Dietetics, building the future
Obesity is a chronic disease that is increasing rapidly worldwide. Although dietitians support many clients with obesity, clients frequently discontinue treatment prematurely, and treatment effectiveness varies from person to person. The key question is: what works best for which client, and at what stage?
Aim
The aim of this study was to investigate which components contribute to effective dietary treatment in primary care dietetics, and resulted in the development of a toolbox.
Approach
By combining quantitative practice data with qualitative methods in a mixed-methods design, it was possible to connect real-world practice data with the perspectives and experiences of both dietitians and patients. The strong grounding in everyday practice through routine data, interviews, and direct observations provided valuable insight into how care is delivered in daily practice. This approach also helped to understand not only outcomes but also the underlying mechanisms and experiences that drive them.
In co-creation with both dietitians and clients, a toolbox was subsequently developed based on the most common condition seen in primary care: overweight with comorbidity. The involvement of these dietitians, patients, and the broader network strengthened the toolbox’s relevance and applicability in practice. In addition, collaboration within the consortium of seven partners brought together a wide range of expertise
Results
Practical data showed that around one-third of patients lost sufficient weight within a year, mainly early in the treatment process. The more consultations patients attended with a dietitian, the greater their likelihood of success. Effectiveness did not depend on a single approach, but on a combination of dietary advice, exercise and behavioural change. Interviews and observations showed that the relationship between patient and dietitian is crucial for successful treatment: trust, a tailored approach and personal attention determine success. The role of the dietitian therefore extends beyond providing dietary advice and also includes counselling, behaviour change support, and attention to psychological and contextual factors.
Based on these insights, a toolbox was developed and tested through co-creation with dieticians and clients. It contains resources to support treatment, including for people with a low socio-economic status, limited health literacy and/or a non-Western background. Dietitians were positive about its usability, but its structural integration into practice still requires attention. The toolbox has been made widely accessible to dietitians and can also be expanded to support other clinical conditions.
Recommendations
- Personalisation is fundamental
What works for one patient with obesity may not work for another. There is no one-size-fits-all approach. Motivation, context, and health literacy vary considerably between patients, and tailoring treatment accordingly is the foundation of effective care. - Strength lies in combination
Effectiveness results from the combination of dietary advice, physical activity guidance, attention to behaviour change, and other lifestyle factors. It is the integration of these elements that makes the difference. - A strong therapeutic relationship
This is a central element of effective treatment. Trust, empathy, shared decision-making, and a non-judgemental attitude are all essential. These factors enable patients to discuss sensitive topics openly, remain motivated, and stay engaged in treatment. - Personalised care requires the right tools
Patients differ in health literacy, motivation, comorbidity, and personal circumstances. The toolbox provides a practical instrument for addressing this variation, but healthcare professionals remain responsible for determining what a patient needs at a particular stage of treatment. - Early intensive support pays off
Patients who make progress early in treatment have the greatest likelihood of achieving clinically relevant weight loss (>5% weight loss). Providing intensive support during the initial phase of treatment is worthwhile, as is identifying in a timely manner when a patient requires additional support. Each additional consultation during the first three months of dietetic treatment is associated with a threefold greater likelihood of achieving a positive outcome. Between months 3 and 6, each additional consultation is associated with a 61% greater chance of success.
Challenges
- Time and reimbursement
Limited consultation time and reimbursement continue to be barriers within dietetic care. Three hours of dietary treatment, as currently reimbursed under the basic health insurance package, is insufficient. While this study does not offer a solution to this issue, it clearly demonstrates that these conditions directly affect the quality and intensity of the care dietitians are able to provide. - Outdated practice datasets
Some of the data used were outdated and lacked important patient characteristics such as motivation, health literacy, and previous experiences. This limited the analyses. - Inclusive research
Including patients with limited health literacy and those with a migration background proved challenging using conventional methods based on written materials and interviews. Investing in inclusive recruitment strategies is worthwhile, including attention to language, format, and methods of data collection, potentially through visual or audio-based approaches.
Blog
Read Marian de van der Schueren's blog, Associate Professor in Dietetics, on the importance of underpinning the (cost-) efficiency of evidence-based, personalized dietary advice.
More information
Features
- Project number:
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10270032021001
- Duration: 100%
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20212026
- Part of programme:
- Related funding round:
- Project lead and secretary:
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Dr. M.A.E. de van der Schueren
- Responsible organisation:
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Wageningen University & Research
Knowledge enhancement and research
More projects
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