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Recommendations Summary

AWM: Special Populations 2022

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: Co-Morbidities

    Registered dietitian nutritionists or international equivalents should collaborate with clients and healthcare teams to manage co-morbidities such as type 2 diabetes mellitus, cardiovascular disease, dyslipidemia and other potential complications associated with overweight or obesity by tailoring MNT to each client’s specific health care needs, including medications, while supporting weight loss.

    Rating: Level 1(B)
    Imperative

    AWM: Pharmacotherapy and Metabolic and Bariatric Surgery

    Adults with obesity who receive pharmacotherapy or metabolic and bariatric surgery should collaborate with registered dietitian nutritionists or international equivalents, as part of an interprofessional healthcare team, to improve and maintain a healthy diet that meets nutritional needs and advances weight-loss efforts to improve cardiometabolic outcomes.

    Rating: Level 1(B)
    Imperative

    AWM: Members of Groups Disproportionately Affected by Overweight or Obesity and Under-Resourced Communities

    For adults who are members of groups disproportionately affected by overweight or obesity, or under-resourced communities (e.g., adults with low socioeconomic status, adults from racial or ethnic minority groups, older adults, adults with disabilities), registered dietitian nutritionists or international equivalents should provide culturally appropriate interventions that are tailored to each client’s values, beliefs and barriers regarding excess weight, and food and physical activity behaviors.

    Rating: Level 1(C)
    Imperative

    • Risks/Harms of Implementing This Recommendation

      Co-Morbidites

      For adults with T2DM administering exogenous insulin, there is a risk for severe hypoglycemia if dietary adjustments are made alone without adjustments to insulin regimens. Dietitians should be in contact with clients and their endocrinologists, especially early in the diet/weight loss phase.

      For adults with class I-III obesity (Centers for Disease Control and Prevention 2021), the amount of weight loss demonstrated by interventions may not be sufficient to change most obesity-related risk factors and may be less than what is desired by clients. Evidence from the meta-analysis suggests the mean percent weight loss was less than 5% (Academy of Nutrition and Dietetics' Evidence Analysis Center 2021), though any weight loss is beneficial. However, there are few harms reported with dietitian-led interventions and other benefits (e.g., improved quality of life (Academy of Nutrition and Dietetics' Evidence Analysis Center 2021, Morgan-Bathke M 2022) or healthier eating patterns (Mitchell, Ball et al. 2017)). It is also possible that interventions provided by a dietitian may prevent excessive weight gain, which might have occurred without the intervention.

      Pharmacotherapy and  Metabolic and Bariatric Surgery

      There are no risks and harms reported from providing MNT from a dietitian to clients undergoing metabolic and bariatric surgery beyond the risks for the surgery itself.

      Members of Groups Disproportionately Affected by Overweight or Obesity and Under-Resourced Communities

      Adults with low socioeconomic status may be less likely to have adequate healthcare coverage and thus may not have access to interventions. Aside from cost, barriers may be time, transportation and child care costs.

      When weight loss occurs, up to 25% of the weight lost may come from lean body tissue (i.e., muscle) rather than fat tissue(Willoughby, Hewlings et al. 2018). This is of greatest concern among older adults who are already at increased risk of sarcopenia due to age-accelerated muscle wasting.

    • Conditions of Application

      Co-Morbidities

      Dietitians prioritize nutrition diagnoses and interventions based on the most significant problems at the time of meeting, safety, client needs, likelihood of the intervention influencing the problem, and client values (Tewksbury, Nwankwo et al. 2022). The dietitian regularly communicates with the other health care providers working with the client to ensure consistent messaging and care plans are being delivered. Coordination of outcome measurements between the dietitian and other members of the healthcare team needs to occur to ensure that client progress is consistently documented. Realistic goals and expectations pertaining to the amount and rate of weight loss are discussed during an initial MNT appointment to ensure that the dietitian and the client are aligned. The dietitian also emphasizes the benefits of following a healthy, balanced diet for gradual weight loss versus the risks of attempting a fad diet or using supplements to rapidly lose weight. When working with adult clients who have obesity or co-morbidities, dietitians should utilize the PAR-Q form (Thomas, Reading et al. 1992), which aims to assess if a client can safely engage in physical activity or requires medical clearance, prior to encouraging physical activity.

