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Providing interventions that facilitate improvement of dietary intake and other health behaviors can improve nutrition-related outcomes in adults with overweight or obesity. Medical nutrition therapy (MNT) behavioral interventions require expertise from registered dietitian nutritionists or international equivalents (dietitians), which no other health care provider can provide for adults with obesity. Current evidence supports the role of MNT behavioral interventions for adults with overweight or obesity as an effective treatment option, when appropriate for and desired by the client. This Academy of Nutrition and Dietetics Position Paper describes potential benefits and concerns regarding dietitian-provided MNT behavioral interventions for adults with overweight and obesity and informs dietitians about implications for practice. This Position Paper is supported by a systematic review examining effectiveness of MNT interventions provided by dietitians and by an evidence-based practice guideline. It is the position of the Academy of Nutrition and Dietetics that MNT behavioral interventions for adults (aged 18 years and older) with overweight or obesity should be a treatment option, when appropriate and desired by the client, to improve cardiometabolic, quality of life, and anthropometric outcomes. Dietitians providing MNT recognize the complex contributors to overweight and obesity, and thus individualize interventions, based on a shared decision-making process, and deliver interventions in an inclusive, compassionate, and client-centered manner. Interventions should include collaboration with an interprofessional team when needed. Dietitians strive to increase health equity and reduce health disparities by advocating and providing opportunities for increased access to effective nutrition care services. This position remains in effect until December 31, 2031. [ABSTRACT FROM AUTHOR]

Background Scientifically sound methods for investigating dietary consumption patterns from self-serve salad bars are needed to inform school policies and programs. Objective To examine the reliability and validity of digital imagery for determining starting portions and plate waste of self-serve salad bar vegetables (which have variable starting portions) compared with manual weights. Design/methods In a laboratory setting, 30 mock salads with 73 vegetables were made, and consumption was simulated. Each component (initial and removed portion) was weighed; photographs of weighed reference portions and pre- and post-consumption mock salads were taken. Seven trained independent raters visually assessed images to estimate starting portions to the nearest ¼ cup and percentage consumed in 20% increments. These values were converted to grams for comparison with weighed values. Statistical analyses Intraclass correlations between weighed and digital imagery–assessed portions and plate waste were used to assess interrater reliability and validity. Pearson’s correlations between weights and digital imagery assessments were also examined. Paired samples t tests were used to evaluate mean differences (in grams) between digital imagery–assessed portions and measured weights. Results Interrater reliabilities were excellent for starting portions and plate waste with digital imagery. For accuracy, intraclass correlations were moderate, with lower accuracy for determining starting portions of leafy greens compared with other vegetables. However, accuracy of digital imagery–assessed plate waste was excellent. Digital imagery assessments were not significantly different from measured weights for estimating overall vegetable starting portions or waste; however, digital imagery assessments slightly underestimated starting portions (by 3.5 g) and waste (by 2.1 g) of leafy greens. Conclusions This investigation provides preliminary support for use of digital imagery in estimating starting portions and plate waste from school salad bars. Results might inform methods used in empirical investigations of dietary intake in schools with self-serve salad bars. [ABSTRACT FROM AUTHOR]

Background Eleven recommendations, based on systematic reviews, were developed for the Evidence Analysis Library’s prevention of type 2 diabetes project. Two recommendations, medical nutrition therapy (MNT) and weight loss, were rated strong. Objective Present the basis of systematic reviews for MNT and weight loss recommendations. Methods Literature searches using Medline were conducted to identify studies that met eligibility criteria. The MNT literature search covered a time span of 1995 to 2012, the weight loss literature search covered 2008 to 2012 due to inclusion of a Cochrane Review meta-analysis of randomized controlled trials (RCTs) published in 2008. Eligibility criteria for inclusion of articles included original research using higher-quality study designs (ie, RCTs, case control, cohort, crossover, and nonrandomized trials) with participants aged >18 years and meeting prediabetes or metabolic syndrome diagnostic criteria. MNT was defined as individualized and delivered by a registered dietitian nutritionist or international equivalent and length of weight loss interventions was ≥3 months. Main outcome measures Two-hour postprandial blood glucose level, glycated hemoglobin level, albumin-to-creatinine ratio (metabolic syndrome samples only), fasting blood glucose level, high-density lipoprotein cholesterol level, systolic and diastolic blood pressure, triglyceride levels, urinary albumin excretion rate (metabolic syndrome samples only), waist circumference (WC), and waist-to-hip ratio were evaluated. Results For MNT, 11 publications were included, with all 11 using an RCT study design and 10 including participants with prediabetes. A majority of publications reported significant improvements in glycemic outcomes, WC, and blood pressure. For weight loss, 28 publications were identified, with one meta-analysis (only included RCTs) and 20 publications using an RCT study design, with the meta-analysis and 10 RCTs including participants with prediabetes. A majority of publications reported significant improvements in glycemic outcomes, triglyceride level, WC, and blood pressure. Conclusions Systematic reviews provided strong evidence that MNT and weight loss alter clinical parameters in ways that should reduce the risk of developing type 2 diabetes. [ABSTRACT FROM AUTHOR]

