NPA-GP: Guideline Overview (2023)
Nutrition and Physical Activity for the General Population Evidence-Based Nutrition Practice Guideline (2021-22)
Guideline Narrative Overview
Lifestyle behaviors, particularly consuming a nutritious diet and obtaining adequate physical activity, can help prevent cardiometabolic diseases such as type 2 diabetes mellitus, cardiovascular disease1, 2 and obesity.3 However, many adults do not meet population-based dietary and physical activity recommendations.4, 5, While most adults desire to achieve and maintain health, 6 each person experiences unique facilitators and barriers to implementing recommended lifestyle behaviors. Nuanced, biased, and evolving information, from both the media and research, may mislead or confuse consumers about which lifestyle behaviors best improve and maintain health.7, 8 Further, dissonance may exist between evidence available that guides lifestyle behaviors and the unique needs of an individual adult.9
Qualified nutrition and exercise practitioners can address challenges to adopting healthy lifestyle behaviors by providing consistent, individualized, and evidence-based education and programming within their professional scopes of practice to improve client outcomes. Evidence-based practice provided by qualified nutrition and exercise practitioners may offer the most practical and sustainable means of providing comprehensive, effective care to diverse adults in a range of environments, because it combines the best available research with clinical expertise and client values.10
High-quality evidence-based nutrition practice guidelines (EBNPGs) function as a starting place for designing and providing individualized nutrition and physical activity interventions. EBNPGs provide recommendations, and directions on how to implement those recommendations, to serve as a guide for professional practice.11 The current EBNPG describes practical methods for adults to improve lifestyle behaviors targeting disease prevention through individualized education and counseling provided by qualified nutrition and exercise practitioners. This EBNPG utilizes results from a recent systematic review12 experience by expert panel members and consideration of client values to assist nutrition and exercise practitioners in developing client-centered nutrition and physical activity programming for adults with or without cardiometabolic disease risk factors, but without diagnosed disease. Additionally, this EBNPG aims to address and clarify common barriers and facilitators encountered when delivering nutrition and physical activity interventions, such as adherence to professional scopes of practice, methods to support behavior change, and methods to support inclusion, diversity, equity, and access (IDEA).
This guideline is based on a systematic review conducted by the project team, consisting of nutrition and exercise practitioners and/or researchers, systematic review and guideline methodologists and evidence analysts. Recommendations were written based on an evidence-to-decision framework that incorporates evidence as well as clinical experience and client values.
This EBNPG includes:
- Recommendation Statements for Nutrition and Physical Activity Interventions for Adults in the General Population
- Supporting Evidence
- Risks and Harms of Recommendations
- Implementation Considerations/Conditions of Application
- Screening, Assessment, Monitoring/Evaluation
- Scope of Practice
- Intervention Amount and Delivery Methods
- Behavior Change Counseling or Coaching Approach
- Population-Based Nutrition and Physical Activity Guidelines
- Individualizing Nutrition and Physical Activity Interventions
- Inclusion, Diversity, Equity and Access
- Potential Resources Associated with Application
- Barriers and Facilitators to Application
- Guideline Strengths and Limitations
- Future Research
The number of supporting documents for this EBNPG includes:
- Recommendations: 2
- Conclusion Statements: 9
- Evidence Summaries: 9
- Worksheets: 45
Expand the section titled Project Team and Disclosures to see a list of individuals who developed this EBNPG with disclosures of conflicts of interest.
Academy guidelines are revisited every five years. An expert workgroup will be convened by the Workgroup Selection Subcommittee of the Council of Research (COR) to determine the need for new and revised recommendations based on the available science. The process includes:
- Conduct a scoping review to identify new research published since the previous searches were completed. Updated inclusion/exclusion criteria and search terms may be warranted.
- Review to determine if the update will include modifications to recommendations and compare them to the earlier version of the guidelines, or development of new recommendations.
- World Health Organization. (2021) Noncommunicable disease. Accessed October 27, 2021 www.who.int/news-room/fact-sheets/detail/noncommunicable-disease.
- World Health Organization (2021). Physical activity. Accessed October 27, 2021, www.who.int/news-room/fact-sheets/detail/physical-activity
- Centers for Disease Control and Prevention (March 21, 2022). Causes of Obesity. Accessed December 7, 2022, www.cdc.gov/obesity/basics/causes.html.
- Centers for Disease Control and Prevention (2022). Adult Physical Inactivity Prevalence Maps by Race/Ethnicity. Accessed March 1, 2022, www.cdc.gov/physicalactivity/data/inactivity-prevalence-maps
- Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (2018). National Health and Nutrition Examination Survey Data. Hyattsville, MD, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2017-2018.
- Robert Wood Johnson Foundation (2020). American Health Values Survey. Accessed January 6, 2022 www.rwjf.org/en/library/research/2016/06/american-health-values-survey-topline-report.html.
- Clark D, Nagler RH, Niederdeppe J. Confusion and nutritional backlash from news media exposure to contradictory information about carbohydrates and dietary fats. Public Health Nutr 2019 22(18): 3336-3348.
- Pilgrim K, and Bohnet-Joschko S. Selling health and happiness, how influencers communicate on Instagram about dieting and exercise: mixed methods research. BMC Public Health 2019 19(1): 1054.
- Close GL, Kasper AM, Morton JP. From Paper to Podium: Quantifying the Translational Potential of Performance Nutrition Research. Sports Med 2019 49(Suppl 1): 25-37.
- Graham R, Mancher M, Miller Woman D, Greenfield S, Steinberg E. Institute of Medicine Committee on Standards for Developing Trustworthy Clinical Practice, G. (2011). Clinical Practice Guidelines We Can Trust. Washington (DC), National Academies Press (US) Copyright 2011 by the National Academy of Sciences. All rights reserved.
- Nitschke E, Gottesman K, Hamlett P, Mattar L, Robinson J, Tovar A, Rozga M. Impact of Nutrition and Physical Activity Interventions Provided by Nutrition and Exercise Practitioners for the Adult General Population: A Systematic Review and Meta-Analysis. Nutrients 2022; 14(9).
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