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Abstract Background Methods for developing national recommendations vary widely. The successful adoption of new guidance into routine practice is dependent on buy-in from the clinicians delivering day-to-day patient care and must be considerate of existing resource constraints, as well as being aspirational in its scope. This initiative aimed to produce guidelines for the management of head and neck squamous cell carcinoma of unknown primary (HNSCCUP) using a novel methodology to maximise the likelihood of national adoption. Methods A voluntary steering committee oversaw 3 phases of development: 1) clarification of topic areas, data collection and assimilation, including systematic reviews and a National Audit of Practice; 2) a National Consensus Day, presenting data from the above to generate candidate consensus statements for indicative voting by attendees; and 3) a National Delphi Exercise seeking agreement on the candidate consensus statements, including representatives from all 58 UK Head and Neck Multidisciplinary Teams (MDT). Methodology was published online in advance of the Consensus Day and Delphi exercise. Results Four topic areas were identified to frame guideline development. The National Consensus Day was attended by 227 participants (54 in-person and 173 virtual). Results from 7 new systematic reviews were presented, alongside 7 expert stakeholder presentations and interim data from the National Audit and from relevant ongoing Clinical Trials. This resulted in the generation of 35 statements for indicative voting by attendees which, following steering committee ratification, led to 30 statements entering the National Delphi exercise. After 3 rounds (with a further statement added after round 1), 27 statements had reached ‘strong agreement’ (n = 25, 2, 0 for each round, respectively), a single statement achieved ‘agreement’ only (round 3), and ‘no agreement’ could be reached for 3 statements (response rate 98% for each round). Subsequently, 28 statements were adopted into the National MDT Guidelines for HNSCCUP. Conclusions The described methodology demonstrated an effective multi-phase strategy for the development of national practice recommendations. It may serve as a cost-effective model for future guideline development for controversial or rare conditions where there is a paucity of available evidence or where there is significant variability in management practices across a healthcare service.

Based on the integrated data of the China General Social Survey (CGSS) from 2010 to 2017, this study observes that body shape – being overweight or underweight – is important for labor market outcomes. Body shape significantly affects the employment opportunities of Chinese individuals, and this effect differs by gender and across the occupational hierarchy. Women face both slim premium and obesity penalty effects. Slim women, those with normal and lower but not excessively lower body weight, are more likely to gain long-term employment contracts in the labor market, while the opposite is observed for overweight individuals. The relationship between women's body shape and employment opportunities also varies by occupation. The obesity penalty is more pronounced in occupations with a higher International Socio-Economic Index (ISEI), while the slim premium is more evident in occupations with a low ISEI. The results suggest that the Chinese labor market is highly demanding regarding women's figures, while it is relatively tolerant of men’s figures. By mechanism analysis, health capital is found to be the leading cause of the body shape effect. In addition, socialization is also a possible pathway of action. This paper has extended implications for the study of stature and employment stability, enriching the empirical research on labor market discrimination.