Medical Nutrition Therapy Interventions Provided by Dietitians for Adult Overweight and Obesity Management: An Academy of Nutrition and Dietetics Evidence-Based Practice Guideline

Abstract

Overweight and obesity affect most adults living in the United States and are causally linked to several adverse health outcomes. Registered dietitian nutritionists or international equivalents (dietitians) collaborate with each client and other health care professionals to meet client-centered goals, informed by the best available evidence, and translated through a lens of clinical expertise and client circumstances and preferences. Since the last iteration of the Academy of Nutrition and Dietetics guideline on adult weight management in 2014, considerable research has been conducted and circumstances confronting dietitians have evolved. Thus, updated guidance is needed. The objective of this evidence-based practice guideline is to provide recommendations for dietitians who deliver medical nutrition therapy behavioral interventions for adults (18 years and older) with overweight and obesity to improve cardiometabolic outcomes, quality of life, and weight outcomes, when appropriate for and desired by the client. Recommendations in this guideline highlight the importance of considering complex contributors to overweight and obesity and individualizing interventions to client-centered goals based on specific needs and preferences and shared decision making. The described recommendations have the potential to increase access to care and decrease costs through utilization of telehealth and group counseling as effective delivery methods, and to address other barriers to overweight and obesity management interventions. It is essential for dietitians to collaborate with clients and interprofessional health care teams to provide high-quality medical nutrition therapy interventions using the nutrition care process to promote attainment of client-centered outcomes for adults with overweight or obesity.

Figure 2.

Definitions of terms used throughout the evidence-based practice guideline for medical nutrition therapy interventions provided by dietitians for adult overweight and obesity management.

Figure 3.

Executive summary of recommendations for registered dietitian nutritionists (RDNs) or international equivalents providing overweight and obesity interventions for adults with overweight and obesity. Executive summary of recommendations for registered dietitian nutritionists (RDNs) or international equivalents providing overweight and obesity interventions for adults with overweight and obesity.

Figure 4.

Ratings for recommendation strength and grades for certainty of evidence. Typically, strong recommendations are created from evidence with HIGH or MODERATE certainty of evidence and weak recommendations are created from LOW or VERY LOW certainty evidence. However, in some cases evidence was limited, but expert panel members came to consensus that a recommendation should be rated as strong due to clinical experience.

Figure 6.

Key elements of the Nutrition Care Process for medical nutrition therapy provided by dietitians for adults with overweight or obesity. ^aT2DM = type 2 diabetes mellitus. ^bCVD = cardiovascular disease. ^cS.M.A.R.T. = specific, measurable, achievable, relevant, time-bound.

Figure 7.

Practitioners that may be included in the interprofessional team supporting adults with overweight or obesity.

Figure 8.

Dietary approaches to consider for adults with overweight or obesity. All dietary patterns suggested require guidance to facilitate caloric reduction to promote weight loss when appropriate for and desired by the client.

Figure 9.

Definitions for inclusion, diversity, equity, and access, and examples concerning overweight and obesity management by registered dietitian nutritionists (RDNs) for adults from under-represented groups.