [9,10] was critically appraised using the same criteria to assess the cross-country applicability of the developed framework. Results The systematic search identified 4275 abstracts, of which 133 were potentially eligible. The full texts of these were critically appraised and 21 articles were included in the review. The results of the literature search and the selection process are presented in Figure 1. Key recommendations for obesity identified in selected UK reports The reports identified key nutritional recommendations. These were to replace energy dense snacks and drinks with healthier alternatives from vending machines in school and fast food outlets [12-14]; to train teachers in healthy food advice and physical activity [12]; to shift consumer demand from high fat, high calorie diets to healthier alternatives [12,15] with the Government and Food Standard Agency (FSA) working together; to sim- plify food labelling for easy interpretation by the general population [16]; to ban marketing of unhealthy foods targeting children [17,18]; and to provide healthy diet and physical activity advice to pregnant and/or breast feeding women to promote weight control [14,15]. The reports identified key recommendations for physi- cal activity. These were that schools and local authori- ties should improve physical activity levels by allocating ≥ 3 hours per week for physical activity among school children; make safer pedestrian routes [12-14]; provide information about pedometers for all age groups [12,14] and to consider single sex physical education classes to improve participation of girls and ethnic minority groups [12-14]. The recommendations for obesity management were that physicians should maintain databases for patients at risk of developing obesity [19] and for those receiving obesity treatment (drugs and surgery) [20-22]; that the Government should provide sufficient funds for the NHS for at least one specialist primary care obesity clinic within each Primary Care Trust area and to expand obesity services in secondary care to include bariatric surgery for morbidly obese people [12,23]; that easy access to specialist treatment for obese children and young people should be provided [24] and funds should be made available for doctors and nurses to train in obesity management [15,23]. These reports recommended that the Government should initiate a health education campaign specifically for tackling obesity [12,15]. Guidelines for drugs and obesity management should be constantly evaluated [25] with information about effectiveness of obesity treat- ment and preventative interventions being disseminated to appropriate health care professionals [26].