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Nutrition Care for the Overweight Patient

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Nutrition Care for the Overweight Patient
Staff In-service

Use
A nutrition staff member should deliver this in-service to nurses, nursing assistants, and kitchen staff.

Introduction
As the prevalence of obesity in the United States grows, the number of overweight and obese residents in long-term care facilities will grow as well. Understanding the issues related to nutrition care of the obese nursing home resident is important. Goals for nutrition care may or may not include weight loss. Each resident must receive careful evaluation and initiation of medical nutrition therapy, if appropriate.

In some cases, supplemental nutrition is needed to help meet elevated protein or calorie needs. If weight loss is recommended, documentation is required in the plan of care.

Objectives
Following the in-service, staff will know:

  • Three health risks related to obesity
  • Why some overweight or obese residents receive supplemental nutrition
  • Why weight loss is not always recommended for obese long-term care residents

Outline
I. Health risks related to obesity:

  • Elevated blood pressure
  • Diabetes
  • Elevated blood lipids
  • Certain cancers
  • Gallbladder disease
  • Stroke
  • Respiratory problems
  • Gout
  • Arthritis and/or joint problems

II. Care issues related to obesity:

  • Decreased ability to perform activities of daily living (ADLs)
  • Decreased mobility (eg, going to the dining room for meals, etc)
  • Increased risk for pressure ulcers if immobile
  • May require two or more staff for toileting, weighing, lifting, etc
  • Difficult to meet calorie, fluid, and protein needs if patient is on tube feeding
  • May need a special scale to obtain weights

III. Should the obese patient be encouraged to lose weight? Consider these factors.

No, because:

  • Federal and state regulations require that residents maintain their usual body weight (exceptions permitted if health risks exist and plan of care for weight loss is documented)
  • A restrictive diet might cause desired weight loss, then result in a downward spiral of weight loss that is irreversible
  • Residents have the right to eat what they choose; they may not want to lose weight or restrict their intake
  • Some evidence suggests that overweight may prevent or delay mortality
  • If residents are overweight and/or had poor eating habits for a lifetime, they are not likely to want to change at this point in their life

Yes, because:

  • Weight loss can improve health status, especially if high blood sugars, blood lipids, or blood pressure also is present
  • Weight loss can improve residents’ ability to perform ADLs, improve their mobility, etc
  • Weight loss can decrease the risk for pressure ulcers in bed-bound patients
  • Weight loss decreases fluid needs, decreasing the chances of dehydration
  • Some residents may desire weight loss

IV. Appropriate interventions for plan of care:

  • Depending on meal intake, presence of pressure ulcers, and other situational factors, overweight residents may require nutrition supplements to help meet protein or calorie needs
  • Additional fluids are maybe necessary to help meet fluid needs
  • Small snacks between meals may help with satiety issues
  • If weight loss is indicated, the care plan must reflect a goal of desired weight loss
  • If residents desire weight loss, but are noncompliant to diet orders, document noncompliance in the medical record

Activity
Review and discuss the following case study.

Note: No right or wrong answers.

Mr Jones was admitted to the facility weighing 350 pounds, with a goal of losing weight so he can return home to live independently. He has diabetes and high blood pressure. He is 65 years old. Mr Jones comes to the kitchen two or three times daily and requests snacks and sodas, even though he complains that he is not losing weight.

  • Should you place Mr Jones on a diet for weight loss?
  • Should you give Mr Jones the snacks he requests from the kitchen?

 

Mrs Smith is a 70-year-old woman who has stayed 30 pounds overweight for most of her life. She is admitted to the nursing home because of her increasing dementia and uncontrolled high blood pressure. Mrs Smith is eating poorly and is losing weight.

  • Should Mrs Smith have weight loss as part of her plan of nutrition care?
  • What steps should the facility take to intervene with Mrs Smith’s intake?

 

Recommended reading
Grabowksi DC, Campbell CM, Ellis JE. Obesity and mortality in elderly nursing home residents. J Gerontol A Biol Sci Med Sci. 2005;60:1184-1189.

Lapane KL, Resnik L. Obesity in nursing homes: an escalating problem. J Am Geriatric Soc. 2005;53:1386-1391.

 

Nutrition Care for the Overweight Patient

Pretest and Posttest

Name: _______________________
Date: ________________________
Department: __________________

  1. True or false: Overweight can result in many health problems.
  2. Which of the following is a care issue related to managing an overweight or obese resident?
    1. Excess weight may affect a patient’s ability to perform ADLs
    2. Excess weight may increase risk for pressure ulcers in a bed-bound patient
    3. An overweight patient may require more than one staff member to help with daily care
    4. All of the above
  3. True or false: All overweight patients should lose weight.
  4. True or false: Never order nutrition supplements for overweight residents.
  5. Which of the following is a good reason to encourage weight loss in a
    resident?
    1. The resident has uncontrolled high blood pressure
    2. The resident is comfortable with their current weight
    3. The resident enjoys eating and eats frequently throughout the day
    4. The resident has stayed overweight for his/her entire life

Answer key

  1. True
  2. d. All of the above
  3. False
  4. False
  5. a. The resident has uncontrolled high blood pressure

 

Review Date 12/10
G-1459 

G_1459_Nutrition_Care_for_the_Overweight_Patient_Staff_In_service.doc

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