Position of the ADA
Saturday, February 21st, 2009 | Uncategorized | No Comments
Earlier this month the American Dietetic Association published its position on weight management, which was endorsed by the American College of Sports Medicine.
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.
The American Dietetic Association (ADA) outlined the evidence supporting this position statement in a paper published earlier this month (Journal of the American Dietetic Association) and also offered several recommendations. The following recommendations are those based on the strongest scientific evidence:
1) Estimated energy needs should be based on resting metabolic rate (through metabolic testing or metabolic calculations).
2) An individualized reduced calorie diet is the basis of the dietary component of a comprehensive weight management program. Reducing dietary fat and/or carbohydrates is a practical way to create a caloric deficit of 500-1000 calories below estimated energy needs and should result in a weight loss of 1 to 2 pounds per week.
3) For people who have difficulty with self selection and/or portion control, meal replacements (e.g., liquid meals, meal bars, or calorie controlled packaged meals) may be used as part of the diet component of a comprehensive weight management program. Substituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance strategy.
4) A comprehensive weight management program should make maximum use of the multiple strategies for cognitive behavioral therapy. Cognitive behavioral therapy in addition to diet and physical activity leads to additional weight loss.
5) FDA Approved weight loss medications may be part of a comprehensive weight management program.
These recommendations are based on strong, science-based evidence. Other recommendations based on good and fair evidence are also listed in this ADA publication, such as portion control and glycemic index. I don’t think the word ‘comprehensive’ can be stressed enough in these recommendations. The reality is that weight loss is a complex journey, involving many different factors. It is the role of the dietitian or other health care provider to listen to each person who struggles with his or her weight as an individual and to then determine what the best and most effective strategy is for him or her. That strategy is very often not a simple one step process. Then comes the most important part: consistent and close follow-ups with adaptations as necessary. This is that critical step that most practitioners leave out.