Medical Nutrition Therapy Interventions Provided by Dietitians for Adult Overweight and Obesity Management: An Academy of Nutrition and Dietetics Evidence-Based Practice Guideline

Morgan‐Bathke, Maria; Raynor, Hollie A.; Baxter, Suzanne Domel; Halliday, Tanya M.; Lynch, Amanda; Malik, Neal; Garay, Jessica; Rozga, Mary

doi:10.1016/j.jand.2022.11.014

Cited by 23 publications

(12 citation statements)

References 155 publications

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“…This finding likely reflects a focus on weight reduction as a recommended therapeutic approach in the CPGs for dyslipidemia, diabetes and hypertension 20,21 . Recently, the Academy of Nutrition and Dietetics released its updated Medical Nutrition Therapy Interventions for Adult Overweight and Obesity Treatment guidelines 7 and, although weight bias and weight stigma are now considered in the guidelines, and weight goals are no longer considered, the guidelines fall short with respect to recommending NWFAs as a therapy practice. By contrast, the Canadian Adult Obesity CPGs could be considered as a leader by their inclusion of NWFAs as one approach to consider when working with higher weight clients 2 .…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] In some instances, NWFAs have also been associated with body satisfaction, and psychological and physical outcomes. 7 Thus, NWFAs could reduce the adverse health and psychological impacts of weight stigma, which has been associated with higher cortisol levels, systemic inflammation, anxiety, depression, disordered eating behaviours, weight cycling and medication non-adherence. [8][9][10][11][12] The use of NWFAs is increasing among dietitians in Canada, as well as globally, 4,13 with approximately 50% of Canadian dietitians using some variation of NWFAs.…”

Section: Introductionmentioning

confidence: 99%

“…In general, these approaches encourage overall diet quality, positive relationships with food, and joyful movement rather than focus on caloric restriction and weight loss 4–6 . In some instances, NWFAs have also been associated with body satisfaction, and psychological and physical outcomes 7 . Thus, NWFAs could reduce the adverse health and psychological impacts of weight stigma, which has been associated with higher cortisol levels, systemic inflammation, anxiety, depression, disordered eating behaviours, weight cycling and medication non‐adherence 8–12 …”

Section: Introductionmentioning

confidence: 99%

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The implementation of non‐weight focused approaches in clinical practice: A Canadian cross‐sectional study among registered dietitians

Lichtfuss,

Franco‐Arellano,

Jefferson

et al. 2024

J Human Nutrition Diet

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BackgroundAn increasing number of dietitians use non‐diet approaches, referred to as non‐weight focused practice approaches (NWFAs), in clinical practice when working with higher weight adult clients. However, the factors that impact dietitians' ability to successfully implement these approaches in practice are unknown.MethodsAiming to examine how implementing NWFAs in clinical practice differs based on the extent to which a dietitian uses NWFAs with their clients, we conducted a cross‐sectional online survey among Canadian registered dietitians who work with higher weight adults (May to July 2021), developed and validated following the Consolidated Framework for Implementation Research. Descriptive statistics were conducted to identify barriers and facilitators with respect to implementing NWFAs. The Kruskal–Wallis was used to test for differences in barriers and facilitators with respect to implementing NWFAs among five different practice approaches. The results showed that, among participants (n = 383; 82% white; 95% women) the most important barriers for implementation of NWFAs were clients' focus on weight as an outcome, when losing weight is a condition to access enhanced services, requiring changes to their practice philosophy, difficulty funding professional development and not having sufficient skills or knowledge to implement NWFAs in practice. Top‐rated facilitators included the use of clinical guidelines, scientific publications and educational materials, which were rated with higher agreement across all implementation stages (p < 0.001).ConclusionsThe present study highlights important factors that may impact the effective implementation of NWFAs in dietetic practice for higher weight adult clients, which is essential to minimise barriers in practice.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The implementation of non‐weight focused approaches in clinical practice: A Canadian cross‐sectional study among registered dietitians

Lichtfuss,

Franco‐Arellano,

Jefferson

et al. 2024

J Human Nutrition Diet

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“…According to the recently published evidence-based practice guide of the Academy of Nutrition and Dietetics, obesity is recognized as excess adiposity. It is correlated with many adverse health outcomes, such as mortality risk, prediabetes, type 2 Diabetes Mellitus (T2DM), cardiovascular disease, obstructive sleep apnea, and certain types of cancer ( 2 , 3 ). Dietary administration combined with physical activity is the most recommended treatment for weight loss ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Dropout in cognitive behavioral treatment in adults living with overweight and obesity: a systematic review

Neri,

Mariotti,

Guglielmetti

et al. 2024

Front. Nutr.

