European Association for the Study of Obesity Position Statement on Medical Nutrition Therapy for the Management of Overweight and Obesity in Adults Developed in Collaboration with the European Federation of the Associations of Dietitians
EASO and EFAD Position Statement on Medical Nutrition Therapy for the Management of Overweight and Obesity in Children and Adolescents
Lead author, Maria Hassapidou, provides context for these publications.
In 2021 on average 23% of adults in the European Union were living with obesity; overweight and obesity affected nearly 60% of adults in Europe. The past three decades have seen a rise in the prevalence of obesity, and although rates are decelerating the trends remain positive. By 2025, 1 in 4 Europeans could be living with obesity, and if trends continue, in some European countries the prevalence of obesity could be much higher. For example, by 2025 the prevalence of obesity in Ireland could reach 43%. Obesity affects individuals across the lifespan, but by 2054 it is projected adults aged 60-69 years old could be the most affected. Regarding children and adolescents, the incidence and prevalence of higher BMI continue to increase, with estimates that by 2025, 340 million 5-19-year-olds will have a BMI classified as overweight or obesity
The 2 position statements that are launched today, one on medical nutrition therapy (MNT) in the management of overweight or obesity in children and adolescents, and a second on MNT for adults living with overweight and obesity, were developed by an expert committee convened by the European Association for the Study of Obesity (EASO) in collaboration with the European Federation of the Associations of Dietitians (EFAD). They are based on the best evidence available from systematic reviews of randomised controlled trials on overweight and obesity treatment and other relevant peer-reviewed literature. Multi-component behavioural interventions are generally considered to be the gold standard treatment for people living with obesity. MNT is an evidence-based nutritional therapeutic approach used in the nutrition care process (NCP) of treating and/or managing chronic diseases. Individual MNT (IMNT) is usually conducted in clinical or primary care settings and includes nutrition assessment, diagnostics, therapy and counselling. There is an identified need for specific and comprehensive evidence-based guidelines informing individual, age-appropriate medical nutrition therapy (MNT), that are consistent with a chronic disease management model to obesity care that is focused on improving health and well-being rather than weight loss alone. Medical Nutrition Therapy should be administered by trained dietitians as part of a multidisciplinary therapeutic approach and should aim to achieve positive health outcomes, not solely weight changes. A diverse range of nutrition interventions are shown to be effective in the treatment of obesity and its comorbidities, and dietitians should consider all options and deliver personalized interventions. Although caloric restriction-based interventions are effective in promoting weight reduction, long-term adherence to behavioural changes maybe be better supported via alternative interventions based on eating patterns, food quality and mindfulness. All healthcare professionals should be aware of conscious and unconscious bias which may hinder access to, and effectiveness of, treatments.
The Nutrition Working Group (NWG) of the European Association for the Study of Obesity (EASO) identified, defined and gained consensus on the scope of the guidelines (age range, geographic region, treatment approaches, context, evidence synthesis process, expert input) and the approach to guideline development. Under the EU Platform for Action on Diet, Physical Activity & Health the Platform, there was a joint commitment made by EASO and the European Federation of the Association of Dietitians (EFAD) to map and address the needs of healthcare professionals and policy-makers in the area of dietetic management of obesity. A standing committee was created from members of the NWG of EASO and the European Specialist Dietetic Network (ESDN) Obesity committee of EFAD, which included dietitians, physicians and other health professionals. In previous years, the committee commissioned a series of reviews and surveys and collaborated with similar organizations abroad for knowledge exchange and the promotion of international collaboration. Prior to the creation of the European Guidelines, the Committee conducted and published a survey of available guidelines for the dietetic treatment of obesity across Europe. Although several guidelines were identified, the majority of European countries did not have guidelines based on the latest scientific evidence; these were lacking regular updates. In a follow-up survey, it was highlighted that dietitians often consult guidelines from other countries or regions when designing obesity treatment plans. Based on these survey results, the committee identified the following priorities in the guideline creation process:
- The guidelines should be based on the latest available evidence
- The guidelines should aim to expand on the existing state-of-the-art knowledge
- The guidelines should act as a platform for collaboration across countries and regions
- The guidelines should be transversal and applicable in all European countries
- The guidelines should allow for local adaptation based on the needs and priorities of each country/region
In the lifetime of the project, the Canadian Adult Obesity Clinical Practice Guidelines (CPGs) were issued by Obesity Canada and the Canadian Association of Bariatric Surgeons and Physicians, which included an extensive review of the literature from January 2006 to June 2018. In the spirit of creating universal guidelines and building upon previous initiatives, the committee decided that the literature review that informed the Canadian CPGs will not be repeated but instead it will be expanded and updated with the latest evidence (2018-2021). A close collaboration with the Canadian Guideline committee was set in place to ensure alignment and in the current paper on MNT for adults living with obesity. Furthermore, a close collaboration was also established with the University of Newcastle (UON) in Australia which had already published systematic reviews on dietary treatment for children living with overweight and obesity in order to base and further update the literature review.
Now that both papers are published, the committee has discussed with EASO and EFAD the next steps and will proceed to develop practical guidelines for health professionals and guidance for patients living with obesity To this end, the committee is planning to collaborate with societies of health professionals and with patient groups in order to assess their needs (through questionnaires, focus groups etc) before developing practical recommendations.
Maria Hassapidou, Professor of Nutrition and Dietetics, International Hellenic University(IHU), Greece Chair of EFAD ESDN Obesity Group, Co-chair, EASO Nutrition Working Group
Maria Hassapidou is currently a Professor in the Department of Nutritional Sciences and Dietetics at the International Hellenic University. She is also the coordinator of the post-graduate course on Clinical nutrition and director of the Human Nutrition Laboratory.
She has coordinated and/or participated in several research projects funded by the EU (Health, Diets I and II, Healthgrain, EURRECA, JANPA, BigO, PROTEIN), the Greek Ministries of Health, Education, Research and Technology as well as food and pharmaceutical companies in the areas of dietary assessment and nutritional evaluation, dietary treatment of obese patients with cardiometabolic diseases and childhood obesity.
She is the national coordinator for Greece for COSI (WHO European Childhood Surveillance Initiative), chair of NWG (Nutrition Working Group) of EASO, member of the board of trustees of EuFoDiN (European Foundation of Dietetics and Nutrition) and chair of the European Specialized Dietetic Network (ESDN) of EFAD on Obesity. She is a member of the Hellenic Nutrition Policy Committee of the Greek Ministry of Health.
She has authored several books and has published more than 100 scientific papers in peer-reviewed journals and conference proceedings in the areas of nutrition and obesity. She is also a reviewer in many related European and International journals.