MNT: Weight Management (2015)

MNT: Weight Management (2015)

• Intervention
  In overweight and obese adults, what is the effectiveness of MNT provided by a Registered Dietitian Nutritionist (RDN) on weight management outcomes?

  • Conclusion
    In overweight or obese adults, strong evidence supports the effectiveness of multiple visits (two to 12 visits, 60-minute initial visit and 20- to 45-minute follow-ups) for Medical Nutrition Therapy (MNT) by a nutrition professional (registered dietitian nutritionist or equivalent). Compelling evidence supports improved weight (-0.5kg to -9.0kg), BMI (-0.2kg/m² to -7.8kg/m²), waist circumference (-2.0cm to -14cm), FBG (-5.2mg to -9.5mg per dL), total cholesterol (-4.3mg to -59mg per dL), LDL-cholesterol (-15mg to -47mg per dL), HDL-cholesterol (+2.0mg to +11mg per dL) and triglycerides (-12mg to -60mg per dL).
  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In overweight and obese adults, what is the effectiveness of MNT provided by a Registered Dietitian Nutritionist (RDN) on weight management outcomes?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Anderson J, Reynolds L, Bush H, Rinsky J, Washnock C. Effect of a behavioral/nutritional intervention program on weight loss in obese adults: a randomized controlled trial. Postgraduate Medicine, 2011; 123: 205-213.
      • 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.
      • Bader A, Gougeon R, Joseph L, Da Costa D, Dasgupta K. Nutritional education through internet-delivered menu plans among adults with type 2 diabetes mellitus: pilot study. JMIR Research Protocols, 2013; 2: e41.
      • Bahadori B, Yazdani-Biuki B, Krippl P, Brath H, Uitz E and Wascher TC. Low-far, high-carbohydrate (low glycaemic index) diet induced weight loss and preserves lean body mass in obese health subjects: Results of 24 week study. Diabetes, Obesity and Metabolism. 2005; 7: 290-293.
      • Barratt R, Frost G, O'Boyle A, Millward J, Truby H. Use of sibutramine to assist obese women with weight loss can be successful in dietitian-led clinics: another tool in the dietitian's toolbox. J Human Nutrition and Dietetics. 2008; 21: 248-255.
      • Brancatisano A, Wahlroos S, Brancatisano R. Improvement in comorbid illness after placement of the Swedish Adjustable Gastric Band. Surgery for obesity and related diseases: official journal of the American Society for Bariatric Surgery; 4: S39-S46.
      • Campbell K, Van Patten C, Neil S, Kirkham A, Gotay C, Gelmon K, McKenzie D. Feasibility of a lifestyle intervention on body weight and serum biomarkers in breast cancer survivors with overweight and obesity. Journal of the Academy of Nutrition and Dietetics, 2012; 112: 559-567.
      • Carnie A, Lin J, Aicher B, Leon B, Courville A, Sebring N, de Jesus J, Dellavalle D, Fitzpatrick B, Zalos G, Powell-Wiley T, Chen K, Cannon R. Randomized trial of nutrition education added to internet-based information and exercise at the work place for weight loss in a racially diverse population of overweight women. Nutrition & Diabetes, 2013; 3:e98.
      • Chaput J, Tremblay A. Sleeping habits predict the magnitude of fat loss in adults exposed to moderate caloric restriction. Obesity Facts, 2012; 5: 561-566.
      • Christensen AS, Viggers L, Hasselstrom K, Gregersen S. Effect of fruit restriction on glycemic control in patients with type 2 diabetes: A randomized trial. Nutr J. 2013; 12: 29.
      • Collinson A, Lindley R, Campbell A, Waters I, Lindley T, Wallace A. An evaluation of an Internet-based approach to weight loss with low glycaemic load principles. J Hum Nutr Diet. 2011; 24:192-195.    
      • Conceicao de Oliveira M, Sichieri R, Moura AS. Weight loss associated with a daily intake of three apples or three pears among overweight women. Nutrition. 2003; 19: 253-256.
      • Cottell K, Dorfman L, Straight C, Delmonico M, Lofgren I. The effects of diet education plus light resistance training on coronary heart disease risk factors in community-dwelling older adults. The Journal of Nutrition, Health & Aging, 2011; 15: 762-767.
