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Recommendations Summary

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.


  • Recommendation(s)

    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). 
     

    Rating: Strong
    Conditional

    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. 
     

    Rating: Strong
    Conditional

    • Risks/Harms of Implementing This Recommendation

      None.

    • 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:

      • Web
      • Telephone
      • Video
      • Text
      • Podcast.

    • 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.

    • Recommendation Narrative

      • 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.

    • Minority Opinions

      Consensus reached.