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Q: Obesity & HIV
I am a dietitian working with HIV+ clients. I am fairly new to this specialty and am concerned about overweight clients who wish to lose weight. (I have two who are well above the upper limits of ideal body weight and one client is, in fact, bordering on obesity.) Aside from discouraging rapid weight loss and/or too much weight loss, are there any other precautionary measures I might take when counseling these clients? (October, 2000)
A: Donna Tinnerello, MS, RD, CD/N responds:
Regarding weight loss in people living with HIV: That is a personal judgement call. YOU really need to evaluate your patients nutritional status each time around. Most of us think that it's the body cell mass that really matters. I highly recommend BIAs (bio-electrical impendance analysis) as a way of assessing nutritional status with respect to lean body mass and body fat.
Lots of People living with HIV/AIDS are doing very well these days -- and weight loss counseling is routine -- keeping in mind most of the parameters you would with non-HIV+ patients. You don't want them to lose muscle either. So it's a healthy diet including adequate protein and exercise. Read more on this site regarding protein and other nutrition issues if you are just starting out. Also read up on lipodystrophy as the "weight gain" here is fat redistribution due to the medications. That is a special situation that takes an understanding of the process.
Another good web site to check out for more information on nutrition and HIV is HIV Resources. I also recommend you subscribe to the newsletter, including back issues. It's great -- we (yes, I'm affiliated with it too) write about all the nutrition issues that surround HIV.
(Administrator's Note: In her articles, Jennifer also dealt with the obesity and HIV issue. I recommend in particular her article Looking Great in 98.)
A: Charlie Smigelski, RD responds:
Regarding weight loss for anyone, the focus is on preserving lean body mass, while losing fat.
I make sure that my HIV+ people are eating 3/4 gram protein per pound of ideal weight, and just ask them to trim fat calories a bit. Keeping to low glycemic index carbs is nice too. On this scheme, supper is maybe 6 oz chicken and 1 cup black beans (not rice and beans), along with salad or broccoli, etc, plus fruit.
I make sure they are willing to exercise, maybe 2 cardio workouts, and 2 resistance workouts a week.
(Administrator's Note: Charlie also has written an excellent workbook called EAT UP! which contains a great deal of information on dealing with HIV/AIDS nutritionally. Ordering information can be found by visiting Charlie's Page on this web site.)
A: Diana Peabody, RD responds:
Weight loss is not necessarily contraindicated in HIV and in some cases may be beneficial. Obesity has its own set of health risks that also affect HIV+ people, especially those with elevated lipids or blood sugars. I agree with Charlie, the most important issue is the preservation of lean tissue with loss of body fat. I recommend relatively high protein, low fat/low sugar, and exercise.
