Outcomes & Goal Setting at Nourish

At Nourish, outcomes are a central way we define, measure, and communicate progress toward each patient’s goals. We believe great outcomes can be achieved when medical nutrition therapy is delivered with consistency, depth, and a strong therapeutic relationship.

While published literature shows natural variability in a patient’s ability to achieve target outcomes, much of that variability reflects differences in program intensity, continuity of care, and patient engagement rather than fixed physiological limits alone. Our approach to outcomes is grounded in the belief that relationship‑driven, well‑supported nutrition care can meaningfully move patients toward their goals, while still acknowledging that outcomes will vary across individuals.

Our estimated outcome targets are based on clinical research and will continue to be refined as we generate more data from Nourish patients. These targets intentionally sit toward the upper end of what many trials report, reflecting the strong progress we see with our care model. While hitting every target for every patient is neither expected nor required, sustained engagement and high‑quality care have been shown to enable many patients to reach these levels of improvement.

Clinical benefit often begins well before many targets are reached. For example, in weight management, relatively modest weight loss is consistently associated with meaningful improvements in glycemic control, blood pressure, and metabolic risk. Early progress matters and is recognized as real success.

As progress becomes more sustained, the scope of benefit often broadens: improvements in lipid patterns and insulin sensitivity, reductions in inflammatory burden, better sleep and joint function, and for some patients, a decreased need for medication over time. Our outcomes framework is designed to measure progress at any level, while also recognizing and rewarding sustained improvement that brings additional benefit.

Overall, our outcomes targets are meant to support thoughtful, patient‑centered conversations about what progress can look like over time, grounded in both evidence and lived clinical experience - and to hold ourselves to lofty standards in service of truly life‑changing care.

Our standard approach is to check labs every three months. This cadence is more frequent than what many traditional guidelines recommend, but those guidelines are typically designed for fee‑for‑service settings in which patients are seen infrequently and the primary goal is to limit utilization.

Our care model is different. Patients are seen regularly for behavior‑change work, and in this context, lab results are not just diagnostic tools - they are feedback mechanisms. Tracking labs, weight, and blood pressure at regular intervals helps patients better understand how their behaviors are influencing their health, reinforces progress, and supports motivation over time.

More frequent monitoring is especially valuable when values fall within the “normal” range but are approaching clinically meaningful thresholds (for example, an A1C of 5.5%, an LDL of 98 mg/dL, or blood pressure trending upward within the normal range). Traditional “normal versus abnormal” framing can oversimplify what is happening biologically. Reference ranges and cutoffs are based on population averages, which makes them useful guides, but they are not strict boundaries between health and disease.

Taken together, our approach to lab monitoring and outcomes reflects the same philosophy: progress is dynamic, feedback matters, and consistent, relationship‑based care creates the conditions for meaningful and sustained improvement.

In addition to labs and vitals, we measure outcomes that reflect how patients feel and function in their day-to-day lives. For several conditions, particularly eating disorders/disordered eating and gut health, patient-reported outcome measures (PROMs) are often the most clinically meaningful indicators of progress.

These tools are validated, widely used in research and clinical care, and designed to capture changes that matter to patients even when traditional biomarkers may be slow to shift or less relevant to patient goals.

1. Weight Loss - MNT only (No GLP-1 Medication)

   Starting BMI Category	Long Term Goal	Example Patient “Why”	Clinical Rationale
   Overweight (27.0–29.9)	3-5% loss (3 mo) 5-8% loss (6 mo)	“I want to feel comfortable hiking again.”	Even a 5-10% weight loss can improve blood pressure, insulin sensitivity, and joint pain.
   Class I Obesity (30.0–34.9)	4-6% loss (3 mo) 6-10% loss (6 mo)	“I want to reduce my risk for diabetes.”	Losses of ≥7% significantly reduce T2DM risk and improve lipid profiles.
   Class II Obesity (35.0–39.9)	5-7% loss (3 mo) 7-12% loss (6 mo)	“I want to move more easily and reduce knee pain.”	Weight loss of ≥10% improves mobility and cardiometabolic health.
   Class III Obesity (≥40.0)	6-8% loss (3 mo) 8-15% loss (6 mo)	“I want to be able to keep up with my kids.”	Larger sustained losses (≥12%) are linked to major improvements in quality of life and disease risk reduction.

