Position of the Academy of Nutrition and Dietetics: Medical Nutrition Therapy Behavioral Interventions Provided by Dietitians for Adults With Overweight or Obesity, 2024.

Providing interventions that facilitate improvement of dietary intake and other health behaviors can improve nutrition-related outcomes in adults with overweight or obesity. Medical nutrition therapy (MNT) behavioral interventions require expertise from registered dietitian nutritionists or international equivalents (dietitians), which no other health care provider can provide for adults with obesity. Current evidence supports the role of MNT behavioral interventions for adults with overweight or obesity as an effective treatment option, when appropriate for and desired by the client. This Academy of Nutrition and Dietetics Position Paper describes potential benefits and concerns regarding dietitian-provided MNT behavioral interventions for adults with overweight and obesity and informs dietitians about implications for practice. This Position Paper is supported by a systematic review examining effectiveness of MNT interventions provided by dietitians and by an evidence-based practice guideline. It is the position of the Academy of Nutrition and Dietetics that MNT behavioral interventions for adults (aged 18 years and older) with overweight or obesity should be a treatment option, when appropriate and desired by the client, to improve cardiometabolic, quality of life, and anthropometric outcomes. Dietitians providing MNT recognize the complex contributors to overweight and obesity, and thus individualize interventions, based on a shared decision-making process, and deliver interventions in an inclusive, compassionate, and client-centered manner. Interventions should include collaboration with an interprofessional team when needed. Dietitians strive to increase health equity and reduce health disparities by advocating and providing opportunities for increased access to effective nutrition care services. This position remains in effect until December 31, 2031.

New insights into projected Arctic sea road: operational risks, economic values, and policy implications.

As Arctic sea ice continues to retreat, the seasonally navigable Arctic expected by mid-century or earlier is likely to facilitate the growth of polar maritime and coastal development. Here, we systematically explore the potentials for opening of trans-Arctic sea routes across a range of emissions futures and multi-model ensembles on daily timescales. We find a new Transpolar Sea Route in the western Arctic for open water vessels starting in 2045 in addition to the central Arctic corridor over the North Pole, with its frequency comparable to the latter during the 2070s under the worst-case scenario. The emergence of this new western route could be decisive for operational and strategic outcomes. Specifically, the route redistributes transits away from the Russian-administered Northern Sea Route, lowering the navigational and financial risks and the regulatory friction. Navigational risks arise from narrow straits that are often icy choke points. Financial risks arise from the substantial interannual sea ice variability and associated uncertainty. Regulatory friction arises from Russian requirements imposed under the Polar Code and Article 234 of the UN Convention on the Law of the Sea. These imposts are significantly reduced with shipping route regimes that enable open water transits wholly outside Russian territorial waters, and these regimes are revealed most accurately using daily ice information. The near-term navigability transition period (2025-2045) may offer an opportunity for maritime policy evaluation, revision, and action. Our user-inspired evaluation contributes towards achieving operational, economic and geopolitical objectives and serves the goal of planning a resilient, sustainable, and adaptive Arctic future. Supplementary Information: The online version contains supplementary material available at 10.1007/s10584-023-03505-4.

Weight Management Interventions Provided by a Dietitian for Adults with Overweight or Obesity: An Evidence Analysis Center Systematic Review and Meta-Analysis.

BACKGROUND: Obesity is associated with a multitude of comorbidities and considerable health care costs. OBJECTIVE: The objective of this review was to examine the efficacy of weight management interventions provided by a registered dietitian or international equivalent (referred to as "dietitian"). METHODS: This systematic review and meta-analysis of randomized controlled trials (RCTs) examined the effect of weight management interventions provided by a dietitian, compared with usual care or no intervention, on several cardiometabolic outcomes and quality of life in adults with overweight or obesity. MEDLINE, Embase, PsycINFO, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, and CINAHL databases were searched for eligible RCTs published between January 2008 and January 2021 in the English language. Meta-analyses were conducted using a random-effects model, publication bias was assessed using funnel plots and Egger's statistics, and heterogeneity was assessed by interpreting I2 values. Efficacy of intervention components, such as telehealth or group contacts, were explored in sub-group analyses. Version 2 of the risk-of-bias tool for RCTs was used to assess risk of bias. The Grading of Recommendations Assessment, Development and Evaluation method was used to determine certainty of evidence. RESULTS: This systematic review included 62 RCTs. Compared with control conditions, weight management interventions provided by a dietitian resulted in improved body mass index (mean difference [MD] -1.5; 95% CI -1.74 to -1.26; moderate evidence certainty); percent weight loss (MD -4.01%; 95% CI -5.26% to -2.75%; high evidence certainty); waist circumference (MD -3.45 cm; 95% CI -4.39 to -2.51 cm; high evidence certainty); blood pressure (MD -3.04 mm Hg; 95% CI -5.10 to -0.98 mm Hg and MD -1.99 mm Hg; 95% CI -3.02 to -0.96 mm Hg for systolic blood pressure and diastolic blood pressure, respectively; moderate and low evidence certainty); and quality of life using the 36-Item Short Form Survey (MD 5.84; 95% CI 2.27 to 9.41 and 2.39; 95% CI 1.55 to 3.23 for physical and mental quality of life, respectively; low and moderate evidence certainty). CONCLUSIONS: For adults with overweight or obesity, weight management interventions provided by a dietitian are efficacious for improving several examined cardiometabolic outcomes and quality of life.