      Type 2 Diabetes Mellitus

      This guideline does not include detailed guidance on comprehensive nutrition care for adults with T2DM. Practitioners should refer to EBPGs (Academy of Nutrition and Dietetics 2015), SOP/SOPPs (Davidson, Ross et al. 2018), and standard of care American Diabetes Association 2021), focused on diabetes for specific nutrition care recommendations. When providing dietary recommendations to adult clients with overweight or obesity and T2DM, dietitians consider the carbohydrate content of specific foods relative to the total calorie content for that eating occasion. The dietitian should be in regular contact with the adult client’s diabetes healthcare team and/or have access to the client’s medical records to ensure that any changes to lab values or medications are communicated in a timely fashion. Furthermore, recommendations for engagement in physical activity should be provided to clients with overweight or obesity and T2DM, being mindful of the dietitian’s scope of practice (Davidson, Ross et al. 2018). Dietitians may find the carbohydrate-controlled dietary approach of the MyPlate method to be helpful.(United States Department of Agriculture 2021) Dietitians treating adults with overweight or obesity and T2DM follow standards of practice and EBPGs (MacLeod, Franz et al. 2017, Tewksbury, Nwankwo et al. 2022) for both conditions, and should be adequately trained to treat T2DM. Dietitians provide education on monitoring blood glucose and consuming consistent carbohydrates to ensure blood glucose values are maintained within goal levels. Adults with T2DM who experience weight loss because of the intervention should have their blood glucose and hemoglobin A1c levels re-assessed, along with their insulin (or other medication) dosage.

      Cardiovascular Disease and Dyslipidemia

      In accordance with recent systematic reviews, the dietitian may consider use of dietary approaches such as the Dietary Approaches to Stop Hypertension (DASH) Diet or the Mediterranean Diet to improve health outcomes related to CVD, such as blood pressure and cholesterol levels, in addition to body weight (Dos Reis Padilha, Sanches Machado d'Almeida et al. 2018, Filippou, Tsioufis et al. 2020). Guidelines for dietitians working with adult clients with heart failure or hypertension are available on the EAL website (Academy of Nutrition and Dietitics' Evidence Analysis Center 2015, Academy of Nutrition and Dietitics' Evidence Analysis Center 2017). 

      Obesity, Classes I-III

      Many adults with obesity may prefer intensive overweight and obesity management programs (Skea, Aceves-Martins et al. 2019). In these cases, adult clients will likely benefit from multi-disciplinary interventions including physical activity, mental health and medical care, in addition to nutrition interventions (Tewksbury, Nwankwo et al. 2022). Dietitians practice within their scope, and refer to colleagues in other disciplines and/or expand their own training to adequately address the complex needs of adults with obesity. The healthcare team may need to include a therapist or mental health professional, particularly if the client is dealing with binge eating or food addiction issues. The amount of calorie reduction needed to achieve weight loss should allow for inclusion of light to moderate physical activity to the extent that the adult client can tolerate exercise. Dietitians should also be aware of issues that may limit physical activity for adult clients with obesity, such as chaffing or orthopedic issues. Dietitians may find it useful to collaborate with physical therapists, personal trainers or other fitness professionals who specialize in activities for individuals with obesity.

      Pharmacotherapy and  Metabolic and Bariatric Surgery

      Individuals who are candidates for metabolic and bariatric surgery are often required to meet with a dietitian to evaluate past attempts at weight loss. Pre-surgery dietary counseling may also include modest weight-loss efforts, dietary behavior change, and preparation for post-operative eating behaviors and food choices. However, there is an opportunity during these visits to develop a rapport with the individual to encourage them to continue working with the dietitian post-surgery. In general, adult clients who undergo metabolic and bariatric surgery or are using pharmacotherapy for weight loss may be less interested in working with a dietitian while they “wait and see” if the management is successful on its own. By using principles of motivational interviewing, the dietitian may increase the “buy-in” from these adult clients. Based on past research, dietitians may wish to focus on adult clients who have had bariatric surgery in the last 6-12 months to help them achieve appropriate weight loss using MNT.(Andromalos, Crowley et al. 2019) Please see Academy resources on MNT for individuals who have had bariatric surgery for more information.(Academy of Nutrition and Dietitics' Evidence Analysis Center 2017)

      Adults with Low SES, who are members of Racial or Ethnic Minority Groups, who have Disabilities or are members of other Under-Represented Groups

