Weight Management Matters

Transcription

Weight Management
Matters
CPEU article
Managing Overweight and Obesity in Adults:
A Summary of the Systematic
Evidence Review from the
Obesity Expert Panel, 2013
By Cathy A. Nonas, MS, RD and Barbara E. Millen, DrPH, RD, FADA
Learning Objectives:
After reading this, RDNs
will be able to:
1. Describe the process
used by AHA/ACC/
TOS and NHLBI to
develop these
Cathy A. Nonas,
guidelines.
MS, RD
2. Delineate the key
principles of the 2013
Management of
Overweight and
Obesity Guidelines
and how RDNs can
apply them to the
prevention and
Barbara E. Millen,
management of
DrPH., RD, FADA
overweight and
obesity.
3. Identify the evidence-based options for
weight loss that can be recommended
to patient/clients based upon their
health risk profile and individual needs
and desires.
4. Discuss the key assets RDNs bring to the
prevention and management of
overweight and obesity.
History, Background and Context
Overweight and obesity is at epidemic
proportions in the U.S., tipping the
proverbial scales at 69%, 36% of these
individuals are obese and the remainder
are classified as being overweight (3). The
leading cause of death in the U.S. remains
cardiovascular disease (CVD). Approximately
68 million Americans have hypertension,
71 million have elevated LDL-Cholesterol
which puts them at risk for CVD (4). Every
organ of the body is affected by excess
body weight and the heart is no exception.
Overweight and obesity can lead to
ventricular hypertrophy, higher risk of fatal
and non-fatal stroke, high blood pressure
and prediabetes and type 2 diabetes. These
concerning facts led the National Heart
Lung and Blood Institute (NHLBI) in 2005 to
bring together thought leaders from clinical
areas relevant to CVD to establish a process
to integrate the science and clinical
recommendations for CVD. This step led to
the updating and integration of the blood
pressure, cholesterol and obesity guidelines
that had, in the past, been researched and
disseminated through the NHLBI (3).
(Continued on page 8)
A Quarterly Publication for Weight Management Leaders
In this Issue
CPEU Article: Managing Overweight and Obesity in
Adults: A Summary of the Systematic
Evidence Review from the Obesity
Expert Panel, 2013
1
Practice Points The Look AHEAD Trial: Look Beyond the
Headlines
2
Bariatric Surgery: Options for Treating Weight Regain
After Roux-en-Y Gastric Bypass
5
From the Chair:
A Year of Growth
12
Physical Activity: Practical Sports Nutrition:
The Four R’s of Recovery
13
Students Corner:
Comparison of Weight-Loss Programs
15
Policy and Advocacy Report:
Agriculture Act of 2014
18
Member Benefits:
Member Services Update
19
From the Editor
20
Research:
Improving Outcomes of a Worksite
Wellness Program with a ClientCentered Nutrition Intervention
21
Book Review:
Too Busy To Diet
24
Stipend Winners
25
WM DPG 2014 Excellence Awards
29
Upcoming Events
30
2013-2014 Weight Management Dietetic Practice Group
Leadership Directory
31
Spring 2014 Volume 12 No. 4
Practice Points
The Look AHEAD Trial: Look Beyond the Headlines
Interview by Hope Warshaw, MMSC, RD, CDE, BC-ADM
Introduction
To date, the Look
AHEAD (Action for
Health in Diabetes) trial
is the largest and
longest National
Institutes of HealthHope Warshaw,
funded multicenter (16
MMSC, RD, CDE,
BC-ADM
sites), randomized study
focusing on the use of
intensive lifestyle intervention to promote
weight reduction in an overweight
population of people with relatively earlyonset type 2 diabetes. The primary trial
endpoint focused on the question: Can an
intensive lifestyle intervention (ILI) program
which achieves and maintains weight loss
and fitness help prevent or delay the
cardiovascular events (including death,
nonfatal myocardial infarctions, nonfatal
strokes or hospitalization for angina), the
most common complication of type 2
diabetes? (1). Look AHEAD was planned for
13.5 years and expected to conclude in
2014 but was halted after 11.5 years late in
2012 after the study’s overseeing body
determined, on the basis of a futility
analysis, that further study would not lead
to additional findings (1).
Initial primary results were presented at the
American Diabetes Association Scientific
Sessions 2013, (2) which I attended.
Concomitantly the publication with the
final results was published in the New
England Journal of Medicine (NEJM) (1). As is
often the case today, NEJM began a social
media push to publicize this article. Within
their initial tweet (on Twitter) was the
statement: “Intensive lifestyle intervention
did not reduce CV events in overweight adults
w/ type 2.” Consumer publications followed
suit. The Wall Street Journal headline read:
“Disappointing Results for Weight Loss and
Diabetes.”
As I’ve attended programs since the NEJM
publication where the Look AHEAD results
have been presented or discussed, these
negative headlines continue to resonate.
However, numerous long-term benefits of
weight management and improved fitness
in the Look AHEAD trial have been reported
(1,2). Registered Dietitian Nutritionists
(RDNs) involved with counseling people
who are overweight and at risk of type 2
diabetes and those with early-onset type 2
diabetes should be well versed in the initial
(3) and final results (1) of the Look AHEAD
trial as well as the strategies for weight
management that were found to be
successful, (4-6) as detailed in this review.
Study Details
A large ethnically and geographically
diverse population (5,145) of overweight
and obese (mean body mass index [BMI]
>35) adults (45 to 76 years of age)
diagnosed with type 2 diabetes (6.8+6.5
years, with range of 3 months to 13 years
(7)) were randomly assigned to the study
group (ILI) or the control group (diabetes
support and education [DSE]) (3). Briefly,
the goals for the ILI group were 7% or
greater weight loss at year 1, greater than
175 minutes of physical activity per week,
and consumption of 1,200 to 1,800 kcal/
day with 30% or fewer kilocalories as fat.
ILI group participants received extensive
support, with weekly support for 0 to 6
months, 3 times per month support from 6
months to 1 year, and less frequent but
continued support throughout the trial.
Parameters for the DSE control group were
designed to mimic usual care for
individuals diagnosed with type 2
diabetes, but in reality, these individuals
received significantly more education and
support than most people with type 2
diabetes do. The DSE subjects were
provided with standard guidance for
eating and physical activity but received
no focus on behavioral strategies. They
were invited to three group sessions per
year separate from the ILI group. Overall
medical care for study participants was
provided by their primary care providers.
Additional details about the study design
and subjects are available (6,8).
Key Results for Weight Loss and
Fitness
The median length of follow-up was 9.6
years, with a retention rate of 96% of study
participants (1).
Weight Loss: As has been observed in other
long-term weight loss studies, including the
Diabetes Prevention Program Trial (DPP), (9)
maximum weight loss was achieved by year
1, with the ILI group losing 8.6% of initial
body weight versus 0.7% for the DSE group
(3). At year 4, ILI participants had lost an
average of 4.7% of their initial weight
compared with 1.1% for DSE participants
(5). Eight-year results showed that ILI
participants maintained the same average
weight loss of 4.7% from initial weight at
year 4 compared with a 2.1% weight loss
for the DSE group (6). Losing a large
amount of weight the first year was by far
the strongest determinant of achieving a
large loss at years 4 (5) and 8 (6). Of note,
the study design implemented intensive
support to achieve maximal weight loss
during year 1 due to findings from previous
studies, such as the DPP (9), that early
weight loss predicts long-term weight
control success. As is also often observed in
long-term weight management, the ILI
group experienced gradual weight regain
through years 1 to 5 of the study, and the
weight regain subsequently stabilized
through year 8, (6) with a mean weight loss
of 6% for ILI and 3.5% for DSE groups (1).
One factor conjectured for this additional
weight loss in the later years of the trial is
the aging process (2) and diabetes (6).
A valuable article by Raynor and associates
(10) detailed behaviors of subjects who
entered the study at a lower BMI. These
included weekly self-weighing, regular
breakfast consumption, decreased intake of
2
Spring 2014
fast foods, decreased portions, and use of
meal replacements. Wadden and colleagues
(4) concluded that factors associated with
success at year 1 included greater use of
meal replacements, more favorable food
intake, and greater attendance at treatment
sessions. At year 4, more favorable food
intake and frequent attendance at
treatment sessions continued to be factors
associated with success (5). At year 8,
weight-maintenance behaviors associated
with 10% or greater weight loss included
high levels of physical activity, reduced
calorie intake, and frequent monitoring of
weight (6).
Use of Insulin and Weight Loss
Although ILI participants who took insulin at
baseline or initiated insulin by year 4 lost less
weight than participants not using insulin,
they did achieve significant weight loss (5).
According to Wadden and associates, (5)
differences in weight loss between insulin
users and nonusers were not clinically
meaningful and should mitigate concerns
that insulin users cannot lose weight,
although the point was made that these
individuals do require sufficient support to
achieve or maintain weight control.
Fitness
ILI participants had greater improvements
in physical fitness at years 1 (3) and 4 (11).
Factors associated with greater weight loss
and improved physical fitness were at least
175 minutes of aerobic activity per week
(the goal for the ILI group) (3) and
resistance training 2 to 3 days per week (5).
Glycemic Control
Results show that glycated hemoglobin
(A1c) was maximally lowered at year 1 in
the ILI group (-0.64%) (3). Over the course
of the trial, A1c gradually rose, but it
remained below the baseline mean of
7.3±1.2% in the DSE group and 7.2±1.1% by
the end of the trial. Final results showed
that the ILI group achieved an estimated
mean A1c lowering of 0.2% (1). It’s
important to note that there was less use of
insulin and other glycemic-lowering
medications in the ILI than the DSE group
(1). A modest number (7.3%) of ILI subjects
achieved partial or complete diabetes
remission at year 4 (12).
Blood Pressure
Systolic blood pressure improved
substantially in the ILI group, but diastolic
blood pressure did not. However, the ILI
group was less likely to use
antihypertensive medication (1).
Lipids
The ILI group had a greater increase in
high-density lipoprotein cholesterol. Both
groups experienced a decrease in lowdensity lipoprotein cholesterol, although
the ILI group required less statin
medication (1). One reason hypothesized
for the lack of greater reduction in
cardiovascular events in the ILI group was
that many DSE participants were prescribed
statin medication during the trial by their
primary care providers.
Additional Health Improvements in the ILI
Group: (1,2)
• 31% reduction in chronic renal disease
• Reduced self-reported symptoms of
retinopathy
• Less depression
• Less sleep apnea
• Less urinary incontinence
In addition, the ILI group used less health
care resources, with reduced cumulative
hospitalizations, less use of medications,
and less cumulative health care services
(1,3).
Conclusion
Although the overall weight loss achieved
and maintained during Look AHEAD was
relatively minimal, this weight loss achieved
myriad health and health care benefits. An
important factor to keep in mind is that in
contrast to the approximately 2 lb/year (13).
that the average American adult gains,
both DSE and ILI participants in Look
AHEAD maintained long-term weight loss
over the course of the study. ILI participants
who had the shortest duration of disease,
were not using insulin, and had good
baseline glycemic control received the
most health benefits from the intervention
(12,14). These results support the critical
importance of early intensive lifestyle
intervention in the prevention and
management of type 2 diabetes.
Look AHEAD is continuing as an
observational trial (1). Many additional
articles will be published detailing various
aspects of the trial that will be important to
RDNs involved in weight management and/
or diabetes care, including a commentary
by Delahanty (15).
We owe a debt of gratitude to all health care
providers involved in Look AHEAD, including a
number of our Weight Management Dietetic
Practice Group (DPG) and Diabetes Care and
Education DPG colleagues.
References:
1.Look AHEAD Research Group; Wing RR,
Bolin P, Brancati FL, et al. Cardiovascular
effects of intensive lifestyle intervention
in type 2 diabetes. N Engl J Med.
2013;369:145–154.
2.Wing RR, Knowler WC, Faulconbridge LF,
Glick H; The Look AHEAD Research
Group. Primary results of the Look
AHEAD randomized controlled trial of a
lifestyle intervention in overweight and
obese individuals with type 2 diabetes.
Presented at the American Diabetes
Association Scientific Sessions, 2013.
3.Look AHEAD Research Group.
Reduction in weight and cardiovascular
disease risk factors in individuals with
type 2 diabetes. Diabetes Care.
2007;30(6):1374-1383.
4.Wadden TA, West DS, Neiberg RH, et al;
Look AHEAD Research Group. One-year
weight losses in the Look AHEAD study:
factors associated with success. Obesity
(Silver Spring). 2009;17:713–722.
5.Wadden TA, Neiberg RH, Wing RR, et al;
The Look AHEAD Research Group. Fouryear weight losses in the Look AHEAD
study: factors associated with long-term
success. Obesity (Silver Spring).
2011;19:1987–1998.
6.Look AHEAD Research Group. Eight-year
weight losses with an intensive lifestyle
intervention: the Look AHEAD Study.
Obesity (Silver Spring). 2014;22:5-13.
7.Bertoni AG, Clark JM, Feeney P, et al; The
Look AHEAD Research Group.
Suboptimal control of glycemia, blood
pressure, and LDL cholesterol in
overweight adults with diabetes: the
Look AHEAD Study. J Diabetes
Complications. 2008;22:1-9.
3
Volume 12 No. 4
(Continued from page 3)
8.The Look AHEAD Research Group;
Wadden TA, West DS, Delahanty L, et al.
The Look AHEAD Study: a description of
the lifestyle intervention and the
evidence supporting it. Obesity (Silver
Spring). 2006;14:737–752.
9.Diabetes Prevention Program Research
Group; Knowler WC, Fowler SE,
Hamman RG, et al. 10-year follow-up of
diabetes incidence and weight loss in
the Diabetes Prevention Program
Outcomes Study. Lancet.
2009;374:1677–1686.
10.Raynor HA, Jeffery RW, Ruggiero AM,
Clark JM, Delahanty LM; Look AHEAD
Research Group. Weight loss strategies
associated with BMI in overweight
adults with type 2 diabetes at entry into
the Look AHEAD (Action for Health in
Diabetes) trial. Diabetes Care.
2008;31:1299–1304.
11.The Look AHEAD Research Group; Wing
RR. Long-term effects of a lifestyle
intervention on weight and
cardiovascular risk factors in individuals
with type 2 diabetes mellitus: four-year
results of the Look AHEAD trial. Arch
Intern Med. 2010;170:1566-1575.
12.Gregg EW, Chen H, Wagenknecht LE, et
al; Look AHEAD Research Group.
Association of an intensive lifestyle
intervention with remission of type 2
diabetes. JAMA. 2012;308:2489–2496.
13.Hill JO, Wyatt HR, Reed GW, Peters JC.
Obesity and the environment: where do
we go from here? Science. 2003;299:853855.
14.Evert AB, Boucher JL, Cypress M, et al;
American Diabetes Association.
Nutrition therapy recommendations for
the management of adults with
diabetes. Diabetes Care. 2013;36:38213842.
15.Delahanty LM. The Look AHEAD Study:
implications for clinical practice go
beyond the headlines. J Acad Nutr Diet.
April 2014 (In press).
Acknowledgements:
The author wishes to thank Linda Delahanty,
MS, RD, and Hollie Raynor, PhD, RD, LD, for
their thoughtful review of this article.
Get Involved in Research that Matters
The Dietetics Practice Based Research
Network (DPBRN) consists of registered
dietitians from various backgrounds who
conduct and promote practical research in
real-world settings.
Join the DPBRN and be part of a network
committed to improving patient and
client outcomes.
Learn how by visiting www.eatright.org/members/dpbrn.
Dietetics Practice Based Research Network – Advancing dietetics through outcomes research.
4
Spring 2014
Options for Treating Weight Regain After
Roux-en-Y Gastric Bypass
By Kathryn Valentine, RD
B
ariatric surgery is a
widely accepted
and effective
treatment for weight
loss. While most
patients successfully
lose weight after
Kathryn Valentine,
surgery, approximately
RD
20-30% of patients do
not achieve their desired weight or regain
weight years after surgery (1). As food
and nutrition professionals and weight
management experts, it is important that
we understand the full scope of options
that exist to help these individuals. This
article will explore some underlying causes
of post-bariatric surgery weight regain,
review existing nutrition recommendations
and treatment modalities, and discuss new
surgical procedures to treat post-surgical
weight gain with endoscopic techniques.
