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Nutrition In The Critically Ill Obese

Release Date: September 2011
Expiration Date for Credit: September 30, 2014

Sponsored by:

Supported by Nestlé HealthCare Nutrition Inc.

Statement of Need

Obesity is one of the leading causes of preventable death in the United States, second only to smoking. The historical viewpoint toward obesity has deemed it to be a lifestyle choice or characterological flaw. However, given the emerging research into the development of obesity and its related complications, our perspective is changing. It is now clear that obesity is a heterogeneous disease with many different subtypes. The pathophysiology associated with weight gain is much more complex than originally thought. The heterogeneous nature of the disease makes the development of treatment strategies for obesity difficult. Obesity should not be considered a single disorder but rather a mixture of numerous subtypes.  In a large cohort study of primary care patients undergoing a general physical exam, physicians only correctly identified obese patients 19.9% (505/2543) of the time. Staff physicians were less likely to identify obese patients than resident physicians.  A poorly understood interaction between genetic, environmental, and complex pathophysiology is involved. The need for an overview of the epidemiology of obesity, discussion of the nature of its heterogeneity, and an explanation of its underlying genetic variability is clearly visible. 

The paucity of information for the nutrition management of the obese, critically ill patient in the literature and in specialty society guidelines is problematic. The absence of such recommendations implies that obese patients should be treated no differently than their lean counterparts. However, there is no evidence that such a concept is true, and clinical experience would suggest just the opposite. Clinicians are often on their own to design the appropriate nutrition regimen, determine the need for indirect calorimetry, select the most appropriate predictive equation, decide whether pharmaconutrition should be used, identify tolerance measures, and set appropriate monitors of feeding for the obese ICU patient.

Intended Audience

Physicians, Physician Assistants, Registered Nurses, Pharmacists, Registered Dietitians caring for the critically ill obese patient. 

Method of participation 

This activity should take approximately one hour to complete.  If CME/CE is desired, participants can then access the two articles by clicking on the links at the bottom of this page. Participants should first read the objectives and other introductory CME/CE information, then proceed to the educational offering.  To receive credit for this activity, participants must complete the post-test with a passing score of 80%, then complete the evaluation. This credit is valid through September 30, 2014. No credit will be given after this date. There is no fee to participate in this activity.

In the event you have questions about this activity or are unable to print the certificate, please e-mail michellem@dannemiller.com and a certificate will be emailed within 2 weeks.

System requirements

• Computer or smart phone with internet access
• Web Browser (IE 7.0+ or Webkit/Mozilla Compatible) with JavaScript enabled

Learning Objectives

Upon completion of this activity, the participant should be able to:

• Discuss the pathophysiology related to obesity. 
• Identify the comorbidities of obesity which complicate ICU care.
• List the current suggested nutritional recommendations for the obese ICU population.

Accreditation

Dannemiller is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Physicians
Dannemiller designates this enduring educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Physician Assistants
AAPA accepts certificates of participation for educational activities certified for Category 1 credit from AOACCME, Prescribed credit from AAFP, and AMA PRA Category 1 Credit(s) ™. from organizations accredited by ACCME . Physician assistants may receive a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. for completing this program.

Registered Nurses
Dannemiller is a provider approved by the California Board of Registered Nursing, Provider Number 4229 for 1.2 contact hours. RNs outside California must verify with their licensing agency for approval of this course.

Registered Dietitians
Dannemiller is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 1.0 continuing professional education units (CPEUs) for completion of this program/material.

Pharmacists
Dannemiller is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This activity is an application based activity. Dannemiller has assigned 1.0 contact hours (0.1 CEU) of continuing pharmacy education credit to this activity. ACPE program number 0522-0000-11-006-H04-P. Release Date: 9/1/2011 Expiration Date: 9/30/2014

Disclosures

In accordance with the Accreditation Council for Continuing Medical Education (ACCME), Dannemiller requires that any person who is in a position to control the content of a CME activity must disclose all relevant financial relationships they have with a commercial interest.

The following faculty stated they have no relevant financial disclosure:

• Thomas H. Frazier, MD
• Lee M. Kaplan, MD, PhD
• Robert Kushner, MD
• Charles W. Van Way III, MD
• Matt Cave, MD
• John Dibaise, MD
• John Drover, MD
• Ken Fujioka, MD
• Dympna Gallagher, EdD
• Craig McClain, MD 

The following faculty have disclosed that they are on the Nestlé HealthCare Nutrition speakers bureau:  

• Stephen A. McClave, MD 
• Robert Martindale, MD
• Lazlo Kiraly, MD 
• Ryan T. Hurt, MD, PhD
• Roland Dickerson, PharmD
• Mark DeLegge, MD 

Juan Ochoa, MD, is the Medical & Scientific Director for Nestlé HealthCare Nutrition.

To resolve identified/potential conflicts of interest, the educational content was fully reviewed by a physician member of the Dannemiller Clinical Content Review Committee who has nothing to disclose. The resulting certified activity was found to provide educational content that is current, evidence based and commercially balanced.

The Dannemiller staff and all others involved in the development of this activity have no relationships with commercial interests. 

Off-label statement

Off label statement provided: This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by FDA. The opinions expressed in the educational activity are those of the faculty. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Further, attendees/participants should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this program.

Disclaimer

The content and views presented in this educational activity are those of the authors and do not necessarily reflect those of Dannemiller or Nestlé HealthCare Nutrition Inc. This material is prepared based upon a review of multiple sources of information, but it is not exhaustive of the subject matter. Therefore, healthcare professionals and other individuals should review and consider other publications and materials on the subject matter before relying solely upon the information contained within this educational activity.

This activity has two external articles: (links open in a new window)

• Obesity Epidemic: Overview, Pathophysiology, and the Intensive Care Unit Conundrum
• Nutrition Therapy of the Severely Obese, Critically Ill Patient: Summation of Conclusions and Recommendations

Take Post Test (Free activity)