Evidence for Nutrition Counseling in the Care of Patients with Obesity

  • Dania SaaronyEmail author
  • Sue Cummings


Prevalence of obesity and related comorbidities is well documented with data showing a continuation in trends. As compared to other diseases, effective therapies for the treatment of obesity are limited. Currently, diet and lifestyle interventions are the foundation of all therapies and commonly recommended as the initial therapy for individuals who are overweight or who suffer from obesity. However, diet and lifestyle interventions alone may not be effective, in which case pharmacotherapy and/or weight loss surgery, combined with diet and lifestyle counseling, may be indicated. Since obesity is a complex disease with multiple etiologies including factors such as food choices, meal timing, and nutritional intake, nutrition counseling is an important component of all obesity therapies. It is the goal of this chapter to outline the evidence for nutrition counseling in treating obesity.


Nutrition Registered dietitian nutritionist Nutrition counseling Micronutrients Nutrition care process Obesity Lifestyle Pharmacotherapy Bariatric surgery Weight management 


  1. 1.
    Kushner RF, Kahan S. Introduction: the state of obesity in 2017. Med Clin North Am. 2018;102(1):1–11.PubMedGoogle Scholar
  2. 2.
    Micha R, Peñalvo JL, Frederick C, Imamura F, Rehm CD, Mozaffarian D. Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. JAMA. 2017;317(9):913.CrossRefGoogle Scholar
  3. 3.
    Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, Hu FB, Hubbard VS, Jakicic JM, Kushner RF, Loria CM, Millen BE, Nonas CA, Pi-Sunyer FX, Stevens J, Stevens VJ, Wadden TA, Wolfe BM, Yanovski SZ. A report of the American College of Cardiology/American Heart Association task force on practice guidelines and the Obesity Society. Obesity. 2014;22(S2):S1–S410.CrossRefGoogle Scholar
  4. 4.
    National Heart, Lung, and Blood Institute, National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. 1998.
  5. 5.
    Center for Disease Control: Obesity, Causes and Consequences: Accessed 1/30/18.
  6. 6.
    Pool AC, Kraschnewski JL, Cover LA, Lehman EB, Stuckey HL, Hwang KO, Pollak KI, Sciamanna CN. The impact of physician weight discussion on weight loss in US adults. Obes Res Clin Pract. 2014;8(2):131–9.CrossRefGoogle Scholar
  7. 7.
    Ahmed NU, Delgado M, Saxena A. Trends and disparities in the prevalence of physicians’ counseling on diet and nutrition among the U.S. adult population, 2000–2011. Prev Med. 2016;89:70–5.CrossRefGoogle Scholar
  8. 8.
    Long BJ, Calfas KJ, Wooten W. A multisite field test of the acceptability of physical activity counseling in primary care: project PACE. Am J Prev Med. 1996;12:73–81.CrossRefGoogle Scholar
  9. 9.
    Mullen PD, Evans D, Forster J. Settings as an important dimension in health education/promotion policy, programs, and research. Health Educ Q. 1995;22:329–45.CrossRefGoogle Scholar
  10. 10.
    Thande NK, Hurstak EE, Sciacca RE, Giardina EG. Management of obesity: a challenge for medical training and practice. Obesity (Silver Spring). 2009;17(1):107–13.CrossRefGoogle Scholar
  11. 11.
    Kolasa KM, Rickett K. Barriers to providing nutrition counseling cited by physicians: a survey of primary care practitioners. Nutr Clin Pract. 2010;25(5):502–9.CrossRefGoogle Scholar
  12. 12.
    Katz DL, Friedman RSC, Lucan SC. Nutrition in clinical practice: a comprehensive, evidenced based manual for the practitioner. 3rd ed. Models of behavior modification for diet and activity patterns and weight management (chapter 46). Philadelphia: Lippincott Williams and Wilkins; 2015. p. 587–606.Google Scholar
  13. 13.
    Bleich SN, Bandara S, Bennett W, Cooper LA, Gudzune KA. Enhancing the role of nutrition professionals in weight management: a cross-sectional survey. Obesity (Silver Spring). 2015;23(2):454–60.CrossRefGoogle Scholar
  14. 14.
    Stelmach-Mardas M, Mardas M, Warchoł W, Jamka M, Walkowiak J. Successful maintenance of body weight reduction after individualized dietary counseling in obese subjects. Sci Rep. 2014;14(4):6620.Google Scholar
  15. 15.
