Exploring Overnutrition, Overweight, and Obesity in the Hospital Setting—A Point Prevalence Study

Abstract

Malnutrition is an international healthcare concern associated with poor patient outcomes, increased length of stay, and healthcare costs. Although malnutrition includes both under and overnutrition, there is a large body of evidence that describes the impacts of undernutrition with limited data on overnutrition in hospitalized patients. Obesity itself is a modifiable risk factor associated with hospital-associated complications. However, there is limited reporting of the prevalence of obesity in hospitals. This one-day cross-sectional study (n = 513) captures the prevalence of both under and overnutrition in a hospitalized population and explores dietetic care provided compared to the Nutrition Care Process Model for hospitalized patients who have obesity. The main findings were: (1) the largest proportion of patients were in the overweight and obese classifications (57.3%, n = 294/513); 5.3% of these patients had severe obesity (class III); (2) patients who were overweight and obese had lower malnutrition risk profiles as well as the prevalence of malnutrition; (3) 24.1% of patients who had obesity (n = 34/141) were receiving dietetic intervention; (4) 70.6% (n = 24/34) did not have a nutrition diagnosis that followed the Nutrition Care Process Model. Study results provide valuable clinical insight into the prevalence of overnutrition and opportunities to improve nutrition care for this vulnerable patient group.

Obesity—A wicked challenge

“…Across my career as a clinical dietitian, I have seen the focus of nutrition care in Australia shift to the governance and systems to support best practice in the prevention and management of malnutrition as this aligns with the National Safety and Quality Health Service Standards to minimise the risk of harm to patients 14 . Further, current prioritisation or triage systems for dietetic care in hospitals prioritise patients who present or co‐present with overweight and obesity as a low priority, 15 resulting in this patient group not receiving dietetic care during an inpatient admission 16 . This is in contrast to my early career, when, as a newly graduated dietitian, patients living with overweight and obesity were often referred and obesity‐related interventions were a significant part of my clinical case load.…”

“…Weight‐related stigma still exists and is known to compromise quality of care and potentially reinforce weight gain and associated negative health consequences in people living with obesity 20 . With the growing prevalence of overweight and obesity in our hospitalised patients, 16,21,22 there is an urgent need to improve the training of dietitians, as well as all healthcare professionals, involved in the care of patients who live with obesity. This is important not only to raise the level of knowledge and understanding of obesity and skill in clinical care but also to help to acknowledge and address the explicit and implicit bias that many have towards patients based on weight and body shape 23–25 …”