Medical Nutrition Therapy Interventions Provided by Dietitians for Adult Overweight and Obesity Management: An Academy of Nutrition and Dietetics Evidence-Based Practice Guideline.

Overweight and obesity affect most adults living in the United States and are causally linked to several adverse health outcomes. Registered dietitian nutritionists or international equivalents (dietitians) collaborate with each client and other health care professionals to meet client-centered goals, informed by the best available evidence, and translated through a lens of clinical expertise and client circumstances and preferences. Since the last iteration of the Academy of Nutrition and Dietetics guideline on adult weight management in 2014, considerable research has been conducted and circumstances confronting dietitians have evolved. Thus, updated guidance is needed. The objective of this evidence-based practice guideline is to provide recommendations for dietitians who deliver medical nutrition therapy behavioral interventions for adults (18 years and older) with overweight and obesity to improve cardiometabolic outcomes, quality of life, and weight outcomes, when appropriate for and desired by the client. Recommendations in this guideline highlight the importance of considering complex contributors to overweight and obesity and individualizing interventions to client-centered goals based on specific needs and preferences and shared decision making. The described recommendations have the potential to increase access to care and decrease costs through utilization of telehealth and group counseling as effective delivery methods, and to address other barriers to overweight and obesity management interventions. It is essential for dietitians to collaborate with clients and interprofessional health care teams to provide high-quality medical nutrition therapy interventions using the nutrition care process to promote attainment of client-centered outcomes for adults with overweight or obesity.

"The stomach I have now has a brain connection:" changes in experiences of hunger and fullness following bariatric surgery.

The rate of obesity in the U.S. is at an all-time high of 42.4%, with 9.2% of cases falling in the severe obesity category. Bariatric surgery results in significant weight loss through two of the most popular options, sleeve gastrectomy and Roux-en-Y gastric bypass. One of the mechanisms through which these surgeries work is via the alteration of neural and hormonal appetite signaling, which leads to decreases in hunger and increases in fullness. The available measures for assessing hunger and fullness were not developed for use in bariatric surgery patients and do not capture physical hunger feelings or normal fullness. A longitudinal mixed-method study of 30 bariatric surgery patients (20% male, 20% African American) was designed to explore the physical and psychological feelings associated with hunger and fullness. Participants were recruited from an accredited bariatric surgery center and interviewed prior to surgery and 6 and 12-months after surgery. Transcripts were coded using a constant comparative method. Themes were created using a grounded theory approach. Different pathways were discovered such that participants' experiences of hunger and fullness varied compared to each other, as well as over time. Hunger had physical and psychological qualities, whereas fullness was generally only described as being physical. These results suggest that pre-surgery and post-surgery counseling should be customized in regard to appetite. Measures should be developed to better capture the true experiences of hunger and fullness among bariatric surgery patients.

The interaction of ice and law in Arctic marine accessibility.

Sea ice levies an impost on maritime navigability in the Arctic, but ice cover diminution due to anthropogenic climate change is generating expectations for improved accessibility in coming decades. Projections of sea ice cover retreating preferentially from the eastern Arctic suggest key provisions of international law of the sea will require revision. Specifically, protections against marine pollution in ice-covered seas enshrined in Article 234 of the United Nations Convention on the Law of the Sea have been used in recent decades to extend jurisdictional competence over the Northern Sea Route only loosely associated with environmental outcomes. Projections show that plausible open water routes through international waters may be accessible by midcentury under all but the most aggressive of emissions control scenarios. While inter- and intraannual variability places the economic viability of these routes in question for some time, the inevitability of a seasonally ice-free Arctic will be attended by a reduction of regulatory friction and a recalibration of associated legal frameworks.