    Gudzune K. Dietary and behavioral approaches in the management of obesity. Gastroenterol Clin N Am. 2016;45(4):653–61.CrossRefGoogle Scholar
  16. 16.
    Bratcher CR, Bellow E. Traditional or centralized models of diabetes care: the multidisciplinary diabetes team approach. J Fam Pract. 2011;60:S6–S11.PubMedGoogle Scholar
  17. 17.
    Houle SK, Chatterley T, Tsuyuki RT. Multidisciplinary approaches to the management of high blood pressure. Curr Opin Cardiol. 2014;29:344–53.CrossRefGoogle Scholar
  18. 18.
    Garg T, Birge K, Rosas U, Azagury D, Rivas H, Morton JM. A postoperative nutritional consult improves bariatric surgery outcomes. Surg Obes Relat Dis. 2016;12(5):1052–6.CrossRefGoogle Scholar
  19. 19.
    Fried M, Yumuk V, Oppert JM, Scopinaro N, Torres A, Weiner R, Yashkov Y, Frühbeck G. Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Surg. 2014;24(1):42–55.CrossRefGoogle Scholar
  20. 20.
    Tapsell LC, Lonergan M, Batterham MJ, Neale EP, Martin A, Thorne R, Deane F, Peoples G. Effect of interdisciplinary care on weight loss: a randomized controlled trial. BMJ Open. 2017;13(7):014533.Google Scholar
  21. 21.
    Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016;315(21):2284–91.CrossRefGoogle Scholar
  22. 22.
    US Preventative Services Task Force: Behavioral Counseling Interventions: An Evidence-based Approach: Accessed 1/30/18.
  23. 23.
    Kushner RF. Providing nutritional care in the office practice. Med Clin N Am. 2016;100(6):1157–68.CrossRefGoogle Scholar
  24. 24.
    Arena R, Lavie CJ. The healthy lifestyle team is central to the success of accountable care organizations. Mayo Clin Proc. 2015;90:572–6.CrossRefGoogle Scholar
  25. 25.
    Manderscheid R, Kathol R. Fostering sustainable, integrated medical and behavioral health services in medical settings. Ann Intern Med. 2014;160:61–5.CrossRefGoogle Scholar
  26. 26.
    Mitchell LJ, Ball LE, Ross LJ, Barnes KA, Williams LT. Effectiveness of dietetic consultations in primary health care: a systematic review of randomized controlled trials. J Acad Nutr Diet. 2017;117(12):1941–62.CrossRefGoogle Scholar
  27. 27.
    Raynor HA, Champagne CM. Position paper of the academy of nutrition and dietetics: interventions for the treatment of overweight and obesity in adults. J Am Diet Assoc. 2016;116:129–47.Google Scholar
  28. 28.
    Melanson KJ, Dell’Olio J, Carpenter MR, Angelopoulos TJ. Changes in multiple health outcomes at 12 and 24 weeks resulting from 12 weeks of exercise counseling with or without dietary counseling in obese adults. Nutrition. 2004;20(10):849–56.CrossRefGoogle Scholar
  29. 29.
    Raatz SK, Wimmer JK, Kwong CA, Sibley SD. Intensive diet instruction by registered dietitians improves weight-loss success. J Am Diet Assoc. 2008;108(1):110–3.CrossRefGoogle Scholar
  30. 30.
    Tol J, Swinkels IC, de Bakker DH, Seidell J, Veenhof C. Dietetic treatment lowers body mass index in overweight patients: an observational study in primary health care. J Hum Nutr Diet. 2014;27(5):426–33.CrossRefGoogle Scholar
  31. 31.
    Welty FK, Nasca MM, Lew NS, Gregoire S, Ruan Y. Effect of onsite dietitian counseling on weight loss and lipid levels in an outpatient physician office. Am J Cardiol. 2007;100(1):73–5.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Parker AR, Byham-Gray L, Denmark R, Winkle PJ. The effect of medical nutrition therapy by a registered dietitian nutritionist in patients with prediabetes participating in a randomized controlled clinical research trial. J Acad Nutr Diet. 2014;114(11):1739–48.CrossRefGoogle Scholar
  33. 33.
    Sun Y, You W, Almeida F, Estabrooks P, Davy B. The effectiveness and cost of lifestyle interventions including nutrition education for diabetes prevention: a systematic review and meta-analysis. J Acad Nutr Diet. 2017;117(3):404–421.e36.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Axten K, Hawkins K, Tybor DJ, Bernoff J, Altman W. Impact of a novel wellness group visit model on obesity and behavior change. J Am Board Fam Med. 2017;30(6):715–23.CrossRefGoogle Scholar
  35. 35.
