METABOLIC NUTRITIONAL REHABILITATION

METABOLIC NUTRITIONAL REHABILITATION

Dr Nicoletta Ara, Specialist in Nutrition Science

Obesity is a complex disorder made up of multiple factors, including genetic and environmental factors, which can be aggravated by a series of complications that increase the risk of illness in obese individuals. Obesity can be traced to an imbalance between energy expenditure and daily caloric intake.

Individuals with a Body Mass Index (BMI) of over 30 are considered to be obese and when the index is over 40 their condition is referred to as third-degree or severe obesity.

Hospital Care

Patients can be treated through:

  • Day Hospital care (for patients with suitable clinical and logistical conditions)
  • Ordinary Hospitalization (for patients suffering from the most severe functional impairments)

Waiting time

For Day Hospital admission     based on bed availability

For Ordinary Hospitalization  based on bed availability up to a maximum of 30 days

Booking

Booking can be made either by phone or in person at the Hospital Admission office of Villa Pineta

Diseases and Conditions Treated

Rehabilitation is aimed at patients with obesity and related complications (dyslipidemia, diabetes mellitus, arterial hypertension, heart diseases, hyperuricemia, non-alcoholic steatohepatitis, sleep apnoea syndrome, gonarthrosis, coxarthrosis and psychological alterations).

Main goals

Obesity is a chronic condition with a multi-factorial aetiology and, as such, it requires multidisciplinary support. It is now well known, in fact, that weight-loss treatment must include at least the following three main components:

■ Calorie restriction

■ Physical exercise, meant as an appropriate and reasonable lifestyle

■ Cognitive-behavioural therapy

A necessary condition for achieving good, long-term results is the combination of all three of these therapies.

It is therefore crucial to involve more than one professional, with clearly distinct but at the same time complementary roles, within an interdisciplinary approach whose exclusive goal is the wellbeing of the patient.

Individual Rehabilitation Plan

The Individual Rehabilitation Plan (IRP) developed by the physician nutrition specialist, in collaboration with the other professionals in the team (nurse, psychologist, rehabilitation therapist, dietician), combines the various components in a mutually enhancing way. It is patient-centred and, as such, is unique to each patient. The IRP:

  • æ   provides a comprehensive overview of the patient’s functional status and residual capacities, using, wherever possible, scales validated and/or recognized by scientific communities
  • æ   defines the interventions that can help achieve the set goals, focussing on the various ascertained problems
  • æ   involves regular assessment of the results achieved and verification of expected goals
  • æ   is shared with the patient and, if possible, with the family

The main areas of IRP intervention are:

  • æ   ComprehensiveDiagnostic Evaluation and Interdisciplinary Assessment
  • æ     Nursing Care
  • æ    Rehabilitation Therapy
  • æ     Psychosocial Support
  • æ    Nutrition Support
  • æ    Education and Behaviour Programmes

 

Comprehensive Diagnostic Evaluation and Interdisciplinary Assessment

The comprehensive diagnostic evaluation, performed in the first days of hospitalization, analyses not only the clinical variables but also the psychological and social variables that may have influenced the development of the disease or condition. The patient approach is developed by the interdisciplinary team which carries out an initial assessment of the patient then ascertains weekly the work done and goals achieved. The physician nutrition specialist will deal with the patient’s clinical examination, existing complications, therapies and recovery of their state health. Should he deem it necessary, he can prescribe further, specialist visits and non routine tests.

Nursing care

The functions performed by nursing staff and care workers are essential in order to:

  • put into effect the intervention plans developed for the patient and related monitoring actions (prevention of surgical infections, treatment/prevention of skin lesions, taking charge of concomitant needs-conditions and so on)
  • comfort and support the patient in tackling minor and major everyday challenges

Rehabilitation therapy

Physical exercise leads to the reduction of body fat mass and to the increase of daily energy expenditure, resulting in a negative energy balance with consequent weight loss. Physical activity has a positive influence on the underlying illness, improves self-esteem and the general sense of wellbeing perceived by the individual.

The physiotherapist will therefore design interventions aimed at gradually fostering the patient’s motor activity, taking into account their actual possibilities, and prompting them to increase their daily opportunities for movement (not only during leisure time but also at work, during household activities and so on).

Psychosocial Support

Individuals who suffer from uncontrolled eating disorders (Binge Eating Disorder) often show psychopathological disorders such as depression, anxiety and obsessive-compulsive behaviours.

The psychologist will be responsible for: investigating and leveraging the patient’s motivation for change; helping them to develop behavioural, cognitive and emotional techniques suited to resolving the psychological problems that contribute to the continuation of the eating disorder; managing anxiety and mood disorders; and helping the patient to understand the connection between their situation, their way of thinking and the emotions that eventually lead to perceptive distortions and possible feelings of guilt associated with transgressions.

Nutrition Support

The physician nutrition specialist will develop a programme of dietary re-education based on correction of eating habits and moderate caloric restriction, taking into account the patient’s individual habits and needs.

Education and Behaviour Programmes

The patient participates in education, nutrition and behaviour lessons conducted by different professionals (physician nutrition specialist, psychologist, dietician, rehabilitation therapist and nurses) aimed at changing the lifestyle, behaviour and dysfunctional ideas that cause and perpetuate obesity and discussing the identified problem areas. The combination of physical activity, diet and cognitive-behavioural therapy is thus the most appropriate therapeutic choice and only the engagement of a competent team and of the patient will secure good long-term results.

Hospital Discharge and Continuum of Therapy and Care

On completion of the rehabilitation plan, the team assesses the effectiveness of the interventions carried out and verifies whether planned goals have been attained, sharing the information with the patient. Together they agree on the patient’s return home or on the need for a hospital discharge under a continuing care scheme.

The physician nutrition specialist fills out the hospital discharge letter, setting down the outcomes of the tests and examinations performed, the recommended drug therapy, any examinations to be carried out at home and the indications for an appropriate lifestyle that the patient will be required to follow.