Andrea Elliott

Aim: Health service usage for eating disorders (EDs) has increased substantially; however, many tertiary hospitals lack resources for specialist ED services. Evidence-based guidelines outline ED management approaches for acute medical stabilisation in non-specialised services, including protocols for care across key disciplines (psychiatry, medicine and dietetics). The study aim was to evaluate collaboration of care within an Australian tertiary hospital following an eating disorder Inpatient Access and Treatment Pathway (IATP). Methods: This retrospective cohort study reviewed 40 patients admitted with an ED diagnosis pre- (2019) and post- (2022) implementation of the IATP. The electronic medical record was utilised to gather patient demographics and health outcomes, and organisation of care (multidisciplinary team meetings, discharge planning). Results: Following the implementation of the IATP, there was a 40% ( p = .01) increase in appropriate discharge planning, classified as ED service referral or suitable community dietetic, medical and psychology follow-up. There was a significant increase in the Care Adherence Score ( p = .004) which quantified organisation of care, utilising four key dichotomous variables. There was also a significant an increase in starting energy prescription (5900 KJ vs 4480 KJ, p = .046). Conclusions: A local IATP supported a significant increase in multidisciplinary collaboration and care adherence, appropriate discharge planning and starting energy provision.

Aim: To assess the prevalence of undernutrition, overnutrition, and simultaneous malnutrition in a hospital setting, as well as undernutrition risk and dietetic intervention rates. Methods: A point prevalence survey was conducted annually from 2016 to 2024 (excluding 2020–2021 due to Coronavirus Disease 2019) across three metropolitan health service hospital sites. Eligible multiday inpatients underwent bedside assessments and medical record reviews to determine Body Mass Index, Malnutrition Universal Screening Tool scores, and undernutrition status based on either the International Classification of Diseases, 10th Revision, or the Global Leadership Initiative on Malnutrition. Data were analysed descriptively. Results: Of 5186 patients surveyed, 21.2% were undernourished, 39.5% were overnourished, and 4.8% were simultaneously under‐ and overnourished. Just over one‐third (37.4%) of all participants were at risk of undernutrition. Dietitian intervention rates were highest among the simultaneously malnourished (70.6%) and undernourished (69.6%), and low among the overnourished (3.6%). Conclusion: The findings underscore the need for improved detection of simultaneous malnutrition and increased rates (towards 100%) of dietary intervention among patients with either under‐ or simultaneous malnutrition during a patient's hospital stay.

Background: Recent studies show a high prevalence in hospital populations and best practice evidence indicates that people living with obesity should receive dietetic advice. However, patients often do not receive this care in acute settings. Understanding the experiences of people living with obesity is crucial to designing successful strategies for management.Objective: This qualitative study aimed to understand the experience of nutrition care for patients living with obesity in the acute hospital setting and to redesign an optimised patient journey using a design approach. Using patient journey mapping, nutrition care across the inpatient admission was explored. A lived experience perspective was applied to reflect on the patient journey and interactions of patients with dietetic services in the acute setting. A co‐creation session was conducted with dietitians and consumers to redesign the patient journey.Results: The patient journey revealed that for patients living with obesity, discussions about weight were absent from the journey from all healthcare professionals. For patients receiving dietetic care, the Nutrition Care Process was followed; nutrition intervention focused on acute nutrition issues with increased energy and protein prescription: a lack of goal setting and absence of discharge planning. The redesign of the nutrition care journey identified pivot points in the pathway to support engagement in obesity‐related care.Conclusion: The findings from this study provide new insights into current nutrition care for people living with obesity in the acute setting. These findings can inform future education, research and advocacy for practice changes to improve dietetic care for people living with obesity.

Background 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. Aim The primary aim of this study was to explore the experiences of dietitians caring for patients living with obesity in acute hospital settings. Methods 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. Results 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. Conclusion 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.

Malnutrition is an international healthcare concern associated with poor patient outcomes, increased length of stay, and healthcare costs. Although malnutrition includes both under and overnutrition, there is a large body of evidence that describes the impacts of undernutrition with limited data on overnutrition in hospitalized patients. Obesity itself is a modifiable risk factor associated with hospital-associated complications. However, there is limited reporting of the prevalence of obesity in hospitals. This one-day cross-sectional study (n = 513) captures the prevalence of both under and overnutrition in a hospitalized population and explores dietetic care provided compared to the Nutrition Care Process Model for hospitalized patients who have obesity. The main findings were: (1) the largest proportion of patients were in the overweight and obese classifications (57.3%, n = 294/513); 5.3% of these patients had severe obesity (class III); (2) patients who were overweight and obese had lower malnutrition risk profiles as well as the prevalence of malnutrition; (3) 24.1% of patients who had obesity (n = 34/141) were receiving dietetic intervention; (4) 70.6% (n = 24/34) did not have a nutrition diagnosis that followed the Nutrition Care Process Model. Study results provide valuable clinical insight into the prevalence of overnutrition and opportunities to improve nutrition care for this vulnerable patient group.

Background: There is limited understanding of patients' and healthcare professionals' perceptions and experiences of receiving and delivering dietetic care, respectively. This systematic review of the literature used qualitative synthesis to explore the perceptions and experiences of multiple stakeholders involved in the delivery of nutrition care and dietetic service.Methods: MEDLINE, Embase, CINAHL, Cochrane Library, Scopus, ISI Web of Science, PsycINFO and ProQuest were systematically searched. Study characteristics and perceptions of stakeholders regarding nutrition care services were extracted. Qualitative synthesis was employed and thematic analysis conducted.Results: Five themes were identified from 44 studies related to stakeholders' perceptions of dietetic services. Studies included quantitative, qualitative and mixed methods involving patients, families, dietitians and other healthcare professionals. The themes were (1) patients desiring a personalised approach to nutrition care; (2) accessing dietetic service; (3) perceived impact of nutrition care on the patient; (4) relationships between stakeholders; and (5) beliefs about nutrition expertise. Two themes were specific to patients; these were the desire for individualised care and the impact of nutrition care. Within each theme perceptions varied with patients' views often contrasting with those of dietetic service providers.Conclusions: Experiences of dietetic service do not always meet stakeholder expectations which impacts on patient engagement. Seeking stakeholder input is imperative to design dietetic services that engage patients in positive and supportive clinical partnerships.

Summary: Design research methods, including user‐centered design, human‐centered design, and design thinking, are iterative processes and frameworks that engage stakeholders to inform the design of initiatives, programs, or research interventions. Design research methods are not yet widely applied in healthcare. To date, there is a limited understanding of how design research methodologies can be applied to develop client‐centered weight loss interventions. This scoping review explores the extent, range, and nature of research projects that used design research methods to guide the development of an obesity treatment intervention. A systematic search of eight databases identified projects that used design research methods to develop a weight loss intervention or strategy. The method and practical application of design research processes for each eligible article were extracted and explored. Design research methods were used to generate ideas or guide the development of a mobile application (n = 6), mHealth device (n = 1), eHealth solution (n = 1), health promotion program (n = 1), or patient–clinician communication tools (n = 2). There was considerable variation in the application of design research processes between studies. Design research methods may provide an iterative, flexible framework to facilitate the development of client‐centered, inclusive interventions and strategies. Design research methods may support research teams to move away from the one‐size‐fits‐all approach to obesity treatment.