      When conducting MNT sessions, dietitians should strive to use inclusive, non-stigmatizing language and use a people-first approach (Ananthakumar, Jones et al. 2020, Howes, Harden et al. 2021), particularly when working with individuals who have low SES, are members of racial or ethnic minority groups or who have a disability. The U.S. Department of Health and Human Services Office on Minority Health and the Centers for Disease Control and Prevention both provide practitioners with tools for communicating in a way that promotes diversity, inclusion, equity and access (Centers for Disease Control and Prevention 2021, U.S. Department of Health and Human Services Office on Minority Health 2022, U.S. Department of Health and Human Services Office on Minority Health 2022). Overweight and obesity management interventions that address the moderators of social and demographic factors are limited (Academy of Nutrition and Dietetics' Evidence Analysis Center 2021). Thus, through assessment of the myriad contributors to overweight and obesity, it should be discussed during nutrition assessment to ensure interventions are individualized to each client’s specific needs and are adjusted as needed over time. Dietitians work with adult clients to individualize dietary recommendations to meet client needs including, but not limited to, dietary preferences, daily schedule, food access, food preparation skills and availability of cooking equipment. For example, dietitians should always ask about a typical day for adult clients, including sleep, meals, work, activity, etc. This will allow the dietitian to gain insights into a variety of factors that can play a role in client success.

      Clients may benefit from resources tailored to their population group. The Academy has several Member Interest Groups (MIGs) which have developed or identified various materials that are useful for overweight and obesity weight management for adults from under-represented groups. For example, the National Organization of Blacks in Dietetics and Nutrition (NOBIDAN) MIG (National Organization of Blacks in Dietetics and Nutrition 2022) has a Library of Resources (National Organization of Blacks in Dietetics and Nutrition 2022) authored by the NOBIDAN First Resources Committee of October 2021-2022. This electronic Library of Resources is available to NOBIDAN members and includes books, cookbooks, blogs, and websites by Black dietitians that are applicable to overweight/obesity weight management in adults.  Also, a new MIG, the Disabilities in Nutrition and Dietetics (“Disabilities”) MIG– for nutrition and dietetics practitioners, students, and interns who have disabilities and/or who work with clients who have disabilities – will begin membership in the 2023-2024 fiscal year. There are also free resources available that are tailored to adults who are transgender or gender diverse.(Linsenmeyer 2020) 

      For clients with low SES, routine screening for food insecurity (Makelarski, Abramsohn et al. 2017) and understanding the existing federal food assistance programs along with localized food help initiatives (i.e., food pantries, produce giveaways), can improve rapport with clients and facilitate their ability to access healthy food (Bruening, Perkins et al. 2022). The U.S. Department of Agriculture provided resources for eating healthily on a budget (U.S. Department of Agriculture 2022). Beyond utilizing traditional methods of payment (see Payment for Services section), dietitians can collaborate with affected adults and stakeholders to brainstorm methods of improving access to care. For example, dietitians could consider using a sliding scale to make visits more accessible to clients with low SES. Another innovative solution includes establishing “Pay It Forward” scholarships which are funded by other clients or individuals who have financial resources and awarded to clients who may find eating healthier to be unaffordable or otherwise inaccessible (Academy of Nutrition and Dietitics 2021). Dietetics programs, particularly those initiating a Future Education Model curriculum, may want to consider developing a reduced fee model for providing MNT to the public using a team of graduate students/dietetic interns with a dietitian supervisor. An example of this structure is in place at Bastyr University, where MNT appointments cost a flat rate of $25 for individuals (Bastyr Center for Natural Health 2021). It will be important to advocate for improved reimbursement and public and private payer coverage for dietitian interventions for adults from diverse and underrepresented groups (Dietitics 2021).

      RDNs are encouraged to incorporate IDEA (inclusion, diversity, equity, and access) in their practices and research regarding overweight and obesity management for adults. The IDEA Table defines each word in the IDEA acronym and provides specific examples.  Addressing health inequities extends beyond providing individualized advice that considers SDoH and other barriers to healthy lifestyle behaviors. Increasing collective consideration for IDEA principles requires a conceptual framework for action, including assessing determinants of health, formulating and implementing solutions and evaluating impacts from an individual to policy level (Tagtow, Herman et al. 2022). The Academy’s website for dietitians, eatrightPRO.org, hosts an IDEA Hub (Academy of Nutrition and Dietetics 2022) to provide networks among and resources for dietitians aiming to advance IDEA principles in their practices and professions. Dietitians can learn more about implicit bias in regards to race, gender, weight and other factors, (Project Implicit 2011, eatrightSTORE 2022) and from education opportunities for improving diversity and inclusion (Dietietics 2022).

