Why healthy eating guidelines don’t apply to the really sick person in a hospital bed

At the absolute centre of weight management is energy balance. We gain energy to live and love through what we eat and drink. We expend energy through just living, breathing and laughing, through our body regulating body temperature, and lastly through any physical activity we do.
If we eat too much over an extended period of time, we gain weight. If we eat too little, we lose weight. So essentially what we eat should almost match what we expend to maintain our weight. Right?

That’s the really simple version.
Let’s look at the really unwell people we know. It could be your frail grandmother with COPD, or your uncle going through cancer treatment, or the friend who’s surgery went wrong. These bodies are under stress, these bodies are not only trying to function normally, but they are trying to heal, recover and stay strong.

When bodies are under stress like this, they need more energy and more protein to function, heal and recover. Which means essentially these people need to eat more than they usually would.

But when we look at these really unwell people we know. That frail grandmother with COPD – breathing is so hard that she really struggles to get through half her meal. When she is served meat, the chewing is just so exhausting so she stops. Moving about the house can be so exhausting, that food preparation is not even on the agenda.

That loved one undergoing cancer treatment – after 6 rounds of chemo, their mouth is so dry and everything tastes like metal, especially meat. Finally, the nausea and vomiting that comes with every round of chemo is starting to die down. Right now lemonade and the occasional paddle pop is all they want and can tolerate.

So when we go back to that energy balance equation. These bodies are expending more energy, but in most cases, while these bodies need to eat more, their really eating far less than they would on a good day.

So these patients lose weight. We see both fat and muscle loss. They’re not eating enough protein to keep their bodies going, so their body utilizes the reserve in their muscles. They become malnourished. This means these people lose strength which can impact their ability to go about daily tasks. Showering themselves, rehabbing with the Physio, doing the groceries can become difficult. They become at more risk of infection, wounds take longer to heal and they’ll likely need to stay in hospital longer. Dentures can also become loose, which mean eating, chewing especially, becomes a whole a lot harder.

So when it comes to food, what does this mean?

We could suggest a a balance plate of half vegetables, a small amount of lean meat and a small serve of rice. Drinking water, and if still hungry snack on some fruit or yoghurt or nuts. Because that’s nutritious, wholefoods, in line with healthy eating recommendations and makes sense to provide our bodies with nourishment when we are that sick.

But the meat comes from a food service system that is a cook-chill (cook, then reheat next day) so the meat isn’t as tender as we would like. That frail grandmother just can’t chew it and absolutely tries her best, but just can’t. She’s exhausted. She pushes the plate away, and grabs her cup of black tea.

The person with cancer can’t stand the taste of the meat, so he only eats the vegetables. With the nausea resolving, this appetite is pretty small, so manages half the stewed peaches.  Water tastes horrible too.

Both eat little, and take in little energy and protein.

We could suggest they have something like eggs or baked beans or tinned spaghetti even, on toast, follow with a chocolate pudding with custard. We could offer juice, lemonade,  a full milk coffee and even a full milk milo, with extra sugar, instead of water. All quite easy to eat and more energy dense, and may even taste better, but not really in line with the guidelines.

When our bodies need more energy, and we physically can’t eat the large volume of food our bodies require, we need to eat those energy-dense foods we normally don’t recommend regularly. There foods are more bang for your buck. The focus from a nutrition perspective is making every mouthful count to minimise the loss of lean body mass.

Unfortunately, things like fruit, vegetables, and watery liquids like tea, coffee and clear soups just don’t cut it. They lack the energy and protein these bodies desperately need.

And that is why general healthy eating guidelines don’t apply to everyone.

When we talk about eating more fruits and vegetables and drinking less soft drink. When we talk about eating less foods from packets, and stop buying our food from petrol stations, and trying to  eat more food from the paddock. We are talking about guidelines that are for the otherwise healthy general population.  They are just not appropriate for specific groups of people.

Just some insight for you all.

Emma, wearing her clinical dietitian hat.


8 thoughts on “Why healthy eating guidelines don’t apply to the really sick person in a hospital bed

  1. As someone working in a clinical setting I jumped to defend this hospital with words mirroring your own – well put

  2. This is the best thing to read, I’m recovering from an ED and refeeding in hospital was eating all those energy dense foods! So hard for people to grasp that some people actually need to PUT ON weight rather than always being told how to lose it. Awesome post to put up and remind people of in the ‘New Years Resolution’ weight loss/health fanatic stage that is happening at the moment. Your stuff is so refreshing and real, love your work.

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