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Adult Weight Management

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Adult Weight Management

Welcome to the Adult Weight Management Guideline and Systematic Review

Overweight and obesity affect most adults living in the United States (U.S.).1 Excess adiposity, typically assessed with body mass index (BMI),2 is causally linked to the development of many adverse health outcomes.3-7 There are large healthcare and societal costs to the high prevalence of overweight and obesity.8 The factors contributing to widespread prevalence of overweight and obesity are complex. Lifestyle behaviors and their consequent outcomes are affected by many factors outside of individual control, including but not limited to genetics, social determinants of health (SDoH) and health inequities, food and physical activity environment, food access, and weight bias and stigma.7,9 Thus, addressing high rates of overweight and obesity requires creating compassionate solutions that can be tailored to a wide variety of adults who each face unique motivations for and barriers to reaching health goals. 

Evidence-Based Nutrition Practice Guideline 

This EBPG is meant to inform clinical decisions for RDNs or international equivalents providing MNT interventions for adults (≥18 years of age) with overweight or obesity (BMI ≥25 kg/m2 or as defined for specific adult populations), including those with cardiometabolic disease such as type 2 diabetes mellitus (T2DM) or cardiovascular disease (CVD). It is based on the Adult Weight Management systematic review.10 Use links in the left navigation bar to view the guideline supporting evidence. 

This EBPG specifically focuses on behavioral lifestyle interventions and addresses the following topics: 

  • MNT Approach for Adult Overweight and Obesity Management
    • Nutrition Care Process
    • Medical Nutrition Therapy Interventions
    • Interprofessional Healthcare Team
    • Monitoring and Evaluation
    • Weight Bias and Weight Stigma
  • Delivering MNT Interventions
    • Number of Contacts
    • Intervention Duration
    • Follow-Up Contacts
    • Telehealth
    • Group Contacts
    • Coordination of Care in a Variety of Settings
  • Payment for Services
  • Dietary and Lifestyle Interventions and Approaches
    • Dietary Patterns
    • Components of a Comprehensive Intervention
  • Special Populations
    • Co-morbidities
    • Pharmacotherapy and Bariatric Surgery
    • Members of Groups Disproportionately affected by Overweight or Obesity, or Under-resourced Communities

Systematic Review

The aim of the 2020-21 systematic review supporting this EBPG was to identify, characterize, and analyze studies examining weight management interventions provided by a registered dietitian nutritionist (RDN) or international equivalent, in adults with overweight or obesity (BMI ≥25 kg/m2 or as defined for specific adult populations). ions provided by a registered dietitian nutritionist (RDN) or international equivalent, in adults with overweight or obesity.

Key Findings:

  • In adults with overweight or obesity, weight management interventions provided by a dietitian result in significantly decreased BMI and waist circumference, and increased percent weight loss and a likelihood of achieving a 5% weight loss.
  • In adults with overweight or obesity and T2DM, high certainty evidence describes weight management interventions provided by dietitians may reduce fasting blood glucose levels.
  • In adults with overweight or obesity, limited evidence suggests non-diet interventions provided by a dietitian did not affect cardiometabolic outcomes.
  • Weight Management interventions provided by dietitians additionally resulted in reduced blood pressure and quality of life (low-to-moderate certainty evidence).

Use the left navigation bar to view the results of the guideline and systematic review. Expand the section below titled Project Team and Disclosures for a listing of individuals who contributed to the development of the project, conflict of interest disclosures, and project funding information. Expand the section titled Project Resources and Articles to view publications developed from this project.