2. Weight Loss - MNT + GLP-1 Medication

   Starting BMI Category	Long Term Goal	Example Patient “Why”	Clinical Rationale
   Overweight (27.0-29.9)	5-8% loss (3 mo) 8-12% loss (6 mo)	“I want to feel more confident and fit into my favorite clothes.”	5–10% weight loss improves insulin sensitivity, reduces cardiometabolic risk, and supports mobility.
   Class I Obesity (30.0-34.9)	6-10% loss (3 mo) 10-15% loss (6 mo)	“I want to reduce my diabetes risk and have more energy.”	≥7% loss significantly improves glycemic control and lipid profiles, lowering CVD risk.
   Class II Obesity (35.0-39.9)	8-12% loss (3 mo) 12-18% loss (6 mo)	“I want to walk without getting out of breath.”	Losses of ≥10% improve functional capacity, reduce inflammation, and improve metabolic markers.
   Class III Obesity (≥40.0)	10-15% loss (3 mo) 15-25% loss (6 mo)	“I want to be healthy enough to travel with my family.”	Large sustained losses (≥15%) can induce T2DM remission, reduce medication needs, and improve quality of life.

3. Type 2 Diabetes and Prediabetes - MNT only

   Starting A1C	Long Term Goal (6 mo)	Example Patient “Why”	Clinical Rationale
   5.7-6.4% (Prediabetes)	5.4-5.9% target A1C (6 mo)	“I want to avoid progressing to diabetes.”	Reducing A1C by ≥0.3% in prediabetes can delay or prevent T2DM onset.
   6.5-7.9% (Mild Diabetes)	5.8-6.8% target A1C (6 mo)	“I want to get my blood sugar under control without more meds.”	A1C <6.5% is associated with reduced risk of microvascular complications.
   8.0-9.9% (Moderate Diabetes)	6.8-8.0% target A1C (6 mo)	“I want to have more energy and avoid long-term complications.”	Reducing A1C by ≥1% significantly lowers the risk of cardiovascular events.
   ≥10% (Severe Diabetes)	8.0-9.5% target A1C (6 mo)	“I’m scared something serious will happen if I don’t get control of this soon.”	Severely uncontrolled diabetes is associated with substantially higher risk of acute complications and accelerated end-organ damage.

4. Type 2 Diabetes and Prediabetes - MNT + Medications

   Starting A1C	Long Term Goal (6 mo)	Example Patient “Why”	Clinical Rationale
   5.7-6.4% (Prediabetes)	5.2-5.6% target A1C	“I want to avoid progressing to diabetes.”	Reducing A1C by ≥0.3% in prediabetes can delay or prevent T2DM onset.
   6.5-7.9% (Mild Diabetes)	5.6-6.5% target A1C	“I want to get my blood sugar under control without more meds.”	A1C <6.5% is associated with reduced risk of microvascular complications.
   8.0-9.9% (Moderate Diabetes)	6.2-7.3% target A1	“I want to have more energy and avoid long-term complications.”	Reducing A1C by ≥1% significantly lowers the risk of cardiovascular events.
   ≥10%(Severe Diabetes)	7.0-8.3% target A1C	“I’m scared something serious will happen if I don’t get control of this soon.”	Severely uncontrolled diabetes is associated with substantially higher risk of acute complications and accelerated end-organ damage.

5. High Cholesterol - MNT only

   Starting LDL	Long Term Goal ( 6 mo)	Example Patient “Why”	Clinical Rationale
   100-129 mg/dL	80-105 mg/dL	“I want to keep my heart healthy as I get older.”	Lowering LDL to ≤105 mg/dL reduces long-term cardiovascular risk in patients with borderline elevations.
   130-159 mg/dL	95-125 mg/dL	“I want to reduce my risk of a heart attack.”	Reducing LDL to ≤125 mg/dL lowers ASCVD risk, especially with additional lifestyle changes.
   160-189 mg/dL	120-150 mg/dL	“I want to avoid needing cholesterol medication.”	Achieving LDL ≤150 mg/dL from higher baselines reduces risk of plaque buildup and CVD events.
   ≥190 mg/dL	140-165 mg/dL	“I want to live long enough to see my grandkids grow up.”	Lowering very high LDL to ≤165 mg/dL significantly reduces heart attack and stroke risk.

6. High Cholesterol - MNT + Statins

   Starting LDL	Long Term Goal ( 6 mo)	Example Patient “Why”	Clinical Rationale
   100-129 mg/dL	55-80 mg/dL	“I want to keep my heart healthy as I get older.”	Lowering LDL to ≤105 mg/dL reduces long-term cardiovascular risk in patients with borderline elevations.
   130-159 mg/dL	65-95 mg/dL	“I want to reduce my risk of a heart attack.”	Reducing LDL to ≤125 mg/dL lowers ASCVD risk, especially with additional lifestyle changes.
   160-189 mg/dL	80-115 mg/dL	“I want to avoid needing cholesterol medication.”	Achieving LDL ≤150 mg/dL from higher baselines reduces risk of plaque buildup and CVD events.
   ≥190 mg/dL	90-125 mg/dL	“I want to live long enough to see my grandkids grow up.”	Lowering very high LDL to ≤165 mg/dL significantly reduces heart attack and stroke risk.

