|Recommendations||NHLBI Grade||NHLBI ES||ACC/AHA COR||ACC/AHA LOE|
|Identifying Patients Who Need to Lose Weight (BMI and Waist Circumference)|
|E (Expert Opinion)||CQ2||I||C|
|E (Expert Opinion)||CQ2||IIa||B|
|Matching Treatment Benefits With Risk Profiles (Reduction in Body Weight Effect on Risk Factors for CVD, Events, Morbidity and Mortality)|
|Diets for Weight Loss (Dietary Strategies for Weight Loss)|
|Lifestyle Intervention and Counseling (Comprehensive Lifestyle Intervention)|
|Selecting Patients for Bariatric Surgical Treatment for Obesity (Bariatric Surgical Treatment for Obesity)|
|N (No Recommendation)||CQ5||—||—|
|E (Expert Opinion)||CQ5||IIb||C|
ACC indicates American College of Cardiology; AHA, American Heart Association; BMI, body mass index; BP, blood pressure; COR, Class of Recommendation; CQ, critical question; CVD, cardiovascular disease; ES, evidence statement; HDL-C, high-density lipoprotein cholesterol; IDF, International Diabetes Federation; LDL-C, low-density lipoprotein cholesterol; LOE, Level of Evidence; NHLBI, National Heart, Lung, and Blood Institute; NIH, National Health Institute; WHO, World Health Organization; and —, not applicable.
↵∗ 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.
↵† 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.
↵‡ There 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 concern that an ACC/AHA Class I recommendation would be interpreted to mean that the 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.
↵§ There is strong evidence that the benefits of surgery outweigh the risks for some patients. These patients can be offered a referral to discuss surgery as an option. This does not mean that all patients who meet the criteria should have surgery. This decision-making process is quite complex and is best performed by experts. The ACC/AHA criterion for a Class I recommendation states that the treatment/procedure should be performed/administered. This recommendation as stated does not meet the criterion that the treatment should be performed. Thus, the ACC/AHA classification criteria do not directly map to the NHLBI grade assigned by the Expert Panel.