Cath Lab Digest

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     Obesity in the US has reached epidemic proportions. Each day, the media features at least one article on the health consequences of extra weight. But another epidemic is occurring much more quietly in our nation’s hospitals, nursing homes, wound care clinics, and patients’ private homes: Medical teams and caregivers are struggling to keep the pounds on patients who have lost interest in eating, endure taste abnormalities, are too fatigued to shop and prepare meals, get a feeling of fullness quickly, and suffer many other impediments to consuming a proper diet.

     Ultimately, many diseases alter the normal metabolic machinery, rendering patients in need of more calories and protein just when their intake dwindles. In response, registered dietitians from across the country have shared best practices, tips, and techniques for dealing with unintended weight loss and wounds.

     Heather Schwartz, MS, RD, Stanford, CA: I work with patients who are chronically ill and often struggle to keep their weight on. To deal with this problem, I frequently encourage the use of liquid oils as a calorie booster. They are heart-healthy, reasonably priced, familiar to most people, and accessible at nearly all markets. Some oils such as flaxseed or walnut oil even may help reduce inflammation. The oils blend in well with most foods and are easily added to dishes such as salads, soups, pasta, rice, shakes, or hot cereals. Oils spread easily on breads or crackers, or you can give the oil by the spoonful or add it to a tube feeding. An added bonus is that these oils are calorie-dense — for example, 1 tablespoon of oil provides 120 calories. That’s a lot of bang for your buck!

     Jan Patenaude, RD, Carbondale, CO: Over the years, I noticed that certain residents only would eat foods with a sweet flavor, such as desserts, juices, fruits, and sweetened medical nutrition supplements. When I sprinkled a small amount of sugar (1 to 2 teaspoons) over meat, potatoes, and vegetables, the residents began to eat 100% of their meals, their body weight stabilized, and we could eliminate many high-calorie supplements. A similar trick is to use more fruit sauces and fruit glazes to add a sweeter flavor to foods.

     Alyson Z. Mar, RD, San Francisco, CA: During my internship, my preceptor, Sandy Von Bieberstein, said, “Eating is like going to work; sometimes you don’t mind it and sometimes you really don’t feel like going, but you do because it’s your job and you have to.” That little talk helps motivate people to eat their meals, even when they don’t want to.

     Janice Baker, MBA, RD, CDE, San Diego, CA: I work with many senior citizens who are dealing with diabetes. Over time, because of changes in dentition, social circumstances, and a general lack of nutrition and diabetes education, they often become afraid to eat certain foods. This puts them at risk for unintended weight loss and failure to thrive. Nutrition counseling that teaches them to relax unnecessary dietary restrictions is very helpful to them, both nutritionally and emotionally. I also include counseling about easy-to-prepare, nutrient-dense meals. When patients understand the facts and the priorities for their health and well being, they can enjoy meals with less stress.

     Sonal R. Patel, MS, RD, LDN, Sparks, MD: At weekly nutrition/skin meetings, we review all of the residents with unintended weight loss, poor meal intake, skin integrity problems, or swallowing issues. We have a team comprised of the unit nurse, the assistant director of nursing, the speech therapist, the food service director, and the registered dietitian. We follow all the residents who have nutrition/skin issues, incorporating the team approach and using root cause analysis to find individualized solutions.