In-service, Training, and Staffing

Using Medical Nutritional Supplements Staff In-Service

January 11, 2017   /


Nutrition staff member to deliver this inservice to nurses, nursing assistants, and kitchen staff. Provide facility nutrition supplements (shakes, 2.0 medication passes) or fortified foods for staff to taste-test.


When patients in medical facilities lose weight, enhancing the meals they receive is the first step in preventing more weight loss. Meals can be enhanced using flavors and colorful garnishes. Calorie and protein level in meals can be increased by providing “super cereals and protein or calorie enriched foods, or more frequent meals.  If food enhancements don’t work or meal intake is very poor, adding supplements such as shakes or high-calorie, high-nutrient supplements may work to stop weight loss. Supplements should be offered between meals, not with meals, to maximize their intake.

Quick reading to review topic:

Huffman, Grace. Evaluating and Treating Unintentional Weight Loss in the Elderly. American Family Physician, February 15, 2002. Available at  Accessed May 6, 2006.

Position of the American Dietetic Association. Liberalization of the Diet Prescription Improves Quality of Life for Older Adults in Long-Term Care. Available at Accessed May 2, 2006.


  1. Staff will know three ways to enhance meals to increase food intake.
  2. Staff will understand why a therapeutic diet is sometimes discontinued for a resident who is losing weight.
  3. Staff will know why medical nutritional supplements may be needed.


  1. Preventing weight loss using food
    1. Liberalize diet, discontinuting any therapeutic diet that may affect flavor of meals.
    2. Enhance flavors (use cinnamon, vanilla, sugar, or other flavorings to increase intake).
    3. Enhance appearance of meals with garnishes and attractive presentation.
    4. Offer six small meals instead of 3 large meals.
    5. Offer double portions if the resident is a good eater.
    6. Use whole milk and cream when making pudding, oatmeal, casseroles, and gravies to add calories.
    7. Increase calorie content of foods by adding butter or margarine, non-fat dried milk, and cheese to foods.
    8. Purchase “super foods or “fortified foods” with caloric enhancements from food service supplier.
  2. Using nutrition supplements to prevent weight loss
    1. Purchase shakes (4 oz, require refrigeration) or canned or aseptically packaged supplements (8 oz).
    2. Different supplements are available: creamy type, fruit beverage type, High-calorie supplements that are mixed into food or beverages.
    3. Offer shakes and liquid supplements between meals rather than on meal trays to maximize their intake.
    4. Offer a 2.0 calorie supplement as part of the medication pass.
  3. Appropriate interventions for plan of care:
    1. Monitor resident for weight loss
    2. Evaluate PO intake, providing calorie-or flavor-enhanced foods if indicated
    3. Add snacks TID or double portions if indicated.
    4. If weight loss and/or poor intake continues, add nutrition supplement.


Taste-test refrigerated shakes, brik-packs of Ensure or similar products, 2.0 med pass, and fruit beverage supplements. Discuss what you like/dislike about each supplement.


Using Medical Nutritional Supplements
Pre and Post Test


  1. True or false: A liquid nutrition supplement should be the first intervention attempted when a resident is losing weight.
  2. Which of the following is not a way to make a food more calorie-dense?
    1. Add whole milk
    2. Add sugar
    3. Add water
    4. Add butter
  3. True or false: Double portions should be ordered for someone who is losing weight, even if they aren’t eating well.
  4. Which intervention should be ordered for a resident who is not eating well?
    1. Order a shake between meals
    2. Order a shake with meals
    3. Order double portions
    4. Order snacks between meals
  5. True or false: If a resident is not eating well, the dietitian might suggest discontinuing a  “no concentrated sweets” diet.
    1. True
    2. d. Order a shake between meals
    3. False
    4. c. Add water
    5. False

Answer key:

  1. False
  2. c. Add water
  3. False
  4. d. Order a shake between meals
  5. True