Adult weight management evidence-based nutrition practice guidelines have been proposed by American Dietetic Association (ADA). These guidelines and recommendations are based on the analysis of recent evidence by ADA. These guidelines also include recommendations and suggestions from the program on Identification, Evaluation and Treatment of Overweight and Obesity in Adults, which was developed by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with National Institute of Diabetes and Digestive and Kidney Diseases in 1995. The chair of Adult Weight Management Evidence-Based Guideline Workgroup was Christina Biesemeier and these guidelines were released in May 2006.
All the recommendations and suggestions in this guideline are evidence based. As stated earlier, most of the recommendations have been adapted from the analysis done by NHLBI. The analysis involved a thorough review of existing literature and includes summaries and worksheets of important studies. All the randomized controlled and clinical trials, case control studies and observational studies done in this area were reviewed and recommendations and guidelines were formulated on the basis of their results.
All the recommendations of this guideline have been categorized into four categories from A to D. These categories determine the level of evidence available for a particular recommendation. The strengths of all the recommendations have also been determined and they have been grouped into five categories ranging from strong evidence to insufficient evidence. Each recommendation also has a conclusion grade and a statement label whether it is conditional or imperative. A grading system devised by Green in 2000 was used to categorize the levels of evidence for a particular recommendation (Green, 2000). The grading of recommendations was based on the system provided by American Academy of Pediatrics (ADA, 2004).
There are a number of recommendations which have been suggested in this guideline to manage adult obesity. It is imperative that BMI and waist circumference should be used for the classification of obesity. These two measures should also be used for follow up and continuous assessment of obese patients to determine the impact of treatment and its effectiveness in managing and reducing weight. In various studies BMI and waist circumference have been associated with obesity and the risk of developing many other diseases due to its complications ((ADA), 2006).
A multi-dimensional approach should be used to lose and maintain weight. This approach includes combination of increased physical activity and exercise, healthy diet and behavioral modifications. There is strong evidence in literature in support of this recommendation that combination of a number of factors has better results than a single therapeutic measure. This recommendation also falls into NHLBI evidence category A ((ADA), 2006).
The evidence also strongly supports that the treatment with medical nutrition to lose weight should at least be continued for 6 months or till the goal is achieved. A more frequent interaction and visits to the doctor help to achieve better results ((ADA), 2006).
It is also imperative that the goal of weight loss should be to lose 1-2 lbs per week for the whole therapy of six months. A person should be able to lose 10% weight initially. This recommendation also falls into evidence category A and B ((ADA), 2006).
The resting metabolic rate for all overweight and obese individuals should be determined via indirect calorimetry. This is used to calculate the energy requirements for all individuals during and after therapy. This is a conditional requirement and is not imperative for all individuals ((ADA), 2006).
In the weight management program, overall caloric intake is reduced to achieve weight loss. This is done by reducing carbohydrates and fat in the diet. This results in the caloric deficit of up to 1000 kilocalories from the baseline requirement of an individual and this deficit helps in achieving the target of weight loss of 2 lbs every week ((ADA), 2006).
The caloric intake should be reduced throughout the day and it is better to consume more calories during the daytime as compared to evening so that they are utilized during daytime work ((ADA), 2006).
Portion control should also be implemented at all meal and snack times. This reduces the caloric intake at each time which results in overall reduction in calories consumed throughout the day. Meal replacements with liquid meals and meal bars can also be done instead of portion control ((ADA), 2006).
Nutritional education also increases the level of awareness amongst individuals and results in better choice of food items. Diets with low glycemic index are not recommended. Diets and dairy products rich in calcium should also be incorporated in the diet to reduce weight as low calcium diets have been associated with weight gain ((ADA), 2006).
It is also suggested that diets low in carbohydrates result in more significant weight loss compared to those with low calories although the evidence available in the favour of this recommendation is limited ((ADA), 2006).
Weight management programs should include a component of physical activity and exercise of at least 30 minutes or more. The behavioral therapy should include stress management, problem solving and self monitoring strategies. FDA approved weight loss medications can also be used in selective obese individuals to achieve the goals ascertained. Bariatric or weight loss surgery is advised for those individuals who do not achieve the targeted weight loss after implementation of above mentioned strategies ((ADA), 2006).
References
- ADA, A. D. (2006). Adult weight management evidence based nutrition practice guideline. Chicago (IL): American Dietetic Association (ADA).
- ADA. (2004). American Dietetic Association from the American Academy of Pediatrics, Classifying Recommendations for Clinical Practice Guideline. Pediatrics , 874-877.
- Green. (2000). A practical approach to evidence grading. J Qual Improv. 700-12.