Implementation of a Vascular Access Team to Reduce Central Line Usage and Prevent Central Line-Associated Bloodstream Infections.

Central line-associated bloodstream infections (CLABSIs) account for one-third of all hospital-acquired infections and can cost the health care system between $21,000 and $100,000 per infection. A dedicated vascular access team (VAT) can help develop, implement, and standardize policies and procedures for central line usage that address insertion, maintenance, and removal as well as educate nursing staff and physicians. This article presents how 1 hospital developed a VAT and implemented evidence-based guidelines. Central line utilization decreased by 45.2%, and CLABSI incidence decreased by 90%. The results of the study demonstrated that a reduced utilization of central lines minimized the risk of patients developing a CLABSI.

Nutrition Care in Bariatric Surgery: An Academy Evidence Analysis Center Systematic Review.

Obesity continues to be a major public health crisis, both nationally and globally. Metabolic and bariatric surgery has been proven to be a safe and effective treatment for this multifactorial chronic disease. However, inconsistent and varied results in bariatric nutrition literature have prevented the implementation of standardized guidelines. The purpose of this Evidence Analysis Library systematic review is to provide an evidence-based summary of nutrition-related practices in bariatric surgery. The systematic review methodology of the Academy of Nutrition and Dietetics was applied. A total of 27 research studies were included, analyzed, and assessed for risk of bias by trained evidence analysts. The literature included in the systematic review was published from 2003 to 2015. Evaluation of the literature resulted in the development of five graded conclusion statements. Limited research demonstrates that registered dietitian nutritionists play a role in improving weight loss outcomes after bariatric surgery; further research is needed to understand the role of registered dietitian nutritionists in changing behaviors after bariatric surgery. Bariatric surgery results in significant reductions in resting metabolic rate and postoperative energy intake. There is no significant relationship between macronutrient distribution and postoperative weight loss. The graded conclusion statements provide registered dietitian nutritionists who practice in the field of bariatric nutrition with more insight and evidence that can guide and support their recommendations.

The step-like evolution of Arctic open water.

September open water fraction in the Arctic is analyzed using the satellite era record of ice concentration (1979-2017). Evidence is presented that three breakpoints (shifts in the mean) occurred in the Pacific sector, with higher amounts of open water starting in 1989, 2002, and 2007. Breakpoints in the Atlantic sector record of open water are evident in 1971 in longer records, and around 2000 and 2011. Multiple breakpoints are also evident in the Canadian and Russian halves. Statistical models that use detected breakpoints of the Pacific and Atlantic sectors, as well as models with breakpoints in the Canadian and Russian halves and the Arctic as a whole, outperform linear trend models in fitting the data. From a physical standpoint, the results support the thesis that Arctic sea ice may have critical points beyond which a return to the previous state is less likely. From an analysis standpoint, the findings imply that de-meaning the data using the breakpoint means is less likely to cause spurious signals than employing a linear detrend.

"Take Me through the History of Your Weight": Using Qualitative Interviews to Create Personalized Weight Trajectories to Understand the Development of Obesity in Patients Preparing for Bariatric Surgery.

BACKGROUND: Obesity can develop during any life stage. Understanding the contexts within which obesity develops can inform our understanding of the disease and help tailor interventions specific to life stages. OBJECTIVE: Using life-course theory as a guiding framework, this study aimed to explain the development of obesity in bariatric surgery patients by creating personalized weight trajectories. DESIGN: Qualitative methods using semistructured interviews were used to uncover participants' experiences with and explanations for the development of obesity. A grounded theory approach using the constant comparative method was used to analyze transcripts for categories and themes. PARTICIPANTS/SETTING: Thirty pre-bariatric surgery patients (24 women, 6 men) were recruited from a bariatric surgery center; 25 participants were available for follow-up. Participants were interviewed before surgery and at 6 and 12 months postsurgery. RESULTS: Four weight history groups were created based on patterns of weight changes from adolescence through adulthood: Always Heavy, Late Peak, Steady Progression, and Weight Cycling. Participants' explanations for weight changes centered around themes of transitions and life-course events or stressors. Differences in the weight history groups could be explained by the timing of transitions, life events, and responses to stress. CONCLUSIONS: The development of obesity does not follow the same pattern for all individuals. Weight gain patterns can be explained by the timing of life-course events, stressors, and the type and effects of environmental transitions. Weight management counseling should include strategies tailored to an individual's current life-stage and circumstance, but also acknowledge previous responses to transitions and stressors.

