Diets for consistency and weight management | CCMA Metabolism and core nutrient roles

Prescribed diets with consistency modifications

Patients may need to change their diet for a variety of reasons, including preparation for a procedure, dental or oral problems, or illness. When the provider orders a specific test or a particular diet, the medical assistant may need to coach the patient on the new diet. As with other instances of coaching, it is important for the medical assistant to provide the patient with a reference handout to take home. This will help guide the patient on the dietary changes. Learning about different medically ordered diets is important for the medical assistant.

Clear liquid diet

A clear liquid diet is made up of foods and beverages that are liquid at room temperature. Clear means you need to see through the liquids. Here are some of the foods included in a clear liquid diet:

Water, tea, coffee, sports drinks, and clear soda
Popsicles and juice without pulp
Soup broth and gelatin (e.g., Jell-O)

Clear liquid diets are ordered for only a short time because they do not contain adequate nutrition. A clear liquid diet may be used when a person experiences diarrhea, vomiting, or nausea. It is commonly ordered after surgery and as part of the preparation for intestinal procedures. If a person is undergoing an intestinal procedure, red or pink clear liquids are not allowed because they could be mistaken for blood in the intestine.

Full liquid diet

A full liquid diet is made up of foods and beverages that are liquid at room temperature. Unlike the clear liquid diet, the full liquid diet includes milk products. These foods are included in a full liquid diet :

Clear liquids (see previous section, Clear Liquid Diet)
Strained creamy soups
Milk, milkshakes, pudding, plain yogurt, custard, and ice cream
Liquid supplements
Sugar, honey, syrups, butter, margarine

Some providers will allow cooked, refined cereals (e.g., cream of rice), baby food, strained meats, and potatoes pureed in soup on a full liquid diet. This diet is a step above a clear liquid diet and below a regular diet.

Soft and mechanical soft diets

A soft diet is a transition between a liquid diet and a regular diet. The foods on this diet are soft in texture, low in fiber, and easy for a person to digest. These foods are included in a soft diet:

Grains: soft breads, crackers, white rice, pasta
Fruits and vegetables: soft cooked, canned (no skin)
Milk products: milk, yogurt, cottage cheese, ice cream, pudding
Protein: tender meat, poultry, and fish; eggs, tofu, smooth peanut butter

The soft diet eliminates foods that are hard to chew and swallow:

Raw fruits and vegetables
Chewy or crispy breads
Tough meats, broccoli, cauliflower, nuts, and seeds
Fried, greasy foods
Highly seasoned or spicy foods

This diet is used for patients recovering from surgery or a lengthy illness. It can also be used for people with chewing or swallowing problems due to illness or dental issues.

Mechanical soft diets consist of foods that have been prepared for easier chewing and swallowing using household tools (e.g., grinder, blender, and knife). Typically, there are no limitations (e.g., spicy, gassy, and fried foods) to mechanical soft diets. Mechanical soft diets are used for the following groups:

Those recovering from head, neck, or mouth surgery
Those who have difficulty swallowing (dysphagia), poor-fitting dentures, or no teeth
Those who are too ill to chew

High- and low-fiber diets

A prior section of the chapter discussed fiber as a carbohydrate. The provider may order a low-fiber or restricted-fiber diet. This type of diet limits the types of vegetables, grains, and fruits eaten. Limiting fiber and food residue (e.g., peels, nuts, and seeds) makes stools smaller and lessens irritation on the intestinal lining. There are several possible reasons for one to go on a low-fiber diet:

Narrowing of the intestine due to a tumor
A flare-up of an intestinal disease (e.g., irritable bowel syndrome, Crohn disease, and diverticulitis)
After intestinal surgery
Prior to an intestinal procedure (e.g., radiation and colonoscopy)

The provider can also order a high-fiber diet. This diet adds more bulk to the stools. High-fiber diets are used for a variety of reasons:

Reducing constipation and possibly lowering the risk of hemorrhoids
Lowering cholesterol levels
Controlling blood glucose levels
Weight loss

Bland diet

A bland diet includes foods that are soft and low in fiber. This diet eliminates foods that are spicy, fried, or raw and beverages that contain caffeine or alcohol. Citrus juices and foods may also be eliminated. The foods included in a bland diet are similar to those incorporated into a soft diet. A bland diet is ordered to help treat gastroesophageal reflux disease (GERD), ulcers, nausea and vomiting, diarrhea, and gas. It can also be used after stomach or intestinal surgery.

Prescribed diets with nutrient modifications

Patients with various conditions, such as hypertension, obesity, and renal disease, require dietary changes. If the dietary change is also a lifestyle change, the provider may refer the patient to a registered dietitian. The registered dietitian can provide in-depth coaching and counseling on dietary changes.

