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Helping Your Patient Achieve an Adequate Weight to be Suitable for Lung Transplant

Beth Coplan, RD, CDE and Christina Migliore, MD
Newark Beth Israel Medical Center
Newark, NJ, USA

Most people have struggled with their weight at some point in their lives. Some people need to lose weight, while others have difficulty gaining weight. Women may want to lose weight to fit in a specific dress, to feel more attractive and confident, or to become healthier, while men may want to build muscle and become more physically fit. But what happens when you are not most people? What happens when you are the person with a life-threatening pulmonary disease, requiring continuous oxygen, taking high dose steroids daily, cannot exercise on a regular basis, and needing a lifesaving procedure such as a lung transplant, but are too obese to be a suitable transplant candidate? It is very easy to tell someone that he/she has to lose weight, but how do we help our patients achieve and then maintain these weight loss goals in order to be a suitable transplant candidate?

Transplant centers have specific weight guidelines in place to ensure that each patient is well nourished prior to transplant, will be able to heal properly and timely, and will be able to thrive after transplant. Weight guidelines tend to include a BMI between 17 - 30 kg/m2 or that a patient must weigh at least 70% of ideal body weight or no more than 130% of ideal body weight. (Weight guidelines may vary slightly at each transplant center.) Since obesity has been a factor for mortality post lung transplant, following the weight guidelines will help to ensure the best outcomes for our patients.

Weight can be a sensitive subject for some people, especially if they have been trying to lose weight, gain weight, or their weight has changed dramatically since becoming ill. The transplant physician, the registered dietitian, and the patient should all be agreeable on the determined goal weight. The patient needs to have a clear understanding of why the weight guidelines are in place and why it is imperative for that patient to reach his/her individual goal weight. It is also important to stress to the patient that even though weight loss is required, staying nourished while losing the weight is key to ensuring the patient will heal properly after transplant.

Losing weight can be extremely difficult, but gaining weight can be just as challenging. Some patients with pulmonary diseases struggle with keeping their weight up. For those patients, reaching a BMI of 20 is just as challenging as patients trying to achieve a BMI of no higher than 30.

Below are lists to help each patient achieve his/her weight goals in order to become a suitable transplant candidate. Continuous follow up with the registered dietitian is always essential to help the patient overcome any obstacles and to keep the patient motivated in order to achieve and maintain the goal weight.

When a Patient Requires Weight Gain

When a Patient Requires Weight Loss

Disclosure Statement: The authors have no conflict of interest.

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