While most of the referrals for dietitian input in aged care facilities relates to unwanted weight loss, dietitians can be asked for input with residents who have unwanted weight gain.

What is overweight?

For many adults we use the Body Mass Index as a basis for identifying a ‘healthy weight range’.  The BMI is a ration of the person’s height to their weight.  (kg/m²)  The BMI is not without its limitations, but generally it is a useful tool in assessing if someone is within the recommended weight range (BMI 20 – 25kg/m²), below it (underweight and malnourished) or above it (overweight and obese).  For older adults, the ‘healthy weight range’ tends to shift upwards.  There is evidence older adults with a BMI between 22 – 27 kg/m², have a longer life expectancy.  There is evidence that older adults who have unwanted weight loss will reduce their life expectancy.

What is the aim?

The first question to ask is whether this weight gain is a cause for health concern, and if there are benefits gained from weight loss.  In some cases weight gain may lead to reduced mobility, worsening blood sugar control, exacerbation of shortness of breath and gastric reflux, problems in fitting clothes, problems with ill-fitting hoists, chairs, and increased difficulty with transfers.  If it agreed that weight loss would be beneficial, the first nutritional goal is to prevent further weight gain.  Aim to stabilise the current weight.  Weight loss may be the next goal once weight stabilisation is achieved.

How much weight to lose?

Stabilising the current weight is a good start.  If weight loss is desired, set a realistic weight goal with the resident.  Health benefits are noticeable with as little as 5% weight loss.  A 85kg woman losing around 4kg should notice some benefits.

The goal of weight loss it to be losing body fat, not body muscle.  If weight loss is too rapid, the risk is that significant muscle mass is lost.  This can lead to worse health outcomes.

Involving the resident who has unwanted weight gain

A discussion with the resident about whether they are noticing any effects from the weight gain, and whether they would like to try and prevent gaining more weight, is essential.  It may be useful to explain the expected health benefits possible with weight loss. Family may also like to be consulted, but the decision and the motivation really needs to come from the resident.

Just telling a resident they need to lose weight, or automatically changing their diet is not treating a resident with respect, nor providing care that is tailored to their needs.  You may feel that the ‘best’ option would be to lose weight. The resident may feel different. They have the right to choose what’s right for them.

What strategies may help unwanted weight gain?

Losing weight is hard.  There needs to be a reduction in the energy intake with an increase in energy output.  Changes to food and changes to levels of activity are needed for optimal results.  Activity and body movement are important in helping to maintain muscle mass.  The diet still needs to remain nutritionally adequate, especially in terms of protein to minimise the loss of body protein too.  Continue to offer quality protein foods, at main meals and tea meals.

An aged care facility menu is nutritionally balanced and tailored to ensure the nutritional needs of the residents are met.  Talk with the resident about what ideas they might be happy to try to help reduce their food intake.  Small changes eventually add up to significant calorie reduction.  Start with changing one or two things only in the diet.  If that is successful, add in other small changes.

Reducing Food Intake

• Target between meal snacks such as morning tea, and/or afternoon tea. If the resident is not hungry at these times, he or she may be able to skip the food offered
• Limit sweet drinks; offer water, ‘diet’ options and a sugar replacement in hot drinks
• Reduce the frequency of desserts in the week, or offer lower calorie options such as fresh fruit, diet jelly, low fat yoghurt. Limit the use of cream on desserts.
• Ensure the size of the main meal is a medium meal (not large), serve extra vegetables if the resident is wanting more food.
• Look at the quantity of food eaten at meals. Reducing the amount slightly can help.
• Target the amount eaten at ‘happy hours’ and other treat times
• Try to encourage the resident to limit the amount of extra foods they may be buying and having in their room
• Ask family and friends not to bring in food items. Suggest other options such as magazines, books, photo albums, flowers

Increasing activity levels

• Encourage the resident to join in the home’s activities
• Encourage the resident to walk more if possible, around the home, to the dining room, around the garden – short distances at first so they gain a sense of achievement
• Family and friends may be able to help by joining the resident in walks or taking them on outings too

These are some ideas to try.  For more information and tailored nutritional advice contact your clinical dietitian.  If the resident is ready to make some changes, offer support and encouragement, to help enable their success.  Be positive.  As with all of us, sometimes we deviate from our own ‘diet’; we have a treat or a dessert or a second helping.  Don’t judge residents, or be so strict with restricting foods.  Avoid using phrases that suggest the resident is ‘being good’ or ‘being naughty’ in terms of whether they are following the agreed diet plan.  There are no ‘good’ foods and ‘bad’ foods.  And finally, weight loss takes time.  Simply stalling the weight increase is a significant achievement.  Long term encouragement and support is essential for successful and sustained weight loss.

Article contributed by: Liz Beaglehole (NZ Registered Dietitian), Canterbury Dietitians

liz@canterburydietitians.co.nz