Weight control diet

When trying to achieve or maintain a healthy weight, a person needs to find the balance between the number of calories eaten and the number used. Extra calories eaten and not used will result in a weight gain. For people to lose 1 to 2 pounds per week, they need to reduce their caloric intake by 500 to 1000 calories a day or increase their exercise to burn more calories. Identifying the calories consumed is an important step in achieving a healthy weight. Food diaries, apps, and trackers are available to help gauge food intake and activity.

Patients trying to achieve a healthy weight should follow these nutritional tips:

Commit to a lifestyle change. Identify resources for information and support.
Track foods eaten and beverages drunk, along with physical exercise.
Set realistic goals, knowing that slips will occur.
Eat healthy meals. They should be low in saturated fat, trans fat, cholesterol, salt, and added sugar. Eat lean meats, fish, poultry, beans, eggs, and nuts. Include fruits (especially whole fruits), vegetables, whole grains, and fat-free or low-fat milk products.
Control portion sizes. Portion size is the amount of food we eat. Serving size is a standard measurement of food (e.g., 1 cup or 1 ounce [oz]). Many foods that come as a single portion actually contain multiple servings. For instance, a serving size of potato chips is 1 oz. The 3-oz potato chip bag is a single portion, but three servings. Another example is bread. You use two pieces of bread for a sandwich (portion size), but a serving is one slice. Most people overestimate serving sizes. It is best to measure the food or use a quick estimate method.

Portion size and obesity

In some cases, portion sizes and serving sizes are the same. Over the years, many portion sizes have changed. Some experts attribute the growing obesity epidemic in the United States to this change. In the 1950s, the dinner plate was 9 inches in diameter; today, it is 11 to 12 inches. Some restaurants use even larger plates. With the plate change, the average portion of food also has increased. Restaurants have increased the amount of food they serve, and more Americans are eating out. With the increase in portions, portion distortion is occurring. The size of restaurant portions is causing Americans to rethink what the “normal” portions of food should be. Here are some examples of portion changes since the 1990s:

Bagels have increased by 3 inches and added 210 calories.
Muffins have increased by 3.5 ounces (oz) and added 290 calories.
Cheeseburgers have increased in size and added almost 260 calories.
Soda size has increased by 13.5 oz and added almost 170 calories.

As these examples show, the increase in portion sizes has led to an increase in the number of calories. Remember, the calories consumed and not used turn into fat. (Information from the National Heart, Lung, and Blood Institute, www.nhlbi.nih.gov/health/educational/wecan/eat-right/distortion.htm.)

Quick methods to estimate portion size

Amount of Food Approximate Size

3 ounces (oz) chicken and lean beef Deck of cards

1 medium potato A computer mouse

½ cup cooked pasta Tennis ball

1 oz of cheese Two dice

1 medium-sized fruit Tennis ball

1 cup fruit or cooked vegetables Baseball

1 oz of nuts Handful

1 oz of chips or pretzels Two handfuls (13–16 chips)

1 cup Woman’s fist

1 tablespoon (T.) First joint of thumb

1 teaspoon (tsp.) Fingertip

Obesity

According to the Centers for Disease Control and Prevention (CDC), about 42.4% of adults were obese in 2017–2018, which was up from 10 years earlier. Obesity-related diseases (e.g., heart disease, type 2 diabetes, stroke, and certain types of cancer) are some of the leading causes of death in the United States.

Childhood obesity remained stable over that time period and affects about 18.5% of children. According to the CDC, about 13.7 million children and adolescents are obese. The prevalence of childhood obesity is higher in children after age 6 than in earlier years of life.

People are considered overweight or obese when they weigh more than what is considered a healthy weight for their height. The body mass index (BMI) is a screening tool for obesity. If a person’s BMI is higher than 25 but lower than 30, that person is considered to be overweight; someone with a BMI of 30 or higher is considered to be obese.

Treatment for obesity includes the following:

Dietary changes: Cutting calories, making healthier choices, restricting certain foods, and meal replacements.
Exercise and activity: Exercising 150 to 300 minutes a week.
Behavior changes: Trying to eliminate the obstacles to managing weight (e.g., high-risk situations). Recording diet and exercise patterns. Counseling and support groups can be helpful.
Prescription weight-loss medications.
- Vagal nerve blockade: An implanted device sends electrical impulses to the vagus nerve, telling the brain when the stomach is empty or full.
- Weight-loss surgery: Also called bariatric surgery, it helps the person feel fuller sooner. Here are some common weight-loss surgeries:
- Gastric bypass surgery: A small pouch is created at the top of the stomach, and the rest of the stomach is stapled shut. The small intestine is cut, and the surgeon attaches the jejunum to a small hole in the pouch. With the smaller intestine, patients may have issues with iron and calcium absorption. Vitamin B12 supplements must be taken.
- Laparoscopic adjustable gastric band (LAGB) surgery: A band is placed on the upper part of the stomach, creating a small pouch that helps restrict food. A small port is implanted below the skin, and fluid can be injected into the band to adjust the size of the pouch outlet.
- Gastric sleeve surgery: A small pouch is created in the stomach, and about 67% of the stomach is removed. The person feels full sooner.