This article is the 12th installment in a statistical series exploring the importance of research design, epidemiologic methods, and statistical analysis as applied to nutrition and dietetics research. The purpose of this series is to assist registered dietitian nutritionists in interpreting nutrition research and aid nutrition researchers in applying scientific principles to produce high-quality nutrition research. This article focuses on the use of crossover designs in nutrition and dietetics research. The purpose is to distinguish the crossover design from the randomized clinical trial, define important terms, illustrate a 2×2 crossover design, discuss potential confounding variables in the crossover design, describe the analysis and interpretation of crossover data, present sample size considerations, provide examples of the use of the crossover design in nutrition and dietetics, and discuss additional considerations when the independent variable has more than two levels. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background When a hypocaloric, low-fat diet is prescribed, intake of currently consumed foods can decrease, foods naturally low in fat and/or added sugar may increase, or fat- or sugar-modified foods may increase. Objective To examine food group intake change and its relation to reductions in energy and fat intake and weight during a lifestyle intervention. Design Secondary cohort analysis. Participants One hundred sixty-nine participants (aged 52.0±8.6 years, body mass index 34.9±4.5, 92% white, 97.6% non-Hispanic, and 56.8% women) with complete data at 0 and 6 months collected in a research setting. Main outcome measures From three 24-hour telephone dietary recalls, 165 food groups from Nutrition Data System for Research software were coded into 25 larger food groups assessing intake of higher-fat and/or added-sugar food groups vs naturally lower-fat and/or added-sugar food groups and into 17 larger food groups assessing intake of nonmodified vs fat- and/or sugar-modified food groups. Statistical analyses performed Repeated measures analyses of covariance (intervention group: covariate) assessed changes from 0 to 6 months. Hierarchical regressions examined changes in food group intake and changes in energy intake, percent energy from fat intake, and weight from 0 to 6 months. Results Significant reductions ( P <0.05) in intake of high-fat and/or high-added-sugar food groups (Higher-Fat Dairy; Higher-Fat Eggs; Higher-Fat Fats; Higher-Fat Fruit; Higher-Fat Meat; Nonmodified Higher-Fat Fats, Oils, and Sweets; Nonmodified Higher-Fat Sugar-Sweetened Fats, Oils, and Sweets; Nonmodified Regular-Fat Dairy; and Nonmodified Regular-Fat Sugar-Sweetened Dairy) occurred. Decreases in the Higher-Fat Meat group were significantly ( P <0.05) related to decreases in energy intake, percent energy from fat intake, and weight. Conclusions When a hypocaloric, low-fat diet is prescribed, reductions in high-fat and/or high-added-sugar food groups occur. Targeting reductions in high-fat meats may improve outcomes. [ABSTRACT FROM AUTHOR]

It is the position of the Academy of Nutrition and Dietetics that successful treatment of overweight and obesity in adults requires adoption and maintenance of lifestyle behaviors contributing to both dietary intake and physical activity. These behaviors are influenced by many factors; therefore, interventions incorporating more than one level of the socioecological model and addressing several key factors in each level may be more successful than interventions targeting any one level and factor alone. Registered dietitian nutritionists, as part of a multidisciplinary team, need to be current and skilled in weight management to effectively assist and lead efforts that can reduce the obesity epidemic. Using the Academy of Nutrition and Dietetics’ Evidence Analysis Process and Evidence Analysis Library, this position paper presents the current data and recommendations for the treatment of overweight and obesity in adults. Evidence on intrapersonal influences, such as dietary approaches, lifestyle intervention, pharmacotherapy, and surgery, is provided. Factors related to treatment, such as intensity of treatment and technology, are reviewed. Community-level interventions that strengthen existing community assets and capacity and public policy to create environments that support healthy energy balance behaviors are also discussed. [ABSTRACT FROM AUTHOR]

