Nutrition Support of Hospitalized Adult Patients with Obesity

Publication Date: August 23, 2013
Last Updated: April 11, 2022

Recommendations

Critically ill patients with obesity experience more complications than patients with optimal BMI levels. Nutrition assessment and development of a nutrition support plan is recommended within 48 hours of ICU admission. (Low, Strong)
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All hospitalized patients, regardless of BMI, should be screened for nutrition risk within 48 hours of admission, with nutrition assessment for patients who are considered at risk. (Low, Strong)
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In the critically ill obese patient, if indirect calorimetry is unavailable, energy requirements should be based on the Penn State University 2010 predictive equation, or the modified Penn State equation if the patient is over the age of 60 years. (High, Strong)
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In the hospitalized obese patient, if indirect calorimetry is unavailable and the Penn State University equations cannot be used, energy requirements may be based on the Mifflin–St Jeor equation using actual body weight. (Moderate, Weak)
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Clinical outcomes are at least equivalent in patients supported with high protein, hypocaloric feeding to those supported with high protein, eucaloric feeding. A trial of hypocaloric, high protein feeding is suggested in patients who do not have severe renal or hepatic dysfunction. Hypocaloric feeding may be started with 50%-70% of estimated energy needs or <14 kcal/kg actual weight. High protein feeding may be started with 1.2 g/kg actual weight or 2-2.5 g/kg ideal body weight, with adjustment of goal protein intake by the results of nitrogen balance studies. (Low, Weak)
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Hypocaloric, low protein feedings are associated with unfavorable outcomes. Clinical vigilance for adequate protein provision is suggested in patients who do not have severe renal or hepatic dysfunction. (Low, Weak)
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Patients who have undergone sleeve gastrectomy, gastric bypass, or biliopancreatic diversion ± duodenal switch have increased risk of nutrient deficiency. In acutely ill hospitalized patients with history of these procedures, evaluation for evidence of depletion of iron, copper, zinc, selenium, thiamine, folate, and vitamins B12 and D is suggested as well as repletion of deficiency states. (Low, Weak)
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Recommendation Grading

Overview

Title

Nutrition Support of Hospitalized Adult Patients with Obesity

Authoring Organization

Publication Month/Year

August 23, 2013

Last Updated Month/Year

August 22, 2023

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

The purpose of this clinical guideline is to serve as a framework for the nutrition support care of adult patients with obesity. 

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Hospital, Long term care

Intended Users

Psychologist, dietician nutritionist, counselor, nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D009765 - Obesity, D009748 - Nutrition Disorders

Keywords

obesity, nutrition, nutritional support

Supplemental Methodology Resources

Data Supplement

Methodology

Number of Source Documents
97
Literature Search Start Date
August 1, 2012
Literature Search End Date
May 2, 2013