Recommendations Summary
AWM: Assess Data to Individualize the Comprehensive Weight Management Program 2014
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
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Recommendation(s)
AWM: Assess Data to Individualize the Comprehensive Weight Management Program
The registered dietitian nutritionist (RDN) should assess the following data in order to individualize the comprehensive weight management program for overweight and obese adults:
- Food- and nutrition-related history, including but not limited to:
- Beliefs and attitudes, including food preferences and motivation
- Food environment, including access to fruits and vegetables
- Dietary behaviors, including eating out and screen time
- Diet experience, including food allergies and past dieting history
- Medications and supplements
- Physical activity.
- Anthropometric measurements, including but not limited to:
- Height, weight, body mass index (BMI)
- Waist circumference
- Weight history
- Body composition (if available).
- Biochemical data, medical tests and procedures, including but not limited to:
- Glucose and endocrine profile
- Lipid profile.
- Nutrition-focused physical findings, including but not limited to:
- Ability to communicate
- Affect
- Amputations
- Appetite
- Blood pressure
- Body language
- Heart rate.
- Client history, including but not limited to:
- Appropriateness of weight management in certain populations (such as eating disorders, pregnancy, receiving chemotherapy)
- Client and family medical and health history
- Social history, including living or housing situation and socio-economic status.
Moderately strong evidence indicates that the food environment is associated with dietary intake, especially less consumption of vegetables and fruits and higher body weight. Strong and consistent evidence indicates that adults who eat fast food often are at increased risk of weight gain, overweight and obesity and that screen time, especially television screen time, is directly associated with increased overweight and obesity.
Rating: Strong
Imperative-
Risks/Harms of Implementing This Recommendation
None.
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Conditions of Application
If BMI is 35kg/m2 or more, waist circumference will likely be elevated and will add no additional risk information.
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Potential Costs Associated with Application
- Costs of medical nutrition therapy (MNT) sessions vary, however MNT sessions are essential for improved outcomes
- Costs of laboratory tests may be additional.
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Recommendation Narrative
From the 2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library (NEL) Evidence-Based Systematic Reviews
- What is the relationship between the environment, body weight and fruit and vegetable consumption?
- An emerging body of evidence has documented the impact of the food environment and select behaviors on body weight in both children and adults. Moderately strong evidence now indicates that the food environment is associated with dietary intake, especially less consumption of vegetables and fruits and higher body weight. The presence of supermarkets in local neighborhoods and other sources of vegetables and fruits are associated with lower BMI, especially for low-income Americans, while lack of supermarkets and long distances to supermarkets are associated with higher BMI. Finally, limited but consistent evidence suggests that increased geographic density of fast food restaurants and convenience stores is also related to increased BMI.
- What is the relationship between eating out and body weight?
- Strong and consistent evidence indicates that children and adults who eat fast food are at increased risk of weight gain, overweight and obesity. The strongest documented relationship between fast food and obesity is when one or more fast food meals are consumed per week. There is not enough evidence at this time to similarly evaluate eating out at other types of restaurants and risk of weight gain, overweight and obesity.
- What is the relationship between screen time and body weight?
- Strong and consistent evidence in both children and adults shows that screen time is directly associated with increased overweight and obesity. The strongest association is with television screen time.
- What is the relationship between the environment, body weight and fruit and vegetable consumption?
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Recommendation Strength Rationale
The Conclusion Statements for Energy Balance and Weight Management, Food Environment and Dietary Behaviors in support of this recommendation received grades of Moderate and Strong.
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Minority Opinions
Consensus reached.
- Food- and nutrition-related history, including but not limited to:
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Supporting Evidence
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
- References
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References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process
2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library (NEL) Evidence-Based Systematic Reviews. Available at http://www.nutritionevidencelibrary.gov/category.cfm?cid=21.