Catherine B. Skinner

The key to weight maintenance goes way beyond menu planning, assistive devices and encouragement. A holistic team approach is a must.

There is no bigger problem in nursing homes than trying to maintain the resident’s weight. Often, the major focus boils down to preventing weight loss. At each care plan meeting, the team hones in on weight, weight, weight. It is an obsession, closely followed by falls.

But when was the last time a team you work with took a holistic approach to the concept of weight maintenance? The full extent of an analysis might consist only of recording percentages of meals consumed, taking monthly weights and addressing if the resident needs to be fed.

True nutrition goes beyond that, taking into consideration cultural differences, individual preferences, meal timing, physical limitations and, yes, even midnight cravings.

Decades ago, Joel Garreau published his classic, “Nine Nations Of America,” outlining our country’s nine distinct economies and cultures — including foods. But the same commercial food suppliers deliver food to those nine regions. It’s important for the menu planner to realize regional or historical preferences. Take the case of chicken wings, viewed as a cheap meat during the Depression. They aren’t necessarily familiar, they’re not easy to eat or nutritious, so why serve them? Serving foods familiar to residents is essential to weight maintenance and dignity. 

Next, consider how meals are plated. White dishes are the norm, of course. But if I have poor eyesight, what will my meal of mashed potatoes, cauliflower and chicken look like? A blur. Studies have shown yellow plates improve food consumption, while blue plates can encourage weight loss.

Glasses and silverware pose other problems. Many residents are unable to drink from a 3-ounce glass. Large glasses need to be no larger than the hand of an elder who has limited joint motion. Lateral ridges can also help with grasp. Even a larger spoon can be a difference maker, easing feeding of common foods like cereal or soup.

Add visual appeal.

Another study showed a prime cause of residents not sleeping through the night was hunger pangs. That’s very plausible as the main meal in most homes is at noon, with a smaller meal in the evening. Even a starchy snack after that small meal will not likely hold hunger at bay. This mid-day main meal is certainly for the convenience of the staff, not the residents. And who is supposed to be our focus? The residents, of course.

As we encourage better nutrition through everyday changes, we should also rethink how we quantify nutrition consumed. We really need to focus on the protein taken in, even if it represents a small spot on the plate. Foods with less nutrition can be encouraged after the high-nutrition items are eaten.

Consider outside factors.

Weight maintenance is not always a reflection on the nursing home’s good cooking or efforts on the part of the staff. The aging and illness process also plays a major role. With advanced age, the taste buds are tired and not sensitive. Combine this with a dry mouth and another major external factor: medications.

A number of meds can alter a resident’s sense of taste dramatically. Weight loss is a natural, unavoidable progression in many diseases.  As death approaches, there is often an aversion to foods. This we must accept as a natural process.

To help reach our goals of better weight maintenance, all staff need regular in-services that address items specific to the changes in their residents. As always, we need to be reminded that we are there for the residents, elders who worked a lifetime to help make our country what it is today.

Cynthia Skinner, BSCN, is a long-time skilled nursing nurse, who has practiced in various parts of the U.S. and Canada. She currently works in Arkansas.