Guest guest Posted September 29, 2004 Report Share Posted September 29, 2004 To address the use of Adj body weight, in the ADA's 6th edition of the Manual of Clinical Dietetics It was stated that "Although included in previous editions of ADA's Manual of Clinical Dietetics, use of an adjusted body weight in calculating needs of overweight/obese patient has been deleted, since there is no scientific basis for the use of an adjusted body weight". This statement also appeared in the ADA Courier a few years back, in the section "Members Are Asking" specifically about using adjusted body weight for obese patients. In both statements, suggested guidelines were given to calculate caloric needs of the obese patient. Every time I see that a facility is still using the "adjusted body weight formula" I feel that the RD's working there are not current with their Association's recommendations. [Kathy Hill] -----Original Message-----From: Bragg [mailto:breizy@...]Sent: Monday, September 27, 2004 1:54 PM Subject: assessments Hi everyone, I am fairly new to bariatric surgery and need to ask some experts a couple of questions. When assessing someone for bariatric surgery (RYGB) initially, do you use Adj BW (20-25 kcal) or Actual BW (20-25 kcal)? Also how do you figure protein needs for wt loss? Thanks for your guidance, AnnistonNutrAssoc@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2004 Report Share Posted September 29, 2004 So what do the guidelines say for calculating the caloric needs? And does it say anything about calculating protein needs? Wotton, RD, CDN Glens Falls Hospital Glens Falls, NY -----Original Message-----From: Bragg [mailto:breizy@...]Sent: Wednesday, September 29, 2004 1:18 PM Subject: Re: assessments Kathy, Thanks so much for pointing that out! I've often had this discussion with other dietitians who work in the hospitals where I fill in prn. I will definitely pass this along. Thanks again, RE: assessments To address the use of Adj body weight, in the ADA's 6th edition of the Manual of Clinical Dietetics It was stated that "Although included in previous editions of ADA's Manual of Clinical Dietetics, use of an adjusted body weight in calculating needs of overweight/obese patient has been deleted, since there is no scientific basis for the use of an adjusted body weight". This statement also appeared in the ADA Courier a few years back, in the section "Members Are Asking" specifically about using adjusted body weight for obese patients. In both statements, suggested guidelines were given to calculate caloric needs of the obese patient. Every time I see that a facility is still using the "adjusted body weight formula" I feel that the RD's working there are not current with their Association's recommendations. [Kathy Hill] -----Original Message-----From: Bragg [mailto:breizy@...]Sent: Monday, September 27, 2004 1:54 PM Subject: assessments Hi everyone, I am fairly new to bariatric surgery and need to ask some experts a couple of questions. When assessing someone for bariatric surgery (RYGB) initially, do you use Adj BW (20-25 kcal) or Actual BW (20-25 kcal)? Also how do you figure protein needs for wt loss? Thanks for your guidance, AnnistonNutrAssoc@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2004 Report Share Posted September 29, 2004 Kathy, Thanks so much for pointing that out! I've often had this discussion with other dietitians who work in the hospitals where I fill in prn. I will definitely pass this along. Thanks again, RE: assessments To address the use of Adj body weight, in the ADA's 6th edition of the Manual of Clinical Dietetics It was stated that "Although included in previous editions of ADA's Manual of Clinical Dietetics, use of an adjusted body weight in calculating needs of overweight/obese patient has been deleted, since there is no scientific basis for the use of an adjusted body weight". This statement also appeared in the ADA Courier a few years back, in the section "Members Are Asking" specifically about using adjusted body weight for obese patients. In both statements, suggested guidelines were given to calculate caloric needs of the obese patient. Every time I see that a facility is still using the "adjusted body weight formula" I feel that the RD's working there are not current with their Association's recommendations. [Kathy Hill] -----Original Message-----From: Bragg [mailto:breizy@...]Sent: Monday, September 27, 2004 1:54 PM Subject: assessments Hi everyone, I am fairly new to bariatric surgery and need to ask some experts a couple of questions. When assessing someone for bariatric surgery (RYGB) initially, do you use Adj BW (20-25 kcal) or Actual BW (20-25 kcal)? Also how do you figure protein needs