Background: There is limited understanding of patients' and healthcare professionals' perceptions and experiences of receiving and delivering dietetic care, respectively. This systematic review of the literature used qualitative synthesis to explore the perceptions and experiences of multiple stakeholders involved in the delivery of nutrition care and dietetic service.Methods: MEDLINE, Embase, CINAHL, Cochrane Library, Scopus, ISI Web of Science, PsycINFO and ProQuest were systematically searched. Study characteristics and perceptions of stakeholders regarding nutrition care services were extracted. Qualitative synthesis was employed and thematic analysis conducted.Results: Five themes were identified from 44 studies related to stakeholders' perceptions of dietetic services. Studies included quantitative, qualitative and mixed methods involving patients, families, dietitians and other healthcare professionals. The themes were (1) patients desiring a personalised approach to nutrition care; (2) accessing dietetic service; (3) perceived impact of nutrition care on the patient; (4) relationships between stakeholders; and (5) beliefs about nutrition expertise. Two themes were specific to patients; these were the desire for individualised care and the impact of nutrition care. Within each theme perceptions varied with patients' views often contrasting with those of dietetic service providers.Conclusions: Experiences of dietetic service do not always meet stakeholder expectations which impacts on patient engagement. Seeking stakeholder input is imperative to design dietetic services that engage patients in positive and supportive clinical partnerships.

Malnutrition is an international healthcare concern associated with poor patient outcomes, increased length of stay, and healthcare costs. Although malnutrition includes both under and overnutrition, there is a large body of evidence that describes the impacts of undernutrition with limited data on overnutrition in hospitalized patients. Obesity itself is a modifiable risk factor associated with hospital-associated complications. However, there is limited reporting of the prevalence of obesity in hospitals. This one-day cross-sectional study (n = 513) captures the prevalence of both under and overnutrition in a hospitalized population and explores dietetic care provided compared to the Nutrition Care Process Model for hospitalized patients who have obesity. The main findings were: (1) the largest proportion of patients were in the overweight and obese classifications (57.3%, n = 294/513); 5.3% of these patients had severe obesity (class III); (2) patients who were overweight and obese had lower malnutrition risk profiles as well as the prevalence of malnutrition; (3) 24.1% of patients who had obesity (n = 34/141) were receiving dietetic intervention; (4) 70.6% (n = 24/34) did not have a nutrition diagnosis that followed the Nutrition Care Process Model. Study results provide valuable clinical insight into the prevalence of overnutrition and opportunities to improve nutrition care for this vulnerable patient group.

Background Obesity is a modifiable risk factor associated with hospital-associated complications. Recent studies show there is a high prevalence of patients with obesity presenting to hospital and evidence indicates that people living with obesity should receive diet advice from a dietitian; however, patients often do not receive this care in acute settings. Aim The primary aim of this study was to explore the experiences of dietitians caring for patients living with obesity in acute hospital settings. Methods A multi-site qualitative study was conducted from October 2021 to November 2023 in Melbourne, Australia. Constructivist grounded theory methodology informed sampling and data collection. Semi-structured interviews were undertaken with dietitians working in acute care. Data were analysed using open coding and constant comparison underpinned by Charmaz’s framework. Results Interviews were conducted with 25 dietitians working across four hospitals. The theory developed from the data describes an enculturated decision-making process whereby acute clinical dietitians are limiting acute nutrition care for people living with obesity in hospital. The theory includes five interdependent categories that influence clinical decision-making and practice: (1) culture of professional practice, (2) science and evidence, (3) acknowledgement of weight bias and stigma, (4) dietitian-led care and (5) hospital systems and environment. Conclusion The findings from this study provide new insights as to why dietitians may not be providing acute nutrition care for people living with obesity. Strategic leadership from clinical leaders and education providers together with the lived experience perspectives of people with obesity is needed to shift the culture of dietetic professional practice to consider all nutrition care needs of patients living with obesity who are accessing acute hospitals for health care.