Weight Regain after
Gastric Bypass Surgery
Roux-en-Y gastric bypass surgery (RYGB) is
a common and effective surgical weight
loss procedure with >60% excess body
weight loss (EBWL) expected within the first
two years (2). Unfortunately, many patients
regain weight with 20-30% of patients
either not achieving their weight loss goals
or regaining weight (1).
Weight regain after RYGB can result from
any of the following (1):
• Exercise non-compliance
• Decreased resting metabolic rate (RMR)
• Alcohol intake or abuse
• Hormonal changes (ghrelin, PYY,
GLP-1, leptin)
• Surgical defects (gastro-gastric fistula,
enlarged pouch or anastamosis)
• Lack of adequate nutrition follow-up
and adherence to recommendations
• Poor self-monitoring or education
Many of the above issues are interrelated;
frequently metabolism, food intake, gastric
pouch and anastomotic (stoma) dilation are
involved. Stoma dilation has been linked
Bariatric Surgery
Nina Crowley, MS, RD, LD, is the bariatric surgery section editor.
Weight regain is probably the biggest fear that our patients have when
they undergo weight loss surgery, and with good reason, research shows it is a very real
phenomenon. As registered dietitian nutritionists, we have many nutrition tools to offer our
patients when they experience weight regain. We also must be equipped with tools and
referrals to offer our patients who do not keep their weight off. Katherine keeps us in the
loop by discussing some new endoscopic options.
with weight regain after bariatric surgery
(3). Non-compliance to nutrition
recommendations may alter pouch
anatomy or stoma dilation. “Stretching,” or
dilation of the pouch or stoma may lead to
decreased satiety and increased hunger,
which in turn may further perpetuate noncompliance with eating behaviors. In
addition to weight gain, patients may have
abdominal complaints related to a dilated
stoma as rapid transit into the small bowel
may cause dumping syndrome.
Another complication that can affect
weight maintenance after RYGB is a fistula
between the gastric pouch and gastric
remnant, a gastro-gastric fistula (GGF). This
is more commonly seen in older surgeries
where surgeons did not divide the stomach
pouch completely from the excluded
remnant stomach. A GGF may inhibit a
patient from achieving adequate weight
loss because food can pass from the pouch
to the excluded stomach, following the
non-bypassed original anatomy, and there
is complete absorption of macronutrients.
This allows patients to ingest larger
volumes of food and may render their
surgery ineffective.
Nutrition Recommendations
for Weight Regain
To the RDN, the fight against weight regain
begins with nutrition counseling. A
thorough evaluation by the bariatric team
is recommended; measurement of resting
metabolic rate using indirect calorimetry or
predictive equations can give patients a
more accurate goal for their calorie needs.
Education and counseling by the dietitian
are critical in the patient’s ability to follow
post-bariatric nutrition guidelines; dietitians
should monitor patients’ energy intake,
activity, and weight closely (1). A variety
of methods can be used to help patients
achieve negative energy balance and
weight loss: very low calorie diets (VLCD) or
a return to the immediate post-operative
full liquid diet for a period of time may
help patients kick-start weight loss again.
Behavioral health is vital for those who
have regained weight after surgery. The
dietitian can play an integral role in
coordinating care to help patients receive
appropriate psychosocial counseling to
address possible reasons for weight regain
(1). Major life changes, injuries or tragedies
causing stress and anxiety may be triggers
that lead patients back to emotional eating
and sedentary habits. To achieve long-term
weight loss, patients must be able to manage
behavioral issues that impede their success.
Procedures to Treat Weight
Regain with Surgical Repair
Two common revision procedures include
Duodenal Switch conversion or band
placement over an existing RYGB pouch.
The Duodenal Switch is a malabsorptive
procedure that works by rerouting the
intestines to create a very short common
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Volume 12 No. 4
limb, approximately 100 centimeters (3).
It is often done in conjunction with a
Biliopancreatic Diversion as a primary
bariatric surgery. The Duodenal Switch
works as a revision procedure by bypassing
a longer segment of small bowel than an
original RYGB in order to reduce absorption
of calories from fat (4). The “Band over
Bypass”, also known as “Salvage Banding”,
places an adjustable gastric band over the
stomach pouch to further restrict the
volume of food the pouch can hold and
slow gastric emptying. Salvage Banding has
been effective in some studies (5), however,
surgical options carry a high complication
rate of up to 50% and a mortality rate of 2%
(6). The Duodenal Switch is a highly complex
procedure that carries an even greater risk
than other bariatric surgeries.
Pictures provided with permission of Apollo Endosurgery and USGI Medical.
Figure 1: Illustration of the ROSE procedure-gastric tissue plication secured with suture and anchors
StomaphyX and Restorative Obesity
Surgery, Endoluminal (ROSE)
procedures
StomaphyX and ROSE procedures are
endoscopic techniques performed by
gastroenterologists and bariatric surgeons
specially trained in advanced endoluminal
therapeutics. StomaphyX uses suction to
create pleats or folds in gastric tissue to
reduce a dilated stoma. The folds are
anchored with polypropelene implants,
which are non-absorbable H-shaped
fasteners. The ROSE procedure also uses a
plication technique performed with large
graspers rather than suction. Folds are fixed
with nitinol anchor sutures. Folds are
created circumferentially around the gastric
pouch or stoma. The StomaphyX procedure
has been ineffective as a treatment for
sustainable weight loss (7). The ROSE
procedure is feasible and safe; studies
report average weight loss of 7.8 to 8.8 kgs
after 3 months (8,9). Further studies are
needed to assess long-term results.
Sclerotherapy
Sclerotherapy is a technique used by
bariatric surgeons and gastroenterologists
to reduce the size of a dilated stoma with a
sclerosing agent. Sodium morrhuate is a
sclerosant typically used to treat varicose
veins by creating inflammation when
injected and causing a blood clot to form,
occluding blood flow and destroying the
vein. When injected at the anastomosis, the
Figure 2: Illustration of endoscopic suturing procedure-gastric outlet reduction and pouch reduction using
interrupted and running stitches.
drug induces scarring which may reduce
the outlet diameter. The procedure may
require repeat injections, typically
performed after 3 months. In some studies,
patients have lost 18-61% of their regained
weight (10,11). Risks of sclerotherapy
include bleeding, an increase in diastolic
blood pressure and pain.
Endoscopic suturing
One of the newest techniques for postbariatric surgery weight regain involves
gastric bypass remodeling with endoscopic
suturing. This procedure is performed by
interventional gastroenterologists as well as
bariatric surgeons. This endoscopic surgery
uses interrupted and running sutures to
approximate tissue. The gastric pouch and/
or outlet are reduced to the original RYGB
anatomy dimensions—approximately 5 cm
and 4-12 mm, respectively. During this
procedure, areas of gastric tissue may be
prepared with Argon Plasma Coagulation
(APC) or other tissue ablation methods,
which de-epithelializes the tissue—
theoretically allowing two prepared areas
to adhere to each other once sutured. In
one trial, patients lost 69.5% of their
regained weight at 6 months and 89% at
12 months (5). In another study, 96% of
subjects who underwent endoscopic
suturing for stoma reduction experienced
weight loss or stabilization (12). Because
this is a novel procedure, limited data is
6
Spring 2014
Pictures provided with permission of Apollo Endosurgery and USGI Medical.
available and further studies are currently
underway.
understand their options and prepare for
another chance at successful weight loss.
Post Revisional Procedure
Diet Advancement
Kathryn Valentine, RD, earned her degree
in Dietetics from Rutgers University. She
completed her dietetic internship with
Sodexo’s New York area program. She has
over 4 years of experience as an RD and has a
private practice, Valentine Nutrition, LLC.
She is the Patient Relations Director for the
National Institute for Bariatric Repair in
northern New Jersey and study coordinator
for the Primary Obesity Multicenter
Incisionless Suturing Evaluation (PROMISE)
trial in NJ. She specializes in out-patient
bariatric nutrition counseling, including postrevision and bariatric complication nutrition
therapy with a special attention to weight
gain after gastric bypass. For more
information, visit www.BariatricRepair.com or
email [email protected]
Nutrition counseling is an integral part of
the interdisciplinary treatment plan for
bariatric patients before and after primary
and revisional procedures. In general, after
revision, patients should return to a postoperative bariatric diet and advance through
the diet stages within approximately 4-6
weeks. Patients progress through clear
liquids, full liquids, and purees/soft solids
with specific recommendations from their
physician and dietitian. They eventually
progress to a modified regular diet low in
carbohydrates and high in lean protein with
a focus on small portions of food. When
equipped with a good understanding of
available revisional procedures, RDNs can
more effectively counsel patients who
experience post-bariatric surgery weight
gain and help make any chosen procedure
more successful.
Conclusion
Bariatric surgery patients may experience
weight regain after successful weight loss
for a number of complex reasons.
Endoscopic procedures present alternatives
for traditional surgical revision. These may
prove advantageous for patients seeking
less invasive procedures to address weight
regain, especially those who may have a
contraindication to trans-abdominal
surgery such as scarring or adhesions. The
field of endoscopic bariatrics is expected
to grow, with new revisional and primary
endoscopic therapies emerging (13).
Bariatric nutrition needs to grow along with
these advancements. Coupled with the
support and guidance of RDNs these
procedures offer a viable second chance for
patients to achieve their goal weight. By
staying abreast of developments in the
field, RDNs can help patients better
References:
1.Johnson Stoklossa, C and Atwal, S.
Nutrition Care for Patients with Weight
Regain after Bariatric Surgery.
Gastroenterology Research and Practice.
2013;2013:1–7
2.Buschwald H, Avidor Y, Braunwalked E
et al. Bariatric surgery: a systemic review
and meta-analysis. JAMA. 2004;292:
1724–1737
3.Abu Dayyeh B, Lautz DB, Thompson CC.
Gastrojejunal Stoma Diameter Predicts
Weight Regain after Roux-en-Y Gastric
Bypass. Clin Gastroenterol Hepatol.
2011;9:228–233
4.Anthone G, Lord R, DeMeester T, et al.
The duodenal switch operation for the
treatment of morbid obesity. Ann Surg.
2003;238(4):618–628
5.Vijgen GH, Schouten R, Bouvy ND, et al.
Salvage banding for failed Roux-en-Y
gastric bypass. Surg Obes Relat Dis.
2012;8:803–808
6.Jirapinyo P, Slattery J, Ryan MB, et al.
Evaluation of an endoscopic suturing
device for transoral outlet reduction in
patients with weight regain following
Roux-en-Y gastric bypass. Endoscopy.
2013;45:532–536
7.Goyal V, Holover S, Garber S. Gastric
pouch reduction using StomaphyX in
post Roux-en-Y gastric bypass patients
does not result in sustained weight loss:
a retrospective analysis. Surg Endosc.
2013;9:3417–3420
8.Mullady DK, Lautz DB, Thompson CC.
Treatment of weight regain after gastric
bypass surgery when using a new
endoscopic platform: initial experience
and early outcomes (with video).
Gastrointest Endosc. 2009;70:440–444
9.Ryou MK, Mullady DK, Lautz DB et al.
Pilot study evaluating technical
feasibility and early outcomes of
second-generation endosurgical
platform for treatment of weight regain
after gastric bypass surgery. Surg Obes
Relat Dis. 2009;5:450–454
10.Abu Dayyeh BK, Jirapinyo P, Weitzner Z,
et al. Endoscopic sclerotherapy for the
treatment of weight regain after Rouxen-Y gastric bypass: outcomes,
complications, and predictors of
response in 575 procedures.
Gastrointest Endosc. 2012;76:275–282
11.Madan AK, Martinez JM, Khan KA, et al.
Endoscopic sclerotherapy for dilated
gastrojejunostomy after gastric bypass.
J Laparoendosc Adv Surg Tech A.
2010;20:235–237
12.Thompson CC, Chand B, Chen YK et al.
Endoscopic Suturing for Transoral
Outlet Reduction Increases Weight Loss
Following Roux-en-Y Gastric Bypass
Surgery. Gastroenterology. 2013;145:
129–137
13.Brigham and Women’s Hospital; Apollo
Endosurgery. Primary Obesity
Multicenter Incisionless Suturing
Evaluation. In: clinicaltrials.gov
[Internet]. Bethesda (MD): National
Library of Medicine (US). 2013- [cited
2014 Jan 17]. Available from: http://
clinicaltrials.gov/ct2/show/
NCT01662024 NLM Identifier:
NCT01662024
7
Volume 12 No. 4
(Continued from the cover)
Panels of experts were selected to update
these blood pressure, cholesterol and
obesity guidelines. For the first time, panel
members were also placed on two cross
cutting work groups for the purpose of
integrating the work of all of the expert
panels. These cross cutting panels included
a lifestyle panel to examine diet and
physical activity related risks for CVD
without weight loss and another panel to
examine methods for assessing CVD risk.
The tasks assigned to these panels were to
develop guidelines that reflected the most
recent evidence, determine where updates
to the last set of guidelines were needed
and to answer new questions that would
enrich clinical practice and identify areas
for future research.
Unique to the work of these panels and
work groups was that the development of
these NHLBI guidelines would use the same
methods and structure to allow them to
blend together as easily as possible when
published. In all, there were 16 questions
answered by the five panels; each of the 16
questions were further deconstructed into
many sub-questions. The expert panels
reviewed the evidence and then rated
the strength of the evidence after an
independent team rated the quality of
thousands of peer reviewed published
articles. Depending upon the last updated
information, (in the case of the overweight
and obesity panel it was 1998), data was
culled from the last update until 2010/11.
It took five years, 23 meetings (conducted
both virtual and in-person) and the
examination of thousands of articles,
to identify a sufficiently sound body of
literature to answer each of the critical
questions discussed in this summary. The
expert panel for overweight and obesity
included both practitioners and researchers.
Summary of the
Research Literature Reviews
After the expert panel for overweight and
obesity was selected and the questions and
criteria identified, an independent, external
company was hired by NHLBI to search the
literature for each question, using criteria
developed by the panel members. This
external group then rated the quality of
Continuing
Professional
Education Section
Hope Warshaw, MMSc, RD, CDE, BC-ADM, is the continuing professional
education section editor
In late 2013, Guidelines for the Management of Overweight and Obesity in Adults were
jointly released by American Heart Association (AHA), the American College of Cardiology
(ACC) and the Obesity Society (TOS) (1,2). The WM DPG leadership believes it is important
for the WM DPG membership to be knowledgeable about these guidelines, understand
the context within which they were developed and be aware of their implications. This
CPE article, written by two members of the expert panel for overweight and obesity, both
registered dietitians and members of WM DPG, summarizes the development, findings and
recommendations of these recently released overweight and obesity guidelines.
each of the studies as good, fair and poor
with additional review and insight from the
panel. From here, evidence tables were
created. The panel then graded the
evidence with the help of the external
company to ensure that the grades were
based on the evidence, not the clinical
experience of expert panel members. When
possible, only randomized clinical trials
(RCTs) with either a “good” or “fair” rating
were used as evidence. In some cases,
RCTs were not available. If this was the case
or in the case of certain questions where
resources were not sufficient to review the
original literature, then systematic reviews
and observational studies were used. The
study quality ratings were based on certain
criteria such as:
1. Was the method of randomization
adequate (i.e., use of randomly
generated assignment)?
2. Were the groups similar at baseline on
important characteristics that could
affect outcomes (e.g., demographics,
risk factors, co-morbid conditions)?
3. Was the overall drop-out rate from
the study 20% or lower? (This was
particularly difficult criteria for
weight loss intervention studies.).
4. Was the differential drop-out rate
(between treatment groups) 15 %
or lower?
5. Were all randomized participants
included in the analysis of the group
to which they were originally
assigned, i.e., did the researchers use
an intention-to-treat analysis?
