Nutritional support of the obese patient

Abstract

Overweight and obesity is the most common chronic disease in the United States and is associated with an increased risk for morbidity and mortality. For the hospitalized patient, the mechanical, metabolic, and inflammatory physiologic changes induced by obesity necessitate additional considerations for care. Calculation of nutritional requirements is problematic and challenging due to difficulty in measuring body composition and energy expenditure. Provision of selective hypocaloric feeding in this population may be particularly beneficial in reducing complications of hyperglycemia, fluid overload, and reduction in fat mass. Clinical care should incorporate a team approach that addresses the special nutritional and metabolic needs of this population.

Impact of obesity on hospitalized patients

“…61 The caloric deficit of a moderately to severely obese patient should not be above 500 to 1000 kcal/day. 62 Recommendations for mildly obese patients suggest weight-maintenance feedings until the acute illness has resolved. 62 All obese patients should be given diets appropriate to the needs of their comorbid medical conditions, and this is where a multidisciplinary approach including a registered dietitian may prove beneficial.…”

“…62 Recommendations for mildly obese patients suggest weight-maintenance feedings until the acute illness has resolved. 62 All obese patients should be given diets appropriate to the needs of their comorbid medical conditions, and this is where a multidisciplinary approach including a registered dietitian may prove beneficial. As previously mentioned, enteral and parenteral access for feeds can be challenging in obese inpatients secondary to imaging issues, instrumentation issues, and venous access issues.…”