AWM: Executive Summary of Recommendations (2022)

AWM: Executive Summary of Recommendations (2022)

Executive Summary of Recommendations  

Below are the recommendations and ratings for the Academy of Nutrition and Dietetics Adult Weight Management (AWM) 2022 Evidence-Based Nutrition Practice Guideline. Use the links on the left to view the Guideline Introduction. Detailed recommendations, including the evidence supporting these recommendations, is available from the Guideline Recommendations and Supporting Evidence tab. 

Each recommendation was developed from specific systematic review questions. Please download the "Relationship between PICO Questions and Recommendations" table (PDF) for details. 

• For  a description of the Academy Recommendation Rating scheme (Strong, Fair, Weak, Consensus, Insufficient Evidence), click here.
• For a description of the GRADE Recommendation Rate scheme (Level 1 (1A, 1B, 1C, 1D), Level 2 (2A, 2B, 2C, 2D), click here

• Nutrition Intervention
  AWM: Utilize the Nutrition Care Process

  It is reasonable for registered dietitian nutritionists or international equivalents to utilize the Nutrition Care Process to provide effective, client-centered interventions based on shared decision-making and clinical judgement and individualized to each client’s needs, circumstances, and goals.

  Consensus

  Conditional
  AWM: Provide Medical Nutrition Therapy

  Medical Nutrition Therapy provided by registered dietitian nutritionists or international equivalents is recommended for adults with overweight or obesity to improve cardiometabolic outcomes, quality of life, and weight outcomes, as appropriate for and desired by each client.

  Level 1(B)

  Imperative
  AWM: Adapt Goals and Interventions

  It is reasonable for registered dietitian nutritionists or international equivalents to monitor and evaluate client outcomes and adapt goals and interventions, including those for weight maintenance, and provide resources as needed for each client.

  Consensus

  Conditional
  AWM: Minimize Weight Bias and Stigma

  It is reasonable for registered dietitian nutritionists or international equivalents to minimize the effects of weight bias and weight stigma and its consequences by targeting client-centered goals, individualizing interventions according to complex contributors of overweight and obesity, communicating using client-preferred terms, and providing an inclusive physical environment.

  Consensus

  Conditional
  AWM: Collaborate with Interprofessional Healthcare Team

  Registered dietitian nutritionists or international equivalents should collaborate with an interprofessional healthcare team to provide comprehensive, multi-component care for adults with overweight or obesity, as appropriate for and desired by each client.

  Level 1(C)

  Imperative
  AWM: Coordinate Care in a Variety of Settings

  Registered dietitian nutritionists or international equivalents providing medical nutrition therapy interventions for adults with overweight and obesity should coordinate care in a variety of settings, including primary care/outpatient, community and workplace settings, to access and support each client with resources in the environment that best suits individualized needs.

  Level 1(B)

  Imperative
  AWM: Number and Frequency of Interactive Contacts

  Registered dietitian nutritionists or international equivalents may provide at least five interactive sessions, when feasible and desired by each adult client with overweight or obesity, to achieve the greatest potential improvement in outcomes. Frequency of contacts should be tailored to each client’s preferences and needs.

  Level 2(C)

  Conditional
  AWM: Intervention Duration

  Registered dietitian nutritionists or international equivalents should provide overweight and obesity management interventions for a duration of at least one year to improve and optimize cardiometabolic and weight outcomes, as appropriate for and desired by each client.

  Level 1(C)

  Conditional
  AWM: Follow-Up Contacts

  Following completion of overweight and obesity management interventions, registered dietitian nutritionists or international equivalents should provide follow-up contacts at least every three months, for as long as desired by each client, to facilitate maintenance of weight loss and improved cardiometabolic outcomes.

  Level 1(C)

  Conditional
  AWM: Telehealth and In-Person Care

  Registered dietitian nutritionists or international equivalents may use telehealth, in-person contacts, or a blend of these delivery methods when providing MNT interventions to adults with overweight or obesity. Outcomes may be optimized by including in-person contacts.

  Level 2(C)

  Conditional
  AWM: Group and Individual Contacts

  Registered dietitian nutritionists or international equivalents may use both individual and group delivery methods when providing MNT interventions to adults with overweight or obesity, as feasible and appropriate for each client.

  Level 2(C)

  Conditional
  AWM: Payment for Services

  It is reasonable and necessary for registered dietitian nutritionists or international equivalents to be aware of and utilize existing channels of payment for services for adults with overweight or obesity to improve client access to care.

  Consensus

  Conditional
  AWM: Dietary Patterns

  Registered dietitian nutritionists or international equivalents should advise adult clients with overweight or obesity that many different dietary patterns can be individualized to support client-centered goals. Prescribed dietary approaches should achieve and maintain nutrient adequacy and be realistic for client adherence. Prescribed calorie levels should be tailored based on estimated or measured needs and should be adjusted to improve weight outcomes, as appropriate for and desired by each client.

  Level 1(C)

  Imperative
  AWM: Components of a Comprehensive Intervention

  Registered dietitian nutritionists or international equivalents should advise the following components as part of a comprehensive adult overweight and obesity management intervention to improve cardiometabolic outcomes, quality of life, and weight outcomes, as appropriate for and desired by each client:

  • Nutritionally adequate diet with adjusted calories to improve weight outcomes and a nutritionally adequate, energy-balanced diet for weight maintenance; 
  • Behavioral strategies, including self-monitoring (diet, physical activity, weight);
  • Appropriate physical activity to meet client goals (within the RDN’s scope of practice or referral to an exercise practitioner). 

  Level 1(C)

  Imperative
  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.

  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.

  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.

  Level 1(C)

  Imperative