      Older Adults

      Dietitians should consider whether a restrictive diet is appropriate for adults ≥75 years of age, because weight loss may be accompanied by loss of lean muscle mass and sarcopenia. Dietitians may consider not recommending weight loss in some cases (e.g., for adults at-risk for or experiencing malnutrition or chronic dehydration (Volkert, Beck et al. 2019)). The level of overweight or obesity may help guide decision making about whether weight loss is appropriate for an older client. Older adults with overweight might be better off maintaining weight if there are no co-morbidities given the risks of lean body mass loss from low-calorie diets. When weight loss is not indicated, dietitians can focus on wellness and healthy dietary intake instead of weight loss (Gill, Bartels et al. 2015, U.S. Department of Agriculture and U.S. Department of Health and Human Services 2020). For adults receiving overweight and obesity interventions, body composition is monitored regularly to ensure that the older adult client is not experiencing muscle loss. Assessment of body composition should include a nutrition-focused physical exam to assess skeletal muscle.

      When working with older adults, dietitians consider protein needs to maintain lean body mass and encourage adequate high-quality protein intake throughout the day. In addition, older adults may have reduced absorption of some micronutrients such as iron and vitamin B12. Nutrition guidance for older adults is available in the 2020-25 Dietary Guidelines for Americans (DGAs) and describes considerations for protein and vitamin B12 intake (U.S. Department of Agriculture and U.S. Department of Health and Human Services 2020). The DGAs highlight the importance of enjoying food, considering the ability to chew and swallow, mobility and strength to procure and prepare food, practicing food safety and referrals to food assistance services (U.S. Department of Agriculture and U.S. Department of Health and Human Services 2020).

      For adults ≥75 years of age, dietitians should consider requesting primary care provider approval for physical activity due to risk of falls and injuries in older adults with frailty. Dietitians consider mobility and functional status when discussing physical activity with older adults. Dietitians should be aware of polypharmacy, drug-nutrient interactions, and medication side effects when providing MNT to older adults. When designing interventions for older adults, dietitians should consider potential challenges with transportation to and from appointments, walking distance from parking areas for older adults with limited mobility, and potential challenges utilizing technology for telehealth appointments.

    • Potential Costs Associated with Application

      The cost of MNT interventions is primarily due to dietitian time (Padwal, Klarenbach et al. 2017). Given the benefits demonstrated, the cost is likely to be appropriate for adults with co-morbidities and overweight or obesity. Interventions provided by dietitians for adults with obesity may be more cost-effective compared to medications which may not yield better responses and are unlikely to impact eating behaviors or food choices the way a dietitian may. Resources needed for the intervention would include access to a dietitian, time, transportation costs, and dietitian fees and/or health insurance.

      The main issue with the feasibility of this recommendation is cost and public and private payer coverage or reimbursement. Consistent coverage for weight loss counseling provided by dietitians would facilitate participation, cost effectiveness, and efficacy for clients. Dietitian services should be covered by the Centers for Medicare & Medicaid services (CMS) and by other public and private payers. There is a need for a high limit or no limit to the number of MNT appointments covered for adults with co-morbidities and/or obesity. While barriers to implementation exist, financial barriers are reduced in the T2DM population and for those with obesity given the ability to reimburse for dietitian (or Certified Diabetes Educator) visits for adults with this disease.

      Pharmacotherapy and  Metabolic and Bariatric Surgery

      Invasive overweight and obesity management interventions may be expensive but result in improved health outcomes (Khera, Pandey et al. 2018, Biobaku, Ghanim et al. 2020). In comparison to the more invasive interventions of metabolic and bariatric surgery and pharmacotherapy, MNT provided by a dietitian is inexpensive. Obesity counseling for adults with a BMI ≥30 kg/m2 is covered by Medicare Part B when billed to a primary care provider (Centers for Medicare and Medicaid Services 2015). Services covered include weekly face-to-face visits for the first month and visits every other week for months 2 to 6. Additional services can be covered when weight loss is successful. However, payment is not available for RDNs working on their own or with overweight and obesity specialists other than primary care providers.

