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Recommendations Summary

AWM: Components of a 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.


  • Recommendation(s)

    AWM: Components of a Comprehensive Weight Management Program

    For weight loss and weight maintenance, the registered dietitian nutritionist (RDN) should include the following components as part of a comprehensive weight management program:

    • Reduced calorie diet
    • Increasing physical activity
    • Use of behavioral strategies.

    Adequate evidence indicates that intensive, multi-component behavioral interventions for overweight and obese adults can lead to weight loss as well as improved glucose tolerance and other physiologic risk factors for cardiovascular disease.

    Rating: Strong
    Imperative

    • Risks/Harms of Implementing This Recommendation

      Adequate evidence indicates that the harm of screening and behavioral interventions for obesity is small. Possible harm of behavioral weight-loss interventions include:

      • Decreased bone mineral density and increased fracture risk
      • Serious injuries resulting from increased physical activity
      • Increased risk for eating disorders.

    • Conditions of Application

      None.

    • Potential Costs Associated with Application

      Costs of medical nutrition therapy (MNT) sessions vary; however, MNT sessions are essential for improved outcomes.

    • Recommendation Narrative

      From Screening for Obesity in Adults (2012)

      • The United States Preventive Services Task Force (USPSTF) recommends screening all adults for obesity. Clinicians should offer or refer patients with a body mass index (BMI) of 30kg/m2 or higher to intensive, multi-component behavioral interventions.
      • Intensive, multi-component behavioral interventions for obese adults include the following components:
        • Behavioral management activities such as setting weight-loss goals
        • Improving diet or nutrition and increasing physical activity
        • Addressing barriers to change
        • Self-monitoring
        • Strategizing how to maintain lifestyle changes.
      From Behavioral Counseling in Primary Care to Promote a Healthy Diet (2003)

      The USPSTF recommends intensive behavioral dietary counseling for adult patients with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease. Intensive counseling can be delivered by primary care clinicians or by referral to other specialists such as nutritionists or dietitians.

      From AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults (2013)
      • Lifestyle Intervention and Counseling (Comprehensive Lifestyle Intervention):
        • 4a. Advise overweight and obese individuals who would benefit from weight loss to participate for six or more months in a comprehensive lifestyle program that assists participants in adhering to a lower calorie diet and in increasing physical activity through the use of behavioral strategies. NHLBI Grade A (Strong); ACC/AHA Level of Evidence Grade A.
        • 4b. Prescribe onsite, high-intensity (i.e.,  14 or more sessions in six months) comprehensive weight loss interventions provided in individual or group sessions by a trained interventionist. NHLBI Grade A (Strong); ACC/AHA Level of Evidence Grade A.
        • 4f. Advise overweight and obese individuals who have lost weight to participate long-term (more than one year) in a comprehensive weight loss maintenance program. NHLBI Grade A (Strong); ACC/AHA Level of Evidence Grade A.
        • 4g. For weight loss maintenance, prescribe face-to-face or telephone-delivered weight loss maintenance programs that provide regular contact (monthly or more frequent) with a trained interventionist who helps participants engage in high levels of physical activity (i.e., 200 to 300 minutes per week), monitor body weight regularly (i.e., weekly or more frequent) and consume a reduced-calorie diet (needed to maintain lower body weight). NHLBI Grade A (Strong); ACC/AHA Level of Evidence Grade A.

    • Recommendation Strength Rationale

      • The ADA Adult Weight Management Work Group concurs with the references cited
      • United States Preventive Services Task Force recommendations both are given Grade B
      • ACC/AHA/TOS recommendations all given NHLBI Grade A (Strong), ACC/AHA Level of Evidence Grade A. Recommendations 4a, 4b, 4f and 4g were based on Critical Question 4, which analyzed systematic reviews and meta-analyses (the literature search included those published from January 2000 to October 2011) and added major RCTs published after 2009 with greater than 100 people per treatment arm.

    • Minority Opinions

      Consensus reached.

  • 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
    • References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process

      Jensen MD, Ryan DH, Apovian CM, Loria CM, Ard JD, Millen BE, Comuzzie AG, Nonas CA, Donato KA, Pi-Sunyer FX, Hu FB, Stevens J, Hubbard VS, Stevens VJ, Jakicic JM, Wadden TA, Kushner RF, Wolfe BM, Yanovski SZ. 2013 AHA/ACC/TOS Guideline for the management of overweight and obesity in adults. J Am Coll Cardiol. 2014; 63(25 Pt B): 2, 985-3, 023.

      United States Preventive Services Task Force. Screening for and management of obesity in adults. Release date: June 2012. Accessible at: http://www.uspreventiveservicestaskforce.org/uspstf/uspsobes.htm.

      United States Preventive Services Task Force. Behavioral counseling in primary care to promote a healthy diet: recommendations and rationale. Am J Prev Med. 2003 Jan; 24(1): 93-100.