Nutrition in the critically-ill obese patient

People are fatter than they used to be. Although the upward trend has slowed in recent years, more than one third of all adults in the US are obese, and one in six children are overweight or obese. Reflecting this reality, there are a large number of obese patients in the intensive care unit. Some 30-35% of adult ICU patients are obese, and 5% or more are morbidly obese. Patients who are both critically-ill and morbidly obese present unique challenges to care. These range from basic care, such as prevention of bedsores and ambulation, to sophisticated issues, such as medication dosing and ventilator management. It takes a team of caregivers, for example, to help a 400-pound patient in and out of bed. One of the most difficult aspects of the care of such patients is nutrition support, which is the subject of the present review.