for wt loss? Thanks for your guidance, AnnistonNutrAssoc@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2004 Report Share Posted September 29, 2004 Can you post the formula? I don't usually have need for it (I use the MedGem) but I know people who still use it. RE: assessments To address the use of Adj body weight, in the ADA's 6th edition of the Manual of Clinical Dietetics It was stated that "Although included in previous editions of ADA's Manual of Clinical Dietetics, use of an adjusted body weight in calculating needs of overweight/obese patient has been deleted, since there is no scientific basis for the use of an adjusted body weight". This statement also appeared in the ADA Courier a few years back, in the section "Members Are Asking" specifically about using adjusted body weight for obese patients. In both statements, suggested guidelines were given to calculate caloric needs of the obese patient. Every time I see that a facility is still using the "adjusted body weight formula" I feel that the RD's working there are not current with their Association's recommendations. [Kathy Hill] -----Original Message-----From: Bragg [mailto:breizy@...]Sent: Monday, September 27, 2004 1:54 PM Subject: assessments Hi everyone, I am fairly new to bariatric surgery and need to ask some experts a couple of questions. When assessing someone for bariatric surgery (RYGB) initially, do you use Adj BW (20-25 kcal) or Actual BW (20-25 kcal)? Also how do you figure protein needs for wt loss? Thanks for your guidance, AnnistonNutrAssoc@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2004 Report Share Posted September 29, 2004 I read that from ADA too, they also discussed this at ADA in SAn last year. After doing my own mini research however, most of the time the mifflon st. jeor was always within 50 kcals of HB and 25 kcals per kilograms adj. body weight. I'm not comfortable assessing needs of the obese at actual body weight up to BMI of 40 because that will way over assess their needs as I have seen when comparing them to medgem results. Also, if you calculate their needs with ideal body weight, then you underestimate their needs depending upon their clinical condition. So I use my clinical judgement and adjust when I feel it is necessary. That doesn't mean I am out of touch with my orgainzations recommendations. ADA has never said not to adjust, only that they haven't studied it enough to verify the accuracy enough to recommend it. RD's should use their clinical judgement and do what they feel is appropriate for the patient at hand. J. Sams MS RD/LD >From: " Kathy Hill " <kahill@...> >Reply- >< > >Subject: RE: assessments >Date: Wed, 29 Sep 2004 12:57:37 -0400 > >To address the use of Adj body weight, in the ADA's 6th edition of the >Manual of Clinical Dietetics It was stated that " Although included in >previous editions of ADA's Manual of Clinical Dietetics, use of an adjusted >body weight in calculating needs of overweight/obese patient has been >deleted, since there is no scientific basis for the use of an adjusted body >weight " . This statement also appeared in the ADA Courier a few years back, >in the section " Members Are Asking " specifically about using adjusted body >weight for obese patients. In both statements, suggested guidelines were >given to calculate caloric needs of the obese patient. Every time I see >that a facility is still using the " adjusted body weight formula " I feel >that the RD's working there are not current with their Association's >recommendations. >[Kathy Hill] > > assessments > > > >Hi everyone, > >I am fairly new to bariatric surgery and need to ask some experts a couple >of questions. When assessing someone for bariatric surgery (RYGB) >initially, do you use Adj BW (20-25 kcal) or Actual BW (20-25 kcal)? Also >how do you figure protein needs for wt loss? > >Thanks for your guidance, > >AnnistonNutrAssoc@... > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2004 Report Share Posted September 29, 2004 So if you have the MedGem measurement, do you use that? assessments>>>>Hi everyone,>>I am fairly new to bariatric surgery and need to ask some experts a couple >of questions. When assessing someone for bariatric surgery (RYGB) >initially, do you use Adj BW (20-25 kcal) or Actual BW (20-25 kcal)? Also >how do you figure protein needs for wt loss?>>Thanks for your guidance,>>AnnistonNutrAssoc@...