Clinical Assessment: Nutritional Status

Today’s post is another excerpt from “Best Weight: A Practical Guide to Office-Based Weight Management“, recently published by the Canadian Obesity Network.

This guide is meant for health professionals dealing with obese clients and is NOT a self-management tool or weight-loss program. However, I assume that even general readers may find some of this material of interest.


Despite a high caloric intake, obese patients often have a number of dietary deficiencies in both macro- and micro-nutrients. Overall nutritional intake is best assessed using food diaries or food frequency questionnaires. While these tools provide a good picture of eating patterns, they do not usually provide an accurate assessment of actual caloric intake unless patients are explicitly taught how to keep them. Food recall is notoriously inaccurate and most patients significantly underestimate true portion sizes.

Inadequate protein intake can reduce satiety and promote the loss of lean body mass.

Inadequate intake of complex carbohydrates can lead to B-vitamin deficiencies.

Inadequate intake of fruits and vegetables can lead to deficiencies in folic acid, magnesium and other minerals.

Inadequate intake of dairy products, together with decreased exposure to sunlight, can result in clinically significant calcium and vitamin D deficiencies, resulting in secondary hyperparathyroidism and loss of bone mineral mass.

Avoidance of red meat can result in iron deficiencies in women.

Nutritional deficiencies are particularly common in people adhering to fad diets, individuals from lower-income strata, and following bariatric surgery.

Although physical signs of nutritional deficiency are not commonly found, the presence of hair loss, easily plucked hair, spooning of the nails, glossitis and or cheilosis, should prompt the evaluation of mineral and vitamin deficiencies.

© Copyright 2010 by Dr. Arya M. Sharma and Dr. Yoni Freedhoff. All rights reserved.

The opinions in this book are those of the authors and do not represent those of the Canadian Obesity Network.

Members of the Canadian Obesity Network can download Best Weight for free.

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