Unintended Weight Loss in Older Adults

UWL: Introduction (2009)

Guideline Title

Unintended Weight Loss (2009) in Older Adults Evidence-Based Nutrition Practice Guideline

Guideline Narrative Overview

The focus of this guideline is on medical nutrition therapy (MNT) for people 65 years and older with unintended weight loss (UWL).

The primary goals of MNT for older adults with unintended weight loss are to increase energy, protein and nutrient intakes, improve nutritional status and improve quality of life.   

Guideline Development 

This guideline is intended for use by Registered Dietitians (RDs) involved in providing MNT to older adults with UWL. The guideline must be individualized,  but it will assist the RD to successfully integrate MNT into the overall medical management of older adults with unintended weight loss. The recommendations in the guideline were based on a systematic review of the literature. Sample topics include:
  • Caloric needs
  • Diet liberalization
  • Modified texture diets
  • Medical food supplements
  • Enteral nutrition
  • Dining environment
  • Eating assistance.

The recommendations are based on the work performed by the American Dietetic Association Unintended Weight Loss expert working group. The number of supporting documents for these topics is below:

  • Recommendations: Nineteen (19)
  • Conclusion Statements:  Twenty-two (22) 
  • Evidence Summaries:  Twenty-one (22)
  • Article Worksheets: One hundred seventy-seven (177).
To view the guideline development and review process, click here.

Application of the Guideline

This guideline will be accompanied by a set of companion documents (i.e., a toolkit) to assist the practitioner in applying the guideline. The toolkit will contain materials such as the Medical Nutrition Therapy (MNT) protocol, documentation forms, outcomes management tools, client education resources and case studies. The toolkit is currently under development and will undergo pilot-testing through the ADA's Dietetic Practice-Based Research Network prior to publication.


The literature search will be repeated for each guideline topic on an annual basis to identify new research that has been published since the previous search was completed. Based on the quantity and quality of new research, a determination will be made about whether the new information could change the published recommendation or rating.

If a revision is unwarranted, then the search is recorded, dated and saved until the next review and no further action is taken. If the determination is that there could be a change in the recommendation or rating, then the supporting evidence analysis question(s) will be re-analyzed following the standard ADA Evidence Analysis Process (see ADA Evidence Analysis Manual in the Methodology section).

When the analysis is completed, the expert workgroup will approve and re-grade the conclusion statements and recommendations. The guideline will undergo a complete revision every three to five years.

Medical Nutrition Therapy and Unintended Weight Loss

Scientific evidence supports the effectiveness of medical nutrition therapy (MNT) to increase effectiveness of therapy for UWL. Topics included in this guideline are:
  • MNT 
  • Caloric needs
  • Diet liberalization
  • Modified texture diets
  • Medical food supplements
  • Enteral nutrition
  • Dining environment
  • Eating assistance.
The Registered Dietitian (RD) plays an integral role on the interdisciplinary care team by determining the optimal nutrition prescription and developing the nutrition care plan for older adults undergoing therapy for UWL. Based on the older adult's treatment plan and comorbid conditions, other nutrition practice guidelines such as critical care guidelines,  may be needed in order to provide optimal treatment.     
Populations to Whom This Guideline May Apply

This guideline applies to older adults with UWL.

Other Guideline Overview Material

For more details on the guideline components, click an item below:

  • Scope of Guideline
  • Statement of Intent
  • Guideline Methods
  • Implementation of the Guideline
  • Benefits and Harms of Implementing the Recommendations.


Clinical judgment is crucial in the application of these guidelines. Careful consideration should be given to the application of these guidelines for older adults with significant medical comorbidities.