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Obesity is a chronic, complex, and multifactorial disease resulting from the interaction of genetic, environmental, and behavioral factors. It is characterized by excessive fat accumulation in adipose tissue, which damages health and deteriorates the quality of life. Although dietary treatment can significantly improve health, high attrition is a common problem in weight loss interventions with serious consequences for weight loss management and frustration. The strategy used to improve compliance has been combining dietary prescriptions and recommendations for physical activity with cognitive behavioral treatment (CBT) for weight management. This systematic review determined the dropout rate and predictive factors associated with dropout from CBT for adults with overweight and obesity. The data from the 37 articles selected shows an overall dropout rate between 5 and 62%. The predictive factors associated with attrition can be distinguished by demographics (younger age, educational status, unemployed status, and ethnicity) and psychological variables (greater expected 1-year Body Mass Index loss, previous weight loss attempts, perceiving more stress with dieting, weight and shape concerns, body image dissatisfaction, higher stress, anxiety, and depression). Common reasons for dropping out were objective (i.e., long-term sickness, acute illness, and pregnancy), logistical, poor job conditions or job difficulties, low level of organization, dissatisfaction with the initial results, lack of motivation, and lack of adherence. According to the Mixed Methods Appraisal quality analysis, 13.5% of articles were classified as five stars, and none received the lowest quality grade (1 star). The majority of articles were classified as 4 stars (46%). At least 50% of the selected articles exhibited a high risk of bias. The domain characterized by a higher level of bias was that of randomization, with more than 60% of the articles having a high risk of bias. The high risk of bias in these articles can probably depend on the type of study design, which, in most cases, was observational and non-randomized. These findings demonstrate that CBT could be a promising approach for obesity treatment, achieving, in most cases, lower dropout rates than other non-behavioral interventions. However, more studies should be conducted to compare obesity treatment strategies, as there is heterogeneity in the dropout assessment and the population studied. Ultimately, gaining a deeper understanding of the comparative effectiveness of these treatment strategies is of great value to patients, clinicians, and healthcare policymakers.Systematic review registration: PROSPERO 2022 CRD42022369995 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022369995.

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“…However, the efficacy of remote nutrition education for individuals with T2DM is unclear, and it is necessary to evaluate its non-inferiority to face-to-face nutrition education through randomized controlled trials (RCTs). Therefore, the benefits of telenutrition education for glycemic management need to be identified in RCTs [ 9 ]. Therefore, this RCT aimed to evaluate the non-inferior efficacy of telenutrition education compared with face-to-face nutrition education for glycemic management among people with T2DM.…”

Section: Introductionmentioning

confidence: 99%

Telenutrition Education Is Effective for Glycemic Management in People with Type 2 Diabetes Mellitus: A Non-Inferiority Randomized Controlled Trial in Japan

Mori,

Taniguchi,

Tamaki

et al. 2024

Nutrients

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This study examined the non-inferior efficacy of telenutrition education compared with face-to-face nutrition education in managing glycemic control in people with type 2 diabetes mellitus (T2DM). Participants had T2DM and a glycated hemoglobin (HbA1c) ranged 6.5–9.5%. Thirty participants were randomly assigned to either the telenutrition or face-to-face nutrition education group. During the 32-week intervention period, the participants received four sessions on nutrition education from a registered dietitian at the hospital. The telenutrition group received remote education via a videoconferencing platform. Face-to-face nutrition education was conducted using paper-based instructions. The main outcome measure was the non-inferiority of HbA1c levels in the telenutrition group compared to the face-to-face nutrition group. The non-inferiority of telenutrition education was considered valid if the intergroup difference in the mean values of the change in HbA1c had a bilateral 95% confidence interval (CI) upper limit below 0.40%. The intergroup difference in the mean HbA1c change from baseline to the fourth nutrition education session was −0.11 (95% CI −0.54–0.32) for both groups. The upper limit of the bilateral 95% CI was 0.32%, which was below the 0.40% non-inferiority margin (non-inferiority test; p = 0.011). Telenutrition education was not inferior to face-to-face nutrition education for glycemic management in people with T2DM.

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Medical Nutrition Therapy Interventions Provided by Dietitians for Adult Overweight and Obesity Management: An Academy of Nutrition and Dietetics Evidence-Based Practice Guideline

Cited by 23 publications

References 155 publications

The implementation of non‐weight focused approaches in clinical practice: A Canadian cross‐sectional study among registered dietitians

The implementation of non‐weight focused approaches in clinical practice: A Canadian cross‐sectional study among registered dietitians

Dropout in cognitive behavioral treatment in adults living with overweight and obesity: a systematic review

Telenutrition Education Is Effective for Glycemic Management in People with Type 2 Diabetes Mellitus: A Non-Inferiority Randomized Controlled Trial in Japan

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