The following are examples of the criteria
for the quality ratings as well as some of
the common flaws seen in the study
designs:
A well-designed, well-executed RCT that
adequately represented populations to
which results were applied and directly
assessed effects on health outcomes, was
rated “high.” If, however, there were any
differences in the treatment between
randomized groups of subjects, this could
result in a “fair” rating if there was a minor
difference but not sufficient to invalidate
the study, or “poor” rating if egregious and
indicating significant risk of bias. For
example, if one intervention group received
dietary information and coupons to
purchase certain foods, and the other
group was given food but the group given
food was also telephoned a couple of
times, this would reduce the quality of
the RCT because the two groups received
different levels of treatment. Another factor
leading to a lower rating was the lack of
inclusion of an intent-to-treat analysis.
Many studies had analysis strategies that
did not include drop-outs, even when the
drop-out rate in the study was substantial.
This made the results look strong, but they
8
Spring 2014
were positively biased. Again, this led to
certain studies being rated as “poor” and
omitted from consideration by the panels
and workgroups. It is the reason why from
the thousands of studies culled a much
smaller number were considered relevant
in this systematic review.
Updating the 1998 Evidence Report
on Overweight and Obesity
The first set of clinical guidelines for the
treatment of overweight and obesity in
adults was published in 1998 (5). The
charge to that 1998 expert panel was
twofold: 1) to cull the scientific literature
from 1980-1997 and 2) to create
recommendations for treatment for the
practicing physician and other health care
providers dealing with overweight and
obese patients.
The 2013 guidelines add to the 1998
guidelines by reevaluating the association
of body mass index (BMI) to CVD and its
CVD risk factors. These updated guidelines
used the same cutpoints for BMI because
the Committee determined that there was
insufficient data to recommend a change
in criteria for overweight and obesity. In
addition, the 2013 guidelines answer some
new, relevant questions such as which
dietary strategies are most successful for
weight loss, which components of lifestyle
modification treatment are most efficacious
and which surgical procedures produce
better outcomes. The 2013 panel used a
rigorous evidence-based approach that
involved a systematic review of the evidence
with priority given to RCTs. The treatment
algorithm directs those in clinical practice
to consider various types of weight loss
treatment or weight maintenance, not just
based on BMI, but also dependent upon
the patient’s own interest, the individual’s
health profile, and success or failure of
methods already attempted. Therefore,
although there are commonalities between
the algorithms from 1998 and 2013, one
result of the 2013 guidelines was to
encourage health practitioners to think
differently about obesity. Clinicians should
consider overweight and obesity as a
chronic metabolic disorder associated
with significant morbidity and mortality.
It requires long-term treatment and has a
high rate of relapse. Nonetheless, while the
amount of weight that most people can
lose and maintain is relatively limited,
available evidence demonstrates that even
modest weight loss, 3-5% (6), confers
significant health benefits and greater
amounts of weight loss are associated
with better outcomes.
The 2013 guideline focused recommendations
on five specific critical questions (CQ): the
first two dealt with the risks of overweight
and obesity and the benefits of losing
weight. The latter three questions dealt
with treatment and include the work RDNs
do to help patients/clients survive within an
obesigenic environment.
CQ 1: Benefits of weight loss – Is weight
loss good for your patient/client?
CQ2: Risks of overweight – How do you
identify who is at risk sufficiently to
mandate weight loss efforts?
CQ3: Diets for weight loss – What is the
efficacy/effectiveness of the different
dietary intervention strategies to promote
weight loss?
CQ4: Comprehensive Lifestyle Intervention
(Diet+Physical Activity + Behavioral
Therapy) – What is the efficacy/
effectiveness of a combined approach to
achieving and maintaining weight loss?
CQ5: Bariatric surgery – What are the
benefits and risks of the various
procedures?
In exploring each of these questions,
subquestions were developed and
examined (for example, did effectiveness of
the intervention differ by demographic or
ethnic characteristics of the population?).
The following are some of the evidence
statements that were graded “high.”
– the greater the individual’s BMI, the
greater the risk of CVD and type 2
diabetes (7,8);
– sustained weight loss of as little as
3-5% can result in meaningful
improvements in the health profile (6);
– six months or more of lifestyle
counseling produces the most
successful outcomes (9–10);
– advise overweight and obese
individuals who have lost weight to
participate in a long-term (≥ 1 yr)
comprehensive weight loss
maintenance program (11,12,13);
– Weight loss at 2 to 3 years following a
variety of surgical procedures in adults
with presurgical BMI ≥ 30 varies from a
mean of 20% to 35% of initial weight
and mean difference from nonsurgical
comparators of 14% to 37%
depending on procedure (14–15).
– s ome 15 dietary regimens were found
to be evidence-based and equally
effective in inducing weight loss as
long as they were calorie-restricted;
All of the above statements and references
are detailed in the guidelines (1,2).
The research evidence demonstrated that
all 15 evidence-based diets (see Table 1)
reviewed performed equally well in
promoting short and long-term weight loss
in adults as long as the calorie intake was
sufficiently restricted to induce weight
reduction. For example, people following
an “ad libitum” diet that severely restricted
carbohydrates, still resulted in a lowercalorie intake and it was this calorie
reduction, not the lower-carbohydrate
intake, that seemed to result in weight loss.
These important findings indicate that
RDNs and other health care providers, as
appropriate, have a wide array of dietary
intervention options to offer their clients
for weight loss management. The 2013
overweight and obesity expert panel
recommended that weight loss programs
be tailored to the individual’s preferences
and needs. It underscored that a “one size
fits all” approach should be avoided in
order to achieve long-term compliance and
success. Among the challenges for the
practitioner are to fully assess each
individual’s health needs and lifestyle
characteristics and to interpret them fully
in establishing a sound, personalized
approach to weight management.
(See for the purpose of one example,
www.healthmain.com for an evidencebased approach to personalize weight
management and other nutrition-related
interventions and medical nutrition
therapy.)
9
Volume 12 No. 4
A comprehensive lifestyle intervention,
consisting of diet, physical activity and
behavioral therapy, providing onsite (in
person) treatment in either group or
individual sessions, weekly for the first
month and then biweekly for 6 months,
produced the greatest weight loss. Longterm programs, consisting of additional
visits for more than a year, were most
successful in reducing the amount of
weight regain (12,13).
An interesting addition to the literature was
the use of electronically delivered,
comprehensive weight loss interventions
(that is, web or other resources used in
conjunction with health care professional
contact). Although less efficacious than
onsite, intensive comprehensive lifestyle
intervention, electronic strategies/tools
carried out in academic settings with the
use of interactive websites, text messaging
and/or emails as well as personalized
feedback from trained interventionists
(dietitians, behaviorists, and exercise
specialists) have been shown to result in
Table 1. 15 Dietary Approaches Associated with Weight Loss by
Expert Panel (1,2)
All of the following dietary approaches (listed in alphabetical order below) are associated
with weight loss if reduction in dietary energy intake is achieved:
A diet from the European Association for the Study of Diabetes Guidelines, which
focuses on targeting food groups, rather than formal prescribed energy restriction
while still achieving an energy deficit. Descriptions of the diet can be found in the
Full Panel Report Supplement.
Higher protein (25% of total calories from protein, 30% of total calories from fat, 45% of
total calories from carbohydrate) with provision of foods that realized energy deficit.
Higher protein Zone-type diet (5 meals/day, each with 40% of total calories from
carbohydrate, 30% of total calories from protein, 30% of total calories from fat)
without formal prescribed energy restriction but realized energy deficit.
Lacto-ovo-vegetarian-style diet with prescribed energy restriction.
Low-calorie diet with prescribed energy restriction.
Low-carbohydrate (initially <20 g/day carbohydrate) diet without formal prescribed
energy restriction but realized energy deficit.
Low-fat (10% to 25% of total calories from fat) vegan style diet without formal
prescribed energy restriction but realized energy deficit.
Low-fat (20% of total calories from fat) diet without formal prescribed energy
restriction but realized energy deficit.
Low-glycemic load diet, either with formal prescribed energy restriction or without
formal prescribed energy restriction but with realized energy deficit.
Lower fat (< 30 % fat), high dairy (4 servings/day) diets with or without increased
fiber and/or low-glycemic index/load foods (low-glycemic load) with prescribed
energy restriction.
Macronutrient-targeted diets (15% or 25% of total calories from protein; 20% or 40%
of total calories from fat; 35%, 45%, 55%, or 65% of total calories from carbohydrate)
with prescribed energy restriction.
Mediterranean-style diet with prescribed energy restriction.
Moderate protein (12% of total calories from protein, 58% of total calories from
carbohydrate, 30% of total calories from fat) with provision of foods that realized
energy deficit.
Provision of high-glycemic load or low-glycemic load meals with prescribed
energy restriction.
The AHA-style Step 1 diet (with prescribed energy restriction of 1,500-1,800 kcal/day,
<30% of total calories from fat, <10% of total calories from saturated fat).
weight loss of up to 5 kg at 6-12 months in
comparison to no or minimal intervention
(16–18).
The Registered Dietitian Nutritionist
The 2013 guidelines are an important
milestone for RDNs. They specifically
recommend, for the first time, that primary
care and other health care providers refer
overweight and obese patients to food and
nutrition professionals (e.g., RDNs) for
counseling on calorie-restricted dietary
interventions. They also acknowledge the
RDN as one of the qualified providers of
comprehensive lifestyle interventions, the
“gold standard” for weight management
(weight loss and weight loss maintenance).
This acknowledgement reflects the
substantial evidence base reviewed by the
expert panel including key professional
backgrounds of providers of effective
interventions for weight loss and weight
loss maintenance. In exploring CQs 3 (diet
strategies) the expert panel considered
whether the RCTs of dietary interventions
implemented largely by food and nutrition
professionals in academic and health care
environments were effective in promoting
weight loss. These studies typically controlled
physical activity and behavioral intervention
methods across study arms. CQs 4 studies
(comprehensive intervention) were typically
conducted by trained interventionists
(e.g., teams of RDNs, exercise specialists,
and behaviorists) in university or health
care settings and compared to “usual care”
protocols (19).
It’s an opportune time for RDNs involved in
weight management to embrace these
2013 overweight and obesity guidelines
and advocate for their visibility and roles
in the prevention and treatment of
overweight and obesity in the population.
No professional group was more strongly
identified in this report as key in
management of these conditions than
RDNs. Multidisciplinary approaches were
advocated and there is an opportunity for
RDNs to lead and collaborate with others in
seeking reimbursement for services and
carrying out programs and initiatives in
clinical, public health, worksite and
educational settings where it is important
to address the needs and problems facing
Americans as they attempt to address
weight-related issues.
10
Spring 2014
Thank you to the individuals who reviewed
and provided input to this article: Catherine
M. Champagne, PhD, RDN, LDN, FADA,
FAND, FTOS, Eileen Ford, MS, RD and Linda
M. Gigliotti, MS, RD, CDE.
References:
1.Jensen MD, Ryan DH, Apovian CM, Loria
CM, Ard JD, Millen BE, Comuzzie AG,
Nonas CA, Donato KA, Pi-Sunyer FX, Hu
FB, Stevens J, Hubbard VS, Stevens VJ,
Jakicic JM, Wadden TA, Kushner RF,
Wolfe BM, Yanovski SZ. 2013 AHA/ACC/
TOS Guideline for the Management of
Overweight and Obesity in Adults: A
Report of the American College of
Cardiology/American Heart Association
Task Force on Practice Guidelines and
The Obesity Society. J Am Coll Cardiol.
Access at: http://jaccjacc.cardiosource.
com/acc_documents/2013_FULL_
Guideline_Obesity.pdf
2.Jensen MD, Ryan DH, Apovian CM, Loria
CM, Ard JD, Millen BE, Comuzzie AG,
Nonas CA, Donato KA, Pi-Sunyer FX, Hu
FB, Stevens J, Hubbard VS, Stevens VJ,
Jakicic JM, Wadden TA, Kushner RF,
Wolfe BM, Yanovski SZ. 2013 AHA/ACC/
TOS Guideline for the Management of
Overweight and Obesity in Adults: A
Report of the American College of
Cardiology/American Heart Association
Task Force on Practice Guidelines and
The Obesity Society. Circulation. Access
at: https://circ.ahajournals.org/content/
early/2013/11/11/01.
cir.0000437739.71477.ee.full.
pdf+html?sid=6af28578-67b4-4bb19a4d-91ebab818a98
3.Flegal KM, Carroll MD, Kit BK, Ogden CL.
Prevalence of obesity and trends in the
distribution of body mass index among
U.S. adults, 1999-2010. Jour Am Med
Assoc. 2012;307(5):491–507.
4.http://www.cdc.gov/features/vitalsigns/
cardiovasculardisease/ Centers for
Disease Control and Prevention 2011.
Accessed: March 4, 2014.
5.National Institutes of Health. Clinical
Guidelines on the Identification,
Evaluation, and Treatment of
Overweight and Obesity in Adults—
The Evidence Report. National Institutes
of Health. Obes Res. 1998;6 Suppl
2:51S-209S.
6.Jensen MD, Ryan DH New obesity
guidelines: promise and potential. Jour
Am Med Assoc.;2014; 311(1):23–4.
7.McGee DL. Body mass index and
mortality: a meta-analysis based on
person-level data from twenty-six
observational studies. Ann Epidemiol.
2005;15:87–97.
8.Whitlock G, Lewington S, Mhurchu CN.
Coronary heart disease and body mass
index: a systematic review of the
evidence from larger prospective cohort
studies. Semin Vasc Med. 2002;2:369–81.
9.Stevens VJ, Obarzanek E, Cook NR et al.
Long-term weight loss and changes in
blood pressure: results of the Trials of
Hypertension Prevention, phase II.
Ann Intern Med. 2001;134:1–11.
10.Subak LL, Wing R, West DS et al. Weight
loss to treat urinary incontinence in
overweight and obese women. N Engl
J Med. 2009;360:481–90.
11.Perri MG, Nezu AM, McKelvey WF,
Shermer RL, Renjilian DA, Viegener BJ.
Relapse prevention training and
problem-solving therapy in the longterm management of obesity. J Consult
Clin Psychol. 2001;69:722– 6.
12.Wing RR, Tate DF, Gorin AA, Raynor HA,
Fava JL. A self-regulation program for
maintenance of weight loss. N Engl
J Med. 2006;355:1563–71.
13.Wing RR. Long-term effects of a lifestyle
intervention on weight and
cardiovascular risk factors in individuals
with type 2 diabetes mellitus: four-year
results of the Look AHEAD trial. Arch
Intern Med. 2010;170:1566–75.
14.Mingrone G, Panunzi S, De Gaetano A
et al. Bariatric surgery versus conventional
medical therapy for type 2 diabetes.
N Engl J Med. 2012;366:1577–85.
15.Schauer PR, Kashyap SR, Wolski K et al.
Bariatric surgery versus intensive
medical therapy in obese patients
with diabetes. N Engl J Med. 2012;366:
1567–76.
16.Hunter CM, Peterson AL, Alvarez LM
et al. Weight management using the
internet a randomized controlled trial.
Am J Prev Med. 2008;34:119–26.
17.Morgan PJ, Lubans DR, Collins CE,
Warren JM, Callister R. The SHED-IT
randomized controlled trial: evaluation
of an Internet-based weight-loss
program for men. Obesity (Silver Spring)
2009;17:2025–32.
18.Tate DF, Jackvony EH, Wing RR. Effects
of Internet behavioral counseling on
weight loss in adults at risk for type 2
diabetes: a randomized trial. Jour Am
Med Assoc. 2003;289:1833–6.
19.Svetkey LP, Stevens VJ, Brantley PJ et al.
Comparison of strategies for sustaining
weight loss: the weight loss
maintenance randomized controlled
trial. Jour Am Med Assoc. 2008;299:
1139–48.
CPEU Process
Access the CPE Assessment and
obtain your Certificate via the online
WM DPG CPE Assessment Center at
www.wmdpg.org. Once logged in to
our WM DPG member site, go to the
CPE Assessment Center and take the
CPE quiz for this newsletter article. You
need to obtain a minimum 70%
correct score to receive your CPE
certificate.
