{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:25:02Z","timestamp":1787502302225,"version":"build-2736575974"},"reference-count":32,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,8,23]],"date-time":"2025-08-23T00:00:00Z","timestamp":1755907200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Introduction: Recent guidelines developed by the European Association for the Study of Obesity (EASO) and the European Federation of the Associations of Dietitians (EFAD) focused on the dietetic management of obesity in adults. The present study aimed to explore the perspectives of healthcare professionals regarding these guidelines. Methods: In total, 85 registered dietitians\/nutritionists from Greece, the Netherlands, the Republic of Ireland, and the United Kingdom completed an online survey, and 10 were interviewed, in February\u2013March 2023. Demographic data were also collected. Results: Awareness of the EASO-EFAD guidelines among registered dietitians\/nutritionists was moderate (57.6%), but only 20% had read them in full. Dietitians with higher education and relevant experience were more likely to have read the guidelines. Less than half reported that key evidence-based recommendations, such as individualized medical nutrition therapy and intensive behavioral interventions, are already included in national guidance. Recommendations like portfolio or DASH diets, partial meal replacements, and calorie restriction were less commonly part of national guidance\/usual practice. A small percentage of participants described their adoption of several nutritional approaches novel to them. These included the portfolio dietary pattern, partial meal replacements, and intermittent fasting or continuous calorie restriction. For some Irish dietitians, prioritizing weight as the main outcome conflicted with their emphasis on overall health and individualized nutrition therapy. Other barriers of recommendation implementation included exclusive availability in English, rapid changes in obesity management, staffing shortages, limited multidisciplinary collaboration, and inconsistent knowledge among healthcare providers. Conclusions: The present study identified gaps in the adoption of the EASO-EFAD guidelines into dietetic\/clinical practice. EFAD will develop strategies to disseminate these guidelines at different levels of stakeholders (national\/local authorities, dietitians\/nutritionists, and patients).<\/jats:p>","DOI":"10.3390\/nu17172736","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:09:32Z","timestamp":1756080572000},"page":"2736","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Dietitians\u2019 Adherence and Perspectives on the European Association for the Study of Obesity (EASO) and the European Federation of the Associations of Dietitians (EFAD) Recommendations for Overweight and Obesity Management: A Mixed-Methods Study"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2849-1994","authenticated-orcid":false,"given":"Odysseas","family":"Androutsos","sequence":"first","affiliation":[{"name":"Laboratory of Clinical Nutrition and Dietetics, Department of Nutrition and Dietetics, School of Physical Education, Sports Science and Dietetics, University of Thessaly, 42132 Trikala, Greece"},{"name":"ESDN-Obesity, European Federation of the Associations of Dietitians (EFAD), The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7257-5119","authenticated-orcid":false,"given":"Hilda","family":"Mulrooney","sequence":"additional","affiliation":[{"name":"ESDN-Obesity, European Federation of the Associations of Dietitians (EFAD), The Netherlands"},{"name":"School of Human Sciences, London Metropolitan University, London N7 8DB, UK"},{"name":"School of Life Sciences, Pharmacy & Chemistry, Kingston University, Kingston-upon-Thames KT1 2EE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7785-4245","authenticated-orcid":false,"given":"Vaios","family":"Svolos","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Nutrition and Dietetics, Department of Nutrition and Dietetics, School of Physical Education, Sports Science and Dietetics, University of Thessaly, 42132 Trikala, Greece"},{"name":"School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7136-1039","authenticated-orcid":false,"given":"Antonis","family":"Vlassopoulos","sequence":"additional","affiliation":[{"name":"ESDN-Obesity, European Federation of the Associations of Dietitians (EFAD), The Netherlands"},{"name":"Department of Food Science & Human Nutrition, Agricultural University of Athens, 11855 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1968-7303","authenticated-orcid":false,"given":"Elisabeth","family":"Govers","sequence":"additional","affiliation":[{"name":"ESDN-Obesity, European Federation of the Associations of Dietitians (EFAD), The Netherlands"},{"name":"Knowledge Centre of Obesity Dietitians, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Hasssapidou","sequence":"additional","affiliation":[{"name":"ESDN-Obesity, European Federation of the Associations of Dietitians (EFAD), The Netherlands"},{"name":"Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,23]]},"reference":[{"key":"ref_1","unstructured":"NCD Risk Factor Collaboration (NCD-RisC) (2024). Worldwide trends in underweight and obesity from 1990 to 2022: A pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet, 403, 1027\u20131050."