Integrative Governance of Environmental Water in Australia's Murray-Darling Basin: Evolving Challenges and Emerging Pathways.

Integration, a widely promoted response to the multi-scale complexities of social-environmental sustainability, is diversely and sometimes poorly conceptualized. In this paper we explore integrative governance, which we define as an iterative and contextual process for negotiating and advancing the common interest. We ground this definition in a discussion of institutional factors conditioning integrative governance of environmental water in Australia's Murray-Darling Basin. The Murray-Darling Basin is an iconic system of social-ecological complexity, evocative of large-scale conservation challenges in other developed arid river basins. Our critical assessment of integrative governance practices in that context emerges through analysis of interviews with policy participants and documents pertaining to environmental water management in the tri-state area of southwestern New South Wales, northwestern Victoria, and the South Australian Riverland. We identify four linked challenges: (i) decision support for developing socially robust environmental water management goals, (ii) resource constraints on adaptive practice, (iii) inter-state differences in participatory decision-making and devolution of authority, and (iv) representative inclusion in decision-making. Our appraisal demonstrates these as pivotal challenges for integrative governance in the common interest. We conclude by offering a perspective on the potential for supporting integrative governance through the bridging capacity of Australia's Commonwealth Environmental Water Holder.

"When the honeymoon is over, the real work begins:" Gastric bypass patients' weight loss trajectories and dietary change experiences.

To understand gastric bypass patients' experiences with managing food and eating for long-term weight management, this study examined patients' self-reported dietary changes and weight loss patterns. Thirteen women and three men between 15 months and 10 years post-gastric bypass surgery were recruited in Upstate New York. They completed two qualitative, in-depth interviews about their weight loss and dietary experiences. Using verbatim transcripts, researchers created timelines for each participant that summarized weight changes and the associated dietary behaviors. Constant comparative analysis of the timelines and transcripts identified a common, initial rapid weight loss period followed by weight stabilization, after which participants' weight loss patterns diverged into three possible long-term trajectories (Maintaining, Regained/Losing, and Regained) and one short-term trajectory (Losing). Dietary management over the periods of weight loss involved six components: physical needs, hunger and fullness, relationship with food, strategy use, habit formation, and awareness of eating. In the "honeymoon period" weight loss was "easy" because "surgery does the work" in limiting appetite, portion sizes, and interest in foods. As weight stabilized, "the work begins" as participants became capable of eating a greater quantity and a wider variety of foods. Differences in weight loss trajectories were associated with participants' abilities to maintain changes in relationship with food, dietary strategies and habits, and awareness of eating behaviors. Viewing weight loss outcomes of gastric bypass surgery as trajectories that develop as the result of dietary transitions and changes in dietary management suggests that patients need to be counseled on a variety of cognitive and behavioral strategies.

Fire in Australian savannas: from leaf to landscape.

Savanna ecosystems comprise 22% of the global terrestrial surface and 25% of Australia (almost 1.9 million km2) and provide significant ecosystem services through carbon and water cycles and the maintenance of biodiversity. The current structure, composition and distribution of Australian savannas have coevolved with fire, yet remain driven by the dynamic constraints of their bioclimatic niche. Fire in Australian savannas influences both the biophysical and biogeochemical processes at multiple scales from leaf to landscape. Here, we present the latest emission estimates from Australian savanna biomass burning and their contribution to global greenhouse gas budgets. We then review our understanding of the impacts of fire on ecosystem function and local surface water and heat balances, which in turn influence regional climate. We show how savanna fires are coupled to the global climate through the carbon cycle and fire regimes. We present new research that climate change is likely to alter the structure and function of savannas through shifts in moisture availability and increases in atmospheric carbon dioxide, in turn altering fire regimes with further feedbacks to climate. We explore opportunities to reduce net greenhouse gas emissions from savanna ecosystems through changes in savanna fire management.

Gastric bypass patients' goal-strategy-monitoring networks for long-term dietary management.

