EASO-EFAD Mapping dietetic guidance on obesity Survey Ellen Govers, RD, NWG (Nutrition working group EASO/EFAD)

European Specialist Dietetic Network Obesity The ESDN Obesity has 6 members Maria Hassapidou Ellen Govers Tanja Callewaert Hilda Mulrooney Oddysseas Androutsos Anthonis Vlassopoulos EFAD | The European Dietitians | www.efad.org | secretariat@efad.org

Programme Why a questionnaire? Outcomes Conclusions

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).

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

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.

General information about the practice: work setting Hospital 84 Private practice 86 Teaching 3 Endocrinology 2 Research Bariatric Surgery Rehabilitation Public Health 1 University Prevention 185

Which country Country N Total 185 Austria 43 Italy 4 Azerbajcan 1 Luxembourg Belgium 10 Netherlands 5 Croatia 3 Norway 12 Cyprus Poland France 31 Portugal Germany Romania 2 Greece Serbia Great Britain 6 Spain Hungary 9 Sweden Ireland Tsjec Republik 11 Israël Turkey Total 185

Information about working experience Years expercience in obesity management Range Missing 155 21,8 1-40 30 Working according to guidelines N Multi-disciplinary Monodisciplinairy Missing 160 135 35 25 Additional training in obesity management N Yes No Missing 177 115 62 8 Working in a multi-disciplinairy team N Yes No Missing 179 137 42 6

Education level of dietitians Number of registered dietitians working per setting N Mean Median Range Missing 180 5 10 0-36 Education level N = 107 N Bachelor 61 Masters 31 PhD 10 Unknown 5 Post HEI courses 8 Psychological/behavioral 3 Food technology management 4

Patient care Total number of patients treated last year Mean Total Missing 166 786 163,260 19 Gender ratio of patients N Male Female Missing 137 32.3% 67.7% 48 No of patients per dietitian per day N Mean Range Missing 150 9 3-40 35

Counselling Frequency of counselling visits per dietitian/year Mean Median Range Missing 138 15 8 1-25 47 Duration of a councelling visit N Mean Median Range Missing 150 40 68 10-120 35

Diagnostic tools Tool Yes No Missing Height, weight, BMI 168 3 14 Waist circumference 119 52 Bio-impedance 118 Nutritional assessment 165 17 Quality of life 128 43 Psychological assessment 115 56 Other diagnostic tools, including several eating questionnaires were reported by 48 respondents; 137 answers missing

Guidelines Guideline Yes No Missing National 142 25 18 Local/institutional 79 86 20 Dietitian has own practice 99 72 14 Guidelines for children 102 66 17

Dietary interventions Diet N= 171 Yes No Missing Diet based on individual dietary assessment 121 50 14 Standard diet 23 148 Moderate hypo caloric diet 32 139 Very low caloric diet 157 Mediterranean diet 52 119 Low carbohydrate/high protein 25 146 Low fat diet 29 142 Use of commercial diets: 160 respondents answered no; 16 missing

Intervention outcomes Intervention N= 185 Yes No Missing 5-15% weight loss 71 100 14 10% weight loss 26 145 BMI 25-35kg/m2 ≥5% weight loss 28 143 BMI >35 kg/m2 ≥10% weight loss 36 135 5 years weight maintenance Improvement of comorbidities 99 172 Improvement of quality of life 108 63

Criteria for effective dietary intervention Yes No Missing Amount of weight loss 56 115 14 Long-term adherence 131 40 Control of comorbidity 97 74 Influence on body composition 99 72 Eating behavior 9 - 176 Self management 171

Weight regain percentage Mean Median Range Missing 9.2% 16% 3-30% 116 Time for Weight regain to occur in years N= 74 Mean Median Range Missing 4.8 5.5 1-10 111

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 .

Conclusions Dietitians specialised in obesity: The majority work in a multi disciplinary team Have followed additional training Are 33%Bsc; 16% masters; 5% Phd Have a mean of 24 years of experience 76% work according to national guidelines 60% also have a specific guideline for obese children 70% treat patients based on dietary assessment

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