Principles and Protocols in Nutritional Rehabilitation
Obesity is a clinical condition characterized by fat mass reserves increased to such an extent as to represent a health risk. The clinical diagnosis of obesity requires a careful nutritional status valuation to get an early diagnosis of malnutrition (unde
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Principles and Protocols in Nutritional Rehabilitation Lorenzo M. Donini and Maria Letizia Petroni Abstract Obesity is a clinical condition characterized by fat mass reserves increased to such an extent as to represent a health risk. The clinical diagnosis of obesity requires a careful nutritional status valuation to get an early diagnosis of malnutrition (undernutrition, overnutrition, or mixed malnutrition); to establish nutrition requirements; to identify those patients who require a nutritional intervention for global or selective nutrient deficiencies; and to check the effectiveness of such an intervention. The main components which characterize nutritional status are energy balance (nutritional habits and physical activity), body composition, body function, and inflammatory status. Nutrition intervention will focus on achieving a weight loss of at least 10 % from baseline body weight with a significant reduction in body fat and preservation of lean mass; reconstructing long-term healthy eating habits (quality, quantity, rate) based on the canons of the Mediterranean Diet; obtaining a patient’s compliance adequate to achieve the established objectives. The nutritional intervention should be included into a process of therapeutic education aimed at the implementation of the knowledge about the disease and its management, and to change behaviors related to it for better management. In addition, therapeutic education allows to understand and to manage the psychological aspects related with the disease itself. An increasing number of new inpatient admissions in Rehabilitation settings consist of either failed or complicated post-surgical cases characterized by malnutrition, functional impairment and psychological uneasiness. Nutritional rehabilitation may be effective in reducing short-term and long-term complications related to bariatric surgery in improving the results of bariatric surgery and the recovery from psychological and functional impairments. L. M. Donini (*) Experimental Medicine Department, Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Sapienza University of Rome, Rome, Italy e-mail: [email protected] M. L. Petroni Clinical Nutrition Laboratory, Istituto Auxologico Italiano IRCCS, Verbania, Italy e-mail: [email protected] M. L. Petroni Department of Biomedical Sciences, University of San Marino, San Marino, Republic of San Marino
P. Capodaglio et al. (eds.), Disabling Obesity, DOI: 10.1007/978-3-642-35972-9_11, © Springer-Verlag Berlin Heidelberg 2013
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L. M. Donini and M. L. Petroni
11.1 Evaluation of Nutritional Status in the Obese Subject Obesity is a clinical condition characterized by fat mass (FM) reserves increased to such an extent as to represent a health risk. Despite the lack of a universally accepted consensus, obesity may be defined as FM exceeding 25 % in men or 35 % in middle-aged women (WHO 1995; Deurenberg et al. 1998, 1999). The overall increase in body weight is therefore j
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