<scp>UK</scp> dietitians' attitudes and experiences of formula very low‐ and low‐energy diets in clinical practice

Brown, Adrian; Brosnahan, Naomi; Khazaei, Dorsa; Wingrove, Jed; Flint, Stuart W.; Batterham, Rachel L.

doi:10.1111/cob.12509

Cited by 4 publications

(3 citation statements)

References 37 publications

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“…According to the current guidelines, obesity specialist dietitians are required to be familiar with more than 10 different nutrition interventions, all with their own intricacies and scientific rationale. A study among UK dietitians highlighted that dietitians' beliefs and barriers in delivering a specific nutrition intervention significantly impacted the degree to which this intervention was employed in clinical practice [ 74 ]. Historically, dietitians do not always report feeling sufficiently trained to treat obesity [ 75 ].…”

Section: Discussionmentioning

confidence: 99%

European Association for the Study of Obesity Position Statement on Medical Nutrition Therapy for the Management of Overweight and Obesity in Adults Developed in Collaboration with the European Federation of the Associations of Dietitians

Hassapidou

Vlassopoulos

Kalliostra³

et al. 2022

Obes Facts

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Introduction: Obesity affects nearly 1 in 4 European adults increasing their risk for mortality and physical and psychological morbidity. Obesity is a chronic relapsing disease characterized by abnormal or excessive adiposity with risks to health. Medical nutrition therapy based on the latest scientific evidence should be offered to all Europeans living with obesity as part of obesity treatment interventions. Methods: A systematic review was conducted to identify the latest evidence published in the November 2018–March 2021 period and to synthesize them in the European guidelines for medical nutrition therapy in adult obesity. Results: Medical nutrition therapy should be administered by trained dietitians as part of a multidisciplinary team and should aim to achieve positive health outcomes, not solely weight changes. A diverse range of nutrition interventions are shown to be effective in the treatment of obesity and its comorbidities, and dietitians should consider all options and deliver personalized interventions. Although caloric restriction-based interventions are effective in promoting weight reduction, long-term adherence to behavioural changes may be better supported via alternative interventions based on eating patterns, food quality, and mindfulness. The Mediterranean diet, vegetarian diets, the Dietary Approaches to Stop Hypertension, portfolio diet, Nordic, and low-carbohydrate diets have all been associated with improvement in metabolic health with or without changes in body weight. In the November 2018–March 2021 period, the latest evidence published focused around intermittent fasting and meal replacements as obesity treatment options. Although the role of meal replacements is further strengthened by the new evidence, for intermittent fasting no evidence of significant advantage over and above continuous energy restriction was found. Pulses, fruit and vegetables, nuts, whole grains, and dairy foods are also important elements in the medical nutrition therapy of adult obesity. Discussion: Any nutrition intervention should be based on a detailed nutritional assessment including an assessment of personal values, preferences, and social determinants of eating habits. Dietitians are expected to design interventions that are flexible and person centred. Approaches that avoid caloric restriction or detailed eating plans (non-dieting approaches) are also recommended for improvement of quality of life and body image perceptions.

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Section: Discussionmentioning

confidence: 99%

European Association for the Study of Obesity Position Statement on Medical Nutrition Therapy for the Management of Overweight and Obesity in Adults Developed in Collaboration with the European Federation of the Associations of Dietitians

Hassapidou

Vlassopoulos

Kalliostra³

et al. 2022

Obes Facts

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“…32 Survey respondents most commonly recommend that patients with T2D avoid very low-carbohydrate (26/51; 51.0%) and very low-calorie (25/51; 49.0%) eating patterns and very few respondents recommend use of these eating patterns among patients with T2D. In contrast, a cross-sectional study of UK dietitians found that 58.1% (75/129) of participants had recommended use of very low-calorie and low-calorie eating patterns for T2D remission and management, 33 and these eating patterns are supported by clinical practice guidelines for T2D management. 8 9 11 Consistent with our findings, a survey of 199 RDs in Indiana, USA demonstrated that most respondents never had (93%) or never would (63%) recommend a very low-carbohydrate eating pattern to patients with T2D, largely due to perceptions that the eating pattern lacks scientific evidence.…”

