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

2. 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 | |

3. Programme
Why a questionnaire?
Outcomes
Conclusions

4. 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).

5. 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

6. 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.

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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 .

20. 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

21. 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