Background Little is known about diet quality with a reduced-energy, low-fat, partial meal replacement plan, especially in individuals with type 2 diabetes. The Action for Health in Diabetes (Look AHEAD) trial implemented a partial meal replacement plan in the Intensive Lifestyle Intervention. Objective To compare dietary intake and percent meeting fat-related and food group dietary recommendations in Intensive Lifestyle Intervention and Diabetes Support and Education groups at 12 months. Design A randomized controlled trial comparing Intensive Lifestyle Intervention with Diabetes Support and Education at 0 and 12 months. Participants/setting From 16 US sites, the first 50% of participants (aged 45 to 76 years, overweight or obese, with type 2 diabetes) were invited to complete dietary assessments. Complete 0- and 12-month dietary assessments (collected between 2001 and 2004) were available for 2,397 participants (46.6% of total participants), with 1,186 randomized to Diabetes Support and Education group and 1,211 randomized to Intensive Lifestyle Intervention group. Main outcome measures A food frequency questionnaire assessed intake: energy; percent energy from protein, fat, carbohydrate, polyunsaturated fatty acids, and saturated fats; trans -fatty acids; cholesterol; fiber; weekly meal replacements; and daily servings from food groups from the Food Guide Pyramid. Statistical analyses performed Mixed-factor analyses of covariance, using Proc MIXED with a repeated statement, with age, sex, race/ethnicity, education, and income controlled. Unadjusted χ 2 tests compared percent meeting fat-related and food group recommendations at 12 months. Results At 12 months, Intensive Lifestyle Intervention participants had a significantly lower fat and cholesterol intake and greater fiber intake than Diabetes Support and Education participants. Intensive Lifestyle Intervention participants consumed more servings per day of fruits; vegetables; and milk, yogurt, and cheese; and fewer servings per day of fats, oils, and sweets than Diabetes Support and Education participants. A greater percentage of Intensive Lifestyle Intervention participants than Diabetes Support and Education participants met fat-related and most food group recommendations. Within Intensive Lifestyle Intervention, a greater percentage of participants consuming two or more meal replacements per day than participants consuming less than one meal replacement per day met most fat-related and food group recommendations. Conclusions The partial meal replacement plan consumed by Intensive Lifestyle Intervention participants was related to superior diet quality. [ABSTRACT FROM AUTHOR]

Single-serving packages (SSPs) may assist people in reducing consumption. Because overweight/obese individuals and individuals practicing dietary restraint may be more responsive to external food cues regarding an amount of food to consume, we examined whether weight and restraint status influence the relationship between package size and consumption. It was hypothesized that SSPs would reduce intake in overweight/obese individuals and individuals practicing dietary restraint compared with standard packages (STPs). Using a 2×2×2 (unrestrained/restrained×normal weight/overweight×SSP/STP) between-subjects design, 64 participants (aged 23.7±3.3 years; 81.3% white; 46.9% female), from June to October 2011, were randomly assigned to receive 20 oz pretzels packaged in SSPs or STPs, and were instructed to eat the pretzels ad libitum for 4 days. Each condition in the design contained eight participants. Total grams consumed was determined by subtracting postconsumption from preconsumption weight of packages provided. Using an analysis of variance for total grams of pretzels consumed, there was a significant interaction (P=0.01) between package size and weight status. Overweight/obese participants in the SSP condition ate fewer grams of pretzels than overweight/obese participants in the STP condition (107.0±101.9 g vs 204.4±144.9; P<0.05). No effect of restraint was found on consumption. For overweight/obese individuals, fewer pretzels were consumed when packaged in SSPs compared with STPs. Thus, replacing STPs with SSPs may assist with reducing consumption in some overweight/obese individuals. [ABSTRACT FROM AUTHOR]

Abstract: Dietary goals specific for lowering energy density (ED) may promote a nutrient-dense diet and weight loss. This pilot study examined the effects of ED-based diet prescriptions on diet quality and weight loss during a 3-month behavior-based obesity intervention conducted in a research setting. Forty-four adults with overweight/obesity (age 52.1±7.6 years, body mass index [BMI; calculated as kg/m2] 34.8±4.8, 81.8% women, and 93.2% white) were recruited between December 2009 and March 2010 and randomly assigned to: Low ED (consume ≥10 foods ≤1.0 kcal/g dietary ED and ≤2 foods ≥3.0 kcal/g dietary ED per day (n=15); Low-Energy, Low-Fat (1,200 to 1,500 kcal/day, ≤30% energy from fat (n=15); or Low-ED, Low-Energy, Low-Fat (n=14). Participants received 12 weekly group sessions led by a research interventionist. Dietary intake (measured by 3-day food records), self-reported physical activity, and weight were measured at baseline and 3 months. Intent-to-treat analyses showed all conditions reduced dietary ED and energy intake (P<0.001). Low-ED and Low-ED, Low-Energy, Low-Fat interventions increased fruit consumption (P<0.05). All conditions increased self-reported physical activity (P<0.001), with no difference between conditions. Although participants in all conditions lost weight (P<0.001), those in the Low-ED condition lost more (P<0.05) than those in the Low-ED, Low-Energy, Low-Fat condition (Low-ED −20.5±7.0 lb, Low-Energy, Low-Fat −16.9±10.1 lb, and Low-ED, Low-Energy, Low-Fat −12.5± 6.5 lb). A diet prescription that lowered ED increased fruit intake and enhanced weight loss compared with other weight loss prescriptions. [Copyright &y& Elsevier]

