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Chapter 5


Association (APA) suggest 2 to 3 pounds of weight gain per week; some treatment centers strive for more. Many fac- tors may influence the rate of weight gain in the inpatient setting, including risk of refeeding syndrome, patient will- ingness to accept nutrition support, and hypermetabolism (because of the high caloric needs of weight restoration). In outpatient care, weight gain may be slower and less con- sistent. APA practice guidelines suggest 0.5 to 1 pound per week.4 These basic recommendations should be modified


depending on your facility’s protocol as well as each indi- vidual’s needs. Modify meal plans on an individual basis by monitoring the pace of weight change. Change meal plans when you see a pattern of data that indicates a patient has reached an appropriate caloric level, rather than on each and every new data point.


Rate of Weight Change


It is unusual for weight gain to follow any exact pattern or to maintain a constant rate over time. This may be disap- pointing to a patient who wants to recover quickly and move on, but it can be reassuring to a patient who is frightened of rapid changes. Either way, it is a teaching opportunity that weight is a consequence of eating over time; one food, one meal, or one day does not have enough power to change everything. Weight loss, weight restoration, and healthy weight maintenance are all long-term, rather than immedi- ate, goals. This may be very different from a patient’s usual “quick fix” methods. At times, weight changes may be dramatic, especially


toward the beginning of treatment. When this occurs, teach your patients that quick weight changes are caused by hor- mone fluctuations, fluid shifts, nutrient replenishment, and the movement of food and beverages through the gastro- intestinal (GI) tract, not by the food they ate yesterday.


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