      • 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. 
      • Dixon J, Schachter L, O'Brien P, Jones K, Grima M, Lambert G, Brown W, Bailey M, Naughton M. Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. JAMA. 2012; 308: 1,142-1,149
      • Endevelt R, Ben-Assuli O, Klain E, Zelber-Sagi S. The role of dietician follow-up in the success of bariatric surgery. Surgery for obesity and related diseases: official journal of the American Society for Bariatric Surgery; 9: 963-968.
      • Finkler E, Heymsfield S, St. Onge M. Rate of weight loss can be predicted by patient characteristics and intervention strategies. Journal of the Academy of Nutrition and Dietetics, 2012; 112: 75-80.
      • Goulet J, Lamarche B, Charest A, Nadeau G, Lapointe A, Desroches S, Lemieux S. Effect of a nutritional intervention promoting the Mediterranean food pattern on electrophoretic characteristics of low-density lipoprotein particles in healthy women from the Quebec City metropolitan area. Br J Nutr. 2004; 92 (2): 285-293.
      • Goulet J, Lapointe A, Lamarche B, Lemieux S. Effect of a nutritional intervention promoting the Mediterranean food pattern on anthropometric profile in healthy women from Quebec city metropolitan area. Eur J Clin Nutr. 2007; 61: 1,293-1,300.
      • Hartmann-Boyce J, Johns D, Jebb S, Aveyard P. Effect of behavioural techniques and delivery mode on effectiveness of weight management: Systematic review, meta-analysis and meta-regression. Obesity Reviews. 2014; 15: 598-609
      • Holmes AL, Sanderson B, Maisiak R, Brown A, Bittner V. Dietitian services are associated with improved patient outcomes and the MEDFICTS dietary assessment questionnaire is a suitable outcome measure in cardiac rehabilitation. J Am Diet Assoc. 2005; 105(10): 1533-1540.
      • Hoy MK, Winters BL, Chlebowski RT, Papoutsakis C, Shapiro A, Lubin MP, Thomson CA, Grosvenor MB, Copeland T, Falk E, Day K, Blackburn GL. Implementing a low-fat eating plan in the Women's Intervention Nutrition Study. J Am Diet Assoc. 2009; 109: 688-696.
      • Imanaka M, Ando M, Kitamura T, Kawamura T. Effectiveness of web-based self-disclosure peer-to-peer support for weight loss: randomized controlled trial. Journal of Medical Internet Research, 2013; 15: e136.
      • Jen KL, Djuric Z, DiLaura NM, Buison A, Redd JN, Maranci V, Hryniuk WM. Improvement of metabolism among obese breast cancer survivors in differing weight loss regimens. Obes Res. 2004; 12(2): 306-312. 
      • Jensen GL, Roy M, Buchanan AE, Berg MB. Weight loss intervention for obese older women: I mprovements in performance and function. Obes Res. 2004; 12(11): 1,814-1,820.
      • John LK, Loewenstein G, Troxel AB, Norton L, Fassbender JE, Volpp KG. Financial incentives for extended weight loss: A randomized controlled trial. J Gen Intern Med. 2011 Jun; 26(6): 621-626.
         
      • Jones N, Furlanetto DLC, Jackson JA, Kinn S. An investigation of obese adults’ views of the outcomes of dietary treatment. J Hum Nutr Diet. 2007; 20 (5): 486-494.
      • Kesman RL, Ebbert JO, Harris KI, Schroeder DR. Portion control for the treatment of obesity in the primary care setting. BMC Res Notes. 2011 Sep 9; 4: 346.
      • Kugler C, Malehsa D, Schrader E, Tegtbur U, Guetzlaff E, Haverich A, Strueber M. A multi-modal intervention in management of left ventricular assist device outpatients: Dietary counselling, controlled exercise and psychosocial support. Eur J Cardiothorac Surg. 2012 Dec; 42 (6): 1,026-1,032.
