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.
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.
Risks/Harms of Implementing This Recommendation
Conditions of Application
Potential Costs Associated with Application
Costs of medical nutrition therapy (MNT) sessions vary; however, MNT sessions are essential for improved outcomes.
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).
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.
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).
Ashley JM, Herzog H, Clodfelter S, Bovee V, Schrage J, Pritsos C. Nutrient adequacy during weight loss interventions: A randomized study in women comparing the dietary intake in a meal replacement group with a traditional food group. Nutrition Journal 2007; 6: 12.
Dengel DR, Kelly AS, Olson TP, Kaiser DR, Dengel JL, Bank AJ. Effects of weight loss on insulin sensitivity and arterial stiffness in overweight adults. Metabolism 2006; 55: 907-911.
Digenio AG, Mancuso JP, Gerber RA, Dvorak RV. Comparison of methods for delivering a lifestyle modification program for obese patients: A randomized trial. Ann Intern Med 2009; 150 (4): 255-262.
Eilat-Adar S, Eldar M, Goldbourt U. Association of intentional changes in body weight with coronary heart disease event rates in overweight subjects who have an additional coronary risk factor. Am J Epidemiol 2005; 161: 352-358.
Feigenbaum A, Pasternak S, Zusk E, Sarid M, Vinker S. Influence of intense multidisciplinary follow-up and orlistat on weight reduction in a primary care setting. BMC Fam Pract. 2005; 6(1): 5.
Holm RP, Taussig MT, Carlton E. Behavioral modification in a weight-reduction program. J Am Diet Assoc. 1983; 83(2): 170-174.
Melin I, Karlstrom B, Lappalainen R, Berglund L, Mohsen R, Vessby B. A programme of behaviour modification and nutrition counselling in the treatment of obesity: a randomized 2-y clinical trial. Int J Obesity 2003;27:1127-1135.
Raatz SK, Wimmer JK, Kwong CA and Shalamar DS. Intensive diet instruction by registered dietitians improves weight-loss success. J Am Diet Assoc. 2008; 108 (1): 110-113.
Richardson CR, Brown BB, Foley S, Dial KS, Lowery JC. Feasibility of adding enhanced pedometer feedback to nutritional counseling for weight loss. J Med Internet Res. 2005; 7 (5): e56.
Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, McManus K, Champagne CM, Bishop LM, Laranjo N, Leboff MS, Rood JC, de Jonge L, Greenway FL, Loria CM, Obarzanek E, Williamson DA. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009; 360 (9): 859-873.
Schneider R, Golzman B, Turkot S, Kogan J, Oren S. Effect of weight loss on blood pressure, arterial compliance, and insulin resistance in normotensive obese subjects. Am J Med Sci. 2005; 330(4): 157-160.
Willaing I, Ladelund S, Jorgensen T, Simonsen T, Nielsen LM. Nutritional counselling in primary health care: a randomized comparison of an intervention by general practitioner or dietician. European Journal of Cardiovascular Prevention and Rehabilitation, 2004; 11: 513-520.
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, 023.