      Members of Groups Disproportionately Affected by Overweight or Obesity and Under-Resourced Communities

      Low SES populations and members of racial or ethnic minority groups have a higher prevalence of obesity (Centers for Disease Control and Prevention 2021) and related comorbidities (Bell, Thorpe et al. 2018) but may also be less likely to have adequate health care coverage or the time to attend multiple appointments. However, successful overweight and obesity management can reduce the burden of disease overall. Adequate health care coverage is essential to implementing this recommendation. 

      In the systematic review supporting this EBPG, there were no intervention studies targeting adults with low SES, who were members of racial or ethnic minority groups, or who had disabilities that reported the outcome of cost-effectiveness.(Academy of Nutrition and Dietetics' Evidence Analysis Center 2021) However, the negative effects of obesity on overall health have important implications for adults in these groups. Providing interventions to these groups is likely cost-effective for public and private payers; however, adults with low SES may not have access to coverage for dietitian services. Older clients with obesity can utilize services coverage from Medicare Part B. However, older adults with overweight may not receive nutrition services coverage. This is problematic because many older adults have low SES.

    • Recommendation Narrative

      Co-Morbidities

      Type 2 diabetes mellitus (T2DM), cardiovascular disease,  dyslipidemia and other co-morbidities are common in adults with overweight and obesity, and management recommendations often overlap (Caleyachetty, Thomas et al. 2017, 2021, American Diabetes Association 2021, Lichtenstein, Appel et al. 2021). In the systematic review supporting this EBPG, the strength of evidence varied across outcomes for adults with overweight or obesity and co-morbidities (Academy of Nutrition and Dietetics' Evidence Analysis Center 2021). There is consensus that the management of T2DM is critical to prevent serious adverse health outcomes (American Diabetes Association 2021), and the systematic review supporting this EBPG described that interventions provided by a dietitian reduced fasting blood glucose (FBG), blood pressure (BP), and waist circumference (WC) (MODERATE to HIGH evidence certainty) in addition to improving weight outcomes in adults with overweight or obesity and T2DM (LOW or VERY LOW certainty evidence).(Morgan-Bathke M 2022). Evidence for the outcome of adverse events including hypoglycemia was graded as VERY LOW. In adults with overweight or obesity and CVD, interventions provided by a dietitian reduced BP (MODERATE certainty evidence) in addition to improving WC, weight and FBG (MODERATE and LOW evidence certainty) (Morgan-Bathke M 2022). In adults with overweight or obesity and dyslipidemia, interventions provided by a dietitian decreased BMI (MODERATE certainty evidence) (Hardcastle, Taylor et al. 2013, Bennett, Steinberg et al. 2018) and WC (Bennett, Steinberg et al. 2018, Ventura Marra, Lilly et al. 2019) and increased the likelihood of achieving 5% weight loss (both LOW certainty evidence) (Bennett, Steinberg et al. 2018, Ventura Marra, Lilly et al. 2019). Two RCTs reported the effect of interventions on BP in this population (Hardcastle, Taylor et al. 2013, Bennett, Steinberg et al. 2018), and there was not a significant reduction in BP compared to control groups (MODERATE certainty evidence).(Hardcastle, Taylor et al. 2013, Bennett, Steinberg et al. 2018). While the lipid profile was not identified as an outcome of interest in the systematic review supporting this guideline, recent systematic reviews have demonstrated the efficacy of dietitian interventions in modifying blood lipid profile, including  adults with dyslipidemia (Sikand, Cole et al. 2018, Ross, Barnes et al. 2019, Mohr, Hatem et al. 2022). Dietitians are an established part of healthcare teams providing management for adults with cardiometabolic diseases (Briggs Early and Stanley 2018), so, the recommendation is likely acceptable to clients, their caregivers, and healthcare providers.

      Pharmacotherapy and  Metabolic and Bariatric Surgery

      Physicians may recommend pharmacotherapy or metabolic and bariatric surgery for adults with obesity. Metabolic and bariatric surgery is common in adult clients with obesity, is fairly safe and can lead to clinically significant weight loss(Kang and Le 2017). The systematic review supporting this EBPG did not specifically investigate the effects of pharmacotherapy or metabolic and bariatric surgery to treat obesity. However, this systematic review did demonstrate improvement of cardiometabolic outcomes (LOW to HIGH evidence certainty) with interventions provided by a dietitian for adults with obesity (Academy of Nutrition and Dietetics' Evidence Analysis Center 2021). Healthy dietary intake is crucial for adults with obesity undergoing more intensive therapies to assist in and advance weight loss and improvement in cardiometabolic risk factors. A prior systematic review by the Evidence Analysis Center reported the effect of MNT in adult clients post-bariatric surgery.  Fair/Moderate evidence describes the following:

