Principles and protocols in nutritional rehabilitation

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.