Following gastric bypass surgery, patients must make dramatic dietary changes, but little is known about patients' perspectives on long-term dietary management after this surgery. This grounded theory, qualitative study sought to advance conceptual understanding of food choice by examining how gastric bypass patients constructed personal food systems to guide food and eating behaviors 12 months post-surgery. Two in-depth interviews were conducted with each of 16 adults, purposively sampled from bariatric support groups. Using constant comparative analysis of verbatim interview transcripts, researchers identified participants' goal-strategy-monitoring networks representing how participants used specific food and eating behaviors towards their main goals of: Weight Management, Overall Health, Avoiding Negative Reactions to Eating, and Integrating Dietary Changes with Daily Life. Linked to each main goal was a hierarchy of intermediary goals, strategies, and tactics. Participants used monitoring behaviors to assess strategy effectiveness towards goal achievement. Individuals' Weight Management networks were compared to uncover similarities and differences among strategy use and monitoring methods among those who maintained weight loss and those who regained weight. The complex, multilevel goal-strategy-monitoring networks identified illustrate the "work" involved in constructing new personal food systems after surgery, as well as advance understanding of strategies as a component of people's personal food systems. These findings provide researchers and practitioners with insight into the long-term dietary issues that gastric bypass patients face and a potential method for representing how people relate deliberate dietary behaviors to their goals.

Understanding dietary monitoring and self-weighing by gastric bypass patients: a pilot study of self-monitoring behaviors and long-term weight outcomes.

BACKGROUND: Weight and dietary monitoring have been associated with better weight loss outcomes among dieters using lifestyle modification, but they have rarely been studied among gastric bypass surgery patients. This exploratory study examined dietary and weight self-monitoring behaviors and their association with weight outcomes in a sample of gastric bypass patients who were at least 12 months post-surgery. METHODS: A convenience sample of 32 female and 5 male patients living in Upstate New York was recruited through support group list-servs. The participants completed an anonymous on-line survey about their weight histories, surgical histories, current weights, dietary monitoring practices, weight monitoring practices, and demographic characteristics. Measures were developed to assess frequency of monitoring behaviors (recording food intake, mentally tracking food, weighing/measuring foods, and self-weighing). Weight loss outcomes, based on self-reported weights, were current body mass index (BMI), percent excess BMI lost, and percent weight loss maintained. RESULTS: Mean pre-surgical BMI was 49.5 ± 6.6. The participants were at an average of 32 months post-surgery with a BMI 31.2 ± 6.6. They maintained 89.2 ± 14.1% of their weight loss and 76.3 ± 26.0% excess BMI was lost. Higher scores for dietary monitoring behaviors, being unmarried, and lower pre-surgery BMI were associated with lower current BMI and greater excess BMI lost when controlling for age, sex, and time since surgery. CONCLUSIONS: This study yielded constructs, measures, and relationships that warrant further examination in a larger sample of gastric bypass patients.

Eating maps: places, times, and people in eating episodes.

This project developed a method for constructing eating maps that portray places, times, and people in an individual's eating episodes. Researchers used seven consecutive days of qualitative eating recall interviews from 42 purposively sampled U.S. adults to draw a composite eating map of eating sites, meals, and partners for each person on a template showing home, work, automobile, other homes, and other places. Participants evaluated their own maps and provided feedback. The eating maps revealed diverse places, times, and partners. Eating maps offer a flexible tool for eliciting, displaying, validating, and applying information to visualize eating patterns within contexts.

Farnesylthiosalicylic acid: inhibition of proliferation and enhancement of apoptosis of hormone-dependent breast cancer cells.

Farnesyltransferase inhibitors (FTIs) are being developed to block Ras-mediated actions, but current data suggest that the FTIs act through other non-Ras pathways. A new agent, farnesylthiosalicylic acid (FTS), blocks the binding of Ras to membrane acceptor sites and causes a marked reduction in Ras levels. Accordingly, FTS could be a useful new agent for the treatment of hormone-dependent breast cancer. We examined the dose-response effects of FTS on the growth of MCF-7 breast cancer cells in vitro and in vivo. Further, we dissected out its specific effects on cell proliferation and apoptosis by measuring BrdU incorporation into DNA and by using an ELISA assay to quantitate the magnitude of apoptosis. FTS and its solubilized conjoiner FTS-cyclodextrin markedly inhibited cell growth in MCF-7 breast cancer cells in culture and in xenografts. This agent exerted dual effects to reduce cell proliferation as assessed by BrdU incorporation and to enhance apoptosis as quantitated by ELISA assay. These data suggest that FTS is a promising agent to be developed for treatment of hormone-dependent breast cancer.