      “Four studies [including gastric bypass, gastric band, sleeve gastrectomy and biliopancreatic diversion patients (with the majority of patients having undergone gastric bypass)] reported that patients receiving medical nutrition therapy (MNT) from a registered dietitian nutritionist (RDN) for two to six visits during the first year post-surgery had a significant excess weight loss ranging from 60% to 80% and significant reduction in body mass index (BMI) ranging from 5% to 31% at 12 months. An MNT session duration of 90 minutes was reported in one study, which also demonstrated that a higher frequency and duration of MNT visits resulted in the greatest weight loss (80% vs. 64% excess body weight loss at one year post-surgery), compared to those receiving standard care.”(Academy of Nutrition and Dietitics' Evidence Analysis Center 2017)

      A 2020 guideline for obesity in adults from the Canadian Medical Association provided a recommendation with evidence category and recommendation strength Level 2a, grade B that: “Pharmacotherapy for weight loss can be used for persons with BMI ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 with adiposity-related complications, in conjunction with medical nutrition therapy, physical activity and psychological interventions (liraglutide 3.0 mg, naltrexone-bupropion combination, orlistat)” (Wharton, Lau et al. 2020). In addition, the 2020 guideline for obesity in adults from the Canadian Medical Association reported it is important for adults with obesity who use pharmacotherapy or metabolic and bariatric surgery to receive MNT from a dietitian at pre- and post-surgery (Wharton, Lau et al. 2020).

      Adults with Low SES, who are members of Specific Racial or Ethnic Minority Groups, who have Disabilities or are members of other Under-Represented Groups

      Overweight and obesity are more prevalent among adults who are members of specific racial or ethnic minority groups compared to white adults, among adults with low SES compared to adults with high SES, and among adults with disabilities compared to adults without disabilities (Centers for Disease Control and Prevention 2021). Perceptions of ideal body weight may vary between adults according to racial or ethnic member group and/or SES (Paeratakul, White et al. 2002, Bennett and Wolin 2006). There was not enough evidence to provide, with any certainty, expected weight loss from interventions provided by dietitians for adults in these populations (Academy of Nutrition and Dietetics' Evidence Analysis Center 2021). In addition, there is little evidence available on overweight and obesity management interventions delivered to adults who are members of gender minority groups (Rozga, Linsenmeyer et al. 2020). As with other groups, it is likely that there is uncertainty and variability about how much adults in these specific groups value weight loss, which may vary depending on baseline weight/BMI as well as cultural and personal values (Bloom, Adler et al. 2018). If overweight and obesity interventions were targeted towards adults with low SES, who are members of specific racial or ethnic minority groups, or who have disabilities, health inequities would likely be reduced. Increasing the number of dietitians who identify as members of under-represented groups is needed to implement successful overweight and obesity interventions for diverse populations of adults.

      Older Adults

      In the U.S., 42.8% of older adults ≥60 years of age have obesity (Centers for Disease Control and Prevention 2021), which may contribute to or exacerbate co-morbidities such as sleep apnea, osteoarthritis, cancer, cognitive dysfunction, metabolic abnormalities, pulmonary abnormalities, urinary incontinence, physical dysfunction and increased frailty (Villareal, Apovian et al. 2005, Gill, Bartels et al. 2015). However, the risk-benefit ratio of providing overweight and obesity management interventions in this population is less straightforward than for younger or middle-aged adults. Weight loss may have unintended consequences such as loss of muscle and bone mass, which is already a concern in older adults and may increase the risk for sarcopenia. In the systematic review supporting this EBPG, overweight and obesity management interventions from a dietitian for older adults with overweight or obesity likely improve weight outcomes and WC (MODERATE certainty evidence) and may improve FBG, BP and QoL (LOW certainty evidence) (Academy of Nutrition and Dietetics' Evidence Analysis Center 2021). More research is needed on overweight and obesity management interventions provided by a dietitian for adults ≥75 years of age.

      More information on the evidence supporting these recommendations can be found in the Summary of Findings Table and Relationships between Recommendation Statements and Evidence Table.

    • Recommendation Strength Rationale

      The recommendation was based on analysis of interventions targeting population sub-groups in the systematic review supporting this EBPG. 

    • Minority Opinions

      No minority opinions.