Nutrition Matters June 2020
Often when a client has a larger body, it can be harder to notice that they have lost weight. As dietitians, we have seen weight loss go unflagged in clients with larger bodies, simply because the facility assumes this “is a good thing for them”.
The evidence suggests otherwise. When any client aged 65 and older experiences weight loss, this should be investigated and monitored thoroughly. Clients in bigger bodies are at risk of malnutrition, just as much as clients in smaller bodies. You cannot tell someone’s nutritional status simply by looking at their body size, especially when they are older.
All clients of this age group are predisposed to the decline in strength and muscle mass called sarcopenia. Weight loss is known to hasten sarcopenia and also leads to a small reduction in bone mass.
Loss of muscle and bone mass in turn result in reduced strength and function, leaving clients less able to transfer and ambulate independently or to assist with these activities and with an increased risk of falls. This decline in mobility is often misinterpreted as excess weight being the cause, when in fact it is largely due to muscle loss.
This devastatingly impacts on quality of life. There is also little evidence that weight loss improves glycaemic control for clients over 65 years old with diabetes.
All weight loss should be monitored and, if needed, referrals should be made to the dietitian.
What if you have clients who are on ‘diets’ or are ‘trying to lose weight’?
There is currently a lack of high-quality studies on whether intentional weight loss is beneficial for older adults with larger bodies in residential aged care settings.
As such, it is best for clients who have self-imposed weight loss plans to be seen by a dietitian and physiotherapist, to make sure muscle loss is prevented as much as possible.
But what if the doctor has recommended it?
If the doctor has recommended that the client intentionally loses some weight, refer the client to the dietitian and physiotherapist.
This ensures that the client receives the best nutrition care that is in line with up-to-date research, and if they do start on an intentional weight loss or weight stabilisation plan, it is safe, does not put them at nutritional risk, and it is being monitored by health professionals.
As a facility, your staff should continue to monitor the client’s food intake and encourage the client to regularly participate in the physiotherapist’s training program.