      • Lapointe A, Weisnagel S, Provencher V, Bégin C, Dufour-Bouchard A, Trudeau C, Lemieux S. Comparison of a dietary intervention promoting high intakes of fruits and vegetables with a low-fat approach: long-term effects on dietary intakes, eating behaviours and body weight in postmenopausal women. The British Journal of Nutrition, 2010; 104: 1,080-1,090.
      • Lee IS, Shin G, Choue R. A 12-week regimen of caloric restriction improves levels of adipokine and pro-inflammatory cytokines in Korean women with BMIs greater than 23 kg/m². Inflammation Research, 2010; 59: 399-405.
      • Lynch EB, Liebman R, Ventrelle J, Avery EF, Richardson DJ. A self-management intervention for African Americans with comorbid diabetes and hypertension: A pilot randomized controlled trial. Preventing Chronic Disease. 2014; 11: E90.  
      • Matsuo T, Murotake Y, Kim M, Akiba T, Shimojo N, Kim M, Tanaka K. High general self-efficacy is associated with less weight loss under a supervised dietary modification program. Obesity Research & Clinical Practice 1986; 4: e83-e162.
      • Miller S, Oates V, Brooks M, Shintani A, Gebretsadik T, Jenkins D. Preliminary efficacy of group medical nutrition therapy and motivational interviewing among obese African American women with type 2 diabetes: a pilot study. Journal of Obesity, Volume 2014; 2014: 345941.
      • Molenaar EA, van Ameijden EJ, Vergouwe Y, Grobbee DE, Numans ME. Effect of nutritional counselling and nutritional plus exercise counselling in overweight adults: A randomized trial in multidisciplinary primary care practice. Family Practice. 2010; 27: 143-150.
      • Morrison Z, Douglas A, Bhopal R, Sheikh A, Understanding experiences of participating in a weight loss lifestyle intervention trial: a qualitative evaluation of south Asians at high risk of diabetes. BMJ Open. 2014; 4: e004736.
      • Nagashima J, Musha H, Takada H, Takagi K, Mochida T, Yoshihisa T, Imagawa Y, Matsumoto N, Ishige N, Fujimaki R, Nakajima H, Murayama M. Three-month exercise and weight loss program improves heart rate recovery in obese persons along with cardiopulmonary function. Journal of Cardiology. 2010; 56: 79-84.
      • Nicklas BJ, Ambrosius W, Messier SP, Miller GD, Penninx BW, Loeser RF, Palla S, Bleeker E, Pahor M. Diet-induced weight loss, exercise, and chronic inflammation in older, obese adults: a randomized controlled clinical trial. Am J Clin Nutr. 2004 Apr; 79 (4): 544-551.
      • Nijamkin MP, Campa A, Sosa J, Baum M, Himburg S, Johnson P. Comprehensive nutrition and lifestyle education improves weight loss and physical activity in Hispanic Americans following gastric bypass surgery: A randomized controlled trial. J Acad Nutr Diet. 2012 Mar; 112(3): 382-390.
      • Noda K, Zhang B, Iwata A, Nishikawa H, Ogawa M, Nomiyama T, Miura S, Sako H, Matsuo K, Yahiro E, Yanase T, Saku K. Lifestyle changes through the use of delivered meals and dietary counseling in a single-blind study. Circ J. 2012; 76: 1335-1344.
      • Nybacka Å, Carlström K, Ståhle A, Nyrén S, Hellström PM, Hirschberg AL. Randomized comparison of the influence of dietary management and/or physical exercise on ovarian function and metabolic parameters in overweight women with polycystic ovary syndrome. Fertil Steril. 2011; 96 (6): 1,508-1,513. doi:10.1016/j.fertnstert.2011.09.006.
      • Orazio LK, Isbel NM, Armstrong KA, Tarnarskyj J, Johnson DW, Hale RE, Kaisar M, Banks MD, Hickman IJ. Evaluation of dietetic advice for modification of cardiovascular disease risk factors in renal transplant recipients. J Ren Nutr. 2011; 21 (6): 462-474.
      • Pritchett AM, Deswal A, Aguilar D, Foreyt JP, Chan W, Mann DL, Ballantyne C, Bozkurt B. Lifestyle modification with diet and exercise in obese patients with heart failure – a pilot study. J Obes Weight Loss Ther. 2012; 2 (2): 1-8. Doi: 10.4172/2165-7904.1000118.
