In obese patients with BMI > 30 kg/m2, which PN/EN recommendations best reflect the guidelines for calories and protein?

• A. 15-20 kcal/kg IBW/day and less than 2.0 g/kg IBW/day
• B. 15-20 kcal/kg IBW/day and greater than or equal to 2.0 g/kg IBW/day
• C. 22-25 kcal/kg IBW/day and less than 2.0 g/kg IBW/day
• D. 22-25 kcal/kg IBW/day and greater than or equal to 2.0 g/kg IBW/day

Answer: (D)

In obesity, the aim is to provide enough energy without overfeeding, and protein to preserve lean body mass. Energy targets are best calculated using ideal body weight (IBW) rather than actual weight because much of the excess weight is adipose tissue with lower metabolic needs. A caloric target of 22–25 kcal per kg IBW per day delivers sufficient energy for recovery while reducing the risk of complications from overfeeding. Protein needs are higher to support nitrogen balance and lean mass; providing at least 2.0 g per kg IBW per day helps preserve muscle and support healing during nutrition support. So, pairing 22–25 kcal/kg IBW/day with protein ≥2.0 g/kg IBW/day aligns with guidelines for obese patients receiving PN or EN.