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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.

Best Weight is also available at Amazon and Barnes & Nobles (part of the proceeds from all sales go to support the Canadian Obesity Network)

If you have already read Best Weight, please take a few minutes to leave a review on the Amazon or Barnes & Nobles website.


  1. I have a slight issues with some of statement for the general public and recovering obese peoples. This is possibly due to the compression to fit all the information into your fine but to small of book. For those interested, these issues are posted on my web site.

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  2. The missing piece of this puzzle is the fact the not all people who are classified as obese have high caloric intakes. In fact, many present and ex-serial dieters and weight loss surgery survivors are supporting a considerably larger than average body on a considerably lower than average caloric intake. It’s not hard to figure out why that would promote nutritional deficiencies. Has this really not occurred to the medical establishment?

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