    Centers for Medicare and Medicaid Services (CMS). Decision Memo for Intensive Behavioral Therapy for Obesity (CAG-00423N). November 29, 2011.
  36. 36.
    Meeting the need for obesity treatment: a toolkit for the RD/PCP partnership. Academy of Nutrition and Dietetics. 2012. ent%20pdf.ashx.
  37. 37.
    EAL: In Academy of nutrition and dietetics evidence analysis library adult weight management. Accessed 3/3/2018.
  38. 38.
    Al Hourani H, Atoum M, Alboqai O, Ismail LC, Al Dhaheri A, Hijjawi N. Effectiveness of dietary intervention for obese women in Jordan. Int J Food Sci Nutr. 2009;60(3):76–82.CrossRefGoogle Scholar
  39. 39.
    Dengel DR, Kelly AS, Olson TP, Kaiser DR, Dengel JL, Bank AJ. Effects of weight loss on insulin sensitivity and arterial stiffness in overweight adults. Metabolism. 2006;55:907–11.CrossRefGoogle Scholar
  40. 40.
    Digenio AG, Mancuso JP, Gerber RA, Dvorak RV. Comparison of methods for delivering a lifestyle modification program for obese patients: a randomized trial. Ann Intern Med. 2009;150(4):255–62.CrossRefGoogle Scholar
  41. 41.
    Eilat-Adar S, Eldar M, Goldbourt U. Association of intentional changes in body weight with coronary heart disease event rates in overweight subjects who have an additional coronary risk factor. Am J Epidemiol. 2005;161:352–8.CrossRefGoogle Scholar
  42. 42.
    Ashley JM, Herzog H, Clodfelter S, Bovee V, Schrage J, Pritsos C. Nutrient adequacy during weight loss interventions: a randomized study in women comparing the dietary intake in a meal replacement group with a traditional food group. Nutr J. 2007;6:12.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Holm RP, Taussig MT, Carlton E. Behavioral modification in a weight-reduction program. J Am Diet Assoc. 1983;83(2):170–4.PubMedGoogle Scholar
  44. 44.
    Melin I, Karlstrom B, Lappalainen R, Berglund L, Mohsen R, Vessby B. A programme of behaviour modification and nutrition counselling in the treatment of obesity: a randomized 2-y clinical trial. Int J Obes. 2003;27:1127–35.CrossRefGoogle Scholar
  45. 45.
    Willaing I, Ladelund S, Jorgensen T, Simonsen T, Nielsen LM. Nutritional counselling in primary health care: a randomized comparison of an intervention by general practitioner or dietician. Eur J Cardiovasc Prev Rehabil. 2004;11:513–20.CrossRefGoogle Scholar
  46. 46.
    NPC 101. Academy of Nutrition and Dietetics. Available from: Accesses 3/11/2018.
  47. 47.
    Decker GA, Swain JM, Crowell MD, et al. Gastrointestinal and nutritional complications after bariatric surgery. Am J Gastroenterol. 2007;102:2571–80.CrossRefGoogle Scholar
  48. 48.
    Bauman WA, Shaw S, Jayatilleke E, Spungen AM, Herbert V. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care. 2000;23(9):1227–31.CrossRefGoogle Scholar
  49. 49.
    Vimaleswaran KS, et al. Causal relationship between obesity and vitamin D Status: Bi-directional Mendelian randomization analysis of multiple cohorts. PLoS Med. 2013;10:e1001383.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, McManus K, Champagne CM, Bishop LM, Laranjo N, Leboff MS, Rood JC, de Jonge L, Greenway FL, Loria CM, Obarzanek E, Williamson DA. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;360(9):859–73.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Gardner CD, Trepanowski JF, Del Gobbo LC, Hauser ME, Rigdon J, Ioannidis JPA, Desai M, King AC. Effect of low-fat vs low-carbohydrate diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion: the DIETFITS randomized clinical trial. JAMA. 2018;319(7):667–79.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S, Franch HA, Franklin B, Kris-Etherton P, Harris WS, Howard B, Karanja N, Lefevre M, Rudel L, Sacks F, Van Horn L, Winston M, Wylie-Rosett J. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. 2006;114:82–96. [Erratum, Circulation 2006;114(1):e27, 114(23):e629CrossRefGoogle Scholar
  53. 53.
    de Souza RJ, Swain JF, Appel LJ, Sacks FM. Alternatives for macronutrient intake and chronic disease: a comparison of the OmniHeart diets with popular diets and with dietary recommendations. Am J Clin Nutr. 2008;88:1–11.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Gardner CD. Tailoring dietary approaches to weight loss. IJO. 2012;2:s11–5.Google Scholar
  55. 55.