7. High Blood Pressure - MNT only

   Starting BP Category	Long Term Goal (3 mo)	Example Patient “Why”	Clinical Rationale
   Elevated (120-129/<80)	110-120/<70-80	“I want to prevent high blood pressure from turning into hypertension.”	Reducing BP to 110-120/<80 can prevent progression to hypertension and lower stroke risk.
   Stage 1 (130-139/80-89)	110-120/<70-80	“I want to avoid medication and control my BP naturally.”	Lowering Stage 1 BP to near-normal reduces lifetime cardiovascular risk.
   Stage 2 (≥140/≥90)	115-125/70-80	“I want to lower my BP to reduce strain on my heart.”	Reducing Stage 2 BP to normal range significantly cuts risk of heart attack and kidney disease.
   Hypertensive Crisis (>180/>120)	150-165/100-110	“I want to feel safe and avoid another hospital visit.”	Rapid reduction from hypertensive crisis levels is critical to avoid life-threatening events.

8. High Blood Pressure - MNT + Antihypertensive Medications

   Starting BP Category	Long Term Goal (6 mo)	Example Patient “Why”	Clinical Rationale
   Elevated (120-129/<80)	110-120/<70-80	“I want to protect my heart and avoid needing higher medication doses.”	Lowering BP through lifestyle support may prevent escalation of therapy and improve cardiovascular outcomes.
   Stage 1 (130-139/80-89)	110-120/<70-80	“I want to stay on the lowest possible dose and feel in control of my health.”	Combining nutrition therapy with medication supports sustainable control and may reduce future medication dependence.
   Stage 2 (≥140/≥90)	110-120/<70-80	“I want to see if healthy changes can help me step down my meds over time.”	Lifestyle-driven BP reduction complements pharmacologic therapy, improving endothelial function and quality of life.
   Hypertensive Crisis (>180/>120)	110-120/<70-80	“I want to stabilize my BP so I can feel safe and prevent another scare.”	Sustained normalization through medication + nutrition significantly reduces risk of recurrence and acute events.

9. Eating Disorder/Disordered Eating Outcomes (EDE-Q)

   • For patients seeking support with eating disorders or disordered eating patterns, we use the Eating Disorder Examination-Questionnaire Short (EDE-QS) to assess changes in eating-disorder psychopathology over time

   • The EDE-QS captures the frequency and severity of key cognitive and behavioral symptoms over the prior 7 days, including: dietary restraint and food avoidance; fear of weight gain and desire to lose weight; preoccupation with food, weight, and shape; loss-of-control and binge eating; compensatory behaviors (e.g., vomiting, laxative use, driven exercise); body dissatisfaction and overvaluation of weight/shape

   • Each item is scored on a 0-3 scale reflecting frequency or severity (from "not at all / 0 days" to "markedly / 6-7 days"), and averaged across all items to produce a composite score ranging from 0 to 3

   • How we interpret improvement

     • Lower composite scores reflect fewer and less severe symptoms

     • Change is assessed by comparing the earliest submission to the most recent submission

     • A ≥0.5-point reduction on the composite score represents a minimally important difference - a level of change that patients can perceive and that clinicians consider clinically meaningful

     • In addition to the composite view, we track progress on individual symptoms so that clinicians can see which specific areas are driving change (e.g., a patient may show improvement in compensatory behaviors while shape/weight concern remains elevated)

     • Because eating disorder recovery is nonlinear, our framework recognizes partial improvement and harm-reduction gains as meaningful outcomes, particularly early in care. Early improvements often reflect increased safety, awareness, and behavioral regulation, even before full symptom remission

10. Gut Health Outcomes (GI-PROMIS)

    • For patients seeking care for gut health concerns, we use a GI-specific subset of the Patient-Reported Outcomes Measurement Information System (PROMIS)

    • Patients report how frequently they experience common GI symptoms such as: constipation; diarrhea; abdominal pain; gas, bloating, or reflux; nausea or vomiting; difficulty swallowing; bowel urgency

    • Responses are captured on a 0-5 frequency scale (from "never" to "once per day or more") and averaged across GI-related items to generate a composite score

    • How we interpret improvement

      • Lower scores reflect fewer or less frequent symptoms

      • Change is assessed by comparing the earliest submission to the most recent submission

      • A ≥0.5-point reduction on the composite score represents a minimally important difference - a level of change that patients can perceive and that clinicians consider clinically meaningful

      • In addition to the composite view, we track progress on individual symptoms so that clinicians can see which specific GI concerns are improving (e.g., a patient's bloating and reflux may resolve while bowel patterns remain unchanged)

    How We Define Success for Patient-Reported Outcomes

    We define meaningful improvement using a consistent, research-backed threshold: a ≥0.5-point reduction from baseline on the composite score represents a minimally important difference - a level of change that patients can perceive and that clinicians consider clinically meaningful.