      • 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.
      • Riecke B, Christensen R, Christensen P, Leeds A, Boesen M, Lohmander L, Astrup A, Bliddal H. Comparing two low-energy diets for the treatment of knee osteoarthritis symptoms in obese patients: a pragmatic randomized clinical trial. Osteoarthritis and Cartilage / OARS, Osteoarthritis Research Society, 2010; 18: 746-754.
      • 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.
      • Singhal R, Kitchen M, Bridgwater S, Super P. Dietetic-led management of patients undergoing laparoscopic gastric banding: early results. Surgical Endoscopy, 2010; 24: 1,268-1,273.
      • Thomson CA, Stopeck AT, Bea JW, Cussler E, Nardi E, Frey G, Thompson PA. Changes in body weight and metabolic indexes in overweight breast cancer survivors enrolled in a randomized trial of low-fat vs. reduced-carbohydrate diets. Nutr Cancer. 2010; 62 (8): 1,142-1,152.
      • Tol J, Swinkels IC, deBakker DH, Seidell J, Veenhof C. Dietetic treatment lowers body mass index in overweight patients: An observational study in primary health care. J. Hum Nutr and Diet. 2014; 27(5): 426–433.
      • Travier N, Fonseca-Nunes A, Javierre C, Guillamo E, Arribas L, Peiró I, Buckland G, Moreno F, Urruticoechea A, Oviedo G, Roca A, Hurtós L, Ortega V, Muñoz M, Garrigós L, Cirauqui B, Del Barco S, Arcusa A, Seguí M, Borràs J, Gonzalez C, Agudo A. Effect of a diet and physical activity intervention on body weight and nutritional patterns in overweight and obese breast cancer survivors. Medical Oncology (Northwood, London, England). 2014; 31: 783.
      • Verheijden MW, Van der Veen JE, Bakx JC et al. Stage-matched nutrition guidance: Stages of change and fat consumption in Dutch patients at elevated cardiovascular risk. J Nutr Educ Behav. 2004; 36: 228-237.
      • Villanova N, Pasqui F, Burzacchini S, Forlani G, Manini R, Suppini A, Melchionda N, Marchesini G. A physical activity program to reinforce weight maintenance following a behavior program in overweight/obese patients. Int J Obes. 2006; 30: 697-703.
      • Welty FK, Nasca MM, Lew NS, Gregoire S, Ruan Y. Effect of onsite dietitian counseling on weight loss and lipid levels in an outpatient physician office. Am J Cardiol. 2007; 100(1): 73-75.
      • 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. 
      • Wong V, Chan R, Wong G, Cheung B, Chu W, Yeung D, Chim A, Lai J, Li L, Sea M, Chan F, Sung J, Woo J, Chan H. Community-based lifestyle modification programme for non-alcoholic fatty liver disease: a randomized controlled trial. Journal of Hepatology, 2013; 59: 536-542.
      • Yoong S, Carey M, Sanson-Fisher R, Grady A. A systematic review of behavioural weight-loss interventions involving primary-care physicians in overweight and obese primary-care patients (1999-2011). Public Health Nutrition, 2013; 16: 2,083-2,099.
  • Search Plan and Results: MNT: Effectiveness of MNT by RDN - Weight Management (2015)
     
  In overweight and obese adults, what is the cost benefit of MNT provided by a Registered Dietitian Nutritionist (RDN)?

  • Conclusion
    Consistent evidence supports the cost-effectiveness, cost benefit and economic savings of Medical Nutrition Therapy (MNT) provided by a registered dietitian nutritionist (a qualified nutrition professional) in overweight and obese adults. Using a variety of cost-effectiveness analyses, the studies affirm that MNT resulted in improved weight loss and improved quality of life. Continued research is needed on the cost-effectiveness, cost benefit and economic savings of outpatient MNT for weight management.
    
  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In overweight and obese adults, what is the cost benefit of MNT provided by a Registered Dietitian Nutritionist (RDN)?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Bogers RP, Barte JCM, Schipper CMA, Vugen S, de Hollander EL, Tariq L, Milder IE, Bremelmans WJ. Relationship between costs of lifestyle interventions and weight loss in overweight adults. Obes Rev. 2010; 11 (1): 51-61.
