From the Association
Position of the American Dietetic Association: Weight Management

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Abstract

It is the position of the American Dietetic Association that successful weight management to improve overall health for adults requires a lifelong commitment to healthful lifestyle behaviors emphasizing sustainable and enjoyable eating practices and daily physical activity. Given the increasing incidence of overweight and obesity along with the escalating health care costs associated with weight-related illnesses, health care providers must discover how to effectively treat this complex condition. Food and nutrition professionals should stay current and skilled in weight management to assist clients in preventing weight gain, optimizing individual weight loss interventions, and achieving long-term weight loss maintenance. Using the American Dietetic Association's Evidence Analysis Process and Evidence Analysis Library, this position paper presents the current data and recommendations for weight management. The evidence supporting the value of portion control, eating frequency, meal replacements, and very-low-energy diets are discussed as well as physical activity, behavior therapy, pharmacotherapy, and surgery. Public policy changes to create environments that can assist all populations to achieve and sustain healthful lifestyle behaviors are also reviewed.

Section snippets

Position Statement

It is the position of the American Dietetic Association that successful weight management to improve overall health for adults requires a lifelong commitment to healthful lifestyle behaviors emphasizing sustainable and enjoyable eating practices and daily physical activity.

Obesity is a condition characterized by excess accumulation of adipose tissue (ie, fat stores). Fat stores can only be changed by a whole body energy imbalance brought on by a change in energy intake, energy output,

Goals of Weight Management

The goals of weight management go well beyond numbers on a scale, whether or not weight change is one of the management objectives. The development of healthful lifestyles with behavior modification is important for overall fitness and health. Realistic expectations should be defined during an intake interview in terms of a more healthful weight vs the normal BMI range. In addition, it is important to set realistic expectations about the time required to make a sustainable behavior change.

Goals

Assessment of Obesity

Assessment, the first step of the Nutrition Care Process (13, 14), involves gathering the necessary information to formulate a diagnosis and develop a care plan. Baseline weight and health indexes should guide weight management goals and are necessary to document outcomes. Clinically useful measures of body weight status are noninvasive, easy to use, inexpensive, reliable, capable of reflecting short- and long-term changes in body fat, and must be correlated to health risk.

The standard

Regulation of Food Intake

A negative energy balance is the most important factor affecting weight loss amount and rate. The first recommendation in obesity treatment is usually a reduction in energy intake: A reduction of 500 to 1,000 kcal/day is advised to achieve a 1 to 2 lb weight loss per week (11, 12). Dietary energy reduction strategies may vary from a focus solely on energy (ie, “calorie counting”), macronutrient composition and/or energy density, or a combination of energy and macronutrient composition along

Weight Maintenance

As demonstrated in the preceding sections, it is possible to lose weight using a number of different strategies. However, weight loss is only one phase of the weight management continuum. Prevention of weight gain (at any BMI level) and prevention of weight regain (after a weight loss) anchor either end of this continuum. Each phase of the continuum possibly requires a transition to a different set of strategies and/or skill set.

The research on weight-loss maintenance is relatively new and far

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