11
Volume 12 No. 4
From the Chair
Julie Schwartz, MS,
RDN, 2013-2014
WM DPG Chair
A year of growth
W
hat a year this has been! I’ve had the fortune to work
with a group of inspirational, talented, and incredibly
knowledgeable professionals on the WM DPG Executive
Committee, and in our membership. I’m humbled to have been
“the leader” of this group, however it’s truly been a team effort. This
job is one of the most rewarding in my 25+ year career!
The Weight Management (WM) Dietetic Practice Group (DPG)
leadership has been busy putting the finishing time line on our
five-year strategic plan which focuses our work on three pillars:
knowledge, leadership, and communication. These three pillars
touch on every aspect of the work the WM DPG is involved in
with both our internal stakeholders, as well as with our external
stakeholders. The responses that you, the members of our DPG
provide on the member survey give the foundation for this
strategic plan. This year, as most years, many new volunteers have
joined committees to add depth and varying perspectives to the
work we do as WM DPG. If you want to become more involved,
please contact us, as there is always room for more volunteers at
a variety of time commitments.
In previous articles, I’ve written about the WM DPG involvement
in advocating for The Treat and Reduce Obesity Act (TROA). I had
the honor to present at the Public Policy Workshop about TROA
and also on the collaborative involvement between the WM DPG,
state affiliates, the Academy of Nutrition and Dietetics and the
Academy’s Policy Initiatives and Advocacy (PIA) team! It has been
a year of collaboration on this important legislation and there will
be continued calls to action. We need to hear the voice of our
membership on this issue. Regardless of your work setting or job
description, and whether you accept insurance, work with
Medicare patients, or are political, this is one bill that has the
potential to impact our profession on every level. Reimbursement
begins with Medicare coverage and trickles down from there.
Clinical jobs tend to set the base salaries for our profession;
reimbursement, or lack there of, impacts salaries. You can see
where this is going! I challenge you to learn more and don’t wait
for the Academy to be your voice. YOU are the voice of the
Academy. YOU are the Academy. For more information, reach out
to either Chris Weithman, Policy and Advocacy Leader (PAL), or
the committee members Betsy Anderson and Amanda Meadows.
Our website is becoming more robust on a weekly basis. The
directory has the potential to be a go to resource of experts in
varying areas of weight management. Are you an expert? Are you
a member? Consider updating your directory listing so that
you’re more easily found. And check out our mini webinars on
the depth of information and navigation of the website, or
peruse for yourself!
Our 2014 Symposium was a huge success! Thank you to
Paul Allen, MBA, MS, RDN, WM DPG symposium chair, and his
committee and advisors: Angie Hasemann, RD, CSP, Christina
Scott, RDN, LD, Lisa Talamini, RD, Hollie Raynor, PhD, RD, LDN, and
Hope Warshaw, MMSC, RD, CDE, BC-ADM. And, a big thank you to
Academy Meetings for enabling the logistics to run smoothly. I
learned something new in every session and there was depth
and variety to meet everyone’s needs. If you missed it live, you
can purchase the recordings and receive CPE. Consider joining us
live next year in Portland, OR!
I also want to thank Paul Moore, MS, RD, CSSD, LDN, CSCS*D,
NSCA-CPT*D, for his leadership as the Newsletter Editor for the
past few years! This is a big job, and I know he’s mentored Betsy
Hirschy, RD, LD, well to be ready to take the reins in June. Paul has
published 8 information-packed newsletters and dedicated
countless hours to provide you with the number one member
benefit. Want to be involved with a low time commitment?
Consider joining the newsletter editing team!
A special thank you to our numerous sponsors as they provide
valuable information for our members. Many sponsors have
made resources available, including educational materials for
informing our clients, pedometers or step counters and
accelerometers to motivate our clients to move, tasty food to
nourish our clients, and even stylish dishes designed to aid
portion control!
There are countless other people to thank for their support and
hard work. Every committee chair and director, as well as each
committee member, has been a contributor to providing the
resources to deliver an incredible newsletter, webinars, a
symposium, a website chock full of resources, and so much more.
I’m excited about the future of the WM DPG as Anne Wolf, MS, RD,
takes the reins and Kristine Clark, PhD, RD, FACSM, steps into her
role of chair-elect. So much is still in progress that will positively
impact our DPG and our profession. Keep your ears open for
news on the Board Certified Specialist in Obesity and Weight
Management (CSOWM).
12
Spring 2014
Practical Sports Nutrition: The Four R’s
of Recovery
By Liz Broad, PhD
Reprinted with permission from SCAN’S PULSE, 2014;33(1):1-3 Sports, Cardiovascular, and Wellness Nutrition (SCAN), Academy of Nutrition and Dietetics, Chicago, IL.
T
he translation of
research findings
into practical
sports nutrition concepts
for athletes is a critical
part of the sports
dietitian’s role. Because
Liz Broad, PhD
optimal recovery is
essential to good health
and subsequent athletic performance, the
promotion of proper recovery nutrition is
often a key focus for the practitioner. This
article presents simple tips that registered
dietitian nutritionists (RDNs) can
incorporate into the training regimens of
high-performance athletes; it is not
intended to provide a comprehensive
review of each component discussed.
The needs for adequate carbohydrate and
rehydration after exercise have long been
recognized, with recommendations
typically involving rapid replenishment of
water and carbohydrates. More recently,
emerging evidence has highlighted the
role of protein in promoting muscle repair,
stimulating muscle protein synthesis, and
supporting the adaptations to all training
stimuli. As such, the “four R’s of recovery”—
repair, refuel, rehydrate, and revitalize—
provide easy-to-remember guidelines that
can promote the recovery of an athlete.
Repair
Evidence supports the beneficial role of
consuming protein soon after completion
of exercise to enhance repair of damaged
muscle and stimulate muscle protein
synthesis, both in terms of muscle fiber
generation as well as the adaptive process
such as increasing mitochondria,
capillarization, and metabolic changes (1).
The key “trigger” appears to be leucine, an
essential amino acid. The amount of protein
consumption required for an optimal
recovery response is approximately 20 g to
25 g during the initial post-exercise period.
While scientists have yet to determine the
variation in this amount according to
Physical Activity
Meagan Moyer, MPH, RD, LD, is the Physical Activity
Perspective Section Editor.
Physical activity is a cornerstone of weight management. Liz Broad, PhD,
reviews the 4 R’s of sports nutrition that every weight management practitioner should
know to help their clients achieve healthier, more active lifestyles.
athlete size, it is unlikely to be an
exceedingly large variation.
Benefits have been detected for a variety of
protein sources, and inclusion of a highquality protein such as whey may be optimal.
There may be beneficial effects of combining
whey with other proteins such as casein or
perhaps even casein and soy protein (2).
Because dairy foods contain both whey and
casein, the use of products such as milk and
yogurt has become an inexpensive solution
to promote repair during recovery. Muscle
protein recovery occurs over 24 to 48 hours,
so repeated small doses of protein (20-25 g/
dose) appear to be a better option than one
large dose followed by a long period without
protein (3).
Refuel
Carbohydrate is the primary fuel for higherintensity exercise. Total carbohydrate
requirements and, hence, the need for
post-exercise refueling are determined by
the intensity and duration of the training
session (4). For athletes who train more
than once a day, it is important to take the
opportunity to replenish muscle glycogen
quickly after training in order to maintain
stores throughout the training week.
Recommendations are as follows: include
1 g to 1.2 g of carbohydrate per kg body
mass during the immediate post-exercise
period, following this up at regular intervals
(i.e., each hour for first 4 hours) and then
resuming daily fuel needs (4). It is important
to use the refueling strategies both during
days of competition and days of vigorous
training. Use of convenient carbohydraterich foods and beverages may help athletes
to meet their goals. Many whole foods can
serve this purpose and at the same time
help to meet daily micronutrient needs.
Rehydrate
Replacement of 120% to 150% of fluid
losses incurred during exercise is typically
recommended. The joint position statement
on nutrition for athletic performance from
the American Dietetic Association (now the
Academy of Nutrition and Dietetics), the
American College of Sports Medicine, and
the Dietitians of Canada recommended
consuming approximately 16 oz to 24 oz of
fluid for every pound of weight lost (5). Any
amount over the loss in weight is meant to
compensate for increased urine production
during the recovery period. It is also
suggested that fluid and electrolyte
replacement can be accomplished through
the consumption of rehydration beverages
and salty foods at meals/snacks.
Understanding fluid losses during exercise
and minimizing the degree of dehydration
are key elements to optimizing hydration
status. By weighing themselves before and
after training, athletes can gain an
understanding of fluid losses, which can
13
Volume 12 No. 4
then guide their post-exercise rehydration
strategies. For example, if 1 kg of sweat is
lost during training, the athlete would be
encouraged to consume 1.2 L to
1.5 L of fluid within the next 1 to 3 hours
post-exercise to optimize rehydration and
approach a state of euhydration.
Revitalize
Athletes are encouraged to incorporate a
range of vitamins, minerals, and other
nutrients during the post-exercise period
through the use of whole foods rather than
single nutrient supplements. Whole foods
deliver additional nutrients, including
antioxidants and other phytonutrients,
while also providing the key nutrients for
recovery. One example is the use of
flavored milk, which provides protein,
carbohydrate, and fluid together with
calcium and B vitamins to support the
overall health needs of an athlete. By taking
a food-first approach, athletes help to
ensure they meet their needs for essential
nutrients, thus helping to avoid deficiencies
that could hinder athletic performance.
Conclusions
It is important to note that these recovery
principles must fit within an athlete’s daily
energy requirements. For some athletes,
especially those trying to lose body fat, it
may be necessary to prioritize recovery
after training by manipulating the time of
training (so that a meal follows immediately
after) or by adjusting the volume and
composition of other meals over the day
(e.g., reducing serving sizes). For those
needing to gain weight, the addition of a
recovery snack in addition to the usual
eating plan can provide the additional
energy required to stimulate body mass
gain. The use of “protein powders” and
other supplements may be considered in
circumstances where athletes find it
difficult or impractical to utilize food and
other fluid sources. Tailoring dietary
guidance to help athletes meet their
dietary needs during recovery is a key
challenge for the sports dietitian.
Liz Broad, PhD, is a senior sports dietitian
working with the Paralympic Program for the
United States Olympic Committee, in Chula
Vista, CA
References:
1.Phillips SM. Dietary protein requirements
and adaptive advantages in athletes.
Br J Nutr. 2012;108:S158–S167.
2.Reidy PT, Walker DK, Dickinson JM, et al.
Protein blend ingestion following
resistance exercise promotes human
muscle protein synthesis. J Nutr. 2013;
143:410–416.
3.Areta JL, Burke LM, Ross ML, et al.
Timing and distribution of protein
ingestion during prolonged recovery
from resistance exercise alters myofibrillar
protein synthesis. J Physiol. 2013;591:
2319–2331.
4.Burke LM, Hawley JA, Wong SHS, et al.
Carbohydrates for training and
competition. J Sports Sci. 2011;29:
S17–S27.
5.Rodriguez NR, DiMarco NM, Langley S.
Position of the American Dietetic
Association, Dietitians of Canada, and
the American College of Sports
Medicine: Nutrition and athletic
performance. J Am Diet Assoc.
2009;109:509–527.
As surgeons keep their instruments and knives always at hand for cases requiring immediate
treatment, so shouldst thou have thy thoughts ready to understand divine and human,
remembering in thy every act, even the smallest, how close is the bond that unites the two.”
–Marcus Aurelius
Recently I had a client exclaim, “I went from zero to 10 in 60 seconds!” While this may sound like the words of a
mis-driven NASCAR driver, (they use the more fitting term to accelerated speed, zero to 60 in 10 seconds) it came
out of the mouth of a 56 yr old overweight housewife who had been unsuccessful at dieting for many years. She
was describing her new awareness of recognition in her hunger to fullness rating. She now has a new tool with
which to objectively rate her stomach sensations.
Shannon Heffern,
RD, CDE
Do you hear similar phrases from your clients when they are encouraged to focus more on their body when
developing mindfulness to their body and eating habits? How do you respond? What tools are you teaching to
clients so they can more easily (and in our fast past world) more quickly acquire the intuitive eating that aids them
in losing weight through a non-diet approach?
As the new counseling section editor, I want to hear your approaches and techniques for the counseling section of the Weight
Management practice group. Please consider sharing your style and words of success with your colleagues. Many of those in science
are soldiering into new and exciting technology for assisting clients towards better health. But still, in counseling, we need to focus
on the tiniest of actions so as to recognize and understand the bonds that better unite our minds to our bodies in order to succeed in
offering our clients with long and lasting change.
14
Spring 2014
Comparison of Weight-Loss Programs
By Jenna Rae Carlson
W
ith the rise in
obesity,
commercial
weight-loss programs
are one avenue that
consumers are using to
battle the epidemic (1).
Jenna Rae Carlson
The North American
weight-loss industry has reached $50 billion
dollars annually, fueled by claims of
products and programs that promise quick,
easy, and long-lasting results (2-4). To help
increase the popularity of the weight-loss
industry, celebrities such as Jessica
Simpson, Jennifer Hudson, Melissa Joan
Hart, and Mariah Carey have joined to show
the world what program they used to lose
weight (5-7). Two-thirds of adults in
Western populations are trying to lose
weight or avoid weight gain (8). Recently,
surveys reported that approximately
30-40% of adults are concerned with their
weight and report using some type of
structured diet (liquid diet supplements,
commercial weight-loss diets, or a special
diet) to manage weight (8). Some of the
most common commercial weight-loss
programs today are Weight Watchers, Jenny
Craig, Medifast, and Nutrisystem.
Background of Weight-loss Programs
Weight Watchers
Weight Watchers was established in 1961 by
Jean Nidetch, after inviting some friends
over each week to talk about their weight,
and feelings about food, this setting of
mutual support and understanding helped
the women begin to lose weight (5, 9-12).
Today, Weight Watchers is the world’s
largest support group for weight loss ,
hosting over 1.5 million members with over
50,000 meetings in over 30 countries
worldwide (5, 11, 13). Weight Watchers
focus is behaviorally oriented by including
four central aspects: a food plan, an activity
plan, a behavior modification plan that uses
cognitive reconstructing, and group
support (14-15). Today, the heart of Weight
Watchers is its food point system; foods are
assigned points depending on the calories
and fat grams, which increase point value,
and fiber grams, which decrease point
Students Corner
Meredith Leigh Johnson is the section editor for the
Students Corner
In this quarter’s student article, dietetic intern, Jenna Carlson,
reviews several popular weight management programs (Jenny Craig,
Nutrisystem, Medifast, and Weight Watchers) and discusses their effectiveness.
**Only selected commercial weight loss programs are discussed in this article. Expert obesity
panel 2013 guidelines are available in this issue in the CPEU article.
value, and then each member is given a
range of allowable daily points (5, 10, 16).
Jenny Craig
Jenny Craig was established in 1983 by
Australians Sid and Jenny Craig with a
mission to help their clients achieve their
weight management goals through a
behavioral change approach, which includes
healthy eating, an active lifestyle, and a
balanced approach to living (7, 9, 17-18). The
Jenny Craig program offers two plans, Jenny
In Center and Jenny Anywhere with weight
management recommendations that are
developed by registered dietitians in
consultation with a multidisciplinary medical
advisory board to help participants lose 1-2
pounds per week (7, 18-19) through an
energy-reduced diet ranging from 1200 to
2000kcal/day. The Jenny Craig program
membership also includes weekly one-onone meetings with trained peer consultants
who are located in community-based
facilities, and help to tailor the program to
the members’ food, menu, and physical
activity (7, 17, 19). The physical activity goals
are to achieve 150+ minutes/week of
physical activity (17, 19).
Medifast
Medifast was established in 1980 by Dr.
William Vitale of Johns Hopkins Hospital,
who was using his precise formulated meal
replacements (MRs) for his patients who
needed to lose life-saving weight (20-21).
