I know a number of nurses who've had herniated discs or worse from attempting to turn morbidly obese patients. It's hard enough to turn a patient with a BMI of 25 who is 2x your size.
On the topic of paralyzed overweight persons, they can't eat food due to swallowing hazards, so they get put on tube feeding which is calculated based on their weight, and they end up gaining more weight, having loose stool, etc... I've legitimately always wondered why a weight loss regiment wasn't calculated into the tube feeding for morbidly obese patients. (Maybe it is?)
might depend on the institution depending what protocols you have
for ours seemed like it was automatic if they were on tube feeds for a certain number of days that nutrition would be consulted and there would be note showing their calcs
fat cells are basically immortal and require like net 0 calories to live
with these immobilized patients if you think this is an opportunity for some starvation weight loss.... bad plan
if you cut calories and they are not even moving from their recliner to the bathroom like they might at home, you're looking at even more atrophy of metabolically active tissue like muscle than you're ALREADY getting because they're immobilized in the hospital
I may have seen somewhere as well that calorie restricted tube feeds can contribute to skin breakdown in this scenario to0
net result of trying to slash their calories in this circumstance might be overall weight loss, but the fat:muscle ratio will be worse than if they were slashing calories but doing even PT or ADLs to maintain muscle
and remember even really fat patients if you starve them can get re-feeding syndrome
so alas, while you don't want to make them *fatter* on TFs, it's not a good opportunity for the *right* kind of weight loss even though you could slash calories
the circumstances of calorie restriction makes a big difference for what you favor losing.... you want to lose fat and maintain muscle/bone
I might be wrong on some of the above
I do remember asking nutrition about this, and was content with the answer that immobilized patients the emphasis in nutrition is trying to make sure they are as nutritionally supported as possible to maintain metabolically active tissue.... that might mean the fat cells get a free ride and get overfed too
it's hard to calculate and if nutrition is following they can try to adjust for weight gain, but weight loss in this scenario is not a priority and is undesirable, and the number one goal is to make sure the immobilized person has the nutrients available for recovery