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Recommendations Summary

AWM: Realistic Weight Goal Setting 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: Realistic Weight Goal Setting

    The registered dietitian nutritionist (RDN) should collaborate with the individual regarding a realistic weight loss goal, such as one of the following:

    • Up to two pounds per week
    • Up to 10% of baseline body weight
    • A total of 3% to 5% of baseline body weight if cardiovascular risk factors (hypertension, hyperlipidemia and hyperglycemia) are present.
    Studies regarding the effectiveness of medical nutrition therapy (MNT) for under six months reported significant weight losses of approximately one to two pounds per week, and six to 12 months of MNT resulted in significant mean weight losses of up to 10% of body weight. While a sustained weight loss of 3% to 5% is likely to result in clinically meaningful reductions in triglycerides, blood glucose, HbA1c, and the risk of developing type 2 diabetes, greater amounts of weight loss will also reduce blood pressure, improve LDL-C and HDL-C, and reduce the need for medications.
     

    Rating: Strong
    Imperative

    • Risks/Harms of Implementing This Recommendation

      None.

    • 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

      Recommendation Narrative from MNT Effectiveness

      • Medical nutrition therapy (MNT) provided by a registered dietitian nutritionist (RDN) results in both statistically and clinically significant weight loss in otherwise healthy overweight and obese adults
      • Four studies regarding the effectiveness of medical nutrition therapy for under six months reported significant weight losses of approximately one to two pounds per week (Holm et al, 1983; Richardson et al, 2005; Schneider et al, 2005; Raatz et al, 2008)
      • Four studies regarding the effectiveness of MNT from six to 12 months reported significant mean weight losses of up to 10% of body weight (Eilat-Adar et al, 2005; Feigenbaum et al, 2005; Dengel et al, 2006; Digenio et al, 2009)
      • Four studies report maintenance of this weight loss beyond one year. In these studies, both individual and group sessions were employed with weekly and monthly sessions (Melin et al, 2003; Willaing et al, 2004; Ashley et al, 2007; Sacks et al, 2009).
      From AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults (2013)

      Matching Treatment Benefits with Risk Profiles (Reduction in Body Weight Effect on CVD Risk Factors, Events, Morbidity and Mortality)
      • Counsel overweight and obese adults with CV risk factors (high BP, hyperlipidemia and hyperglycemia) that lifestyle changes that produce even modest, sustained weight loss of 3% to 5% produce clinically meaningful health benefits, and greater weight loss produces greater benefits:
        • Sustained weight loss of 3% to 5% is likely to result in clinically meaningful reductions in triglycerides, blood glucose, HbA1C and the risk of developing type 2 diabetes
        • Greater amounts of weight loss will reduce BP, improve LDL-C and HDL-C, and reduce the need for medications to control BP, blood glucose and lipids, as well as further reduce triglycerides and blood glucose.
      • NHLBI Grade A (Strong). ACC/AHA Level of Evidence Grade A.

    • Recommendation Strength Rationale

      • Recommendation strength rationale from MNT effectiveness: Conclusion statement in support of the recommendation received Grade I
      • ACC/AHA/TOS recommendation given NHLBI Grade A (Strong), ACC/AHA Level of Evidence Grade A. Recommendation Two was based on Critical Question One, which analyzed systematic reviews and meta-analyses; the literature search included those published from January 2000 to October 2011.

    • Minority Opinions

      Consensus reached.