AWM: Incorporating Telenutrition Interventions 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.
AWM: Incorporating Telenutrition Interventions for Weight Loss
If the registered dietitian nutritionist (RDN) incorporates telenutrition interventions for weight loss, medical nutrition therapy (MNT) should consist of both in-person and non-in-person encounters. Research on telenutrition interventions involving an RDN reported that hybrid interventions (containing both in-person and non-in-person components) were more effective for weight loss than using telenutrition interventions (only non-in-person components).
AWM: Incorporating Telenutrition Interventions for Weight Maintenance
If the registered dietitian nutritionist (RDN) incorporates telenutrition interventions for weight maintenance, medical nutrition therapy (MNT) may consist of either in-person or non-in-person encounters. Research on telenutrition interventions involving an RDN reported that either hybrid interventions (containing both in-person and non-in-person components) or telenutition interventions (only non-in-person components) were effective for weight maintenance.
Risks/Harms of Implementing This Recommendation
Conditions of Application
These recommendations apply when the registered dietitian nutritionist (RDN) incorporates telenutrition interventions, depending on the technological skills, access and knowledge of everyone involved.
Examples of telenutrition interventions involve, but are not limited to, the following delivery methods:
Potential Costs Associated with Application
- Costs of medical nutrition therapy (MNT) sessions vary; however, MNT sessions are essential for improved outcomes
- Costs associated with implementing preferred technology.
- For weight loss, hybrid telenutrition interventions (containing both face-to-face and non-face-to-face components) involving an RDN are effective (Gleason et al, 2002; Krukowski et al, 2008; Djuric et al, 2009; Harvey-Berino, West et al, 2010; Izquierdo et al, 2010; Rossi et al, 2010; Touger-Decker et al, 2010)
- The use of solely non-face-to-face telenutrition interventions for weight loss is not adequately researched (Turner-McGrievy et al, 2009)
- Due to the variation in telenutrition interventions in this emerging area of research, further studies on specific telenutrition interventions for weight loss are needed
- For weight maintenance, the use of both hybrid (containing both face-to-face and non-face-to-face components) and solely non-face-to-face telenutrition interventions involving the RDN are effective (Harvey-Berino, Pintauro, Buzzell et al, 2002; Harvey-Berino, Pintauro and Gold, 2002; Harvey-Berino, Pintauro et al, 2004; Haugen et al, 2007; Krukowski et al, 2008; Djuric et al, 2009; Donaldson et al, 2013)
- Due to the variation in telenutrition interventions in this emerging area of research, further studies on specific telenutrition interventions for weight maintenance are needed.
From AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults (2013)
Lifestyle Intervention and Counseling (Comprehensive Lifestyle Intervention)
- 4c. Electronically delivered weight loss programs (including by telephone) that include personalized feedback from a trained interventionist can be prescribed for weight loss but may result in smaller weight loss than face-to-face interventions. NHLBI Grade B (Moderate). 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 Conclusion Statements in support of this recommendation both received Grade I
- ACC/AHA/TOS recommendation given either NHLBI Grades A (Strong) or B (Moderate), ACC/AHA Level of Evidence Grade A. Recommendations 4c 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.
- Risks/Harms of Implementing This Recommendation
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).
Djuric Z, Mirasolo J, Kimbrough L, Brown DR, Heilbrun LK, Canar L, Venkatranamamoorthy R, Simon MS. A pilot trial of spirituality counseling for weight loss maintenance in African American breast cancer survivors. J Natl Med Assoc. 2009; 101(6): 552-564.
Gleason JA, Bourdet KL, Koehn K, Holay SY, Schaefer EJ. Cardiovascular risk reduction and dietary compliance with a home-delivered diet and lifestyle modification program. J Am Diet Assoc. 2002 Oct; 102 (10): 1,445-1,451. PMID: 12396164
Harvey-Berino J, West D, Krukowski R, Prewitt E, Van Biervliet A, Ashikaga T, Skelly J. Internet delivered behavioral obesity treatment. Prev Med. 2010; 51 (2): 123-128.
Izquierdo R, Lagua CT, Meyer S, Ploutz-Snyder RJ, Palmas W, Eimicke JP, Kong J, Teresi JA, Shea S, Weinstock RS. Telemedicine intervention effects on waist circumference and body mass index in the IDEATel project. Diabetes Technol Ther. 2010; 12 (3): 213-220.
Krukowski RA, Harvey-Berino J, Ashikaga T, Thomas CS, Micco N. Internet-based weight control: The relationship between web features and weight loss. Telemed J E Health. 2008; 14(8): 775-782.
Rossi MC, Perozzi C, Consorti C, Almonti T, Foglini P, Giostra N, Nanni P, Talevi S, Bartolomei D, Vespasiani G. An interactive diary for diet management (DAI): A new telemedicine system able to promote body weight reduction, nutritional education, and consumption of fresh local produce. Diabetes Technol Ther 2010; 12 (8): 641-647.
Touger-Decker R, Denmark R, Bruno M, O'Sullivan-Maillet J, Lasser N. Workplace weight loss program; comparing live and internet methods. J Occup Environ Med. 2010; 52(11): 1112-1118.
Turner-McGrievy GM, Campbell MK, Tate DF, Truesdale KP, Bowling M, Crosby L. Pounds off digitally study: a randomized podcasting weight-loss intervention. Am J Prev Med. 2009; 37: 263-269.
Donaldson EL, Fallows S, Morris M. A text message based weight management intervention for overweight adults. J Hum Nutr Diet. 2013 Jun 6. doi: 10.1111/jhn.12096. [Epub ahead of print].
Harvey-Berino J, Pintauro SJ, Gold EC. The feasibility of using Internet support for the maintenance of weight loss. Behav Modif. 2002; 26(1): 103-116.
Harvey-Berino J, Pintauro S, Buzzell P, Gold EC. Effect of internet support on the long-term maintenance of weight loss. Obes Res. 2004; 12(2): 320-329.
Harvey-Berino J, Pintauro S, Buzzell P, DiGiulio M, Casey Gold B, Moldovan C, Ramirez E. Does using the Internet facilitate the maintenance of weight loss? Int J Obes Relat Metab Disord. 2002; 26(9): 1,254-1,260.
Haugen HA, Tran ZV, Wyatt HR, Barry MJ, Hill JO. Using telehealth to increase participation in weight management programs. Obesity (Silver Spring). 2007; 15(12): 3067-3077.
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 Jul 1; 63(25 Pt B): 2, 985-3, 024.