Stimuli that promote eating in the absence of the physiological need for food are pervasive and can facilitate excessive energy intake. The practices of mindful eating (ME) and intuitive eating (IE) have been developed to minimize external drivers of energy intake by helping individuals emphasize the sensory properties of foods and internal indicators of hunger and fullness. To enhance understanding about the effect of ME and IE interventions on dietary intake, this systematic review included randomized trials of ME and IE interventions that examined dietary intake, defined as energy intake or diet quality, in adults of varying weight status without a diagnosis of an eating disorder. The selection of literature followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review process, in which PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases were searched for studies published between January 1980 and November 2019. Studies were included if they met the following criteria: randomized trial design in which 1 arm was an intervention with an ME or IE component and there was at least 1 control or active comparison arm; enrolled participants were of a healthy weight or with overweight or obesity and reported not having an eating disorder (ie, anorexia, bulimia nervosa, or binge eating disorder) or other health conditions in which dietary restrictions were applied; were at least 18 years of age; and outcomes of energy intake or diet quality were reported at baseline and post intervention. The modified Downs and Black checklist was used to assess risk of bias for each study that met inclusion criteria. A total of 13 studies, including 8 investigating ME interventions and 5 investigating IE interventions, represented in 14 articles, were included in the review. Seven of the 9 articles reporting on energy intake did not find significant group differences. Eight of the 12 articles reporting on diet quality did not find significant group differences. The mean bias assessment score was 13.6 out of 28, indicating poor quality. Little evidence suggests that ME and IE interventions influence energy intake or diet quality. To draw strong conclusions about the effect of ME and IE on dietary intake, future research using study designs of high rigor are needed. [ABSTRACT FROM AUTHOR]

Obesity is associated with a multitude of comorbidities and considerable health care costs. The objective of this review was to examine the efficacy of weight management interventions provided by a registered dietitian or international equivalent (referred to as "dietitian"). This systematic review and meta-analysis of randomized controlled trials (RCTs) examined the effect of weight management interventions provided by a dietitian, compared with usual care or no intervention, on several cardiometabolic outcomes and quality of life in adults with overweight or obesity. MEDLINE, Embase, PsycINFO, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, and CINAHL databases were searched for eligible RCTs published between January 2008 and January 2021 in the English language. Meta-analyses were conducted using a random-effects model, publication bias was assessed using funnel plots and Egger's statistics, and heterogeneity was assessed by interpreting I 2 values. Efficacy of intervention components, such as telehealth or group contacts, were explored in sub-group analyses. Version 2 of the risk-of-bias tool for RCTs was used to assess risk of bias. The Grading of Recommendations Assessment, Development and Evaluation method was used to determine certainty of evidence. This systematic review included 62 RCTs. Compared with control conditions, weight management interventions provided by a dietitian resulted in improved body mass index (mean difference [MD] –1.5; 95% CI –1.74 to –1.26; moderate evidence certainty); percent weight loss (MD –4.01%; 95% CI –5.26% to –2.75%; high evidence certainty); waist circumference (MD –3.45 cm; 95% CI –4.39 to –2.51 cm; high evidence certainty); blood pressure (MD –3.04 mm Hg; 95% CI –5.10 to –0.98 mm Hg and MD –1.99 mm Hg; 95% CI –3.02 to –0.96 mm Hg for systolic blood pressure and diastolic blood pressure, respectively; moderate and low evidence certainty); and quality of life using the 36-Item Short Form Survey (MD 5.84; 95% CI 2.27 to 9.41 and 2.39; 95% CI 1.55 to 3.23 for physical and mental quality of life, respectively; low and moderate evidence certainty). For adults with overweight or obesity, weight management interventions provided by a dietitian are efficacious for improving several examined cardiometabolic outcomes and quality of life. [Display omitted] [ABSTRACT FROM AUTHOR]