DAA Best Practice Guidelines for the Treatment of Overweight and Obesity in Adults Report to inform the 2011 revision of the 2005 guidelines 25 January 2012 1 Acknowledgements It is important to acknowledge the members of the DAA consortium who have conducted the review of the evidence. These are as follows:- University of Newcastle (UoN) consortium team members . Professor Clare Collins, FDAA (Chair), Co-Director of The University of Newcastle Priority Research Centre in Physical Activity and Nutrition, NHMRC Career Development Fellow . Dr Melinda Neve, APD, (Project Manager), Postdoctoral Research Fellow, School of Health Sciences, Faculty of Health, The University of Newcastle. Dr Michelle Palmer, APD, formerly the School of Public Health, Griffith University, Qld . Dr Lesley MacDonald-Wicks, APD, Lecturer in Nutrition and Dietetics, School of Health Sciences, Faculty of Health, The University of Newcastle. Professor Lauren Williams, AdvAPD, formerly UoN, currently The University of Canberra . Dr Surinder Baines, APD, Senior Lecturer in Nutrition and Dietetics, School of Health Sciences, Faculty of Health, The University of Newcastle . Dr Tracy Burrows, AdvAPD, Lecturer in Nutrition and Dietetics, School of Health Sciences, Faculty of Health, The University of Newcastle . Dr Alexis Hure, AdvAPD, Postdoctoral Research Fellow, Centre for Research Excellence in Women’s Health in the 21st Century, Faculty of Health, The University of Newcastle The assistance of the following dietitians is also acknowledged Kristine Pezdirc APD, Lana Mitchell APD, Roberta Asher APD, Jenna Hollis APD and Caitlin West. Thanks also to Professor Sandra Capra, AM, FDAA. We thank the Obesity Reference Group appointed by DAA to provide advice to the consortium review team and who critiqued the survey and review. These are as follows:- . Dr Janet Franklin APD . Corinna Michael APD . Jacqueline Muller APD . Kay Gibbons FDAA . Melanie McGrice AdvAPD . Riana Pienaar APD . Anita Star APD . Melissa Barnes APD . Amy Lewis APD . Megan Alsford APD 2 ISBN 978-0-9871143-6-5 DAA Canberra 2012 3 Table of contents List of tables ............................................................................................................................................................................................. 6 List of figures ........................................................................................................................................................................................... 8 Executive summary............................................................................................................................................................................ 12 1. Part One: Systematic review of the literature ......................................................................................................... 16 1.1 Background ............................................................................................................................................................................... 16 1.2 Methodology ............................................................................................................................................................................. 16 1.3 Results ......................................................................................................................................................................................... 18 1.3.1 Energy restriction systematic review ............................................................................................................... 18 1.3.1.1 Energy restriction ........................................................................................................................................................ 19 1.3.1.2 Meal replacements and VLCDs................................................................................................................................ 21 1.3.1.3 Macronutrient composition ..................................................................................................................................... 25 1.3.1.4 Popular diets....................................................................................................................................................................... 27 1.3.2 Modification of fat composition systematic review ..................................................................................... 28 1.3.2.1 Monounsaturated fatty acids .................................................................................................................................. 29 1.3.2.2 Omega-3 Fatty Acids .................................................................................................................................................. 30 1.3.3 Modification of carbohydrate composition systematic review ....................................................................... 32 1.3.3.1 Glycaemic index/glycaemic load ................................................................................................................................. 33 1.3.4 Modification of calcium or dairy composition systematic review ......................................................... 35 1.3.4.1 CLA supplementation ................................................................................................................................................. 36 1.3.4.2 Calcium and Vitamin D supplementation ........................................................................................................... 36 1.3.4.3 Calcium supplementation ......................................................................................................................................... 36 1.3.4.4 Amount of calcium ...................................................................................................................................................... 37 1.4.4.5 Source of calcium .............................................................................................................................................................. 38 1.3.5 Behavioural/psychological approaches to dietary interventions systematic review ............................ 39 1.3.6 Meal frequency literature review ........................................................................................................................ 43 1.3.7 Nutragenetics literature review ........................................................................................................................... 43 1.3.8 Drug therapy literature review ............................................................................................................................. 44 1.3.9 Comparisons between 2005 DAA weight management guidelines and current findings .................... 47 1.4 Discussion .................................................................................................................................................................................. 48 1.5 References ................................................................................................................................................................................. 50 1.6 Summary of evidence tables .............................................................................................................................................. 70 2. Part Two: Survey of dietetic intervention in overweight and obesity ....................................................... 141 2.1 Objectives................................................................................................................................................................................ 141 2.2 Methods ................................................................................................................................................................................... 141 2.2.1 Sample and recruitment................................................................................................................................................ 141 4 2.2.2 Survey development ....................................................................................................................................................... 141 2.2.3 Measures ............................................................................................................................................................................. 141 2.2.3.1 Demographic and service profile ........................................................................................................................ 141 2.2.3.2 DAA Best Practice Guidelines for the Treatment of Overweight and Obesity Evaluation .............. 141 2.2.3.3 Current dietetic practice ............................................................................................................................................. 142 2.2.4 Data analysis ...................................................................................................................................................................... 143 2.3 Results ...................................................................................................................................................................................... 143 2.3.1 Demographic and service profile ...................................................................................................................... 143 2.3.2 DAA Best Practice Guidelines for the Treatment of Overweight and Obesity in