AWM: Duration and Frequency of MNT 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: Duration and Frequency of MNT for Weight Loss
For weight loss, the registered dietitian nutritionist (RDN) should schedule at least 14 medical nutrition therapy (MNT) encounters (either individual or group) over a period of at least six months. High-frequency comprehensive weight loss interventions result in weight loss.
AWM: Duration and Frequency of MNT for Weight Maintenance
For weight maintenance, the registered dietitian nutritionist (RDN) should schedule at least monthly medical nutrition therapy (MNT) encounters over a period of at least one year. High-frequency comprehensive weight maintenance interventions result in maintenance of weight loss.
Risks/Harms of Implementing This Recommendation
Conditions of Application
An example of a weight loss schedule would be weekly encounters for the first six to 12 weeks, with less frequent encounters over the remaining months, individualized as needed.
Potential Costs Associated with Application
Costs of medical nutrition therapy (MNT) sessions vary; however, MNT sessions are essential for improved outcomes.
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
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.
- 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).
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; 63(25 Pt B): 2, 985-3, 023.