ABSTRACT
The standard denition of obesity is based on the body mass index (BMI), which is a calculation of an individual’s weight in kilograms divided by their height in meters squared. Currently, overweight is dened as a BMI of 25.0-29.9 and obesity is a BMI ≥30.0 [1]. In addition, obesity can be further classied as grade 1 (BMI 30 to <35), grade 2 (BMI 35 to <40), and grade 3 (BMI >40) [1]. The most recent National Health and Nutrition Examination Survey (NHANES) data from 2011 through 2012, cited the prevalence of obesity among adults more than 20 years old as 34.9% [2] with no signicant change compared to data from 2003 through 2008 or 2009-2010 [2,3]. NHANES data from this same time period indicates the prevalence of grades 2 and 3 obesity was 14.5% and 6.4%, respectively [3]. Following this general trend, an estimated 25%–30% of ICU patients are obese [4]. Obese patients are predisposed to a variety of comorbid conditions that can be exacerbated during critical illness [5-9]. A well-established concept is that providing routine medical care can be more challenging for this patient population [9]. However, researchers have also coined the phrase obesity ICU conundrum to describe the surprising nding that critically ill obese patients often have equivalent or improved mortality rates compared with nonobese critically ill patients [9]. Obese ICU patients are often medically and metabolically complex. Critical care RDs must understand the medical complexities and metabolic issues affecting this patient population to implement nutrition support regimens that optimize clinical outcomes without exacerbating the harmful effects of over-or underfeeding.
