AWM: Adults with Obesity BMI >/=30 (2020-21)

Intervention
In adults with obesity, what is the effect of weight management interventions provided by an RDN or international equivalent, compared to usual care or no intervention from an RDN, on BMI?
- Conclusion
  In adults with obesity, weight management interventions provided by a dietitian may reduce BMI. Interventions that included in-person contacts and group contacts were the most efficacious compared to controls in sub-group analyses.
- Grade: Low (C)
  - 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 adults with obesity, what is the effect of weight management interventions provided by an RDN or international equivalent, compared to usual care or no intervention from an RDN, on BMI?
- Search Plan and Results: AWM: Interventions from a Dietitian (2021)
In adults with obesity, what is the effect of weight management interventions provided by an RDN or international equivalent, compared to usual care or no intervention from an RDN, on percent weight loss?
- Conclusion
  In adults with obesity, weight management interventions provided by a dietitian increased percent weight loss and increased the likelihood of achieving 5% weight loss. Interventions that included a multi-disciplinary team and at least 5 contacts with a dietitian were the most efficacious compared to controls in sub-group analyses.
- Grade: High (A)
  - 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 adults with obesity, what is the effect of weight management interventions provided by an RDN or international equivalent, compared to usual care or no intervention from an RDN, on percent weight loss?
- Search Plan and Results: AWM: Interventions from a Dietitian (2021)
In adults with obesity, what is the effect of weight management interventions provided by an RDN or international equivalent, compared to usual care or no intervention from an RDN, on waist circumference?
- Conclusion
  In adults with obesity, weight management interventions provided by a dietitian reduced waist circumference. Interventions that included both in-person and remote contacts, individual contacts, and at least 5 contacts with a dietitian were the most efficacious compared to controls in sub-group analyses.
- Grade: High (A)
  - 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 adults with obesity, what is the effect of weight management interventions provided by an RDN or international equivalent, compared to usual care or no intervention from an RDN, on waist circumference?
  - Detail
  - Worksheets
    
    Almanza-Aguilera E, Brunius C, Bernal-Lopez M, Garcia-Aloy M, Madrid-Gambin F, Tinahones F, Gómez-Huelgas R, Landberg R, Andres-Lacueva C. Impact in plasma metabolome as effect of lifestyle intervention for weight-loss reveals metabolic benefits in metabolically healthy obese women. Journal of Proteome Research 2018; 17:2600-2610
    
    Annesi J, Whitaker A. Weight loss and psychologic gain in obese women-participants in a supported exercise intervention. The Permanente Journal 2008; 12:36-45
    
    Bennett G, Herring S, Puleo E, Stein E, Emmons K, Gillman M. Web-based weight loss in primary care: a randomized controlled trial. Obesity 2010; 18:308-313
    
    Bennett G, Steinberg D, Askew S, Levine E, Foley P, Batch B, Svetkey L, Bosworth H, Puleo E, Brewer A, DeVries A, Miranda H. Effectiveness of an app and provider counseling for obesity treatment in primary care. American Journal of Preventive Medicine 2018; 55:777-786
    
    Cai R, Chao J, Li D, Zhang M, Kong L, Wang Y. Effect of community-based lifestyle interventions on weight loss and cardiometabolic risk factors in obese elderly in China: A randomized controlled trial. Experimental Gerontology 2019; 128:110749
    
    Foster-Schubert K, Alfano C, Duggan C, Xiao L, Campbell K, Kong A, Bain C, Wang C, Blackburn G, McTiernan A. Effect of diet and exercise, alone or combined, on weight and body composition in overweight-to-obese postmenopausal women. Obesity 2012; 20:1628-1638
    
    Haste A, Adamson A, McColl E, Araujo-Soares V, Bell R. Web-based weight loss intervention for men with type 2 diabetes: pilot randomized controlled trial. JMIR Diabetes 2017; 2:e14
    
    Hollis G, Franz R, Bauer J ,Bell J. Implementation of a very low calorie diet program into the pre-operative model of care for obese general elective surgery patients: outcomes of a feasibility randomised control trial. Nutrition & Dietetics 2020; 77:490-498
    
    Innes A, Thomson G, Cotter M, King J, Vollaard N, Kelly B. Evaluating differences in the clinical impact of a free online weight loss programme, a resource-intensive commercial weight loss programme and an active control condition: a parallel randomised controlled trial. BMC Public Health 2019; 19:1732
    
    Uemura M, Hayashi F, Ishioka K, Ihara K, Yasuda K, Okazaki K, Omata J, Suzutani T, Hirakawa Y, Chiang C, Aoyama A, Ohira T. Obesity and mental health improvement following nutritional education focusing on gut microbiota composition in Japanese women: a randomised controlled trial. European Journal of Nutrition 2019; 58:3291-3302
    