>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2004 Report Share Posted September 29, 2004 At our facility, we use an "adjusted" body wt (mid pt between ideal and actual) in the HB equation for those w/BMI 30-50 kg/m2 because we have validated this w/indirect calorimetry studies-see Echevarria et al few years back in JPEN -Sue Manchester RE: assessments To address the use of Adj body weight, in the ADA's 6th edition of the Manual of Clinical Dietetics It was stated that "Although included in previous editions of ADA's Manual of Clinical Dietetics, use of an adjusted body weight in calculating needs of overweight/obese patient has been deleted, since there is no scientific basis for the use of an adjusted body weight". This statement also appeared in the ADA Courier a few years back, in the section "Members Are Asking" specifically about using adjusted body weight for obese patients. In both statements, suggested guidelines were given to calculate caloric needs of the obese patient. Every time I see that a facility is still using the "adjusted body weight formula" I feel that the RD's working there are not current with their Association's recommendations. [Kathy Hill] -----Original Message-----From: Bragg [mailto:breizy@...]Sent: Monday, September 27, 2004 1:54 PM Subject: assessments Hi everyone, I am fairly new to bariatric surgery and need to ask some experts a couple of questions. When assessing someone for bariatric surgery (RYGB) initially, do you use Adj BW (20-25 kcal) or Actual BW (20-25 kcal)? Also how do you figure protein needs for wt loss? Thanks for your guidance, AnnistonNutrAssoc@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 30, 2004 Report Share Posted September 30, 2004 Yes, but mainly for the outpatients as part of their counseling sessions. We don't have the policy and procedure in place to charge for it inpatient yet. But we will use it to experiment from time to time for comparisons and difficult patients with non healing wounds. J. Sams MS RD/LD >From: " Bevlyann " <bevlyann@...> >Reply- >< > >Subject: Re: assessments >Date: Wed, 29 Sep 2004 15:14:20 -0500 > >So if you have the MedGem measurement, do you use that? > assessments > > > > > > > >Hi everyone, > > > >I am fairly new to bariatric surgery and need to ask some experts a >couple > >of questions. When assessing someone for bariatric surgery (RYGB) > >initially, do you use Adj BW (20-25 kcal) or Actual BW (20-25 kcal)? >Also > >how do you figure protein needs for wt loss? > > > >Thanks for your guidance, > > > >AnnistonNutrAssoc@... > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 4, 2004 Report Share Posted October 4, 2004 I use the medgem measurement. My thoughts are this... we dont calculate blood pressure, we measure it we dont calculate albumin, we measure it therefore, we should not calculate metabolism, we should measure it. If you look back at the original work by Benedict they did not intend for their formula to be used on an individual basis. Again, my 2 cents But you have to TRUST the method you are using to do the " measurement " with. I have never been very comfortable with these little machines that anyone can purchase and use to do measurements with. They could be accurate, or they could be highly inaccurate based on many different factors. Just like BP measurements are subject to a certain amount of differences or inaccuracies, but at least there are published guidelines to try to standardize this. The medical center I am at seems to change how they measure albumin every few years, I hope this means they are getting more accurate and not just trying to save money....just my thought as well. Anyway, I will be taking the ADA Weight Management certification course later this week and will ask more details about MedGem and other such devices. I will readily admit I am ignorant about what is currently available out there for measuring metabolic rate, and if any of the available methods have any validity or reliability. Have a good week, everyone! Hilleary, MPH, RD San Diego VA Healthcare System P.S. Could someone send me the file on the patient pre-test to me as an e-mail? I don't seem to be able to access the documents uploaded to the website. Thanks in advance--this sounds like a great idea! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2006 Report Share Posted March 10, 2006 I know this has been discussed on the list before and I did look at the archives, but can't find what I'm looking for...Mac is up for his 3 yr. re-eval and the psych asked me what type of testing I wanted her to do and I told her I'd get back to her...help!! What are some of the assessments that are definitely NOT appropriate for most of our kids and what are some that may be more appropriate (I realize there is probably no test that can adequately and accurately assess many of our kids, mine included). Mac is 8 yrs. old and in 2nd grade--*included* for the most part in the general ed curriculum. Thanks. Jill Mom to Mac and Kit Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.