EASO-EFAD Mapping dietetic guidance on obesity  - PowerPoint Presentation

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EASO-EFAD Mapping dietetic guidance on obesity 

Survey Ellen Govers, RD, NWG (Nutrition working group EASO/EFAD)

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European Specialist Dietetic NetworkObesity

The ESDN Obesity has 6 membersMaria HassapidouEllen Govers

Tanja CallewaertHilda Mulrooney

Oddysseas Androutsos

Anthonis

Vlassopoulos

EFAD | The European Dietitians | www.efad.org | secretariat@efad.org

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Programme

Why a questionnaire?Outcomes Conclusions

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Why a questionnaire

The first questionnaire had little response.We had no insight in the methods and knowledge of dietitians treating obesity.Dietitians are a valuable source of expertise in the management of obesity which should be used to increase the quality of interventions applied in all centers where obese patients are treated. The aim of the survey

was to identify best practice by dietitians in terms of dietary intervention and to improve quality and evidence based care.Mapping

gives additional information for development

of FBDG

for

obese adults & children (phase 1 and 2).

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Methods

First questionnaire to COM’s (2016)Same questionnaire + some more questions through EFAD secretariat (survey monkey) to all member associationsResponses collected, december 2016Analyses by ESDN Obesity

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Outcomes

229 questionnaires were returned, of which 44 questionnaires were not fit for analysis.Exclusion criteria: absence of general information (work setting and country). 185 questionnaires were used for the analysis.

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General information about the

practice: work setting

SettingNHospital

84Private practice

86

Teaching

3

Endocrinology

2

Research2

Bariatric

Surgery

2

Rehabilitation

3

Public Health

1

University

1

Prevention

1

185

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Which country

Country

NCountryNAustria

43Italy

4

Azerbajcan

1

Luxembourg

1

Belgium

10

Netherlands

5

Croatia

3

Norway

12

Cyprus

1

Poland

1

France

31

Portugal

5

Germany

3

Romania

2

Greece

10

Serbia

1

Great Britain

6

Spain

12

Hungary

9

Sweden

2

Ireland

1

Tsjec

Republik

11

Israël

1

Turkey

10

Total

185

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Information

about working experience

Years expercience in obesity managementN

YearsRangeMissing

15521,81-40

30

N

Multi-

disciplinary

MonodisciplinairyMissing160

135

35

25

Working

according

to guidelines

N

Yes

No

Missing

177

115

62

8

Additional

training in obesity management

N

Yes

No

Missing

179

137

42

6

Working

in a

multi-disciplinairy

team

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Education level of dietitians

N

MeanMedianRangeMissing 1805

100-365

Number of

registered

dietitians

working per setting

Education level

N = 107

N

Bachelor

61

Masters

31

PhD

10

Unknown

5

Post HEI courses

8

Psychological/

behavioral

3

Food

technology

management

4

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Patient care

N

Mean Total Missing 166786

163,26019

Total number of patients treated

last

year

N

Male

Female Missing 137

32.3%

67.7%

48

Gender ratio of patients

N

Mean

Range

Missing

150

9

3-40

35

No of patients per dietitian per day

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Counselling

NMeanMedianRange Missing13815

81-2547

Frequency of

counselling

visits per dietitian/year

N

Mean Median

Range

Missing

150

40

68

10-120

35

Duration of a

councelling

visit

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Diagnostic

tools

Tool YesNoMissing Height, weight, BMI168

314Waist circumference

1195214

Bio-

impedance

11852

14Nutritional assessment165

317Quality of life

128

43

14

Psychological

assessment

115

56

14

Other

diagnostic

tools,

including

several

eating

questionnaires

were

reported

by

48 respondents; 137

answers

missing

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Guidelines

Guideline

YesNoMissing National 14225

18Local/institutional

798620

Dietitian has

own

practice 9972

14Guidelines for children

10266

17

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Dietary interventions

Diet N= 171

Yes No MissingDiet based on individual dietary assessment121

50 14Standard diet

23148 14

Moderate hypo

caloric

diet 32139

14Very low caloric diet 14

157 14Mediterranean

diet

52

119

14

Low

carbohydrate

/high protein

25

146

14

Low fat diet

29

142

14

Use of commercial diets: 160 respondents answered no; 16 missing

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Intervention

outcomes

Intervention N= 185Yes No Missing5-15% weight loss 71

1001410% weight

loss 26145

14

BMI 25-35kg/m

2 ≥5% weight loss 28

14314

BMI >35 kg/m2 ≥10% weight loss

36

135

14

5 years weight maintenance

28

143

14

Improvement of

comorbidities

99

172

14

Improvement

of

quality

of life

108

63

14

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Criteria

for effective dietary intervention

YesNo MissingAmount of weight loss

5611514

Long-term adherence131

40

14

Control of comorbidity

97 7414

Influence on body composition 99

72

14

Eating

behavior

9

-

176

Self

management

14

-

171

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Weight

regain percentage

N= 69 Mean MedianRange Missing

9.2%16%3-30%

116

Time

for

Weight regain to occur in years

N=

74Mean

Median

Range

Missing

4.8

5.5

1-10

111

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The main barriers to diet adherence

No frequent contact with the dietitian; Lack of time; Lack of motivation; Sedentary lifestyle; Family and friends; Not having a proper lunch break; Lack of knowledge; Physiologically increased hunger and decreased satiety; Do not weigh foods anymore; Underestimate energy content in foods and overestimate energy expended by physical activity;

Fast Food; Alcoholic Drinks; Food frequency; Psychological factors; Medical condition;

Habits;Financial problems; Decrease of disturbed eating behavior and obsessive thinking about foods; Restrictive eating in itself;

Lack of awareness about inner physical cues;

Lack of adequate coping styles with stress or negative affect .

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Conclusions

Dietitians specialised in obesity: The majority work in a multi disciplinary teamHave followed additional

trainingAre 33%Bsc; 16% masters; 5% PhdHave a mean of 24 years of

experience76% work according to

national

guidelines

60% also have a specific guideline for obese children

70% treat patients based on dietary assessment

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Points for evaluation

Dietitians set no sharp targets for weight loss and weight maintenance (SMART)More emphasis on quality of life as weight loss outcome than on weight loss

Waist circumference is not measured

by 30%Evidence based objectives

for

weight loss management seem not clear for

many

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