Position of the American Dietetic: Association Weight Management

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. Americans are increasing in body fat as they become more sedentary. Obesity has reached epidemic proportions and health care costs associated with weight-related illnesses have escalated. Although our knowledge base has greatly expanded regarding the complex causation of increased body fat, little progress has been made in long-term maintenance interventions with the exception of surgery. Lifestyle modifications in food intake and exercise remain the hallmarks of effective treatment, but are difficult to initiate and sustain over the long term. The dietitian can play a pivotal role in modifying weight status by helping to formulate reasonable goals which can be met and sustained with a healthy eating approach as outlined in the Dietary Guidelines for 2000. Any changes in dietary intake and exercise patterns which decrease caloric intake below energy expenditure will result in weight loss, but it is the responsibility of the dietitian to make sure the changes recommended are directed toward improved physiological and psychological health. A thorough clinical assessment should help define possible genetic, environmental, and behavioral factors contributing to weight status and is important to the formulation of an individualized intervention. The activation of treatment strategies is often limited by available resources and cost. Reimbursement by third party payers for services is limited. Health care dollars are consumed for treatment of weight-related diseases. Public policy must change if the obesity epidemic is to be stopped and appropriate weight management techniques activated. In the past decade, our growing knowledge of the genetic, physiological, psychological, metabolic, and environmental influences on body weight has increased our awareness of the complexities of weight management. New research has provided a basis for evaluating our traditional intervention strategies and outcome goals. Americans are gaining weight at an alarming rate (1). Obesity is rapidly becoming an epidemic in this country. A sedentary life coupled with access to an abundance of energy-dense food has led to an increase in this chronic disease with national health care costs reaching $70 billion per year (2) and (3). Currently, available data on lifestyle weight loss interventions indicate that they produce low levels of sustained loss (4). Typically reported weight losses remaining after 4-5 years are about 3% to 6% of initial body weight (5). A 5% weight loss does have health benefits and counters weight gain that may have occurred if one had not been involved with weight loss strategies. There is a prevailing need for dietetics professionals and other health care professionals to document outcomes on weight loss programs/interventions, since there is limited data from commercial, hospital, and other interventions. e are spending a considerable amount of money on weight loss programs, and outcome data is needed to document the effectiveness of these. For most people who are overweight or obese, treatment recommendations are based on decreasing caloric intake, increasing physical activity, and making permanent, healthy lifestyle changes. Self-reports from individuals who lose weight and keep it off on their own, without professional support, indicate that these individuals are able to sustain changes in physical activity and food intake over time (5), (6) and (7). Evaluating the efficacy of weight management strategies depends on identifying outcome goals. Traditionally, evaluation has been on total weight loss; it is now realized that prevention of weight gain as well as weight loss and improving health status are important goals. We must move away from assuming that weight management is synonymous with the achievement of slenderness. Rather than recommending an unrealistic weight loss which is usually not achieved or maintained, patients must be helped to achieve and accept a healthier weight and adopt healthier lifestyles that lead to reducing health risks (8). Given our current obesity-conducive environment, significant change will require a concerted effort by both public and private sectors to address the environmental contributors to both childhood and adult obesity. Dietitians and other health care providers also have a responsibility to address these public health issues. While this paper doesn’t specifically concentrate on pediatric and adolescent obesity, the general concept about lifestyle can apply to this population.