Bridging the gap in nutrition assessment: Barriers and knowledge impact of an educational session on body composition and energy metabolism

Background: Body composition and energy metabolism assessments are central to nutrition care but remain underused. This study evaluated dietitians’ access, use, education, and beliefs toward these assessments, and the impact of an educational session. Methods: Dietitians (≥1 year experience) within Alberta Health Services completed online surveys on their access, use, education, confidence, and clinical protocol awareness regarding body composition and energy metabolism assessments. Participants attended a 4-h virtual educational session on these topics, with presession and postsession knowledge recall compared using Wilcoxon signed rank test. Results: We surveyed 36 participants (97% women), primarily from inpatient care (36%) or oncology (31%). Most (86%) never used body composition methods, despite access to computerized tomography (CT; 31%), ultrasound (US; 25%), bioelectrical impedance analysis (BIA; 6%), and dual-energy x-ray absorptiometry (DXA; 3%). Although 67% received body composition education (47% BIA, 31% DXA, 22% CT, 8% US), 64% lacked confidence. Protocol awareness was 67% for malnutrition and 8% for sarcopenia. Most never (58%) or occasionally (19%) used energy metabolism methods; Q-NRG (COSMED; 28%) and standard metabolic carts (19%) were the most available devices. Although 67% received energy metabolism education (53% metabolic cart, 31% Q-NRG), 50% were not confident in using these methods. After the educational session, body composition knowledge recall improved (median, +20% [IQR, 10–30]; P < 0.001), whereas energy metabolism scores were unchanged (P = 0.530). Conclusion: Despite prior education, dietitians used body composition and energy metabolism assessments inconsistently because of limited access, insufficient applied knowledge, lack of protocols, and low confidence. These results underscore the need to strengthen curriculum and professional development to support adoption.