References

  1. Centers for Disease Control and Prevention. Adult Obesity Facts. https://www.cdc.gov/obesity/data/adult.html. Published 2021. Accessed June 30,, 2021.
  2. Centers for Disease Control and Prevention. Defining Adult Overweight & Obesity. Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. https://www.cdc.gov/obesity/basics/adult-defining.html. Published 2021. Accessed April 21, 2022.
  3. Yeh TL, Chen HH, Tsai SY, Lin CY, Liu SJ, Chien KL. The Relationship between Metabolically Healthy Obesity and the Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis. J Clin Med. 2019;8(8).
  4. Yu HJ, Ho M, Liu X, Yang J, Chau PH, Fong DYT. Association of weight status and the risks of diabetes in adults: a systematic review and meta-analysis of prospective cohort studies. Int J Obes (Lond). 2022.
  5. Jayedi A, Rashidy-Pour A, Khorshidi M, Shab-Bidar S. Body mass index, abdominal adiposity, weight gain and risk of developing hypertension: a systematic review and dose-response meta-analysis of more than 2.3 million participants. Obes Rev. 2018;19(5):654-667.
  6. Opio J, Croker E, Odongo GS, Attia J, Wynne K, McEvoy M. Metabolically healthy overweight/obesity are associated with increased risk of cardiovascular disease in adults, even in the absence of metabolic risk factors: A systematic review and meta-analysis of prospective cohort studies. Obes Rev. 2020;21(12):e13127.
  7. Centers for Disease Control and Prevention. Adult Obesity Causes & Consequences. https://www.cdc.gov/obesity/adult/causes.html. Published 2021. Accessed September 17, 2021.
  8. Tremmel M, Gerdtham UG, Nilsson PM, Saha S. Economic Burden of Obesity: A Systematic Literature Review. Int J Environ Res Public Health. 2017;14(4).
  9. Wu YK, Berry DC. Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: A systematic review. J Adv Nurs. 2018;74(5):1030-1042.
  10. Morgan-Bathke M DBS, Halliday TM, Lynch A, Malik N, Raynor HA, Garay JL, Rozga M, . Weight Management Interventions Provided by a Dietitian for Adults with Overweight or Obesity: An Evidence Analysis Center Systematic Review and Meta-Analysis. J Acad Nutr Diet In Press. 2022.
  • Scoping Review Project Team and Disclosures (2019)

    The following individuals contributed their valuable time and expertise to the 2019 Adult Weight Management Scoping Review:

    Project Team

    • Feon Cheng, PhD, MPH, RDN, CHTS-CP, Project Manager
      Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Jessica Redmond, PhD, RD, FAND, Lead Analyst
      Utica College, Cazenovia, NY, USA
    • Deepa Handu, PhD, RDN, Methodologist
      Senior Scientist, Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Amanda Wanner, MLS, AHIP, Medical Librarian
      Freelance Information Specialist, Kelowna, BC, Canada

    Content Advisors

    • Allison A. Childress, PhD, RDN, CSSD, LD
      Assistant Professor and Chief Clinical Dietitian, Texas Tech University, Lubbock, TX, USA
    • Hollie A. Raynor, PhD, RD, LDN
      Professor, Department of Nutrition and Interim Assistant Dean of Research, University of Tennessee Knoxville, Knoxville, TN, USA

    Financial Contributors

    • Weight Management Dietetic Practice Group
    • Academy of Nutrition and Dietetics Foundation
    • Academy of Nutrition and Dietetics

    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members and content advisors have with companies that sell products or services that are relevant to this topic. Workgroup members and content advisors are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have adverse impact on the content, but they are noted here to fully inform readers:

    • Raynor H: NIH grants on childhood obesity, consultant work for Board Certified Specialist in Obesity and Weight Management (CSOWM)

     

  • Project Resources and Articles

    The following resources from this project have been developed: 

    • Weight Management Interventions for Adults With Overweight or Obesity: An Evidence Analysis Center Scoping Review J Acad Nutr Diet Sept. 2021 121(9):1855-1865 doi: https://doi.org/10.1016.j.jand.2020.07.022 
       
    • Weight Management Interventions Provided by a Dietitian for Adults with Overweight or Obesity: An Evidence Analysis Center Systematic Review and Meta-Analysis.  J Acad Nutr Diet 2022 Mar 25;S2212-2672 (22)00170-8. doi: 10.1016/j.jand.2022.03.014. Online ahead of print.
       
    • Medical Nutrition Therapy Interventions provided by Dietitians for Adult Overweight and Obesity Management: An Academy of Nutrition and Dietetics Evidence-Based Practice Guideline. J Acad Nut Diet 2023:23(3):520-545. doi: https://doi.org/10.1016/j.jand.2022.11.014
       
    • Adult Weight Management (2022) Guideline Presentation: this 40-slide MS Powerpoint presentation includes the recommendations and ratings of the guideline. Ideal for use in meetings, in-service presentations, and classroom lectures (this product is not designed for the consumer). Download for free.
       