      • Bogers RP, Barte JCM, Schipper CMA, Vugen S, de Hollander EL, Tariq L, Milder IE, Bremelmans WJ. Relationship between costs of lifestyle interventions and weight loss in overweight adults. Obes Rev. 2010; 11 (1): 51-61.
      • Bradley DW, Murphy G, Snetselaar LG, Myers EF, Qualls LG. The incremental value of medical nutrition therapy in weight management. Manag Care Langhorne Pa. 2013; 22(1): 40-45.
      • Bradley DW, Murphy G, Snetselaar LG, Myers EF, Qualls LG. The incremental value of medical nutrition therapy in weight management. Manag Care Langhorne Pa. 2013; 22(1): 40-45.
      • Forster M, Veerman JL, Barendregt JJ, Vos T. Cost-effectiveness of diet and exercise interventions to reduce overweight and obesity. Int J Obes. 2005. 2011; 35 (8): 1,071-1,078. doi: 10.1038/ijo.2010.246.
      • Forster M, Veerman JL, Barendregt JJ, Vos T. Cost-effectiveness of diet and exercise interventions to reduce overweight and obesity. Int J Obes. 2005. 2011; 35 (8): 1,071-1,078. doi: 10.1038/ijo.2010.246.
      • Hertzman P. The cost effectiveness of orlistat in a one-year weight-management programme for treating overweight and obese patients in Sweden: A treatment responder approach. PharmacoEconomics. 2005; 23(10): 1007-1020.
      • Hertzman P. The cost effectiveness of orlistat in a one-year weight-management programme for treating overweight and obese patients in Sweden: A treatment responder approach. PharmacoEconomics. 2005; 23(10): 1007-1020.
      • Olsen J, Willaing I, Ladelund S, Jorgensen T, Gundgaard J, Sorensen J. Cost-effectivenss of nutritional counseling for obese patients and patients at risk of ischemic heart diease. Int J Technol Assess Health Care. 2005; 21(2): 194-202.
      • Olsen J, Willaing I, Ladelund S, Jorgensen T, Gundgaard J, Sorensen J. Cost-effectivenss of nutritional counseling for obese patients and patients at risk of ischemic heart diease. Int J Technol Assess Health Care. 2005; 21(2): 194-202.
      • Osland EJ, Powell EE, Banks M, Jonsson JR, Hickman IJ. Obesity management in liver clinics: Translation of research into clinical practice. J Gastroenterol Hepatol. 2007; 22(4): 504-509.
      • Osland EJ, Powell EE, Banks M, Jonsson JR, Hickman IJ. Obesity management in liver clinics: Translation of research into clinical practice. J Gastroenterol Hepatol. 2007; 22(4): 504-509.
      • van Baal PHM, van den Berg M, Hoogenveen RT, Vijgen SMC, Engelfriet PM. Cost-effectiveness of a low-calorie diet and Orlistat for obese persons: Modeling long-term health gains through prevention of obesity-related chronic disease. Value Health. 2008; 11(7): 1033-1040.
      • van Baal PHM, van den Berg M, Hoogenveen RT, Vijgen SMC, Engelfriet PM. Cost-effectiveness of a low-calorie diet and Orlistat for obese persons: Modeling long-term health gains through prevention of obesity-related chronic disease. Value Health. 2008; 11(7): 1033-1040.
      • Wolf AM, Siadaty M, Yaeger B, Conaway MR, Crowther JQ, Nadler JL, Bovbjerg VE. Effects of lifestyle intervention on health care costs: Improving Control with Activity and Nutrition (ICAN). J Am Diet Assoc. 2007; 107: 1365-1373.
      • Wolf AM, Siadaty M, Yaeger B, Conaway MR, Crowther JQ, Nadler JL, Bovbjerg VE. Effects of lifestyle intervention on health care costs: Improving Control with Activity and Nutrition (ICAN). J Am Diet Assoc. 2007; 107: 1365-1373.
  • Search Plan and Results: MNT: Effectiveness of MNT by RDN - Weight Management (2015)