Poobalan et al. BMC Public Health 2010, 10:17 http://www.biomedcentral.com/1471-2458/10/17 R E S E A R C H A R T I C L E Open Access Analysis of the UK recommendations on obesity based on a proposed implementation framework Amudha S Poobalan1*†, Lorna S Aucott1†, Sheraz Ahmed2, W Cairns S Smith1† Abstract Background: There is considerable expertise in the obesity field in identifying, appraising, and synthesising evidence to develop guidelines and recommendations for policy and practice. The recommendations, while based on evidence, are not formulated in a way that readily leads to implementation. This paper analyses the recent UK recommendations on obesity using a proposed implementation framework. Methods: Two bibliographic databases (Medline and Embase) and various health related and government websites were systematically searched for obesity recommendations published between 1996 and 2007. All the documents published on recommendations for either prevention or treatment of obesity in the UK were assessed. A proposed implementation framework was developed for the purpose of this review. All the UK recommendations were critically appraised and results summarised according to the criteria used within the framework. Cross-country applicability of the proposed framework was assessed using the Swedish policy recommendations on obesity. Results: Most recommendations on obesity while demonstrating their basis in evidence, fail to meet the implementation standards. They tend to be non-specific in identifying who is responsible for implementation and monitoring, and often no timescale is indicated. The costs of implementation are rarely estimated and those responsible for such funding are not specified. There are some notable exemptions to the general pattern emanating from more operational and locally based groups. The Swedish policy details 79 proposals with responsibility clearly identified and costs are presented for 20 of them. This policy satisfied most of the framework criteria but failed to give details on evaluation, monitoring and the timeframe for implementation. Conclusions: Public health has developed skills in appraising evidence and formulating recommendations based on appropriate evidence but these are often not implemented. Different skills are required to translate these recommendations into actions. Public health clearly needs to develop the implementation skills to a level comparable to the ability to synthesise evidence. Background The UK adult overweight/obesity prevalence has increased steadily in the past three decades [1-3], despite targets set by the government [4] to reduce obesity levels. A review conducted by National Audit Office (NAO) in 1996 [5] showed no evidence of reduction. The Health Survey for England [6] in 2005 reported two thirds of adults and a third of children as overweight/ obese. The recent obesity Foresight document [7] sug- gests that if current trends continue that by 2015, 36% * Correspondence: a.poobalan@abdn.ac.uk † Contributed equally 1Section of Population Health, Division of Applied Health Sciences, University of Aberdeen, Medical School, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK of males and 28% of females will be obese, increasing to 60% and 50% respectively by 2050. This increase in obe- sity has consequences for individuals with increased risk of co-morbidities and costs, and for society with the current total cost (including NHS) at £7 billion rising to £50 billion per year by 2050 [7]. Systematic reviews and reviews of reviews [8] have investigated the evidence on prevention and treatment of obesity. These give various recommendations from which policies and strategies have been published with the common aim to reduce the rise in obesity. The aim of this assessment is to critically appraise all published UK obesity recommendations (1996-2007) for imple- mentation criteria using a proposed implementation fra- mework. An additional aim is to assess the cross- © 2010 Poobalan et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.