This review outlines the evidence and proposed professional consensus on one-to-one dietetic weight management for UK adults. New opportunities and challenges are arising for dietitians as the status afforded to obesity management increases. It is timely therefore to reflect on dietetic practice and consider the associated evidence. Despite a long standing history of working in obesity, little is known about the specific nature of UK dietetic practice, making it difficult to determine whether services are evolving and meeting recommended guidelines. It is essential that an evaluation of dietetic practice is undertaken and, importantly, that findings are published and disseminated to the profession. Assessment is the foundation of good weight management. However, given the complexity of obesity, the practice of completing both an assessment and instigating treatment during a brief consultation may not be feasible. The practitioner’s interpersonal skills are central to treatment outcomes and merit regular review and comprehensive training. The ability to express empathy is a key skill, which is particularly important given the widespread weight bias in healthcare. Evidence supports multicomponent interventions combining diet, physical activity and behaviour modification. Following stabilisation of eating, as well as improvements to diet quality, the evidence supports the 600-kcal deficit, meal replacements and, in carefully selected individuals, very low energy diets. A weight maintenance component to management is linked with reduced weight regain, although the optimal frequency, duration and content of sessions are unclear. For many services, this higher intensity provision will likely require a multidisciplinary, multi-agency approach.