Research & Practice
Clinical Decision-Making by Registered Dietitians Caring for Patients Who are Obese by BMI in Acute Care: A Qualitative Study
Objective: Dietitians in acute care settings are tasked with providing nutrition support to individuals with obesity amid complex clinical and systemic challenges, including variable application of clinical guidelines. This qualitative study aimed to examine registered dietitian nutritionists’ (RDNs) experience and perspectives related to providing nutrition care for individuals with obesity in acute care settings.
Methods: Fourteen RDNs working in acute care settings in the greater Seattle area participated in semi-structured interviews conducted virtually or in person. Interview data were analyzed using reflexive thematic analysis to explore experiences related to how dietitians interact with institutional protocols or guidelines, how they communicate with the interdisciplinary team, and how they interact with patients and family members in the context of weight- and nutrition-related decisions
Results: Dietitians interviewed as part of this study described equations for estimating patients’ energy and protein needs as an imperfect tool, and use of these tools was shaped by clinical experience and institutional practice culture. Participants also described how their ability to provide care to patients with obesity in acute care settings was shaped by a perceived lack of evidence in national guidelines for this patient population, the uneven application and training in conducting and assessing nutrition-focused physical examinations, power dynamics within the larger interprofessional team, increasing use of glucagon-like-peptide-1 receptor agonist therapies among patients, and societal attitudes towards body weight and health.
Conclusions: The results of this study enhance understanding of how factors such as clinical guidance, interdisciplinary dynamics, and institutional protocols shape nutrition care delivery in acute care. Results also provide insight into the challenges dietitians working in acute care settings with obese patients face when making complex decisions in providing nutrition care.
Project Type(s): Master's Thesis
Author(s): Gabrielle Siros
Program(s): Master of Science, RDN Training
Year: 2026
Adviser(s):