Rosanna P. Watowicz

Registered Dietitian Nutritionists (RDNs) have long been part of the interdisciplinary team recommended for obesity treatment. Obesity education for RDNs is important not only for ensuring adequate knowledge but also for reducing weight stigma. The objective of this study was to benchmark the inclusion of obesity-related competencies in dietetic supervised practice programs, as self-reported by supervised practice directors, to begin to understand the training that U.S. RDNs receive. This was an exploratory, cross-sectional, online survey of U.S. dietetic supervised practice directors distributed in July of 2022. The directors were asked about the importance and extent of inclusion of 31 obesity-related competencies, as well as barriers for inclusion. The competencies were derived from the 2017 Provider Competencies on the Prevention and Management of Obesity. We received 36 survey responses, representing 10.4% of supervised practice directors in the U.S. Very few programs reported ‘not at all incorporated’ for any competencies; the most frequent were ‘potential role of genetics/epigenetics’ (15%, n = 5) and ‘physiology/pathophysiology of obesity’ (12%, n = 4). The competencies most frequently reported as ‘very important’ were ‘perform effectively in an interprofessional team’ and ‘discuss obesity in a non-judgmental manner’. Lack of time in the curriculum was the most frequently reported barrier. For programs hoping to both expand obesity education and decrease weight stigma in a limited amount of time, improving coverage of competencies related to non-modifiable causes of obesity may be an area to prioritize.

Background: Research is the scientific basis for the profession of dietetics, as it must be located and applied in evidence‐based practice (EBP). EBP is often presented as a foundational skill for research. CEAR – Core, Evidence Application, Research – is a newly proposed model that separates Research and Evidence Application skills into distinct domains, jointly supported by a set of Core skills, thus acknowledging that education and advancement in one domain neither requires nor precipitates education and advancement in the other. The goal was to investigate the content and construct validity of the new CEAR Model.Methods: A cross‐sectional online survey of randomly selected dietitians in the United States was used to collect CEAR domain scores, validated measures of research or EBP skills and self‐reported characteristics. Exploratory factor analysis, Cronbach's α and Pearson correlation between various tools and CEAR domains were used to assess validity and reliability. Analysis of variance (ANOVA) and multiple linear regression between CEAR domains and participant characteristics were used to assess convergent and divergent validity.Results: One hundred and fifty‐four responses with a valid CEAR score were received and led to a three‐factor solution, supporting the theorised differentiation of research from evidence application skills (content validity). Internal reliability for the CEAR Model overall and for each domain was high. The hypothesised correlations between existing research or EBP measurement tools and the relevant CEAR domains were found (construct validity). Known groups analysis demonstrated the expected differences in CEAR domain scores based on participant characteristics.Conclusions: The CEAR Model demonstrates preliminary validity and internal reliability. It adds to the current literature by acknowledging the separateness of evidence application skills from research skills.

Registered dietitian nutritionists (RDNs) are an integral part of weight management teams; however, previous research indicates that RDNs may hold weight-related biases. Additionally, there may be a gap between what RDNs learn about weight management during their education and training and the competencies that RDNs should achieve before working in weight management. The objective of this study was to examine whether a 15-week graduate course on pediatric obesity led to a short-term increase in self-perceived knowledge of 13 Obesity Medicine Education Collaborative competencies, as well as a short-term decrease in weight bias. Nutrition graduate students enrolled in the course completed a survey before and after the course. The survey asked students to indicate their confidence in each of the 13 knowledge-related obesity competencies using a five-point Likert scale. Weight bias was assessed using the 14-item Fat Phobia Scale. Sixteen students completed both the pre- and post-course questionnaire, and results indicated a significant increase in self-perceived knowledge and decrease in weight bias. A graduate course on obesity may be a strategy for increasing knowledge and decreasing weight bias for dietetic trainees, though additional, larger studies are necessary. A strength of this study is that a standardized set of competencies was used to assess change in self-perceived knowledge; use of standardized competencies in future research will allow studies to be pooled.

Previous studies of the relationship between energy intake and child weight have shown mixed results and have largely not described differences in diet quality or the impact of underreporting. The objective of this study was to investigate the relationship between dietary intake and childhood obesity by assessing energy intake and diet quality across BMI categories for 2–19-year-old children before and after excluding underreporters. Energy intake and the Healthy Eating Index 2010 (HEI) were studied for 2–19-year-old children using data from 2005–2014 NHANES. Underreporters were defined as children consuming p < 0.001). Excluding underreporters, 6–11-year-old children in the overweight, obesity, and severe obesity categories had a higher energy intake than healthy weight children (p < 0.001). In both analyses, children in the overweight, obesity, and severe obesity categories reported consuming a lower % REE than healthy weight children. Diet quality in all children is low, and the relationship between reported energy intake and BMI remains complex. Healthy eating messages should target all children.

The purpose of this pilot study was to assess the acceptability to adolescents (11–18 years old) and their parents using a revised protein-sparing modified fast (rPSMF) for 12 months as an intervention for severe obesity in a tertiary pediatric weight management clinic (PWMC). To assess acceptability (satisfaction, confidence) with the rPSMF protocol, surveys were completed by adolescents and parents at baseline, 1, 3, 6, and 12 months, with adolescent height and weight measured. Analyses were conducted to assess differences in satisfaction and confidence based on adolescent response (weight loss) and adherence to the rPSMF. Adolescents’ adherence with the rPSMF was close to 50% in the first 3 months, but dropped to 14.7% at 6 months. Adolescents were most confident with choosing low carbohydrate foods at baseline. Over 12 months, adolescents and parents reported weight loss as “the most liked” part of the rPSMF. Adolescents who were adherent were more satisfied with their weight loss than their non-adherent peers. Parents and adolescents reported lack of food variety and difficulty following the protocol as challenges with the rPSMF. Adolescents and their parents were able to follow the rPSMF protocol, with weight loss, but with decreased adherence over time.

Treatment options are limited for children and adolescents with severe obesity. One alternative treatment is the protein-sparing modified fast (PSMF), a low-carbohydrate, high-protein diet that can result in substantial weight loss. The aim of the study is to evaluate the adherence and efficacy of a revised PSMF (rPSMF) for severe obesity in a pediatric tertiary care weight-management program. The rPSMF with 1200–1800 calories, 40–60 g of carbohydrate/day and 1.2–1.5 g protein/kg of ideal bodyweight was implemented over 12 months. Twenty-one participants enrolled in the study. Mean age 16.2 ± 1.4 years, females (76.2%) and mean weight at baseline was 119 ± 19.9 kg. Regardless of adherence to the rPSMF, the mean weight change at 1 month was −3.7 ± 3.5 kg, (range −13.5 kg to 0.9 kg); at 3 months was −5.5 ± 5.1 kg, (range −19.3 kg to 1.8 kg) and at 6 months was −4.7 ± 6.6 kg, (range −18.3 kg to 8.6 kg). At 12 months, the mean weight change was −1.3 ± 10.6 kg (range −17.7 kg to 14.8 kg). Parent and child-reported physical and psychosocial quality of life (HRQOL) improved. Despite limited adherence, the rPSMF diet resulted in clinically significant weight loss and improved HRQOL for children and adolescents with severe obesity.