Standardized Management of Medical Nutrition for Weight Loss: Workflow and Initial Assessment Strategies

Obesity is a potential risk factor for diabetes, cardiovascular disease, other metabolic diseases, and cancer. Weight loss treatment includes various methods such as lifestyle modifications (diet and physical activity), medical medication, and surgical treatment. Scientific and rational nutritional therapy combined with exercise intervention remains the most effective and safest basic treatment. In 2016, nearly one hundred authoritative experts in obesity and clinical nutrition research from the Nutrition and Metabolic Management Branch of the China International Exchange and Promotion Association for Medical and Health Care, the Nutrition Physician Professional Committee of the Chinese Medical Doctor Association, and the Chinese Nutrition Society, based on evidence-based medicine and scientific research progress in medical nutrition therapy for obesity in my country, and combined with the epidemiological characteristics and nutritional status of obesity in China, jointly released my country's first medical weight loss consensus-the "Expert Consensus on Medical Nutrition Therapy for Overweight/Obesity in China (2016)" (hereinafter referred to as the "Medical Weight Loss Consensus")-to make medical weight loss more scientific, standardized, and easy to implement. Based on extensive literature review, the consensus recommends the use of calorie-restricted diets (CRD), high-protein diets (HPD), and intermittent fasting, which can be used for overweight and obese individuals of all types and physiological stages. Understanding the indications and timing of use is crucial for safe weight loss. By establishing a medical nutrition weight loss workflow, the consensus ensures that patients can safely use nutritional therapy for weight loss under medical supervision. I. Medical Nutrition Weight Loss Workflow To further standardize the principles and pathways of medical nutrition weight loss, the consensus also recommends a standardized workflow for weight loss under a medical model. With patient safety as the primary goal, assessment, screening, and follow-up are integrated throughout the entire process, enabling clinical nutrition professionals and healthcare personnel to master and utilize this workflow to better serve those seeking weight loss. Initial screening includes: measuring height and weight and calculating BMI; assessing weight loss intentions; and assessing follow-up eligibility. Assessment 1 mainly covers: medical history and medication history; clinical risks (existence of clinical risks, such as diabetes, cardiovascular disease, etc.); and physical assessment (blood pressure, pulse, edema). For those without a strong desire for follow-up, it is recommended to avoid unhealthy lifestyle habits, control weight gain, guide and treat other risk factors, and monitor weight regularly. If necessary, a low-energy balanced diet or intermittent fasting may be adopted. Assessment 2 mainly includes: dietary survey (24-hour dietary review); lifestyle survey (family, culture, beliefs, exercise); detailed physical examination (waist circumference, fat, muscle, grip strength, edema); psychological assessment (referencing the Zung Anxiety Self-Rating Scale and its score); quality of life assessment (referencing the EQ-5D Health Index); body composition analysis (BIA); and auxiliary examinations (biochemical indicators, organ function, metabolic tests). Finally, a weight loss plan will be developed based on BMI classification and any comorbidities or complications. II. Initial Screening and Assessment for Medical Nutrition Weight Loss Following the medical nutrition weight loss management process, during the initial consultation, nutritional assessment, risk assessment, and weight loss intention assessment are conducted based on the individual's dietary habits, lifestyle, medical history, and other factors. Furthermore, the individual's health status, lifestyle, weight loss goals, and payment situation are comprehensively considered to tailor a weight loss plan, thereby achieving targeted and scientific weight loss and providing greater safety assurance for patients.