Academy Position Paper

Weight Management
Original position paper compiled by Helen M. Seagle, Gladys Witt Strain, Angela Makris and
Rebecca S. Reeves.
Provided in the Journal of the Academy of Nutrition and Dietetics or American Dietetic
Association February 2009 Volume 109

Pooja Rampal
Senior Seminar
October 8, 2014

According to Helen M. Seagle, Gladys Witt Strain, Angela Makris and Rebecca S.
Reeves in February 2009, 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 behaviours emphasizing sustainable and enjoyable eating practices and daily
physical activity. This position was in effect until December 31, 2013.
Obesity is a condition of having excess of bodys fat stores. Millions of Americans and
people worldwide are obese. This can put people at risk for many health problems. With the right
treatment and motivation, it's possible to lose weight and lower the long-term disease risk.
Setting the right goal is an important first step. Most people trying to lose weight have one goal
i.e. weight loss. Whereas, the focus should be on the eating habits and lifestyle changes that will
lead to long-term weight change. It is important to set SMART goals which are specific,
measurable, attainable, realistic and time based for sustainable behaviour change.
Academys Nutrition Care Process includes nutrition assessment, nutrition diagnosis,
nutrition intervention, and nutrition monitoring and evaluation. It is essential to include each of
these steps into weight management care plans. Assessment, involves collecting necessary
information to formulate diagnosis. Assessment has four components which are Anthropometric,
Biochemical, Psychological and Nutritional. All of these four parameters should be considered.
Its an on-going dynamic process. Appropriate treatment should be implemented before
beginning a nutritional intervention.
The first recommendation in obesity treatment is usually a reduction in energy intake: a
minimum reduction of 500 kcal/day is advised to achieve 1 lb weight loss per week.
A low-fat, reduced-energy diet is the best studied weight loss dietary strategy and is most
frequently recommended by governing health authorities but caution should be used in

suggesting these diets in patients with osteoporosis and kidney diseases. Additional strategies of
controlling portions, changing meal frequency and meal timings have been included to give
better results to the clients with the goal of achieving weight loss.
Registered dietitians (RD) play a very important role. They encourage weight loss clients
to control the portions which will help in reducing the energy load of the food consumed. RDs
recommend the frequent meals and encourage consumption of greater energy intake during the
day and lesser evening consumption. Clients who have problems in controlling portion or
selecting meals, a calorie control packaged meals or meal replacements are recommended. One
or two meals can be substituted with these, for weight loss. Very low energy diets which are
liquid formulations rich in proteins, vitamins and minerals are used to achieve large weight loss
but maintenance of that weight is problematic. RDs have a role in reinforcing appropriate
physical activities which will help clients in prevention of weight gain as well as sustaining
weight loss. More than 250 minutes/week of moderate-intensity physical activity will prevent
weight re-gain. Behavioural therapies are used to help clients achieve their weight loss goals. It
is observed that with behavioural interventions clients not only lose more weight, but also there
is great reduction in medical diseases. RDs collaborate with other health care team members
regarding the use of FDA approved weight loss medications for treatment of clinically
significant obesity. It is also important for RDs working in weight management to be
knowledgeable about the common surgical procedures, their mechanism, complications and
concerns. Before surgery, the role of the RD is important for screening to evaluate weight
history, efforts to lose weight, food preferences and behaviour related to food in assisting the
optimal procedure for the patient. Post- surgery, RDs help patients about the lifestyle changes
and the supplementations requirements for maintaining weight loss. They use their skills in

teaching behaviour change and their understanding of energy input and output. They educate
health care professionals about the importance of weight maintenance and the strategies required
for the same. RDs must be updated with the latest research for weight management. Attending
workshops and certificate trainings sponsored by the Academy commission is always advised.
RDs should use medical nutrition therapy as a model for the coverage of obesity, which is a
scientific evidence for the treatment of diabetes and renal diseases. It is also important to
communicate with other health care providers to meet all needs of the patient. Above all, RDs
should be the leaders in eradicating the Obesity epidemic by using their broad nutritional skills.
My opinion of the position is that it is very convincing and contains a lot of factual
knowledge with evidence. Many facts are supported with the evidence to ensure the validity of
the claims. The position paper includes updated information on weight-loss surgery, weight-loss
medications and other dietary and behavioural interventions. The importance of physical activity
in the position is very well documented and focussed. Regular physical activity may result in
lowering risk for chronic diseases. Moderate intensity workout not only increase endurance but
also reduces the risk of many adverse outcomes (2). The position has mentioned latest surgical
methods for weight loss and has also advised RDs to keep themselves updated with the
knowledge of these procedures and their mechanisms. People with severe obesity, suffering
from chronic disease like diabetes and who have tried all interventions and are not able to get
success and cure, can opt surgery for long term weight loss. This can help them in leading a
healthy and confident life.(3). The most absorbing point for me in the position is the welldefined role of RDs. It provides guidance to nutritional professionals who are uniquely qualified
to improve the health of the public through effective weight management interventions. It is very
motivating when it urges them primarily to take a leadership role in addressing the country's

obesity epidemic through partnerships among health professionals, government, and other
organizations.

Reference:

1. Seagle M H, Strain GW, Reeves S, Markis A. Weight management. Journal of

ADA.2009;109(2):330-346.
2. Physical activity guidelines advisory committee report to the Secretary of Health and
Human Services, 2008. US Department of Health and Human Services Website.
http://www.health.gov/paguidelines/guidelines/chapter2.aspx Accessed October 15,2014.
3. International Conference on Gastrointestinal Surgery to Treat Type 2 Diabetes.
Diabetes surgery summit. Studio Congressi Website.
http://www.scstudiocongressi.it/media/dss/dss.pdf. Accessed October 15, 2014.