Obesity

EVIDENCE SUPPORTS DIETITIAN EFFECTIVENESS IN OBESITY TREATMENT

Obesity Decreases Life Span

Obesity is associated with increased chronic diseases and appears to lessen life expectancy markedly.  Data from the Third National Health and Nutrition Examination Survey  (NHANES III) showed that as overweight and obesity increased in this population, so did the prevalence of numerous health outcomes, including type 2 diabetes, gallbladder disease, coronary heart disease, high blood cholesterol, high blood pressure, and osteoarthritis.  The prevalence of having two or more health conditions increased with weight status across all racial and ethnic subgroups. (JAMA, 2003, JAMA 1999 Oct 27: 282(16):1523-1529. ATPIII, June 2001)

Dietary Strategies Underlie Success

Evidence-based guidelines emphasize that the most appropriate treatment strategy for obesity is DIET in combination with physical activity and behavior therapy, as well as adjunctive treatment with other modalities including pharmacotherapy and gastric surgery.  Dietetic professionals have been successful in utilizing various combinations of dietary strategies, including healthy eating plans and meal replacements, to achieve a 5 to 10 percent reduction in body weight.  Weight loss is associated with significant reductions in percent body fat, insulin and cholesterol levels.  Studies have shown that obese patients with diabetes who received nutrition intervention services from dietitians as the case managers can achieve better treatment outcomes, such as better metabolic control, and reduced body weight and waist circumference, than a usual care group.  In addition, people who receive e intervention group decreased the number of prescription medications.  (The evidence report.  NIH Publication No. 98-4083, 1998; Arch Inter Med. 2001;  Wolfe, 2003)

Diet and Lifestyle Changes Critical

Two studies, the Diabetes Prevention Program and Finnish Diabetes Prevention Program, demonstrated that diabetes could be delayed through diet and exercise—reducing the development of diabetes as much at 58 percent.   The weight loss varied between 8 lbs in the Finnish study and 12 lbs in the Diabetes Prevention Program.  Participants in the lifestyle intervention received diet, exercise and behavior modification skills.  In the Finnish study they received care at 10 individual sessions throughout the study.  (http://www.preventdiabetes.com. Aug 8, 2001)

Energy Balance is Still the Key

Many strategies are successful in the short term for healthy people (e.g. balanced carbohydrate, protein fat, low fat, high protein, meal replacements).  Long term studies continue to show that both diet and physical activity are critical to getting and keeping healthy weights.  Dietitians are uniquely qualified to assist clients in determining their individual strategies to attain and maintain weight. 

Multidisciplinary Treatment Needed

The Institute of Medicine report identified three components essential for weight management programs:  a match between the consumer and program, soundness and safety of program, and outcome of program.  Guidelines state that a variety of effective options exist for the management of overweight and obese patients, including diet therapy approaches such as low-calorie diets and lower-fat diets; altering physical activity patterns; behavior therapy techniques; pharmacotherapy, surgery, and combinations of these techniques.  Dietetic professionals are well positioned to assist consumers in identifying programs that match their needs and dietary intake is a critical component in all the techniques.  Guidelines include new recommendations for the treatment of metabolic syndrome, a clustering of hyperlipidemia, hypertension, and pre-diabetes, which addressed the importance of weight management.  (IOM Report on The Role of Nutrition in Maintaining Health in the Nation’s Elderly, Weighing the Options, NHLBI Guidelines, ATP III Guidelines)