    Ventura Marra M, Lilly C, Nelson K, Woofter D, Malone J. . A pilot randomized controlled trial of a telenutrition weight loss intervention in middle-aged and older men with multiple risk factors for cardiovascular disease. Nutrients 2019; 11:
- Search Plan and Results: AWM: Interventions from a Dietitian (2021)
In adults with obesity, what is the effect of weight management interventions provided by an RDN or international equivalent, compared to usual care or no intervention from an RDN, on fasting blood glucose?
- Conclusion
  In adults with obesity but without Type 2 Diabetes Mellitus (T2DM), weight management interventions provided by a dietitian likely result in little to no difference in fasting blood glucose (MODERATE). However, in adults with obesity and T2DM, weight management interventions provided by a dietitian may reduce fasting blood glucose (LOW).
- Grade: Moderate (B)
  - 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 adults with obesity, what is the effect of weight management interventions provided by an RDN or international equivalent, compared to usual care or no intervention from an RDN, on fasting blood glucose?
  - Detail
  - Worksheets
    
    Almanza-Aguilera E, Brunius C, Bernal-Lopez M, Garcia-Aloy M, Madrid-Gambin F, Tinahones F, Gómez-Huelgas R, Landberg R, Andres-Lacueva C. Impact in plasma metabolome as effect of lifestyle intervention for weight-loss reveals metabolic benefits in metabolically healthy obese women. Journal of Proteome Research 2018; 17:2600-2610
    
    Bennett G, Steinberg D, Askew S, Levine E, Foley P, Batch B, Svetkey L, Bosworth H, Puleo E, Brewer A, DeVries A, Miranda H. Effectiveness of an app and provider counseling for obesity treatment in primary care. American Journal of Preventive Medicine 2018; 55:777-786
    
    Cai R, Chao J, Li D, Zhang M, Kong L, Wang Y. Effect of community-based lifestyle interventions on weight loss and cardiometabolic risk factors in obese elderly in China: A randomized controlled trial. Experimental Gerontology 2019; 128:110749
    
    Innes A, Thomson G, Cotter M, King J, Vollaard N, Kelly B. Evaluating differences in the clinical impact of a free online weight loss programme, a resource-intensive commercial weight loss programme and an active control condition: a parallel randomised controlled trial. BMC Public Health 2019; 19:1732
    
    Johnson K, Alencar M, Coakley K, Swift D, Cole N, Mermier C, Kravitz L, Amorim F, Gibson A. Telemedicine-based health coaching Is effective for Inducing weight loss and improving metabolic markers. Telemedicine Journal and e-Health 2019; 25:85-92
    
    Trepanowski J, Kroeger C, Barnosky A, Klempel M, Bhutani S, Hoddy K, Gabel K, Freels S, Rigdon J, Rood J, Ravussin E, Varady K. Effect of alternate-day fasting on weight loss, weight maintenance, and cardioprotection among metabolically healthy obese adults: a randomized clinical trial. JAMA 2017; 177:930-938
- Search Plan and Results: AWM: Interventions from a Dietitian (2021)
In adults with obesity, what is the effect of weight management interventions provided by an RDN or international equivalent, compared to usual care or no intervention from an RDN, on blood pressure?
- Conclusion
  In adults with obesity, weight management interventions provided by a dietitian may result in little to no difference in blood pressure.
- Grade: Moderate (B)
  - 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 adults with obesity, what is the effect of weight management interventions provided by an RDN or international equivalent, compared to usual care or no intervention from an RDN, on blood pressure?
  - Detail
  - Worksheets
    
    Alencar M, Johnson K, Gray V, Mullur R, Gutierrez E, Dionico P. Telehealth-based health coaching increases m-health device adherence and rate of weight loss in obese participants. Telemedicine Journal and e-Health 2020; 26:365-368
    
    Almanza-Aguilera E, Brunius C, Bernal-Lopez M, Garcia-Aloy M, Madrid-Gambin F, Tinahones F, Gómez-Huelgas R, Landberg R, Andres-Lacueva C. Impact in plasma metabolome as effect of lifestyle intervention for weight-loss reveals metabolic benefits in metabolically healthy obese women. Journal of Proteome Research 2018; 17:2600-2610
    
    Annesi J, Whitaker A. Weight loss and psychologic gain in obese women-participants in a supported exercise intervention. The Permanente Journal 2008; 12:36-45
    
    Bennett G, Herring S, Puleo E, Stein E, Emmons K, Gillman M. Web-based weight loss in primary care: a randomized controlled trial. Obesity 2010; 18:308-313
    