    This threshold applies to both of our patient-reported outcome measures:

    • EDE-QS: We average scores across all 12 items on a 0–3 scale. A ≥0.5-point drop in that average indicates meaningful improvement in eating disorder symptom severity.

    • GI-PROMIS: We average scores across all 8 GI symptom items on a 0–5 scale. A ≥0.5-point drop in that average indicates meaningful improvement in GI symptom frequency.

    In practice, this means:

    • Small but consistent symptom reductions are counted as success

    • Patients do not need to reach "zero symptoms" to demonstrate meaningful progress

    • Early gains are recognized, reinforcing engagement and momentum

    • Per-symptom tracking is available for both measures, giving visibility into which specific symptoms are driving overall change

Weight Reduction

• Wing RR, Bolin P, Brancati FL, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes (Look AHEAD). New England Journal of Medicine. 2013;369(2):145–154.

• Lean MEJ, Leslie WS, Barnes AC, et al. Primary care–led weight management for remission of type 2 diabetes (DiRECT). The Lancet. 2018;391(10120):541–551.

• Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults. Circulation. 2014;129(25 Suppl 2):S102–S138.

• Wadden TA, Webb VL, Moran CH, Bailer BA. Lifestyle modification for obesity: new developments in diet, physical activity, and behavior therapy. Circulation. 2012;125(9):1157–1170.

• Dombrowski SU, Knittle K, Avenell A, Araújo-Soares V, Sniehotta FF. Long-term maintenance of weight loss with non-surgical interventions in obese adults. BMJ. 2014;348:g2646.

• Johns DJ, Hartmann-Boyce J, Jebb SA, Aveyard P. Diet or exercise interventions vs combined behavioral weight management programs. International Journal of Obesity. 2014;38(3):376–388.

Metabolic Health

• Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine. 2002;346(6):393–403.

• Wing RR, Bolin P, Brancati FL, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. New England Journal of Medicine. 2013;369(2):145–154.

• Lean MEJ, Leslie WS, Barnes AC, et al. Primary care–led weight management for remission of type 2 diabetes (DiRECT). The Lancet. 2018;391(10120):541–551.

• Evert AB, Dennison M, Gardner CD, et al. Nutrition therapy for adults with diabetes or prediabetes: A consensus report. Diabetes Care. 2019;42(5):731–754.

• Hallberg SJ, McKenzie AL, Williams PT, et al. Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year. JMIR Diabetes. 2018;3(1):e7.

Blood Pressure

• Sacks FM, et al. Effects on blood pressure of reduced dietary sodium and the DASH diet. N Engl J Med. 2001;344:3–10.

• Appel LJ, et al. Effects of comprehensive lifestyle modification on blood pressure control. JAMA. 2003;289(16):2083–2093.

• Stevens VJ, et al. Long-term weight loss and changes in blood pressure. Ann Intern Med. 2001.

• Neter JE, et al. Influence of weight reduction on blood pressure. Hypertension. 2003.

• Blumenthal JA, et al. Effects of exercise and diet on blood pressure. Arch Intern Med. 2000.

Lipids

• Jenkins DJA, Kendall CWC, Marchie A, et al. Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids. JAMA. 2003;290(4):502–510.

• Jenkins DJA, Kendall CWC, Faulkner D, et al. Assessment of the longer-term effects of a dietary portfolio of cholesterol-lowering foods. American Journal of Clinical Nutrition. 2006;83(3):582–591.

• Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. New England Journal of Medicine. 2013;368(14):1279–1290.

• Sacks FM, et al. Effects on blood lipids of reduced dietary sodium and the DASH diet. New England Journal of Medicine. 2001;344:3–10.

• Clifton PM. Diet, exercise and weight loss and dyslipidaemia. Pathology. 2019;51(2):222–226.

• Nordestgaard BG, Langsted A, Mora S, et al. Fasting is not routinely required for determination of a lipid profile. European Heart Journal. 2016;37(25):1944–1958.

Patient-Reported Outcomes

• Gideon N, Hawkes N, Mond J, et al. Development and psychometric validation of the EDE-QS, a 12-item short form of the Eating Disorder Examination Questionnaire (EDE-Q). PLOS ONE. 2016;11(5):e0152744.

• Prnjak K, Mitchison D, Fursland A, et al. Further development of the 12-item EDE-QS: identifying a cut-off for screening purposes. BMC Psychiatry. 2020;20:146.

• Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Medical Care. 2003;41(5):582–592.