Elliott Andrea, Bauer Judy, McDonald Cassie, Gibson Simone
Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, VIC, Australia.
Dietetics and Nutrition Department, Alfred Health, Prahran, VIC, Australia.
Int J Obes (Lond). 2025 Apr;49(4):698-705. doi: 10.1038/s41366-024-01697-y. Epub 2024 Dec 5.
Obesity is a modifiable risk factor associated with hospital-associated complications. Recent studies show there is a high prevalence of patients with obesity presenting to hospital and evidence indicates that people living with obesity should receive diet advice from a dietitian; however, patients often do not receive this care in acute settings.
The primary aim of this study was to explore the experiences of dietitians caring for patients living with obesity in acute hospital settings.
A multi-site qualitative study was conducted from October 2021 to November 2023 in Melbourne, Australia. Constructivist grounded theory methodology informed sampling and data collection. Semi-structured interviews were undertaken with dietitians working in acute care. Data were analysed using open coding and constant comparison underpinned by Charmaz's framework.
Interviews were conducted with 25 dietitians working across four hospitals. The theory developed from the data describes an enculturated decision-making process whereby acute clinical dietitians are limiting acute nutrition care for people living with obesity in hospital. The theory includes five interdependent categories that influence clinical decision-making and practice: (1) culture of professional practice, (2) science and evidence, (3) acknowledgement of weight bias and stigma, (4) dietitian-led care and (5) hospital systems and environment.
The findings from this study provide new insights as to why dietitians may not be providing acute nutrition care for people living with obesity. Strategic leadership from clinical leaders and education providers together with the lived experience perspectives of people with obesity is needed to shift the culture of dietetic professional practice to consider all nutrition care needs of patients living with obesity who are accessing acute hospitals for health care.
肥胖是一种可改变的风险因素，与医院相关并发症有关。最近的研究表明，肥胖患者到医院就诊的比例很高，而且有证据表明肥胖者应接受营养师的饮食建议；然而，患者在急性病环境中往往得不到这种护理。
本研究的主要目的是探讨营养师在急性医院环境中护理肥胖患者的经历。
2021年10月至2023年11月在澳大利亚墨尔本进行了一项多地点定性研究。建构主义扎根理论方法为抽样和数据收集提供了指导。对从事急性护理工作的营养师进行了半结构化访谈。数据采用开放式编码和基于 Charmaz 框架的持续比较法进行分析。
对在四家医院工作的25名营养师进行了访谈。从数据中得出的理论描述了一个文化化的决策过程，即急性临床营养师在限制医院中肥胖患者的急性营养护理。该理论包括影响临床决策和实践的五个相互依存的类别：(1) 专业实践文化，(2) 科学与证据，(3) 对体重偏见和污名的认识，(4) 营养师主导的护理，(5) 医院系统与环境。
本研究的结果为营养师为何可能不为肥胖患者提供急性营养护理提供了新的见解。需要临床领导者和教育提供者的战略领导，以及肥胖者的生活经验观点，以改变饮食专业实践的文化，从而考虑到因健康问题前往急性医院就诊的肥胖患者的所有营养护理需求。