The Medifast program is a low-calorie meal
plan that is composed of individual MRs
packets, which are nutrient dense and
fortified with 24 vitamins and minerals (20)
that are mixed with water and refrigerated
or microwaved (22). The program is
assessed by a scientific advisory board,
which reviews the effectiveness, safety, and
nutritional benefits of products and
programs (20). Members also have the
option to visit a Medifast Weight Control
Center that offers weekly-individualized
counseling, and support with medical
oversight (21)
Nutrisystem
Nutrisystem is a program based on MRs,
which serve as the core of the home-based
program and are available to purchase
online or by telephone (6, 18). This
program was designed by an advisory
council of physicians, and obesity
researchers over 40 years ago, and is
tailored for the busy, on-the-go client (6,
18). The Nutrisystem membership offers
seven, 28-day food package options to
choose from, which revolve around the
glycemic index (23). Also, included in the
membership are the internet-education
based components (6, 18).
Conclusions on effectiveness
With the exception of Weight Watchers,
evidence to support the effectiveness of
other commercial weight-loss programs is
limited, due to the lack of studies in both
short and long term (24, 25).
15
Volume 12 No. 4
Program
Weight Loss
Claim
1-2lbs per week
1-2lbs per week
Length of
Program
Best for
Patient Who
Until weightloss is met
Looking for
structured program
w/flexibility built in
Entry
Requirements
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background
questionnaire
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members successful in
the program) who
attend 48-hour training
session with monthly
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4
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NONE
Looking for more
28-day cycles
and phoneof other
private
weight-loss
until
weightWith the exception of Weight Watchers, evidence to support internet
the effectiveness
consultants
experience that
loss is met
includesis
MRs
diet due to the lack of studies in both short and long
commercial weight-loss programs
limited,
NONE
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Patients with a
2-5lbs-first 2 weeks
term (24,Chosen
25).
review if
higher BMI (>30)
program plan
1-2lbs- after 2 weeks
Medifast
who
work
until weight-has been
Weight-loss
seen
towith
lower mortality
rate Weight
up to 24%. Also, losing 10% of total
Control Center
guidance and
loss is met
is available
supervision
a
body weight can considerably
improveofblood
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physician
1-2lbs per week
26). Weight-loss interventions that involve attention to food intake such as diet alone, diet and
Lifetime members
NONE
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members
who
meetings,
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and
behaviors
are
exercise, MRs, and weight-loss medications combined with diet have(former
been shown
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the
reached their goal
group support,
taught
weight
and6 complete
insbut then weight-loss often plateaus
most promising short-term weigh
results,
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andwho
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goals of a successful weight management programs should be to reduce
2lbs of goal) that
receive leadership
body weight over a long period of time (over 1 year)
training
According to Consumer Reports, the four most popular diets weight-loss diets were
rankedvariety,
on whether
they incorporated
the variables into
there
weight-loss,
loss,
rateprogram:
of weight initial
loss, physical
activity,
encouragement
of fruits and
self-monitoring, uncontrolled factors such
vegetables, and exercise, which was based
maintenance,
calorie
food
variety,
of fruits
vegetables,
and
Weight loss has been seen to lower
as stress, and
socialand
support.
Initial weight
on a scale
of 1 toawareness,
5, 1 being the
worst,
3 encouragement
mortality rate up to 24%. Also, losing 10% of
loss has been identified as a predictor for
being neutral, and 5 being the best, as
which
waschart
based
on a(27).
scale of 1 to 5, 1 being
the worst,
3 being
and 5 and
being the
total body weight can considerably improveexercise,
additional
weight
loss,neutral,
weight regain,
shown
in the
below
blood pressure, diabetic control, lipids, and
weight-loss maintenance (28-29). Typically,
seen by
the chart
below
arthritis (2, 4, 26). Weight-loss interventionsbest, asFactors
when an individual loses a large amount of
affecting
weight
loss(27).
maintenance,
that involve attention to food intake such as
weight rapidly, like those seen on a diet that
whether a commercial weight-loss program
diet alone, diet and exercise, MRs, and
contains MRs (Nutrisystem, Jenny Craig,
is used or not include (28): initial weight
weight-loss medications combined with
diet have been shown to produce the most
Nutrisystem
promising short-term results, but then
5
Best
Jenny Craig
weight loss often plateaus around 6 months
Medifast
(4). The goals of a successful weight
4
Weight Watchers
management programs should be to
reduce and maintain a lower body weight
3
over a long period of time (over 1 year)
According to Consumer Reports, the four
most popular weight-loss diets were ranked
on whether they incorporated the variables
into their program: initial weight loss,
maintenance, calorie awareness, food
2
Worst
1
Initial Wt. Loss Calorie Awareness Fruit & Vegetables
16
Spring 2014
Medifast), they are more likely to regain
weight (6-7, 20, 30). In a two year trial study
conducted by Heshka and associates,
researchers found that the commercial
weight loss (Weight Watchers) group
maintained a weight loss of 9-11lbs at the
end of the first year, and 6-7 lbs weight loss
at the end of the second year, along with
improvements in waist circumference, and
BMI compared to when they began (31).
Along with slow and steady weight loss,
physical activity has been shown to relate to
long-term weight loss maintenance.
Physical activity assists weight maintenance
by influencing clients to expend energy,
and in turn improving health, (32), which
commercial weight-loss programs like
Weight Watchers, Medifast, and Jenny Craig
emphasize (5-6, 20).
The most effective strategies to maintain the
slow and steady weight loss and
maintenance is through a lower total calorie
intake, smaller portion sizes, a decrease in
snacking, less dietary fat (28, 33), and the
consumption of fruits and vegetables (16),
which is also encouraged by Weight
Watchers, Jenny Craig, and Nutrisystem (5-6).
Another factor that goes hand in hand with
weight loss maintenance is the act of
self-monitoring, which can be done through
recording food intake, physical activity, and
regular weigh-ins, which helps the individual
stay aware of their body weight (32).
Self-monitoring can be seen in programs
such as Weight Watchers and Jenny Craig
(5-6). Even factors that cannot be controlled,
such as stress, affect whether an individual
will maintain the weight loss, and research
shows that the best way to battle these
factors is through social support (one-on-one
or group focused) (34), which can be seen in
commercial weight loss programs like Weight
Watchers, Jenny Craig, and Medifast (5-6, 20).
Due to the lack of data in regards to longterm studies effectiveness, Medifast, Jenny
Craig (10), and Nutrisystem have yet to be
able to prove that their program claims help
their members keep their weight off.
Good health is always a work in progress (35).
To be successful in weight loss maintenance
requires long-term commitment to making
healthy changes in eating and exercise habits
(36). Developing healthy eating and exercise
habits can help lower the health risks
associated with obesity (37).
Jenna Rae Carlson is currently a graduate
student and dietetic intern at Eastern Illinois
University. She completed her bachelor of arts
degree in food, nutrition and dietetics at
Concordia College, Moorhead in Minnesota.
References:
1.Collins C, Morgan P, Jones, P, et al.
Evaluation of a commercial web-based
weight loss and weight loss maintenance
program in overweight and obese
adults: A randomised controlled trial.
BMC Public Health. 2010;10:669-676.
2.Koche L. Obesity and its treatments: An
overview. Your Weight Matters Magazine.
n.d.; Retrieved from http://www.
obesityaction.org/educational-resources/
resource-articles-2/weight-loss-surgery/
obesity-and-its-treatments-an-overview.
Accessed December 10, 2013.
3.Freedhoff Y, Sharma A. “Lose 40 pounds
in 4 weeks”: Regulating commercial
weight-loss programs. Can Med Assoc J.
2009;180(4):367.
4.Franz M, VanWormer J, Crain A, et al.
Weight-loss outcomes: A systematic
review of meta-analysis of weight-loss
clinical trials with a minimum 1-year
follow-up. J Am Diet Assoc.
2007;107(10):1755-1767.
5.Weight watchers homepage. website.
http://www.weightwatchers.com/index.
aspx. Accessed: 12/10/13
6.Nutrisystem homepage. website.
http://www.nutrisystem.com/jsps_hmr/
home/index.jsp. Accessed: 12/10/13
7.Jenny Craig homepage. website.
http://www.jennycraig.com.
Accessed: 12/10/13
8.Leske S, Strodl E, Hou X. A qualitative
study of the determinants of dieting and
non-dieting approaches in overweight/
obese Australian adults. BMC Public
Health. 2012;12(1):1086-1098.
9.Hamilton M, Greenway F. Evaluating
commercial weight loss programmes: An
evolution in outcomes research. Obes
Rev. 2004;5(4):217-232.
10.Witherspoon B, Rosenzweig M.
Industry-sponsored weight loss
programs: Description, cost, and
effectiveness. J Am Acad Nurse Pract.
2004;16(5):198-205.
11.Vignali C, Henderson S. Weight watchers:
Social event centered marketing. Journal
of Food Products Marketing.
2008;14(2):99-112.
12.Shuman J. Weight-loss programs: Is one
right for you?. Am J Nurs.1993;93(5):7073.
13.Moisio R, Beruchashvili M. Questing for
well-being at weight watchers: The role
of the spiritual-therapeutic model in a
support group. J Consum Res.
2010;36(5):857-875.
14.Pinto A, Fava J, Hoffmann D, Wing R.
Combining behavioral weight loss
treatment and a commercial program: A
randomized clinical trial. Obesity (Silver
Spring). 2013;21(4):673-680.
15.Lowe M, Kral T, Miller-Kovach K. Weightloss maintenance 1,2, and 5 years after
successful completion of a weight-loss
programme. Br J Nutr. 2008;99(4):925930.
16.Ma Y, Pagoto S, Griffith J, et al. A dietary
quality comparison of popular weightloss programs. J Am Diet Assoc.
2007;107(10):1786-1791.
17.Finley C, Barlow C, Greenway F, et al.
Retention rates and weight loss in a
commercial weight loss program. Int J
Obes. 2007;31(2):292-298.
18.Hubbard B. Commercial program and
product review: Meal replacement-based
weight-loss programs. Obes Manag.
2007;292-295.
19.Martin C, Talamini L, Johnson A, et al.
Weight loss and retention in a
commercial weight-loss program and
the effort of corporate partnership. Int J
Obes. 2010;34(4):742-750.
20.Medifast homepage. website.
http://www.medifast1.com/index.jsp.
Accessed: 12/10/13
21.Arroyo A. Medifast: Losing weight to win.
Equities. 2004;52(2):16-18.
22.Leavell A. Commercial program and
product review. Obes Manag. 2008;250256.
23.Mayo Clinic Staff. Glycemic index diet:
What’s behind the claims. Collect Papers
Mayo Clinic Mayo Found. 2011;1-2.
24.Tsai A, Wadden T. Systematic review: An
evaluation of major commercial weight
loss programs in the United States. Ann
Intern Med. 2005;42(1):56-66.
25.Dansinger M, Gleason J, Griffith J, et al.
Comparison of the atkins, ornish, weight
watchers, and zone diets for weight loss
and heart disease reduction. JAMA.
2005;293(1):43-53.
26.Ahern A, Olson A, Aston L, Jebb S.
Weight watchers on prescription: An
observational study of weight change
among adults referred to weight
watchers by the NHS. BMC Public Health.
2011;11(1):434-438.
27.Pick your ideal diet. Consumer Reports.
2011;76(6):14-16.
17
Volume 12 No. 4
28.Elfhag K, Rossner S. Who succeeds in
maintaining weight loss? A conceptual
review of factors associated with weight
loss maintenance and weight regain.
Obes Rev. 2005;6(1):67-85.
29.Berzins L. Protecting the consumer
through truth-in-dieting laws. J Soc Issues.
1999;55(2):371-382.
30.DeLegge M, Keith J. Medical weight
management. In: C. Thompson (Ed).
Bariatric Endoscopy. New York: Springer;
2013:19-35.
31.Heskha S, Anderson J, Atkinson R, et al.
Weight loss with self-help compared with
a structured commercial program. JAMA.
2003;289(14):1792-1798.
32.Weight-control Information Network.
Choosing a safe and successful weightloss program. National Institute of Health.
2012;8:1-5.
33.Truby H, Hiscutt R, Herriot A, et al.
Commercial weight loss diets meet
nutrients requirements in free-living
adults over 8 weeks: A randomised
controlled weight loss trial. Nutr J.
2008;7(25):1-13.
34.Middleton K. M. R., Patidar S. M., Perri M.
G. The impact of extended care on the
long-term maintenance of weight loss: A
systematic review and meta-analysis.
Obes Rev. 2012;13:509-517.
35.Gustafson, T. For kinder, gentler approach
to weight loss. Auburn-Reporter. 2014;1
36.Mayo Clinic Staff. Weight loss: Choosing a
diet that’s right for you. Collect Papers
Mayo Clinic Mayo Found. 2012;1-2.
37.Rohrer, J., Cassidy, H., Dressel, D., &
Cramer, B. Effectiveness of a structured
intensive weight loss program using
health educators. Disease Management
and Health Outcomes. 2008;16(6):449-454.
Agriculture Act of 2014
By Amanda Meadows, MS, RD/LD, CDE, NASM-CPT
P
resident Obama
signed into law
the Agriculture
Act of 2014 ( i.e. “Farm
Bill”) into law on
February 7th. The new
five-year, one trillion
Amanda Meadows,
dollar
Farm Bill has
MS, RD/LD, CDE,
NASM-CPT
been supported by the
Academy throughout
the bill’s legislative process. The final bill
will provide essential nutrition assistance
and education, increase funding for
nutrition and agriculture research, and
introduce new initiatives that will improve
the health of the country.
The final bill protects the SNAP program
which includes the following highlights;
SNAP-Ed funding being restored to Health
Hunger-Free Kids Act (HHFKA) levels, SNAP
eligibility criteria are maintained from
2008, Community Supported Agriculture
(CSA) businesses can now be authorized as
SNAP retailers, and incentives to purchase
fruits and vegetables with SNAP dollars. In
addition, SNAP can be used for
homebound seniors and disabled
participants using nonprofit home delivery
services.
Other key initiatives that focus on
community-based and regional agriculture
will be expanded, including new
investments for beginning farmers and
Policy and
Advocacy Report
Amanda Meadows, MS, RD/LD, CDE, NASM-CPT, is the
section editor for the Policy and Advocacy Report
Did you know the Farm Bill has a formal name? Did you know that an incredible amount
of effort was put forth by many including our Academy leaders as well as members of
Congress to finalize this legislation? SNAP and SNAP Ed funding were just 2 of the key
areas the Academy was working to influence. The Academy’s website policy section
should be one of your bookmarks to keep up-to-date on all of the Academy Public Policy
priority areas.
ranchers that provide incentives to grow
healthy food.
Funding was maintained and/or
reauthorized for all of the following
programs or agencies: National Institute of
Food and Agriculture (NIFA), Agricultural
Research Service (ARS), Human Nutrition
Research Centers (HNRC), Specialty Crop
Block Grants, Senior Farmers Market
Program, Fresh Fruit and Vegetable
Program, Farmers Market Promotion
Program, Seniors Farmer’s Market.
The completed version of the bill took
over two years for Congress to finalize and
will not need to be reauthorized for the
next five years. Over this period of time,
Nutrition Professionals [RDN’s and DTR’s]
can continue to engage their
Congressperson on the role they play in
the well-being of their constituents. The
Academy will continue to support and
pursue initiatives that provide overall wellbeing of the nation. As the Farm Bill is
implemented through the US Department
of Agriculture look for opportunities for
Academy members in Eat Right Weekly. For
information from the academy website on
the Farm Bill see: http://www.eatright.org/
Members/content.aspx?id=6442479879.
18
Spring 2014
Member Benefits
Member Survey 2014 Results
By Juliet Mancino, MS, RD, CDE
A
copy of the WM
DPG Annual
Member Survey
was sent to all members
via email with a link in
February 2014. We
would like to thank the
Juliet Mancino MS,
880+ members who
RD, CDE
completed the survey
and shared your valuable input with the
Executive Committee (EC). All feedback is
reviewed and used to shape our plan of
work and activities for the following
membership year. Below is a summary of
the questions and key answers.
With respect to the value of various services
offered by the DPG (Question 1), the top
three services most valued were the Weight
Management Matters newsletter, our webinars
and the website. More than 800 respondents
(88.6%) Strongly agreed or Agreed that our
DPG seeks and values member opinions
(Question 2). Comments of members who
disagreed were forwarded to the appropriate
committee chairs. Over 300 comments were
received regarding newsletter topic
suggestions (Question 3). We are glad to have
these ideas and they were forwarded to Paul
Moore and Betsy Hirschy, Newsletter Editors.