Section: Discussionmentioning

confidence: 99%

“…Survey respondents most commonly recommend that patients with T2D avoid very low-carbohydrate (26/51; 51.0%) and very low-calorie (25/51; 49.0%) eating patterns and very few respondents recommend use of these eating patterns among patients with T2D. In contrast, a cross-sectional study of UK dietitians found that 58.1% (75/129) of participants had recommended use of very low-calorie and low-calorie eating patterns for T2D remission and management, 33 and these eating patterns are supported by clinical practice guidelines for T2D management. 8 9 11 …”

Section: Discussionmentioning

confidence: 99%

Nutrition counsellors’ recommended eating patterns for individuals with type 2 diabetes in the USA

Khosrovaneh,

Hisamatsu,

Reiss

et al. 2024

BMJNPH

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IntroductionMultiple eating patterns can promote glycaemic control and weight loss among patients with type 2 diabetes mellitus (T2D). Clinical practice guidelines for T2D management encourage health professionals to guide patients’ selection of a patient-centred eating pattern. This study aims to characterise beliefs about and recommendations for and against practice guideline-concordant eating patterns among registered dietitians (RDs) and other healthcare professionals who provide nutrition counselling to patients with T2D.MethodsThis was a cross-sectional online survey. We invited 82 RDs affiliated with an academic health system in the midwestern USA to participate. We also invited health professionals who provide nutrition counselling to patients with T2D and are affiliated with 264 primary care practices within the Michigan Collaborative for Type 2 Diabetes. Participants were asked to select the eating pattern(s) that they commonly recommend or avoid for patients with T2D and why.ResultsSurvey respondents (n=81) most commonly recommend low-carbohydrate (77.8%); Mediterranean-style (52.8%) and energy-modified/calorie-restricted (36.1%) eating patterns. Survey respondents most commonly recommend avoiding very low-carbohydrate (51.0%) and very low-calorie (49.0%) eating patterns. Respondents who did not recommend very low-carbohydrate were most concerned about the eating pattern being too restrictive (93.0%).ConclusionsSurvey respondents recommend a range of guideline-adherent eating patterns to patients with T2D but tend to recommend against very low-carbohydrate and very low-calorie eating patterns. Additional strategies are needed to increase patient-centred use of these evidence-based options in clinical practice settings.

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UK dietitians' attitudes and experiences of formula very low‐ and low‐energy diets in clinical practice

et al. 2022

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Despite evidence that formula very low-energy diets (VLED) and low-energy diets (LED) are both effective and safe as treatments for obesity and type 2 diabetes, these diets remain underutilized in the United Kingdom. The aim of this study was to explore UK dietitians' attitudes and experiences of using formula VLED and LED. A cross-sectional survey was disseminated between September 2019 and April 2020 through websites, social media platforms and dietetic networks using snowball sampling. In total, 241 dietitians responded to the online survey with 152 participants included in the final analysis (female [94.1%], mean age 40.8 years [SD 9.5]; median 12 years [interquartile range 8, 22] within dietetic practice). One hundred and nine (71.7%) participants reported currently using VLED/LED in clinical practice and 43 (28.3%) did not. Those with lower motivation and confidence in implementing VLED/LED in clinical practice were less likely to use them.Cost and adherence were the two highest reported barriers to use. Dietitians perceived VLED/LED were effective, but concerns remained about long-term effectiveness, particularly for some patient groups. Dietitians also reported that further education, funding and service infrastructure, including access to clinic space and administrative support, were required to help embed VLED/LED into routine clinical practice. With clinical services now regularly offering VLED/LED programmes in the United Kingdom, dietitians are ideally placed to provide long-term support. However, understanding, reporting and addressing the potential barriers (funding/infrastructure and education) appear to be key requirements in increasing the delivery of VLED/LED programmes nationally.

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UK dietitians' attitudes and experiences of formula very low‐ and low‐energy diets in clinical practice

Cited by 4 publications

References 37 publications

European Association for the Study of Obesity Position Statement on Medical Nutrition Therapy for the Management of Overweight and Obesity in Adults Developed in Collaboration with the European Federation of the Associations of Dietitians

European Association for the Study of Obesity Position Statement on Medical Nutrition Therapy for the Management of Overweight and Obesity in Adults Developed in Collaboration with the European Federation of the Associations of Dietitians

Nutrition counsellors’ recommended eating patterns for individuals with type 2 diabetes in the USA

UK dietitians' attitudes and experiences of formula very low‐ and low‐energy diets in clinical practice

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