    Apovian CM, Aronne LJ, Bessesen DH, McDonnell ME, Murad MH, Pagotto U, Ryan DH, Still CD. Pharmacological management of obesity: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2):342–36.CrossRefGoogle Scholar
  56. 56.
    Wadden TA, Foreyt JP, Foster GD, Hill JO, Klein S, O'Neil PM, Perri MG, Pi-Sunyer FX, Rock CL, Erickson JS, Maier HN, Kim DD, Dunayevich E. Weight loss with naltrexone, SR/bupropion SR combination therapy as an adjunct to behavior modification: the COR-BMOD trial. Obesity (Silver Spring). 2011;19:110–20.CrossRefGoogle Scholar
  57. 57.
    Wadden TA, Berkowitz RI, Womble LG, Sarwer DB, Phelan S, Cato RK, Hesson LA, Osei SY, Kaplan R, Stunkard AJ. Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med. 2005;353:2111–20.CrossRefGoogle Scholar
  58. 58.
    Sjöström L. Review of the key results from the Swedish Obese Subjects (SOS) trial – a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34.CrossRefGoogle Scholar
  59. 59.
    Kushner RF, Sorensen KW. Prevention of weight regain following bariatric surgery. Curr Obes Rep. 2015;4(2):198–206.CrossRefGoogle Scholar
  60. 60.
    Sjöström L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, Dahlgren S, Larsson B, Narbro K, Sjöström CD, Sullivan M, Wedel H. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. Swedish obese subjects study scientific group. N Engl J Med. 2004;351(26):2683–93.CrossRefGoogle Scholar
  61. 61.
    Mechanick JI, Youdim A, Jones DB, Timothy Garvey W, Hurley DL, Molly McMahon M, Heinberg LJ, Kushner R, Adams TD, Shikora S, Dixon JB, Brethauer S. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient – 2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & bariatric surgery. Surg Obes Relat Dis. 2013;9(2):159–91.CrossRefGoogle Scholar
  62. 62.
    Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the surgical weight loss patient 2016. Update: micronutrient. Surg Obes Relat Dis. 2017;13(5):727–41.CrossRefGoogle Scholar
  63. 63.
    American College of Surgeons and the American Society of Metabolic and Bariatric Surgery. MBSAQIP Standards Manual v2.0: Resources for optimal care of the metabolic and bariatric surgery patient. 2016. Accessed 3/11/2018.
  64. 64.
    Camilleri M. Peripheral mechanisms in appetite regulation. Gastroenterology. 2015;148(6):1219–33.CrossRefGoogle Scholar
  65. 65.
    Cummings S, Isom K, editors. Pocket guide to bariatric surgery. 2nd ed. Chicago: Academy of Nutrition and Dietetics/American Diabetes Association; 2015.Google Scholar
  66. 66.
    Endevelt R, Ben-Assuli O, Klain E, Zelber-Sagi S. The role of the dietician follow-up in the success of bariatric surgery. Surg Obes Relat Dis. 2013;9(6):963–8.CrossRefGoogle Scholar
  67. 67.
    Cummings S. Nutrition managment pre- and post-surgery. In: Kushner R, Stills C, editors. Nutrition and bariatric surgery, nutrition management pre- and post-surgery. Boca Raton: CRC Press; 2014.Google Scholar
  68. 68.
    Steinberg DM, Bennett GG, Askew S, Tate DF. Weighing everyday matters: daily weighing improves weight loss and adoption of weight control behaviors. J Acad Nutr Diet. 2015;115(4):511–8.CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Devkota S, Layman DK. Protein metabolic roles in treatment of obesity. Curr Opin Clin Nutri Metab Care. 2010;13:403–7.CrossRefGoogle Scholar
  70. 70.
    Moize V, Andreu A, Flores L, Torres F, Ibarzabal A, Delgado S, Lacy A, Rodriguez L, Vidal J. Long-term dietary intake and nutritional deficiencies following sleeve gastrectomy or roux en Y gastric bypass in a Mediterranean population. Acad Nutr Diet. 2013;113(3):400–10.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Clinical NutritionStanford Health CareStanfordUSA
  2. 2.MGH Weight CenterMassachusetts General HospitalBostonUSA

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