    • Adult Weight Management (2022) Pocket Guide - this practice reference pocket guide contains the AWM 2022 evidence-based recommendations. Available in print and digital formats.  Learn more 
       
    • Position of the Academy of Nutrition and Dietetics: Medical Nutrition Therapy Behavioral Interventions Provided by Dietitians for Adults with Overweight or Obesity. Published November 28, 2023. DOI: https://doi.org/10.1016/j.jand2023.11.013
  • Project Team and Disclosures (2013-2014)

    The following individuals contributed their valuable time and expertise to this project:

    Workgroup Members

    • Rebecca Reeves, DrPH, RD, FADA, Chair
    • Chris Biesemeier, MS, RD, LD, FADA
    • Molly Gee, MEd, RD, LD
    • Patricia Harper, MS, RD, LDN
    • Sachiko St. Jeor, PhD, RD

    Former Workgroup Members

    • Jackie Boucher, MS, RD, LD, CDE
    • Kajuanda H. Huntley, MS, RD

    Project Manager/Lead Analyst

    • Erica K. Gradwell, MS, RD

    Association Position Committee Members

    • Alana Cline, PhD, RD
    • Christine A. Rosenbloom, PhD, RDN, LD, FAND
    • Karen Greathouse, PhD, RD

    Evidence Analysts

    • Lori Brizee, MS, RDN, CSP
    • Laura Cook, PhD, RD
    • Sharon Foley, PhD, RD, LDN
    • Carol Klitzke, PhD, RDN, SNS
    • Kim Bandelier, MPH, LD
    • Helen Solomon, MBA, RD
    • Renee Korczak, PhD, RD
    • Michelle Lee, PhD, RD

    Guideline Reviewers

    • Elizabeth T. Anderson, MS, LDN
    • Kristine Clark, PhD, RDN, FACSM
    • Monica Lebre, MS, RDN, LDN
    • Juliet Mancino, MS, RDN, LDN, CDE
    • Ashley Mullins, RD, LD, CNSC
    • Eileen Stellefson Myers, MPH, RDN, LDN, CEDRD, FADA, FAND
    • Stacy Paine, RDN, LD, CLT
    • Julie Schwartz, MS, RDN, CSSD, LD, ACSM-HFS
    • Kristen N. Smith, MS, RD
    • Anna Tourkakis, MPA, DTR
    • Rebecca J. Threlkeld, MS, RDN
    • Kristin B. Walters, RD
    • Samantha R. Weiss, MPH, RD, LD
    • Christine K. Weithman, MBA, RD, LDN

    Academy Staff

    • Taylor Wolfram, MS, RD, LDN
    • Kari Kren, MPH, RD
    • Deborah Cummins, PhD
    • Joan Schwaba, MS, RD

    Financial Contributors

    • Systematic Review
      • Academy of Nutrition and Dietetics
      • Weight Management Dietetic Practice Group
    • Evidence-Based Guidelines
      • Academy of Nutrition and Dietetics


    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic. Workgroup members are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have an adverse impact on the content, but they are noted here to fully inform readers.

    • None of the workgroup members listed above disclosed potential conflicts.
  • Guideline and Systematic Review Project Team and Disclosures (2022)

    The following individuals contributed their valuable time and expertise to this project: 

    Expert Workgroup Members

    • Maria E. Morgan-Bathke, MBA, PhD, RDN, CD, FAND, Chair
      Associate Professor, Viterbo University, LaCrosse, WI, USA
    • Suzanne Domel Baxter, PhD, RD, LD, FADA, FAND
      Affiliate Research Professor, University of South Carolina, College of Social Work, Columbia, SC, USA
    • Tanya M. Halliday, PhD, RD
      Assistant Professor, University of Utah, Salt Lake City, UT, USA
    • Amanda I. Lynch, PhD, RDN
      Associate Professor, Oakland University, Rochester, MI, USA
    • Neal G. Malik, DrPH, MPH, RDN, CHES, ACSM-EP
      Assistant Professor, California State University San Bernardino, San Bernardino, CA, USA
    • Hollie A. Raynor, PhD, RDN
      Associate Dean of Research, University of Tennessee Knoxville, Knoxville, TN, USA

