Nutritional care of the obese intensive care unit patient

Purpose of review: This review discusses the unique metabolic changes in critically ill obese patients and the challenges in estimating and providing them with nutritional support while in the intensive care unit. It provides some of the scientific data in support of and against hypocaloric high-protein nutritional support in critically ill obese patients. Recent findings: The growing prevalence of obesity worldwide and particularly in the developed countries has resulted in concerns regarding the implementation of effective and specialized nutritional support for critically ill obese patients. The concerns arise from the limited data regarding the obese individual's response to various metabolic stresses, especially trauma and burns. There is continuous debate about the most appropriate method of calculating the critically ill obese patient's basic energy and calorie needs. Summary: Nutritional support of the critically ill obese represents a unique challenge but early administration of protein followed by carbohydrates and finally lipids can results in net protein anabolism and better glycemic control.