Question 4 yielded over 250 comments and
ideas for webinars and these ideas were
forwarded to Kristin Walters who heads our
Professional Development Committee. The
Research Committee specifically requested
questions about research needs of members
for this year’s survey. Over 500 members rated
their number one research interest for
newsletter articles as understanding research,
followed by how to collect outcomes. About
60% of members had visited the new WM
DPG website at the time of the survey. Our
blast email team asked what day is best for
members to received blast emails, and the
top choice was Monday. The subject line is
what holds the greatest influence as to
whether members open blast emails. Our
survey asked about social media use. About
25% of survey takers accessed Facebook daily,
but used other social media less frequently.
About half of respondents rarely used
LinkedIn and 75% rarely used Pinterest or
Twitter. With respect to starting a coaching
special subunit, about 75% of respondents
were interested; our goal for 2014-15 is to
start a coaching special interest group. Many
names were submitted for our WM DPG
awards and those were forwarded to Jackie
Ballou and the Nominating Committee. Many
members volunteered to become more
involved in WM DPG and also to be state
liaisons. These names have been forward to
the appropriate EC teams (expect an email).
We are eager to get you involved and thank
you for your support and interest! Lastly,
about 25% of survey respondents have been
to the WM DPG Symposium. Ideas of topics,
place, and time of year were collected and
forwarded to Paul Allen and the 2015
Symposium Committee.
Again, the EC thanks you for your input. We
truly value your input and want this DPG to
serve your needs. Please keep your feedback
coming – contact any person on the EC via
the website. No need to wait for the annual
survey!
Got Data? Update on the new
Member Benefit Award
By Kristine Clark, PhD, RD, FACSM
C
ompare these two
WM members: Lori
has been an RDN
for 5 years and a WM
DPG member for 5 years
while Renee has been an
RDN for 38 years and a
Kristine Clark, PhD, WM DPG member for 10
(the DPG is only 11 years
RD, FACSM
old). But where the true
common thread runs is that both have been
involved in research for only 1 year, inspired
to collect data in their work environments by
the new WM DPG award for emerging
researchers. Keep in mind that neither RDN
is employed as a “researcher.” Rather, Lori
works as a bariatric dietitian and Renee is
the Director of a university-based weight
management program, yet both are eligible
to apply for the new emerging researcher
award.
The new WM DPG member benefit award
(Excellence in Research Outcomes Award
for the Emerging Researcher), established
in 2013, is intended to promote data
collection in all work environments,
demonstrating how nutrition services
impact weight management outcomes.
When Lori read about the award for the first
time she said she was, “always interested in
research, but inspired to take the next steps
necessary to apply for the award.” She
looked into where she could get involved in
a work-based research project, and then
became part of a research team, collecting
weight loss outcomes data post-surgically.
She wrote an abstract reflecting the study
outcome for her upcoming presentation at
the Society of Nutrition Education and
Behavior meeting in June 2014. Only one
published abstract is required to become
eligible to apply for the Emerging
Researcher Award. So many WM DPG
members engaged in collecting outcomes
data in their own work environments could
turn that data into beneficial research
projects further demonstrating the
effectiveness of their work. So, be inspired!
Eligibility criteria for this award can be
found on the WM DPG website under
awards and honors. This member benefit
may truly apply to you!
19
Volume 12 No. 4
From the Editor
Paul Moore, MS, RD, CSSD, LDN, CSCS*D,
NSCA-CPT*D
2013-2014 WM DPG Newsletter Editor
All Good Things Must
Come to an End
A
incredible group of volunteers, members, authors, editors and
everyone associated with the WM DPG. I could not have asked or
imagined a better experience or being able to work with a more
professional group of individuals.
s the spring season symbolizes the end to the long and
relentless winter, the Weight Management Matters
spring newsletter symbolizes the end of the member
year and my term as the Editor for this wonderful publication. I
have enjoyed the last two years of being blessed to work with an
The WM DPG Nominating Committee is pleased to announce the
results of the 2014 Election!
Congratulations and a warm welcome to our new elected
members of the Executive Committee:
Chair Elect: Kristine Clark, PhD, RD, FACSM
Kristine Clark, PhD,
RD, FACSM
Treasurer: Lori F. Greene, MS, RD, CSSD, LD
Lori F. Greene, MS,
RD, CSSD, LD
Monica Lebre, MS,
RD, LDN
Nominating Committee Director-Elect:
Monica Lebre, MS, RD, LDN
Congratulations to Mary Lynn Vassar and Beth Cecil, who won WM DPG 2014-2015 memberships, and Kris Mogensen, who won a $50
gift card by completing their WM Member Surveys and entering the drawing.
Thanks to all of you who participated. Your input is so valuable to to plan the activities and direction of the WM DPG.
J
ulie Schwartz, Chair, and the entire
Executive Committee of the WM DPG
send congratulations to the following
WM DPG members, who are celebrating 50
years as Academy members in the year 2014:
Nancy C. Blaydes
Celia M. Darland
Carol D. Kourany
Maryann Meade
Sachiko St. Jeor
Jean A. Trainor
Celia M. Darland
Carol D. Kourany
Maryann Meade
Jean A. Trainor
20
Spring 2014
Improving Outcomes of a Worksite Wellness
Program with a Client-Centered Nutrition
Intervention
By Seletha Poole, MPH, Becka Wilson, MS, ACSM-CPT, and Hollie Raynor, PhD, RD, LDN
Research
Hollie Raynor, PhD, RD, LDN, is the
research section editor.
Seletha Poole, MPH
R
Becka Wilson, MS,
ACSM-CPT
egistered Dietitian Nutritionists (RDNs)
can provide their expertise to improve
the population’s health in a variety of
settings. One setting in which RDNs are
increasingly providing their expertise is in
the worksite, particularly in how a healthy
diet can enhance employee wellness. Places
of employment use worksite wellness as an
initiative to promote health within an
organization. These initiatives are designed
to influence health behaviors through
altering environmental factors, changing
worksite policy, and incorporating various
programs to influence individual health
behaviors (1).
Programs commonly incorporated into
worksite wellness initiatives include health
fairs, health education seminars, medical
screenings, health coaching, weight
management programs, newsletters, and
fitness programs. Ideally, worksite wellness
initiatives improve employee health, which
in turn increases worker productivity and
decreases health care costs (1).
Within the worksite setting, RDNs can plan,
implement, and evaluate worksite wellness
programs. Steps in program planning
include conducting a needs assessment to
identify needs and priorities, identifying
evidence-based techniques that can be
incorporated into programs to target
identified needs and priorities, and
developing goals and objectives that can
be met by developed programs. Program
implementation involves overseeing
delivery of the developed programs. Finally,
process and outcome evaluations should
The Academy proposes that research is the foundation of the
dietetics profession, as research provides the basis for practice,
education, and policy. This article by Seletha Poole, MPH, Becka Wilson, MS, ACSM-CPT
and myself, is an example of program planning, implementation and evaluation. Ideally,
programs are developed from evidence-based practice and outcomes are collected to
demonstrate the effectiveness of the program. Collecting outcomes from programs in
which RDNs are involved is important for demonstrating the value of RDNs. This article
describes the process of how a Worksite Wellness program, which included a nutrition
component, was developed using evidence-based practices, and how outcome data
were collected.
be conducted to understand how well
programs have been implemented and if
planned goals and objectives were met.
nutrition intervention component to be
included in the program.
The purpose of this article is to provide
an example of the process of planning,
implementing, and evaluating a clientcentered nutrition counseling component
that was added to an existing worksite
wellness program. In particular, this article
focuses on the evaluation design, which
compared dietary changes of employees
who participated in the nutrition counseling
component to those who did not.
To address the need to include a clientcentered nutrition intervention component,
the Worksite Wellness Coordinator contacted
a professor at the University of Tennessee’s
(UT) Department of Nutrition, a RD who
specializes in weight management, about
the possibility of strengthening the worksite
wellness program by incorporating a clientcentered nutrition component. Employee
feedback indicated that employees at
RSC needed group sessions that provided
nutrition education on the Dietary
Guidelines and healthy eating in restaurants.
Additionally, individual sessions were
needed to help employees set individual
goals around the Dietary Guidelines (2),
establish self-monitoring methods for
individual dietary goals, develop action
plans to assist with meeting individual
dietary goals, and problem-solve barriers
to meeting goals.
Radio Systems® Corporation (RSC)
Worksite Wellness Program
Radio Systems® Corporation (RSC) is a
company with approximately 300
employees and is the largest manufacturer
of electronic pet training products in the
U.S. RSC employs a Worksite Wellness
Coordinator who developed a worksite
wellness program to increase the amount
of physical activity employees engaged in
to reduce employee health risk factors.
However following an assessment of
employee satisfaction of the RSC worksite
wellness program, employee feedback
indicated a desire for a client-centered
Program Planning
Planning discussions led to the decision
to develop a two-month intervention
consisting of group and individual nutrition
counseling sessions. As all RSC employees
21
Volume 12 No. 4
participate in a bi-yearly health screening,
it was decided that employees with two or
more health risk factors (i.e., overweight/
obese and have high blood pressure) would
be recommended to attend two group and
four individual nutrition sessions. Employees
with one risk factor were recommended
to attend one group and two individual
nutrition sessions, and employees without
any risk factors were recommended to attend
one group nutrition session. Further, RSC
provided an insurance credit to employees
that attended all recommended sessions
to motivate employee engagement in the
nutrition component of the wellness program.
The team identified four group session
topics to meet the needs of employees
(Table 1). These topics were offered during
nine group sessions over the course of the
two-month program. Each topic was offered
two or three times during the workday so
that employees would have multiple
opportunities to attend sessions. Group
sessions were designed to be 30-45 minutes
in length and started with a check-in, in
which the group leader discussed progress
towards meeting dietary goals with group
members, followed by a planned session
topic that included general nutrition
education and evidence-based cognitive
behavioral strategies that assisted with
making and maintaining behavioral changes.
Over the course of the program, 138
individual sessions were offered to employees.
The individual sessions were designed to
be 20-30 minutes in length and were based
upon a Motivational Interviewing (MI)
approach. The MI approach is an evidencebased, client-centered approach that is
used to produce behavior change in
individuals by helping clients work through
ambivalence and commitment to change
(3). The counselor guides the client toward
goal setting using reflective listening and a
combination of closed-ended and openended explorative questions to better
understand the client’s goals, motivation,
and barriers to making a behavior change.
The goal of MI is for clients to identify
reasons for ambivalence to change,
problem-solve, and to make their own
decisions on how to move forward (3). This
approach allows clients to make informed
decisions regarding behavior change.
To evaluate the impact of adding clientcentered nutrition counseling to the
program, process and outcome evaluation
measures were identified. The process
evaluation included collecting attendance
at both group and individual nutrition
sessions. The outcome evaluation was
designed to evaluate improvements in
dietary intake, particularly regarding
reductions in energy, fat, and sugar
sweetened beverage (SSB) intake and
increases in fruit and vegetable consumption.
Dietary outcomes were assessed via threeday food records. The dietary measures
were to be collected from all RSC
employees, regardless of participation in
the nutrition intervention component of
the wellness program. This would allow
comparisons in changes in dietary intake
in those receiving the nutrition component
part of the wellness program versus those
not. Participation in the evaluation
component was optional for all RSC
employees and was separated from
participating in the wellness program.
To assist with motivation to participate
in the evaluation component, those who
completed all evaluation questionnaires
prior to and after implementation of the
nutrition counseling program were entered
into a drawing to receive a $100 gift card.
Program Implementation
Beginning March 2012, all RSC employees
were invited via email to participate in the
evaluation component of the wellness
program. Employees were notified that
participating in this component was
optional and would not impact on
intervention received in the wellness
program. This email also included an
informed consent form approved by the
Institutional Review Board at UT. All
employees providing consent were given
the evaluation questionnaires (i.e., threeday food record and two-dimensional,
portion-size estimation tools). The nutrition
counseling component was delivered from
May to June 2012. At the beginning of the
program, all employees were emailed the
group session schedule and a schedule of
the available individual sessions. The day
prior to each individual and group session,
all employees who were signed up for a
session were sent reminder emails. All group
and individual sessions were provided by a
master’s level nutrition graduate student,
who was supervised by an RDN.
Program Evaluation
For the process evaluation, attendance rates
for the three risk groups (≥ 2 health risk
factors, 1 health risk factors, and no health
risk factors) were collected and analyzed
using a one-way analysis of variance
(ANOVA) to determine if employees in the
high-risk category (≥ 2 health risk factors)
attended more group or individual sessions
than employees in the other risk groups.
For the outcome evaluation, dietary intake,
measured by three-day food records, was
assessed both prior to the start and at the
end of the 2-month program. Complete
records were entered into Nutrition Data
System for Research (NDS-R) version 2011
for analysis (4). Energy and energy from fat;
along with fruit, vegetable, and SSB servings
consumed per day were averaged and
change scores were computed for each
variable. Additionally, at the end of the
program, employees who participated in
the wellness program and provided
consent were asked to complete an
evaluation survey. This survey included
questions on the overall helpfulness of the
program in meeting personal goals and
how often employees implemented
information/behaviors that were learned in
group and individual sessions. Furthermore,
the survey included an option for employees
to write in specific comments on their likes
and dislikes of the program.
Outcomes
Sixty employees engaged in the nutrition
counseling component for the worksite
wellness program (see Table 1). Of these
60 employees, 55.0% were in the high-risk
category, 36.6% were in the low-risk
category, and 8.3% did not have any riskfactors. Of the employees in the high-risk
and low-risk categories, only two
employees from each category engaged in
the recommended number of group and
individual sessions. However, all employees
without any risk factors met and exceeded
group session attendance recommendations.
Employees with ≥ 2 health risk factors
attended 1.8 ± 1.2 individual sessions and
1.2 ± 1.0 group sessions, while employees
with one risk factor attended an average
of 1.3 ± 1.0 individual and 0.7 ± 0.6 group
sessions. Employees without any risk factors
did not attend any individual sessions;
however, they attended an average of
1.2 ± 0.4 group sessions. Results from the
22
Spring 2014
Table 1. Group Intervention Session Topics and Attendance
Number of Times Offered and Weeks During the Group Session
Concepts Introduced
Program When Offered Average Number
of Employees
Attending (M + SD)
1. Self-Monitoring and Goal Setting
– How to set goals
– Identifying problematic behaviors
– How to keep track of behaviors
– How to read a food label
– 3 times: Weeks 1 and 3
3.6 ± 4.0
2. What Exactly Is Healthy Eating?
– Carbohydrates, protein, and fat
– Healthy eating behaviors
– Serving sizes
13.0 ± 1.4
3. Working With What’s Around You
– Identifying eating cues
– Identifying social cues
– How to avoid/change eating and social cues
– Adding helpful eating and social cues
11.0 ± 5.6
4. Healthy Eating in Restaurants
– Meal planning
– Eating at fast food restaurants
– Healthy food options
– 3 times: Weeks 5, 6, and 8
13.3 ±1.5
Total Participants
Attending Group: 51*
*9 employees did not attend group sessions, but only attended individual sessions.
one-way ANOVA revealed that employees
with ≥ 2 health risk factors and participants
with one risk factor attended significantly
(p < 0.05) more individual sessions than
employees without any risk factors. There
was no significant difference between
employees with ≥ 2 risk factors and
employees with one risk factor in number of
individual sessions attended. No significant
difference occurred in number of group
sessions attended between the three risk
factor categories.
