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Management of the Obese Patient

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Part of the Nutrition and Health book series (NH)

Abstract

Obesity is common, being seen in about one-third of all patients, including critically ill patients. Obese patients have particular problems in management. Obesity itself may or may not be a risk factor for poor outcomes; evidence varies. But there is clear evidence that several associated problems produce difficulties. Hyperglycemia and insulin resistance are common, especially in grade II and III obesity. Diabetes mellitus, likewise, predisposes to a poor outcome. Management of the glucose levels can be difficult, as insulin resistance tends to become worse in stress or following trauma or surgery. Hypoventilation syndrome and/or obstructive sleep apnea are common. Cardiac impairment is common. Past all of these co-morbidities, it is difficult to know even how much to feed obese patients. Determination of the proper calorie and protein intake by the usual formulas is inaccurate. Some obese patients are actually poorly nourished, with low muscle mass and other signs of malnutrition. This “sarcopenic obesity” is a risk factor in itself. Obese patients tend to have a high protein turnover rate, indicating a need for higher than usual protein intake. Current management has focused on a hypocaloric, high protein, feeding regimen. There is published evidence that this is effective in terms of nitrogen balance. But larger and more comprehensive studies are still needed.

Keywords

  • Obesity
  • Enteral nutrition
  • Parenteral nutrition
  • Hyperglycemia
  • Insulin resistance
  • Insulin
  • Hypercapnia
  • Steatosis
  • Fatty liver disease
  • Nitrogen balance
  • Nitrogen
  • Protein
  • Weight loss
  • Fat oxidation
  • Lipolysis
  • Diabetes mellitus
  • Carbohydrate
  • Clinical outcomes
  • Body mass index
  • Requirements
  • Vitamins
  • Thiamine
  • Vitamin B12
  • Essential fatty acid deficiency
  • Energy
  • Energy deficit
  • Hypercaloric
  • Hypocaloric
  • Eucaloric
  • Energy expenditure

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Fig. 11.1

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Dickerson, R.N. (2016). Management of the Obese Patient. In: Seres, D., Van Way, III, C. (eds) Nutrition Support for the Critically Ill. Nutrition and Health. Humana Press, Cham. https://doi.org/10.1007/978-3-319-21831-1_11

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