Liberalized Diets: From Restriction to Empowerment 

liberalized diets
Written by Olivia Farrow, RD, MHSc

Written by Olivia Farrow, RD, MHSc

Reviewed by Krista Kolodziejzyk, RD, MPH, MBA

As healthcare professionals, we are always looking for ways to improve the health and quality of life patients and clients. Liberalized diets have been gaining traction as the ideal approach to support individuals in care settings in maintaining their autonomy, nutritional status, and quality of life. 

Learn more about supporting older adults or those in a long-term care setting, specifically in DSC’s Nutrition for Older Adults & Long-Term Care Dietetics Evidence Summary

What is a liberalized diet?

Older adults in care settings are traditionally prescribed therapeutic dietary restrictions based on their health conditions or medical concerns. A liberalized diet approach relaxes restrictions of therapeutic diets, allowing individuals to eat a “regular diet” that includes foods they enjoy, potentially leading to improved nutritional intake (1,2,3).

The Academy of Nutrition and Dietetics (US), in a 2018 position paper, supported the use of “individualized nutrition approaches for older adults” due to the risks of malnutrition in post-acute care settings and the potential benefits of liberalizing therapeutic diets to enhance quality of life (1). 

Liberalized Diet vs. Therapeutic Diet

Therapeutic diets are commonly ordered in post-acute care settings such as long-term care, rehabilitation, and home care (1). Healthcare providers with appropriate delegation may prescribe therapeutic diet interventions for individuals with chronic conditions, including diabetes, chronic kidney disease, and cardiovascular disease (1,3).

Therapeutic diet orders to manage chronic health conditions may include:

      • Diabetic Diet

      • No Concentrated Sweets

      • Low Sodium

      • No Added Salt

      • Low Fat

      • High Fiber

      • Calorie Controlled

      • Renal Diet

    On the surface, it may seem appropriate to prescribe these dietary interventions to individuals with nutrition-related chronic disease. However, the risks of malnutrition may be greater than any benefit from a restrictive diet (1). 

    Consider this: you’re used to eating the same foods your entire life. Suddenly, you are living in a new environment. You are away from family and friends, your regular routine, and the independence to have full autonomy over the foods you eat. You may also be facing physical and mental changes associated with your health condition or aging. Now you are no longer allowed to eat your favorite foods. Would you eat enough in this situation to meet your nutritional needs? 

    Living in a care setting can negatively impact food intake due to social isolation, lack of independence, and taste and cognitive changes. Further restriction of allowed foods can be harmful and lead to lowered intake (1). 

    However, some individuals may wish to follow a therapeutic eating pattern, such as a diabetic diet, which should still be respected (3). Consider education and discussion with capable clients/patients, their families, and secondary decision-makers on the benefits and reasons for diet liberalization. 

    Some persons with certain medical conditions may still need a more restricted diet. For example, individuals with dysphagia may need texture modification to swallow safely (3). If a speech-language pathologist (SLP) is on your team, work with them to liberalize diets safely.

    Overall, nutrition should be individualized to help increase the desire to eat and improve quality of life (9,1).

    What are the benefits of a liberalized diet approach?

    The benefits of a liberalized diet approach may include: (1,2,3)

        • Improved nutrient intake
              • Older adults in care settings may struggle to consume enough nutrients. Relaxing some of the dietary restrictions can make it easier for them to eat a wider range of foods and nutrients, reducing the risk of deficiencies and malnutrition. 

          • Improved quality of life
                • Allowing autonomy around food choices can enhance quality of life for individuals in care settings. The freedom to eat the foods they enjoy may help individuals feel more satisfied and fulfilled. This can help to reduce feelings of deprivation or frustration that may arise from strict dietary restrictions.

            • Increased socialization
                  • For many people, mealtime is a social event. Having the option of a wider variety of foods can facilitate socialization and increase the enjoyment of mealtime. This can be particularly important for older adults living alone.

              • Improved health
                    • A liberalized diet approach may appeal more to older adults than a strict, regimented diet. By allowing choices about what they eat, within the context of an overall nutritious menu, they may be more likely to eat within their dietary recommendations.

              Barriers to Implementing

              Liberalized diets may be a new concept to the other healthcare providers in your workplace, the individual client/patient and their family or support circle. In an ideal setting, healthcare professionals would work with each client/patient to develop a personalized diet plan that meets their needs and preferences (3). 

              Some potential barriers can make this more challenging to implement, including: 

                  • Training and resources
                        • Implementing a liberalized diet may require health care team members to be trained on supporting autonomy over food choices while ensuring that nutritional needs are being met. Additional staff resources and training can be challenging in some care settings.

                    • Concerns about safety
                          • Your colleagues may be concerned that a liberalized diet could harm the health of those with medical conditions. 

                      • Regulatory and legal issues
                            • Most care facilities are subject to various regulations and legal requirements that may make implementation difficult. 

                        • Cultural and dietary preferences
                              • Accommodating certain dietary preferences in a care setting may not be possible.

                          • Lack of family support
                                • In some cases, family members may be resistant to a liberalized diet for their loved one, particularly if they are concerned about the safety or effectiveness of the approach. 

                          Consulting with all individuals involved in the care of your client/patient, reviewing their charts to determine their overall health and nutritional status, and staying on top of your documentation can help you advocate for them successfully (3). Creating a supportive and empowering environment that promotes better health and well-being for all is possible.

                          Remember that some persons with certain medical conditions may still need a more restricted diet. For example, individuals with dysphagia may need texture modification to swallow safely (3). If a speech-language pathologist (SLP) is on your team, work with them to liberalize diets safely. 

                          Liberalized Diets in other practice settings

                          Liberalized diets do not need to be limited to post-acute care settings. Emphasizing flexibility and inclusivity rather than strict rules and limitations can be a departure from traditional diets that focus on the strict elimination of certain foods. Promoting a more balanced and intuitive approach to eating may help individuals develop a healthier relationship with food and their bodies and eat without guilt or shame. This can increase satisfaction with eating and may lead to the intake of more nutrients and a more nutritious diet overall. 

                          DSC’s Intuitive Eating video course can help you learn more about working with a variety of clients to liberalize their own approach to eating. 

                          Key Takeaways

                              • A liberalized diet approach can be an effective way to improve overall health and quality of life. 

                              • Relaxing traditional dietary restrictions and therapeutic diets can help individuals to consume a wider range of nutrients, reduce the risk of malnutrition, and enjoy mealtimes more fully.

                              • There may be barriers to the implementation of a liberalized approach. Considering the unique needs of each individual client/patient and their support team may help to overcome these barriers.

                             

                            References

                            1. Dorner, Becky, and Elizabeth K Friedrich. “Position of the Academy of Nutrition and Dietetics: Individualized Nutrition Approaches for Older Adults: Long-Term Care, Post-Acute Care, and Other Settings.” Journal of the Academy of Nutrition and Dietetics vol. 118,4 (2018): 724-735. doi:10.1016/j.jand.2018.01.022
                            2. Farrer, Olivia et al. “Systematic review of the evidence for a liberalized diet in the management of diabetes mellitus in older adults residing in aged care facilities.” Diabetes research and clinical practice vol. 108,1 (2015): 7-14. doi:10.1016/j.diabres.2014.12.021
                            3. Dietitians of Canada. Ontario long-term Care Action Group. Best practices for nutrition, food service and dining in long-term care homes. Dietitians of Canada/Les diététistes du Canada, 2013.

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