Twenty-nine employees provided dietary
data prior to the start of the worksite
wellness program, and 15 employees
provided dietary data prior to and at
completion of the worksite wellness
program. Of the 15 employees providing
pre- and post-intervention data, 8
employees participated in the nutrition
counseling component of the program. For
the 15 employees providing pre- and postintervention information, they were age
40.0 ± 9.2 years, 37.5% male, 87.5% nonHispanic White, 62.5% married, and 75%
with some college education. For health
conditions, 75.9% were overweight or
obese, 51.7% had elevated blood pressure,
27.6% had elevated cholesterol, 27.6% had
low levels of high-density lipoproteins,
10.3% had elevated triglycerides, and 24.5%
had elevated blood glucose. Almost 50%
had at least two of the risk factors. Prior to
the start of the program, self-reported daily
dietary intake was 2533 ± 980 kcal/day with
24.9 ± 11.6% energy from fat. Employees
also reported consuming 1.5 ± 1.3 servings/
day of fruit, 2.4 ± 1.2 servings/day of
vegetables, 0.9 ± 1.3 servings/day of SSB,
with 0.5 ± 1.1 servings/day of SSB in the
form of soft drinks. While not significant,
evaluation of change scores found several
important trends. For example, employees
who engaged in the wellness program on
average reduced their energy intake (–200
± 631 kcal/day vs. –20 ± 629 kcal/day) and
sugar sweetened beverage intake in the
form of soft drinks (–0.7 ± 1.6 servings/day
vs. +0.2 ± 0.3 servings/day) more so than
employees who did not engage in the
wellness program. No trends were found in
changes in percent energy from fat or
servings of fruits and vegetables.
A total of seven employees completed the
evaluation survey. Of these employees, 71.5%
reported finding the nutrition counseling
component of the wellness program as
being useful, and 57.0% reported finding
the individual nutrition sessions being the
most helpful in working towards goals.
Furthermore, 57.0% of employees found that
monitoring behaviors (such as eating and
physical activity behaviors) was useful in
working towards goals. For the group
sessions, 43% of employees reported that
hearing suggestions from peers was useful.
Furthermore, 71.5% of employees reporting
using information provided in group nutrition
sessions at least one to two days per week.
Frequent comments included program
scheduling issues and the desire to have a
more structured, individualized program.
Conclusion
Previous RSC wellness programs focused on
physical activity, which did not satisfy the
needs of all employees. The incorporation of
a client-centered nutrition intervention
allowed for RSC to improve the existing
wellness program to better meet employee
needs. Approximately 20% of RSC’s
employees participated in the new clientcentered nutrition intervention. While only a
small number of employees participated in
the outcome evaluation, collected measures
suggested that employees engaging in the
program improved their diet by reducing
overall energy intake and consumption of
SSBs. Increasing employee incentives to
participate in outcome evaluations may
lead to improvement in participation and
allow for significant dietary changes to be
detected. Employee feedback indicated that
the individual nutrition counseling sessions
were more helpful for employees in making
behavior changes than the group sessions,
thus increasing the number of individual
nutrition counseling sessions offered to all
RSC employees, not just those at higher risk,
to increase future participation in the
program. To better ascertain long-term
impact of the client-centered nutrition
intervention, follow-up measures on
physiological outcomes and health care
23
Volume 12 No. 4
utilization are needed to ascertain
changes to employees’ health and overall
health care costs.
This program was partially supported by an
Outreach and Engagement Grant from the
University of Tennessee.
Seletha Poole, MPH, is currently a doctoral
student in Nutrition Sciences and Dietetic
Intern at the University of TennesseeKnoxville. She graduated with her Masters of
Public Health in Community Health Education
in May 2014 and will complete the Dietetic
Internship in June 2014. Seletha is primarily
interested in research, focusing on pediatric
weight management and basic eating
research investigating environmental factors
that impact on food consumption.
Becka Wilson, MS, ACSM-CPT, has a Master of
Science in Exercise Physiology from the
University of Tennessee and is currently the
Wellness & Associate Engagement Manager
for Radio Systems® Corporation. In the 5 years
she’s been there, the wellness program has
grown from being primarily activities based
to having an Onsite Medical Clinic and
programing tied to the benefits plan. Becka is
passionate about getting people engaged in
their own health, to take personal ownership.
She enjoys learning how other companies
strive towards this and sharing best practices.
References:
1.Centers for Disease Control and
Prevention. Workplace Health Model.
http://www.cdc.gov/workplacehealth
promotion/model/index.html. Accessed
November 9, 2013.
2.U.S. Department of Agriculture and U.S.
Department of Health and Human
Services. Dietary Guidelines for
Americans, 2010. 7th edition.
Washington, D.C. U.S. Government
Printing Office; 2010.
3.Emmons KM, Rollnick S. Motivational
interviewing in health care settings:
Opportunities and limitations. Am J Prev
Med. 2001; 20:68–74.
4.Schakel S: Maintaining a Nutrient
Database in a Changing Marketplace:
Keeping Pace with Changing Food
Products—A Research Perspective.
J Food Comp and Anal. 2001; 14:315–22.
Book Review
Review by Amy Giffin, MS, RD, CD
Too Busy To Diet
Author: Jacqueline King, MS, RDN, CDE, FADA
and Monica Joyce, MS, RDN, CD
“
Don’t do anything while dieting
that you can’t do for the rest of
your life” is one of the main
points emphasized by Jacqueline
King, MS, RDN, CDE, FADA and
Monica Joyce, MS, RDN, CD, in their new book “Too Busy to Diet.”
Amy Giffin, MS,
The book provides science-based nutritional information in an easy to
RD, CD
read format that anyone can use daily to make healthier lifestyle
choices. The format is refreshing; you don’t need to read the book cover to cover to get
the information you need. Each chapter covers a specific topic so the book can be picked
up as needed to answer your most pressing nutritional questions. Chapter topics range
from fiber and the glycemic index to sushi, carnival fare, and superfoods.
Throughout the book, the authors provide inspirational quotes, quizzes to test your
knowledge, and useful tips, tricks, and lists to help you calculate calories in the food you
eat or calories burned per type of exercise. They provide simple and helpful resources for
planning your meals and logging your food intake, as well as suggested meal plans for
breakfast, lunch, and dinner.
Unfortunately, while this book is filled with resources, being in a hard copy format is
limiting. The authors do have an online blog that they post to regularly; however, they
could also improve their book by creating an electronic version. This would allow readers
to easily connect to the websites and additional resources included and give them the
option to print and utilize all of the lists and tools provided.
Overall, the book is a handy resource for anyone looking to eat healthier or lose weight
and is short on time. Too Busy to Diet provides readers with the well-researched and
current information they need to balance good nutrition with a busy lifestyle.
24
Spring 2014
Stipend Winners
WM DPG SYMPOSIUM:
turning the obesity epidemic around one
student at a time.
Jan Abdelnour, MS, RD, LD, CDE
Jan is a Dietitian/
Diabetes Educator in
the outpatient Diabetes
and Nutrition Resources
Department at Baptist
Health in Jacksonville,
Florida. She graduated
from the Coordinated Undergraduate
Program in Dietetics, University of
Alabama, Tuscaloosa, AL and with a
Masters of Science in Human Nutrition
from the University of Florida, Gainesville,
FL. She has been a Registered Dietitian for
over 30 years, and a Certified Diabetes
Educator for over 10 years.
She has worked in inpatient and outpatient
settings in many areas of dietetics over the
years, including renal, critical care, cardiac
care, diabetes, weight management and
recently bariatrics. The most rewarding
part of her work is helping people make
lifestyle changes to improve their health
and manage their weight.
Jan was thrilled to find out she had won a
stipend to the Weight Management DPG
Symposium 2014! One of her goals for this
year was to attend a professional meeting.
This gave her the opportunity to network
and stay up to date with the latest research
and practice in the area of weight
management, especially bariatrics.
Jill Englett, MS, RD, LD, RN
Jill Goode Englett joined
the faculty at the
University of North
Alabama in September
2005 as an Instructor
of Food and Nutrition.
She is responsible for
teaching nutrition courses offered in the
Department of Human Environmental
Sciences. She has a Certificate of Training
in Childhood and Adolescent Weight
Management and has a passion for
teaching students of all ages about the
benefits of healthy eating with the hope of
Mrs. Englett has been a registered dietitian
for over twenty years. As a longtime
member of the Academy of Nutrition and
Dietetics she held various leadership roles
on a national level, including chair of the
Renal Dietitians DPG (RPG). Mrs. Englett
holds a BS in Foods and Nutrition and a
BSN in Nursing from the University of North
Alabama, an MS in Clinical Nutrition for East
Tennessee State University, and is currently
working towards a DCN in Clinical Nutrition
at Rutgers University. Mrs. Englett
completed her dietetic internship at
University Hospital in Augusta, Georgia.
Lynn Umbreit, MS, RD, LD
Lynn Umbreit MS, RD,
LD, has specialized in
the areas of weight
management and sports
nutrition during her
years as a Registered
Dietitian. She is
presently a Care Manager & Diabetes
Educator with the Southwest
Endocrinology Associates in Albuquerque,
NM where she sees weight loss and
diabetic clients. Previous employments also
include at Clinical Nutrition Center in
Denver, CO (weight management), Diet
Modification Clinic (Houston, TX) and St.
Joseph’s Hospital & Medical Center
(Phoenix, AZ). She has also been a nutrition
consultant to numerous community and
corporate clients, and has taught graduatelevel and adult education nutrition classes.
Lynn has a Master’s degree in Sports
Medicine from Chapman University
(Chapman, CA) and a BS in Nutrition from
Colorado State University (Ft. Collins, CO)
Lynn is Past-Chair of the WM (Weight
Management) and SCAN (Sports,
Cardiovascular, & Wellness Nutrition)
dietetic practice groups of the Academy of
Nutrition and Dietetics, and has served in
numerous other capacities in local, state &
national dietetic organizations. Lynn’s
personal interests complement her
professional ones. She is a recreational
athlete who enjoys running, biking & hiking
as well as loves to garden, travel & spend
time with her husband.
Meridan Zerner, MS, RD, CSSD, LD
Meridan Zerner joined
the Cooper Clinic
Nutrition Department
in 2007, and has
more than 25 years of
experience in health and
fitness. She specializes
in weight management, exercise and sports
nutrition, cardiovascular health and
nutrition through the life cycle. Meridan
is a member of the Academy of Nutrition
and Dietetics, and the SCAN and WM DPGs,
and was a continuing education provider
for the American Council on Exercise. A
marathoner and a former national aerobic
champion, Meridan is also a group exercise
instructor at Cooper Fitness Center. She is a
Certified Wellness Coach and holds a
Master of Science in nutritional science
with an emphasis in health promotion from
the University of Oklahoma and a Bachelor
of Science from Syracuse University.
Elaine Minden, RD
Elaine Minden works as
a Registered/Licensed
Dietitian for Kersh
Health, a corporate
wellness company
based out of Dallas, TX.
She counsels clients
participating in a weight management
program, called Right Weigh. She earned
her bachelor of science degree in
Nutritional Sciences from Texas A&M
University and completed her dietetic
internship at Saint Louis University with an
emphasis in Nutrition and Physical
Performance. Elaine has a passion for
wellness and loves to help others strive
towards a healthy lifestyle. She was grateful
for the opportunity to attend the 2014 WM
DPG Symposium because, as a new
dietitian, she feels that she has so much
more to learn from experienced dietitians
25
Volume 12 No. 4
and practitioners about weight
management counseling. Elaine hopes to
advance her practice skills so that she can
be successful in helping her clients make
positive changes in their nutrition, physical
activity, and overall health.
Jenna Abrassart, MPH, RD
Jenna Abrassart
currently reside in
Redlands, CA, which is
known as the “Gem of
the Inland Empire.” She
graduated from Loma
Linda University with a
master’s in Public Health-Nutrition and
Dietetics in December of 2012. She has
gained experience in a variety of dietetic
fields in her first year; ranging from Skilled
Nursing facilities, an AIDS clinic, hospice,
and some long-term pediatrics. Currently,
she works in two fields, one as a dietitian in
a pharmacy working with the parents of
children on formulas and enteral feeding
and the other as a consultant dietitian for a
Bariatric/Weight management privatebased surgery group in Corona/Murrieta,
CA. As a bariatric dietitian, she works closely
with the clients who are planning on having
the surgery in the hopes of improving their
overall health. She leads clients through a
6-month weight management program,
which includes designing handouts and
leading the lecture portion of the support
group. Additionally, she conducts initial
assessments, monthly follow-ups, and postop consultations. The organization’s vision is
that bariatric surgery can be used as a “tool”
which when coupled with proper nutritional
habits, physical activity, and lifestyle
changes can lead to overall wellness. She
enjoyed the informational and networking
opportunities that were available at the
symposium. She hopes to be able to add
new knowledge and skills to her repertoire
to better serve her clients, as well as further
her own ambition to learn more in the field
of weight management nutrition. She is
eager to learn and meet new people who
share her passion for weight management.
Danielle Mach, RDN, LD
Danielle Mach
graduated from the
University of Illinois
Champaign Urbana with
a BS in Dietetics and
completed her dietetic
internship at Saint Louis
University. After passing the RD exam, she
continued to pursue graduate school at
Saint Louis University to achieve a Master’s
degree in Nutrition and Physical Performance
to achieve more knowledge in both
nutrition and exercise physiology. She plans
on working with a weight loss camp for
children for her thesis in hopes to complete
the project by the end of 2014. Her goal
after receiving her master’s degree is to
work with adults and children in the
community to educate them on proper
nutrition and exercise protocols to aid in
achieving a consistently, healthy lifestyle.
She is very grateful and appreciative to
have received a stipend for the 2014 WM
DPG Symposium to learn more about up
and coming research related to weight
management for both adults and children
to utilize in future career opportunities.
Nataliia Johnson, student at
Tennessee State University
Nataliia Johnson just
graduated Summa Cum
Laude with B.S. in
Dietetics from
Tennessee State
University, TN.
Nataliia was born into a military family in
Russia. When she was about 5 years old, her
family moved to Ukraine. Throughout her
middle and high school years, Nataliia took
part in various academic competitions,
such as chemistry, biology, reading and
writing Olympiads. In addition, she was
very active playing badminton, basketball,
and volleyball. At 17 years old, Nataliia
graduated from the specialized school of
History with high honors. Then, she
enrolled in Nikolayev State University to
study linguistics. She speaks Russian,
English, and Ukrainian fluently.
In 2007, Nataliia Johnson moved to the
U.S. in pursuit of knowledge. Her lifelong
fascination with health, nutrition, and the
dream of becoming a Registered Dietitian,
led her to choose a career in Foods and
Nutrition at TSU. Nataliia is currently working
as a research assistant on a USDA-Funded
research project at her university. In
addition, she has a part-time job as a Dietary
Aid at The Heritage at Brentwood, TN.
Although, at times it is challenging to juggle
work and a personal life, Nataliia still finds
time to volunteer. She is extremely proactive
when it comes to advocating for nutrition,
bringing awareness about a healthy lifestyle,
emphasizing the issue of hunger, and paying
it forward by volunteering in places that
make a difference in people’s lives. She is
also currently teaching nutrition education
classes for preschool children at the Martha
O’Bryan Center.
Nataliia’s short term goal is to complete an
internship program. She persistently seeks
to prepare herself for the competitive
internship application by regularly reading
subject-relevant books, scientific journals,
and attending meetings and seminars. She is
working to get her master of science degree
within 4 years of graduation in order to
deepen the knowledge of the field and to
be able to better compete in the workplace.
Another career goal is to work for the
Academy of Nutrition and Dietetics as a
valuable contributor and a spokesperson.
Finally, the highlight of Natallia’s career
would be to open her own health and
wellness clinic to contribute to the wellbeing of the community. Her preparation for
a lifetime career as a nutritionist is ongoing.
She has determination and patience to take
on any task that may arise along her way to
fulfill her life plan.
Nataliia has been a fan of the Weight
Management Practice Group for a long
time and winning this stipend means the
world to her. She admires their
commitment to optimizing the nation’s
health through weight and lifestyle
management. The stipend enabled her to
meet the Weight Management Symposium.
It gave her a chance to meet new people in
her field of interest. The symposium helped
her to further her understanding of the
complicated issues involved in weight
management.
