Footnotes
a
Trained interventionist: In the studies reviewed, trained interventionists included mostly health
professionals (e.g., registered dietitians, psychologists, exercise specialists, health counselors, or
professionals in training ) who adhered to formal protocols in weight management. In a few cases,
lay persons were used as trained interventionists; they received instruction in weight management
protocols (designed by health professionals) in programs that have been validated in high-quality trials
published in peer-reviewed journals.
b
Nutrition professional: In the studies that form the evidence base for this recommendation, a
registered dietitian usually delivered the dietary guidance; in most cases, the intervention was delivered
in university nutrition departments or in hospital medical care settings where access to nutrition
professionals was available.
c
ere is strong evidence that if a provider is going to use a very low-calorie diet, it should be done with
high levels of monitoring by experienced personnel; that does not mean that practitioners should
prescribe very-low-calorie diets. Because of the concern that an ACC/AHA Class I recommendation
would be interpreted to mean that patients should go on a very-low-calorie diet, it was the consensus of
the Expert Panel that this maps more closely to an ACC/AHA Class IIa recommendation.
d
ere is strong evidence that the benefits of surgery outweigh the risks for some patients. ese patients
can be offered a referral to discuss surgery as an option. is does not mean that all patients who meet
the criteria should have surgery. is decision-making process is quite complex and best performed by
experts. e ACC/AHA criterion for a Class I recommendation states that the treatment/procedure
should be performed/administered. is recommendation as stated does not meet the criterion that
the treatment should be performed. us, the ACC/AHA classification criteria do not directly map to
the NHLBI grade assigned by the Expert Panel.
Recommendations