},{"key":"ref_2","unstructured":"World Health Organization (2025, July 15). European Regional Obesity Report 2022. WHO Regional Office for Europe., Available online: https:\/\/iris.who.int\/bitstream\/handle\/10665\/353747\/9789289057738-eng.pdf."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1038\/s41430-020-00820-2","article-title":"Dietetic management of obesity in Europe: Gaps in current practice","volume":"75","author":"Vlassopoulos","year":"2021","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1159\/000528083","article-title":"European Association for the Study of Obesity position statement on medical nutrition therapy for the management of overweight and obesity in adults developed in collaboration with the European Federation of the Associations of Dietitians","volume":"16","author":"Hassapidou","year":"2023","journal-title":"Obes. Facts"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Diamantis, D.V., Karatzi, K., Kantaras, P., Liatis, S., Iotova, V., Bazdraska, Y., Tankova, T., Cardon, G., Wikstr\u00f6m, K., and Rurik, I. (2022). Prevalence and Socioeconomic Correlates of Adult Obesity in Europe: The Feel4Diabetes Study. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191912572"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e027693","DOI":"10.1161\/JAHA.122.027693","article-title":"Obesity and Overweight: Probing Causes, Consequences, and Novel Therapeutic Approaches Through the American Heart Association\u2019s Strategically Focused Research Network","volume":"12","author":"Clark","year":"2023","journal-title":"J. Am. Heart Assoc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1159\/000442721","article-title":"Obesity Management Task Force of the European Association for the Study of Obesity. European Guidelines for Obesity Management in Adults","volume":"8","author":"Yumuk","year":"2015","journal-title":"Obes. Facts"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S288","DOI":"10.37765\/ajmc.2022.89292","article-title":"A review of current guidelines for the treatment of obesity","volume":"28","author":"Cornier","year":"2022","journal-title":"Am. J. Manag. Care"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Carrasco, D., Thulesius, H., Jakobsson, U., and Memarian, E. (2022). Primary care physicians\u2019 knowledge and attitudes about obesity, adherence to treatment guidelines and association with confidence to treat obesity: A Swedish survey study. BMC Prim. Care, 23.","DOI":"10.1186\/s12875-022-01811-x"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"159","DOI":"10.21037\/hbsn-2024-672","article-title":"Dietitians\u2019 role in obesity care: Insights from the Academy of Nutrition and Dietetics","volume":"14","author":"Boaventura","year":"2025","journal-title":"Hepatobiliary Surg. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1038\/s41366-025-01780-y","article-title":"Dietitians\u2019 utilization, attitudes, and experiences towards low-energy diets and very low-energy diets in dietary treatment of obesity","volume":"49","author":"Abild","year":"2025","journal-title":"Int. J. Obes."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1111\/obr.12889","article-title":"Management of overweight and obesity in primary care-A systematic overview of international evidence-based guidelines","volume":"20","author":"Semlitsch","year":"2019","journal-title":"Obes. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1111\/jhn.12855","article-title":"Experiences and perceptions of dietitians for obesity management: A general practice qualitative study","volume":"34","author":"Abbott","year":"2021","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.1017\/S1463423623000683","article-title":"Healthcare professionals\u2019 perceptions and experiences of obesity and overweight and its management in primary care settings: A qualitative systematic review","volume":"25","author":"Jeffers","year":"2024","journal-title":"Prim. Health Care Res. Dev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual. Res. Psychol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e50357","DOI":"10.2196\/50357","article-title":"Experience of health care professionals using digital tools in the hospital: Qualitative systematic review","volume":"10","author":"Wosny","year":"2023","journal-title":"JMIR Hum. Factors"},{"key":"ref_17","first-page":"e43","article-title":"Investigating the perceptions of primary care dietitians on the use of information technology in their workplace: Qualitative study","volume":"6","author":"Jones","year":"2018","journal-title":"JMIR Med. Inform."