Archive for the 'Nutrition' Category

The Struggle is Real! The Difficulties of Discussing Obesity with Your Patients

discussing-obesity-with-patients-image2Discussing weight issues with a healthcare provider can be uncomfortable; especially when you are being seen by your physician for an unrelated issue and neither party knows how to approach the topic. However; it is important for people suffering from obesity and other weight related issues to receive the proper individual treatment they need. With two-thirds of American adults being classified as overweight or obese, that conversation becomes even more vital. Being overweight increases your risk of diabetes, heart disease, and a slew of other medical problems. Often, people who are overweight are concerned about  their health, but find it difficult to talk about the subject. As a medical doctor you must treat your patient as a partner and speak to them in a caring matter about the subject.

Regularly checking your patient’s BMI is a great segue into discussing maintaining a do-image1healthy weight and further evaluation using body composition analysis.  It is recommended you discuss weight loss with your patient if they have a BMI of 30 or above, a BMI between 25 and 30 with additional health issues, or a waist size of 40 inches (men) or 35 inches (women)1.  While BMI is a great starting point, it doesn’t tell the whole story and can often have false positives with fit patients, false negatives with TOFI patients – leading to misdiagnosis.  Using medical body composition analyzers such as the seca mBCA 514 and mBCA 525, you can measure multiple parameters (i.e., fat and fat-free mass, skeletal muscle mass, visceral adipose tissue (VAT), intra and extra-cellular water) giving you and your patient a comprehensive look at the composition of their body.

An essential component to assist with weight discussion is the seca directprint 284 or 286.  Both offer a completely integrated system, measuring height and weight, then automatically printing a custom BMI report. The easy-to-read document outlines the nutritional condition of the patient based on her BMI and provides tips on maintaining a healthy weight.  The report takes a short time to print, fitting in the clinician’s workflow and facilitates as an ice breaker to help with bringing up the topic of weight.  If you determine that a patient needs assistance, start the conversation by listening2. For many, they may have never discussed their weight before and may even be unaware of the potential risk factors that they could be at risk for. Others may have been criticized in the past about their weight making it a sensitive subject to talk about. Its best to start from a place of empathy and even ask for permission to talk about the issue. Many healthcare providers worry about offending their patients during this discussion. The best way to be sure is to avoid passing judgement, eliciting confrontation, and giving  advice. Allow the patient to see that change is possible and educate them on the importance of measuring body composition to help with achieving realistic weight loss goals.

 

[1] Puhl, Rebecca, PhD. “Talking with Patients about Weight Loss: Tips for Primary Care Providers.” National Institute of Diabetes and Digestive and Kidney Diseases. National Institute of Health, Nov. 2012

2Milken Institute School of Public Health. WHY WEIGHT? A Guide to Discussing Obesity & Health With Your Patients. Washington: Milken Institute School of Public Health, 2014. StopObesityAlliance. George Washington University

The Importance of Nutrition Screening for Wound Care Patients

It is reported that as many as 35% to 55% of patients entering acute hospitals are at risk of malnutrition. Malnutrition is defined as an imbalance of nutrition1. This includes both under and over-nutrition. Under-nutrition is often seen in developing countries while over-nutrition is more common in developed nations. Malnutrition can develop as a result of a lack of proper nutrition, poor absorption resulting from an illness, excessive nutrient losses, and an increase in nutrition requirements from a disease1. Malnutrition can have disastrous consequences for hospitalized patients including increased hospital stay, higher infection rates, muscle loss, increased morbidity and mortality, and impaired wound healing1. Often times patients are admitted into hospitals already malnourished from their condition. Since undernourishment is difficult to detect, it can go a long time before being discovered.

Malnutrition and the Hospitalized Wound PatientThe best thing a hospitalist can do in this regard is administer a nutrition risk screening. Body composition analyzers such as the seca mBCA 525 (or for patients able to stand, the mBCA 514) should be used for  these screenings to detect undernourishment. Other parameters that can also be identified are losses in lean body mass, skeletal muscle mass, and measuring total body water (hydration) status. These analyzers are also capable of measuring a patient’s phase angle, which can indicate a low range of body cell mass (BCM), pointing to poor nutrition status, or potentially the need for further testing (such as a blood panel for example) to check for other underlying health conditions that may be causing it.

The seca mBCA 525 is  the mobile version of the mBCA 514 that requires the patient to be measured in the supine position, optimal when dealing with bedridden, acute, and wound healing patients under the care of a treatment team that includes a registered dietitian. The healing process slows down significantly with the absence of proper nutrition. The body is incapable of supporting itself without proper nutrients. That is why it’s important for newly-admitted patients to be screened for malnutrition as soon as they are admitted to their acute care facility.

[1] Barker, Lisa A., Belinda S. Gout, and Timothy C. Crowe. “Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System.” International Journal of Environmental Research and Public Health 8.2 (2011): 514-27. National Institutes of Health. Web. 17 Aug. 2016.

Leininger, Susan. “How to Help Wounds Heal.” Ed. Helen Lippman. RN Magazine 1 Aug. 2004: n. pag. Print.