Adult Weight Management

AWM: Introduction (2006)

Guideline Overview

Guideline Title

Adult Weight Management (2006) Evidence-Based Nutrition Practice Guideline

Guideline Narrative Overview

Guideline Narrative Overview

The focus of this guideline is on the treatment of adult overweight and obesity. Overweight is defined as a body mass index (BMI) of 25.0 to 29.9 kg/m2 and obesity as a BMI≥30.0 kg/m2.

Obesity is a complex multifactoral chronic disease that develops from an interaction between genetics and the environment. The development of obesity involves the integration of social, behavioral, cultural, physiological, metabolic and genetic factors. Treatment of obesity should be based on a comprehensive weight management program to produce weight loss, prevent further weight gain and maintain weight loss over a prolonged period.

Guideline Development

This guideline is intended to provide the most current information on adult overweight and obesity based on the systematic review of the literature. The recommendations developed in this guideline involved the review of multiple articles to determine the most appropriate course of action for the practitioner. A summary of the evidence analysis is below:

Topics include:

  • Determination of Resting Metabolic Rate
  • Eating Frequency and Patterns
  • Portion Control
  • Meal Replacements
  • Nutrition Education
  • Low Glycemic Index Diets
  • Dairy/Calcium and Weight Management
  • Low Carbohydrate Diet.

In addition, several recommendations were based on the evidence analysis done by the National Heart Lung and Blood Institute (NHLBI). The topics presented in the guideline are the first step towards a comprehensive list of recommendations to address overweight and obesity. As an ongoing project, the expert workgroup has identified several other topic areas to address in this guideline, which may include very recent and emerging publications that would present additional or more insightful recommendations.

The number of supporting documents for these topics is below:

  • Recommendations: 16
  • Conclusion Statements: 19
  • Evidence Summaries: 19
  • Article worksheets: 151.

Application of the Guideline

This guideline is accompanied by a set of practice tools, the Adult Weight Management Toolkit,  to assist the practitioner in applying the guideline. The toolkit contains materials such as the Medical Nutrition Therapy protocol, documentation forms, outcomes management tools, client education resources and case studies. The toolkit underwent pilot-testing through the ADA's Dietetics Practice-Based Research Network prior to publication and is for sale at www.eatright.org..

An adapted form of these guideline recommendations is also currently being pilot-tested in the ADA Blue Cross and Blue Shield of North Carolina Medical Nutrition Therapy Cost/Utilization Study.

The NHLBI Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults

These recommendations for adult weight management are based on a combination of recent ADA evidence analysis and recommendations from the evidence-based guidelines developed by the Expert Panel on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults, which was convened in May 1995 by the National Heart, Lung, and Blood Institute’s Obesity Education Initiative in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases. The NHLBI guidelines were based on a systematic review of the literature found in MEDLINE from January 1980 to September 1997 of topics identified by the panel as key to extrapolating the data related to the obesity evidence model. Evidence from approximately 394 randomized controlled trials was considered by the expert panel, which was comprised of 24 members, eight ex-officio members and a methodologist consultant. The NHLBI evidence statements and recommendations were categorized by levels of evidence ranging from A to D.

Medical Nutrition Therapy and Adult Weight Management 

Obesity is associated with increased morbidity and mortality. Scientific evidence supports the effectiveness of weight loss among individuals who are overweight or obese in:

  • Reduction of risk factors for diabetes and cardiovascular disease
  • Reduction of blood pressure in both hypertensive and prehypertensive individuals
  • Reduction of blood glucose levels in persons with diabetes and prediabetes
  • Reduction of hemoglobin A1c levels in persons with type 2 diabetes
  • Reduction of serum triglycerides
  • Reduction of total serum cholesterol
  • Reduction of low-density lipoprotein (LDL) cholesterol
  • Reduction of risk for certain types of cancer.

National evidence-based guidelines recommend diet therapy as an integral component of a comprehensive weight management program. The registered dietitian plays an integral role in the interdisciplinary healthcare team by designing the optimal nutrition prescription that coincides with physical activity, behavior therapy and pharmacotherapy, when necessary. Based on the client’s treatment plan and comorbid conditions, other nutrition practice guidelines, such as hypertension, type 2 diabetes mellitus, childhood overweight and nutrition care in bariatric surgery may be needed in order to provide optimal treatment.

Populations to Whom This Guideline May Apply 

Population groups, medical conditions or coexisting diagnoses, where the adult weight management recommendations may be indicated, include:

  • Coronary heart disease (CHD)
  • Diabetes mellitus (type 2)
  • Gallstones
  • Gynecological abnormalities
  • Hypertension (HTN)
  • Metabolic syndrome
  • Osteoarthritis
  • Sleep apnea
  • Stress incontinence

Other Guideline Overview Material

For more details on the guideline components, use the links on the left to access::

  • Scope of Guideline
  • Statement of Intent and Patient Preference
  • Guideline Methods
  • Implementation of the Guideline
  • Benefits and Harms of Implementing the Recommendations.

Contraindications

Clinical judgment is crucial in the application of these guidelines. Careful consideration should be given to certain conditions, such as pregnancy, HIV/AIDS, oncology treatment, severe psychiatric disorders and metabolic diseases such as Prader-Willi Syndrome.