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"294","DOI":"10.4162\/nrp.2024.18.2.294","article-title":"Exploring dietitians\u2019 views on digital nutrition educational tools in Malaysia: A qualitative study","volume":"18","author":"Manaf","year":"2024","journal-title":"Nutr. Res. Pract."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e379","DOI":"10.1016\/S2542-5196(19)30171-8","article-title":"Nutrition in medical education: A systematic review","volume":"3","author":"Crowley","year":"2019","journal-title":"Lancet Planet. Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/j.mcna.2022.04.007","article-title":"Nutrition guidelines for improved clinical care","volume":"106","author":"Wilson","year":"2022","journal-title":"Med. Clin. N. Am."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"100321","DOI":"10.1016\/j.advnut.2024.100321","article-title":"Addressing the urgent need for clinical nutrition education in postgraduate medical training: New programs and credentialing","volume":"15","author":"Krishnan","year":"2024","journal-title":"Adv. Nutr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"532","DOI":"10.3945\/an.116.014738","article-title":"Perspective: Improving Nutritional Guidelines for Sustainable Health Policies: Current Status and Perspectives","volume":"8","author":"Magni","year":"2017","journal-title":"Adv. Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"k2426","DOI":"10.1136\/bmj.k2426","article-title":"Role of government policy in nutrition\u2014Barriers to and opportunities for healthier eating","volume":"361","author":"Mozaffarian","year":"2018","journal-title":"BMJ"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"B\u00e9n\u00e9, C., Fanzo, J., Prager, S.D., Achicanoy, H.A., Mapes, B.R., Alvarez Toro, P., Ezzine-de-Blas, D., MacMillan, S., Thorlakson, T., and Herrero, M. (2020). Global drivers of food system (un)sustainability: A multi-country correlation analysis. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0231071"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Augustus, E., Haynes, E., Guell, C., Morrissey, K., Murphy, M.M., Halliday, C., Jia, L., Iese, V., Anderson, S.G., and Unwin, N. (2022). The impact of nutrition-based interventions on nutritional status and metabolic health in Small Island Developing States: A systematic review and narrative synthesis. Nutrients, 14.","DOI":"10.3390\/nu14173529"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e574","DOI":"10.1093\/nutrit\/nuae035","article-title":"Digital applications for diet monitoring, planning, and precision nutrition for citizens and professionals: A state of the art","volume":"83","author":"Abeltino","year":"2025","journal-title":"Nutr. Rev."},{"key":"ref_27","unstructured":"World Health Organization (2025, July 15). Reformulation of Food and Beverage Products for Healthier Diets: Policy Brief. Available online: https:\/\/iris.who.int\/bitstream\/handle\/10665\/355755\/9789240039919-eng.pdf."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1139\/apnm-2013-0026","article-title":"Healthy strategies for successful weight loss and weight maintenance: A systematic review","volume":"39","author":"Ramage","year":"2014","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"van Baak, M.A., and Mariman, E.C.M. (2019). Dietary Strategies for Weight Loss Maintenance. Nutrients, 11.","DOI":"10.3390\/nu11081916"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"20","DOI":"10.7570\/jomes20065","article-title":"Optimal Diet Strategies for Weight Loss and Weight Loss Maintenance","volume":"30","author":"Kim","year":"2020","journal-title":"J. Obes. Metab. Syndr."},{"key":"ref_31","unstructured":"Clarke, V., and Braun, V. (2013). Successful Qualitative Research: A Practical Guide for Beginners, SAGE Publications Ltd."},{"key":"ref_32","unstructured":"Bryman, A. (2016). Social Research Methods, Oxford University Press."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/17\/2736\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:34:50Z","timestamp":1760034890000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/17\/2736"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,23]]},"references-count":32,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["nu17172736"],"URL":"https:\/\/doi.org\/10.3390\/nu17172736","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,23]]}}}