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Recommendations Summary

AWM: Monitor and Evaluate the Effectiveness of the Comprehensive Weight Management Program 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: Monitor and Evaluate the Effectiveness of the Comprehensive Weight Management Program

    The registered dietitian nutritionist (RDN) should monitor and evaluate the effectiveness of the comprehensive weight management program for overweight or obese adults, through the following data

    • Food and nutrition-related history, including but not limited to:
      • Beliefs and attitudes, including motivation
      • Food environment, including access to fruits and vegetables
      • Dietary behaviors, including eating out and screen time
      • Medications and supplements
      • Physical activity.
    • Anthropometric measurements, including but not limited to:
      • Weight and BMI
      • Waist circumference
      • Body composition (if available).
    • Biochemical data, medical tests and procedures, including but not limited to:
      • Glucose/endocrine profile
      • Lipid profile.
    • Nutrition-focused physical findings, including but not limited to:
      • Affect
      • Appetite
      • Blood pressure
      • Body language
      • Heart rate.
    Moderately strong evidence indicates that the food environment is associated with dietary intake, especially less consumption of vegetables and fruits and higher body weight. Strong and consistent evidence indicates that adults who eat fast food often are at increased risk of weight gain, overweight and obesity and that screen time, especially television screen time, is directly associated with increased overweight and obesity.

    Rating: Strong
    Imperative

    • Risks/Harms of Implementing This Recommendation

      None.

    • Conditions of Application

      If BMI is 35kg/m2 or higher, waist circumference will likely be elevated and will add no additional risk information.

    • Potential Costs Associated with Application

      • Costs of medical nutrition therapy (MNT) sessions vary, however MNT sessions are essential for improved outcomes
      • Costs of laboratory tests may be additional.

    • Recommendation Narrative

      From the 2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library (NEL) Evidence-Based Systematic Reviews

      • What is the relationship between the environment, body weight and fruit and vegetable consumption?
        • An emerging body of evidence has documented the impact of the food environment and select behaviors on body weight in both children and adults. Moderately strong evidence now indicates that the food environment is associated with dietary intake, especially less consumption of vegetables and fruits and higher body weight. The presence of supermarkets in local neighborhoods and other sources of vegetables and fruits are associated with lower BMI, especially for low-income Americans, while lack of supermarkets and long distances to supermarkets are associated with higher BMI. Finally, limited but consistent evidence suggests that increased geographic density of fast food restaurants and convenience stores is also related to increased BMI.
      • What is the relationship between eating out and body weight?
        • Strong and consistent evidence indicates that children and adults who eat fast food are at increased risk of weight gain, overweight and obesity. The strongest documented relationship between fast food and obesity is when one or more fast food meals are consumed per week. There is not enough evidence at this time to similarly evaluate eating out at other types of restaurants and risk of weight gain, overweight and obesity.
      • What is the relationship between screen time and body weight?
        • Strong and consistent evidence in both children and adults shows that screen time is directly associated with increased overweight and obesity. The strongest association is with television screen time.

    • Recommendation Strength Rationale

      The Conclusion Statements for Energy Balance and Weight Management, Food Environment and Dietary Behaviors in support of this recommendation received grades of moderate and strong.

    • Minority Opinions

      Consensus reached.