    Bennett G, Steinberg D, Askew S, Levine E, Foley P, Batch B, Svetkey L, Bosworth H, Puleo E, Brewer A, DeVries A, Miranda H. Effectiveness of an app and provider counseling for obesity treatment in primary care. American Journal of Preventive Medicine 2018; 55:777-786
    
    Cai R, Chao J, Li D, Zhang M, Kong L, Wang Y. Effect of community-based lifestyle interventions on weight loss and cardiometabolic risk factors in obese elderly in China: A randomized controlled trial. Experimental Gerontology 2019; 128:110749
    
    Innes A, Thomson G, Cotter M, King J, Vollaard N, Kelly B. Evaluating differences in the clinical impact of a free online weight loss programme, a resource-intensive commercial weight loss programme and an active control condition: a parallel randomised controlled trial. BMC Public Health 2019; 19:1732
    
    Liljensøe A, Laursen J, Bliddal H, Søballe K, Mechlenburg I. Weight loss intervention before total knee replacement: a 12-month randomized controlled trial. Scandinavian Journal of Surgery 2021; 110:3-12
    
    Trepanowski J, Kroeger C, Barnosky A, Klempel M, Bhutani S, Hoddy K, Gabel K, Freels S, Rigdon J, Rood J, Ravussin E, Varady K. Effect of alternate-day fasting on weight loss, weight maintenance, and cardioprotection among metabolically healthy obese adults: a randomized clinical trial. JAMA 2017; 177:930-938
- Search Plan and Results: AWM: Interventions from a Dietitian (2021)
In adults with obesity, what is the effect of weight management interventions provided by an RDN or international equivalent, compared to usual care or no intervention from an RDN, on quality of life?
- Conclusion
  In adults with obesity, weight management interventions provided by a dietitian likely increase quality of life.
- Grade: Moderate (B)
  - 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 adults with obesity, what is the effect of weight management interventions provided by an RDN or international equivalent, compared to usual care or no intervention from an RDN, on quality of life?
  - Detail
  - Worksheets
    
    Hollis G, Franz R, Bauer J ,Bell J. Implementation of a very low calorie diet program into the pre-operative model of care for obese general elective surgery patients: outcomes of a feasibility randomised control trial. Nutrition & Dietetics 2020; 77:490-498
    
    Liljensøe A, Laursen J, Bliddal H, Søballe K, Mechlenburg I. Weight loss intervention before total knee replacement: a 12-month randomized controlled trial. Scandinavian Journal of Surgery 2021; 110:3-12
    
    Villareal D, Chode S, Parimi N, Sinacore D, Hilton T, Armamento-Villareal R, Napoli N, Qualls C, Shah K. Weight loss, exercise, or both and physical function in obese older adults. The New England Journal of Medicine 2011; 364:1218-1229
    
    Villareal D, Aguirre L, Gurney A, Waters D, Sinacore D, Colombo E, Armamento-Villareal R, Qualls C. Aerobic or resistance exercise, or both, in dieting obese older dults. New England Journal of Medicine 2017; 376:1943-1955
- Search Plan and Results: AWM: Interventions from a Dietitian (2021)
In adults with obesity, what is the effect of weight management interventions provided by an RDN or international equivalent, compared to usual care or no intervention from an RDN, on cost-effectiveness?
- Conclusion
  There were no weight management intervention studies targeting adults with overweight/obesity and cardiovascular disease that reported the outcome of cost-effectiveness.
- Grade: Ungraded
  - 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.
In adults with obesity, what is the effect of weight management interventions provided by an RDN or international equivalent, compared to usual care or no intervention from an RDN, on adverse events?
- Conclusion
  In adults with obesity, weight management interventions provided by a dietitian likely do not result in serious adverse events. Minor diet-related events such as dry skin or gastrointestinal symptoms were noted infrequently.
- Grade: Very Low (D)
  - 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 adults with obesity, what is the effect of weight management interventions provided by an RDN or international equivalent, compared to usual care or no intervention from an RDN, on adverse events?
  - Detail
  - Worksheets
    
    Liljensøe A, Laursen J, Bliddal H, Søballe K, Mechlenburg I. Weight loss intervention before total knee replacement: a 12-month randomized controlled trial. Scandinavian Journal of Surgery 2021; 110:3-12
    
    Villareal D, Aguirre L, Gurney A, Waters D, Sinacore D, Colombo E, Armamento-Villareal R, Qualls C. Aerobic or resistance exercise, or both, in dieting obese older dults. New England Journal of Medicine 2017; 376:1943-1955
- Search Plan and Results: AWM: Interventions from a Dietitian (2021)