Addressing bias to facilitate accurate nutrition assessment in obesity

Malnutrition is often overlooked in patients with obesity because of pervasive weight bias and the misconception that excess body weight precludes undernutrition. Current malnutrition diagnostic criteria from the American Society for Parenteral and Enteral Nutrition, the Academy of Nutrition and Dietetics, and the Global Leadership Initiative on Malnutrition are intended to be applied to patients of all body sizes, although biases and perceived challenges in applying these criteria can hinder objective clinical evaluations. This review explores the prevalence of malnutrition among patients with obesity, the impact of weight bias on care, and practices that support accurate nutrition assessment in this population. We also emphasize the importance of a comprehensive nutrition-focused physical examination and offer practical guidance for clinicians, including key physical findings relevant to patients with obesity. Through education, communication, and fostering inclusive environments, healthcare providers can successfully assess and manage malnutrition in patients with obesity.