    Project Leaders

    • Mary R. Rozga, PhD, RDN, Project Manager
      Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Jessica Garay, PhD, RDN, CSCS, FAND
      Assistant Professor, Department of Nutrition and Food Studies, Syracuse University, Syracuse, NY, USA
    • Deepa Handu, PhD, RDN, Methodologist
      Senior Scientist, Academy of Nutrition and Dietetics, Chicago, IL  USA
    • Amanda Wanner, MLIS, AHIP

    Evidence Analysts

    • Megan Baumler, PhD, RD, Lino Lakes, MN, USA
    • Lyanne Chin, PhD, RD, Garden, CA, USA
    • Amy Huang, Basel, Switzerland
    • Telma Moreira, MS, RD, CSO, CNSC, Houston, TX, USA
    • Keiy Murofushi, MS, RD, Los Angeles, CA, USA
    • Maja Redzic, MS, RD, Chicago, IL, USA
    • Helen Solomon, MBA, RD, Wildwood, MO, USA

    Guideline Reviewers

    • Farah Al-Hawasil, MPH, RDN, LD
      Consultant, Covington, WA, USA
    • Lisa  Ann Cooper, MS, RD, LDN 
      Dietitian, Orlando Health, Orlando, FL, USA
    • Kimberly J. Hammon, MS, RD, LDN, CBDCE
      Outpatient Dietitian, Northwest Community Healthcare – Weight Management Clinic, Arlington Heights, IL, USA 
    • Melissa Marie Page, MS, RD, CSQWM, LDN 
      Senior Bariatric Dietitian, Main Medical Center, Portland, ME, USA
    • Janet Peterson, DrPH, RDN, RCEP, FACSM 
      Professor/Private Practice Dietitian, Linfield University, Newberg, OR, USA
    • Lema Safadi, MS, RD 
      Gastroenterology Medical Scribe, Good Samaritan Free Health Center, Cincinnati, OH, USA
    • Julie A. Schwartz, MS, RDN, CSOWM, LD, ACSM-EP, NBC-HWC 
      Obesity Medicine Registered Dietitian Nutritionist Case Manager, Intellihealth, Inc., San Francisco, CA, USA
    • Geeta Sikand, MA, RDN, FAND, FNLA, CLS, CDE 
      Associate Clinical Professor of Medicine, University of California Irvine, Irvine, CA, USA
    • Dorna Y.L. Silaban, MD, MN 
      Clinical Nutrition Specialist, University of Tarumanagara, Brawija Mother and Child Hospital, South Jakarta, Indonesia
    • Alicia M. Vance Agular, PhD, RDN, LD, FAND 
      Assessment Coordinator, University of Iowa, Cedar Rapids, IA, USA
    • Chunyun Xiao, RDN, LD, CNSC, CMI 
      Dietitian, Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
    • James Zhan, MS, RD, LD 
      PhD Candidate, Emory University, Decatur, GA, USA
       

    Financial Contributors

    • Weight Management Dietetic Practice Group
    • Academy of Nutrition and Dietetics
    • Academy of Nutrition and Dietetics Foundation

    The views or interests of the funding bodies did not influence the development of the systematic review or evidence-based guideline.


    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic within 5 years of the start of the project through completion of the project. Workgroup members are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have an adverse impact on the content, but they are noted here to fully inform readers.

    • Baxter - received speaker funding from the Academy of Nutrition and Dietetics for presentation at FNCE; meeting expenses from Research DPG to attend FNCE 2016 and FNCE 2017; meeting expenses from Academy Foundation for Diversity Leader Training and Diversity Leaders Program; Co-investigator on grant from Pediatric Nutrition DPG.
    • Halliday - grant funding from NIH R21 through June 2021; NIH KL2 award through September 2022
    • Malik - funding from Optimal Healthy daily, LLC for podcast
    • Raynor - principal investigator on NIH grant on child weight management; principal investigator on adult weight management project funded by Weight Watchers


    10/11/2022