26
Spring 2014
Christine Chan, MBA, student in
Kansas State University Distance
Didactic Program
Pui Lun Christin Chan
resides in Las Vegas and
is currently a senior in
Kansas State
University’s Distance
Didactic Program. She
will be graduating in
May 2014. She is a non-traditional college
student, looking for a career shift to
become a Registered Dietitian after having
spent several years in another field. She
has a BA in English Literature from the
University of Nevada, Las Vegas, and an
MBA from the University of Wisconsin,
Whitewater. In her former career, she
worked in e-commerce retail and IT
product management.
As a dietetics student, she tried to obtain
as much experience as she could in the
profession by volunteering and working
for different facilities. Some of the
experiences include working as a diet clerk
at a local hospital, delivering nutrition
education to over 1,000 children for the
Southern Nevada Health District,
participating in the recipe analysis
committee for the Flavors of the Heart
Annual Event for the American Heart
Association, packing lunches and helping
at a youth homeless shelter on behalf of
the Three Square Food Bank. Finally, she
also recently published an article on the
benefits of prenatal and postnatal yoga in
the latest book by Bridget Swinney, RD,
Eating Expectantly, 4th edition.
She is thrilled to be the recipient of the
Weight Management Symposium 2014
student stipend. One of the practice areas
of dietetics that she is most interested in is
weight management. This award allowed
her to attend the event and meet industry
professionals. Without the award, she
would not have been able to afford to do
so. She was very excited to have the
opportunity to gain an in-depth
understanding of the subject of weight
management. Not only did this award
enhance her knowledge, it also helped
prepare her to become a better dietitian.
Public Policy Workshop:
Wendy Baier, RD
Wendy is a new
registered dietitian,
recently graduated
from the University of
Maryland College Park
Dietetic Internship.
Since her graduation,
she has been an active member of the
Connecticut Dietetic Association on their
communications committee, focusing on
their blog. She has just begun her first RD
job with the Mid-Fairfield AIDS project in
Norwalk, CT providing nutritional counseling
and working with their food pantry.
Last year, she was able to attend a day of
the Public Policy Conference as an intern.
She was very excited to get the full
experience this year and see nutrition
advocates in action. She firmly believes
that if nutrition is your profession, politics
is your business!
Stella Uzogara, PhD, MS, RDN, LDN,
CFS
Dr. Stella Gladys Uzogara
is a nutritional
epidemiologist in the
Bureau of Family Health
and Nutrition at the
Massachusetts
Department of Public
Health, in Boston, Massachusetts and
recipient of a Public Policy workshop
stipend. Stella earned her PhD degree in
food science from Kings College, University
of London, UK. She has an MS degree in
nutrition and food science from Drexel
University in Philadelphia, PA and a BS
degree in biochemistry from University of
Ibadan, Nigeria. Stella had her training in
nutrition and dietetics at Simmons College
in Boston MA and at Iowa State University
in Ames Iowa. Stella is a certified food
scientist (CFS), a registered dietitian
nutritionist (RDN) & a licensed dietitian
nutritionist (LDN) in the Commonwealth of
Massachusetts. She resides in Lexington,
Massachusetts with her husband and
children.
Susan Burke March, MS, RD, LDN, CDE
Susan Burke March is a
registered dietitian with
advanced certificates in
adult and pediatric &
adolescent obesity
management and is a
certified diabetes
educator. She graduated magna cum laude
from Queens College of the City University
of New York, where she also earned her
Masters Degree in Nutrition & Exercise
Sciences. Susan was an important
contributor to the development of
commercial online weight management
programs. As Vice President of Nutrition
Services and Chief Nutritionist for industry
leader eDiets.com, she managed the
creation and administration of the
technology-enabled nutritional and
wellness components of products,
programs and services.
Susan is the author of Making Weight
Control Second Nature: Living Thin Naturally,
(2009, Mansion Grove House), plus the
study guide, published by Wolf Rinke
Associates, providing professionals with 26
continuing education credits (CPEUs). Her
recent eBook (2011 Amazon.com) is called
The Common Cent$ Diet, a smart, budgetfriendly and convenient way to practice
portion control by utilizing healthy frozen
entrees plus daily fresh fruits, vegetables
and dairy choices.
In her private consultant and counseling
practice, Susan works with individuals on a
one-to-one basis to incorporate lifestyle
modifications and improve health and
reduce risk for diseases associated with
overweight and obesity. She consults with
corporations to create and deliver
innovative strategies designed to improve
health and accomplish weight goals.
Susan is a media spokesperson for the
Florida Dietetic Association and is a
founding member of the Weight
Management Dietetic Practice Group of the
Academy of Nutrition and Dietetics, where
she served a two-year elected position as
Secretary, and served a three-year term as
Sponsorship Relations Director.
27
Volume 12 No. 4
She was honored to be able to attend The
2014 Academy of Nutrition and Dietetics
Public Policy Workshop on behalf of the
WM DPG. She would like to thank Weight
Management for their generous stipend.
She had never attended this workshop. It
was a great networking and educational
experience and she was thankful for
learning about the critical policies that
impact the health of the nation and the
dietetics profession, and having the
opportunity to meet with members of
Congress and voicing her opinion was a
chance of a lifetime. She would like to
thank the Weight Management DPG for
fulfilling her dream.
Mehr Cox, MS, RDN
Mehrshid (Mehr) Cox, is
a Registered Dietitian
Nutritionist and is
licensed to practice in
the State of Texas. She
has her Bachelor and
Master Degrees in Food,
Nutrition and Institution Management
from East Carolina University, and has
been a resident of Coppell, Texas for the
past 20 years.
Mehr started her career as a clinical
dietitian in Greenville, NC at Pitt County
Memorial Hospital. Following that, she and
her husband purchased and operated an
upscale, fine-dining restaurant in the same
city prior to moving to Texas in the early
1980s.
Once in Texas, Mehr accepted a position
with Parkland Memorial Hospital in Dallas,
as an administrative and purchasing
dietitian for this 1000 bed hospital. Several
years later, Mehr was offered a position to
serve as the Director of Nutrition Services
for the USDA Child and Adult Care Food
Program at ChildCareGroup, a not for profit
organization serving over 20,000 low
income children with an operating budget
of over 50 million dollars. After 10 years in
that capacity, Mehr was promoted to VP of
Marketing and Community Outreach
overseeing 5 operating divisions. In
December 2012, after serving the
organization for over 26 years, Mehr
resigned from her position to spend more
time with her family, travel the United
States, and continue to help and consult
with the facilities that care for low income
children to promote healthy nutritional
habits and fight against childhood obesity.
Throughout the years, Mehr has been an
advocate for low income families to receive
the best nutritional care for their children.
As a member of the Weight Management
DPG and the recipient of the stipend for the
Public Policy Workshop in 2014, Mehr was
thrilled to have the opportunity to attend
this worthy conference to learn as much as
she can in order to continue her passion
and advocate for critical policies affecting
the health and well-being of millions of
Americans. Her mission has and will always
be to find and share the resources needed
for families to access proper nutrition.
CDR Certificate of Training in
Weight Management:
Allison Rueff, RD, LD
Allison is a registered
dietitian with The Christ
Hospital in Cincinnati
Ohio. Through the
hospital she provides
outpatient nutrition
counseling, runs a community weight loss
program and provides corporate wellness
services to companies throughout the TriState. Along with being a member of the
Weight Management DPG, she is also a
member of the Sports, Cardiovascular &
Wellness Nutrition DPG. She is grateful for
receiving the Weight Management
Certification stipend because it gives her
the opportunity to enhance her knowledge
of weight management which will help to
increase the success of the clients she
works with.
Elaine C Souza, MPH, RD
Elaine received her BS in
Community Nutrition
from University of
California Davis, and
completed her Master’s
in Public Health
Nutrition and Dietetic
Internship at the University of Minnesota
Twin Cities campus. Currently, she works as
a Senior Dietitian at the University of
California Davis Medical Center’s Bariatric
Surgery Clinic. Most recently she
participated as primary author on an
accepted poster at Obesity Week 2013.
She worked for several years in research;
first, at the University of Pittsburgh, School
of Public Health working on nutrition
epidemiology studies, then for the USDA
Western Human Nutrition Research Center.
While at the WHNRC she had the
opportunity to work on many research
studies focusing on diet assessment, and
ultimately became project manager on a
weight loss study grant, from which she has
been fortunate to have shared authorship
on several manuscripts. During this time,
she also worked per diem for Kaiser
Permanente as a health educator for their
Healthy Ways and Medically Supervised
Weight Loss Programs.
Elaine is a member of Northern Area
Dietetic Association, California Dietetic
Association, the Academy of Nutrition and
Dietetics (Weight Management Dietetic
Practice Group and Women’s Health
Practice Group) and an affiliate member
of ASMBS.
Receiving this stipend allowed her the
opportunity to continue her education
in obesity treatment, a field that she is
passionate about. She was thankful for this
chance, and would like to express sincere
gratitude to the Weight Management
Dietetic Practice group for providing a
great support for professional
development.
28
Spring 2014
WM DPG 2014 Excellence Awards
Congratulations to the 2014 WM DPG Excellence Award winners.
Excellence in Weight Management Outcomes Research:
Susan Raatz, PhD, MPH, RD
Excellence in Weight Management Practice:
Eileen Stellefson Myers, MPH, RD, FAND
Dr. Susan Raatz completed a BS in Nutrition at
Northern Michigan University in Marquette,
MI; her internship at the VA Hospital in
Saginaw, MI; a MS in Foods & Nutrition at
Eastern Michigan University in Ypsilanti, MI;
and a MPH in Epidemiology and PhD in
Human and Clinical Nutrition at the University
of Minnesota in Minneapolis, MN. She’s been a WM DPG member
since 2009.
Eileen has been an Academy of Nutrition and
Dietetics member since 1980 and WM DPG
member since 2007. She completed her
undergraduate degree at Penn State, her
dietetic internship at the Peter Bent Brigham
Hospital in Boston, and her MPH at the
University of North Carolina. Eileen developed
a weight management gram at the Faulkner Hospital near Boston
and developed and ran a wellness program at St. Francis Xavier
Hospital in Charleston, South Carolina. In 1990, Eileen was
recruited to the Medical University of South Carolina where she
was Associate Director of Weight Management and the Nutrition
Specialist for the Eating Disorders Program. Prior to her current
position as Vice President, Affiliations and Patient Centered
Strategies for The Little Clinic, Eileen ran a successful private
practice focused on patient counseling, writing, speaking
and mentoring.
Dr. Raatz currently is a Research Nutritionist at the USDA
Agricultural Research Service and Grand Forks Human Nutrition
Research Center in Grand Forks, ND. She also serves as an
Adjunct Associate Professor for the Department of Food Science
and Nutrition at The University of Minnesota, St. Paul, MN and an
Adjunct Scientist at the Neuropsychiatric Research Institute in
Fargo, ND. Dr. Raatz’s research focuses on the evaluation of the
role of dietary macronutrient distribution in the promotion of
optimal health and the prevention of chronic diseases. She
primarily works with the utilization of whole foods diets to
modify energy distribution from macronutrient substrates. Her
work is focused primarily on macronutrient (carbohydrate,
protein and fat) modification for metabolic control, body weight
management, and the prevention of chronic diseases.
Eileen spent many years teaching and mentoring dietetic interns,
medical students, nurse midwifery students, psychology interns
and psychiatry residents about nutrition, weight management
and eating disorders at programs in Massachusetts, South
Carolina and Tennessee. She pioneered incorporating cognitivebehavioral therapy and motivational interviewing into nutrition
counseling in the early 1990s.
Eileen has served as Network Chair, Secretary, and Nominating
Chair for the Weight Management Dietetic Practice Group and
currently serves as co-chair for the committee developing the
Standard of Practice/Standard of Professional Performance for
weight management.
The WM DPG recognizes McNeil Nutritionals, LLC for sponsoring the
2014 Excellence in Weight Management Outcomes Research Award
29
Volume 12 No. 4
Upcoming Events for 2014-2015
June 26-28, 2014
CDR Certificate of Training in Adult Weight
Management
Columbus, OH
www.cdrnet.org
September 25-28
Obesity Action Coalition National Convention
Orlando, FL
www.obesityaction.org
October 18-21, 2014
Academy of Nutrition and Dietetics
Food & Nutrition Conference & Expo (FNCE)
Atlanta, GA
www.eatright.org/fnce
July 9-12, 2014
NSCA Annual Conference
Las Vegas, NV
www.nsca.com
November 2-7, 2014
Obesity Week
Boston, MA
www.obesityweek.com
September 4-6, 2014
CDR Certificate of Training in Childhood and
Adolescent Weight Management
Newport Beach, California
www.cdrnet.org
April 17-19, 2015
WM DPG Symposium
Portland, OR
www.wmdpg.org/symposium
Weight Management Dietetic Practice Group
Mission
Empower members to be the nation’s weight management and lifestyle change leaders.
Vision
Optimize the nation’s health through weight and lifestyle management.
Viewpoints and statements in this newsletter do not necessarily reflect policies and/or official positions of the Academy of Nutrition and Dietetics.
© 2014 Weight Management Dietetic Practice Group of the Academy of Nutrition and Dietetics.
30
Spring 2014
2013-2014 Weight Management Dietetic Practice Group
Leadership Directory
Chair
Julie Schwartz, MS, RDN, CSSD, LD
[email protected]
Special Projects Chair
Emily Korns, MBA, RD
[email protected]
Student Services Coordinator
Meredith Johnson, MS, RDN, LD
[email protected]
Chair-Elect
Anne Wolf, MS, RD
[email protected]
CPEU Chair
Amanda (Amy) Giffin, RD, CD
[email protected]
Volunteer Chair
Barbara J. Ivens, MS, RD, FADA
[email protected]
Past-Chair
Linda Gigliotti, MS, RD, CDE
[email protected]
Communications Director
Lori F. Greene, MS, RD, LD
[email protected]
Sponsorship Relations Director
Kristen Smith, MS, RD, LD
[email protected]
Secretary
Eileen Ford, MS, RD
[email protected]
Website Editor
Ashley Mullins, RD, LD, CNSC
[email protected]
Sponsorship Relations Assistant Director
Meghan Ariagno, RD
[email protected]
Treasurer
Monica Lebre, MS, RD, LDN
[email protected]
Associate Website Editor
Caroline Luck, RD, LD
[email protected]
Bariatric Surgery Subunit Chair
Stacy Paine, RD, LD
[email protected]
HOD DPG Delegate
Pat Harper, MS, RD, LDN
[email protected]
Newsletter Editor
Paul Moore, MS, RD, CSSD, LDN
[email protected]
Pediatric Subunit Chair
Samantha Weiss, RD
[email protected]
Nominating Committee Director
Jackie Ballou, MS, RD, LDN
[email protected]
Associate Newsletter Editor
Betsy Hirschy, RD, LD
[email protected]
Reimbursement and Public Policy
Amanda Meadows, MS, RD/LD, CDE, NASMCPT
[email protected]
Awards and Honors Chair
Lynn Grieger, RD, CDE, CPT
[email protected]
Assistant Newsletter Editor
Emily Stern
[email protected]
Policy and Advocacy Leader
Chris Weithman MBA, RDN, LDN
[email protected]
Professional Development Director
Kristin Walters, RD
[email protected]
Electronic Mailing List (EML) Chair
Sandra Carpenter, MS, RD, LDN, CDE
[email protected]
Network Director
Sue Cummings, MS, RD, LDN
[email protected]
2014 Symposium Chair
Paul Allen, MBA, MS, RDN
[email protected]
Blast eMail Chair
Laura Andromalos, RD, LDN
[email protected]
Network Director Assistant
Kellene Isom, MS, RD, LDN
[email protected]
Research Chair
Hollie Raynor, PhD, RD, LDN
[email protected]
Member Services Director
Juliet Mancino, MS, RD, LDN, CDE
[email protected]
Weight Management DPG
Administrative Manager
Lisa Sands, MS
[email protected]
800.877.1600 x 1150
Member Recruitment & Retention Chair
Angie Hasemann, RD, CSP
[email protected]
31
Volume 12 No. 4
Paul Moore, MS, RD, CSSD, LDN, CSCS*D, NSCA-CPT*D
232 Boone Heights Drive
Boone, NC 28607

Weight Management Matters

Transcription

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