Obesity is a severe medical condition affecting over 1.9 billion adults worldwide, and the prevalence of obesity continues to grow in both developed and developing countries.
Obesity can lead to many health complications, including cardiovascular disease, type 2 diabetes mellitus, sleep apnea, osteoarthritis, and some types of cancer.
Nurses are tasked with caring for patients who have obesity on an everyday basis. This blog post will explore the diagnosis of obesity and the nursing care plan that should be provided based on current evidence-based practice guidelines, hence guiding nursing students.
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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.
What is Obesity?
Obesity is defined as a body mass index of 30 or higher. The body mass index (BMI) is a number calculated from a person’s weight and height.
Obesity was originally defined as the point at which 50% of people are overweight. However, it has been found that using a BMI of 30 or higher, in combination with other risk factors such as high blood pressure or cholesterol levels, can be used to define obesity.
Obesity classifications include:
Class 1 Obesity – BMI of 30-34.9
Class 2 Obesity – BMI 35-39.9
Class 3 Obesity – BMI 40 and above
An individual’s weight status is determined by their body mass index (BMI) – a measure of body fat based on height and weight. Body Mass Index (BMI) is defined as one’s weight in kilograms divided by the square of one’s height in meters, expressed as kg/m2.
In the U.S., BMI cutoffs are typically used to determine obesity and other weight categories. A person with a BMI of:
BMI 25-29.9 = Overweight
BMI 30+ = Obese
1) Nutrition-less than body requirements related to excessive weight
This may be due to psychosocial factors, socioeconomic status, possibly evidenced by a history of food insecurity.
2) Imbalanced Nutrition: more than body requirements related to inability or desire to increase consumption of food, which leads to altered nutrition element being deficient.
Imbalanced nutrition may be due to environmental or social factors such as lack of access to healthy foods, limited knowledge.
4) Risk for impaired skin integrity related to immobility due to size. Excess weight leads to increased pressure, which may lead to a breakdown of the skin barrier.
Before the Nurse Interventions -Obtain a clear picture of what is happening for this patient. The nurse knows that obesity can lead to many conditions and complications, including: “Coronary heart disease, stroke, type 2 diabetes mellitus, osteoarthritis and certain types of cancer.” (NANDA Diagnosis Reference Manual – Obesity, 2013).
Evidence indicates that the nurse needs to assess the patient’s readiness to change and then develop a plan of care based on this assessment. The nurse knows that patients cannot make changes if they are not motivated to do so.
The patient has a BMI of 46 kg/m2 and reports a desire to lose weight. His waist circumference is 102 cm (40 inches). He has been following an exercise plan but states that he has had to stop doing it because of knee pain as a nurse aide. He reports the inability to afford better quality foods and says that he often eats at fast-food restaurants along with his children. His wife is a stay-at-home mom who cooks for the entire family.
Since childhood, the patient has been experiencing shame and embarrassment regarding his weight when he was called names by other children.
The patient has a BMI of 46 kg/m2 and reports knee pain from his job as a nurse aide. The patient’s immobility may cause a breakdown of the skin barrier.
The patient reports that constipation is a significant problem and that he can’t make it to the bathroom at work.
The patient has degenerative discs in his lower back and struggles with back pain, aggravated by excess weight.
The patient reports knee pain from his job as a nurse aide, aggravated by excess weight.
Most likely, the patient is experiencing anxiety due to his inability to make healthy changes in his life and not having access to quality foods.
The nurse should work with the patient on goal setting. Set short-term goals that can be achieved quickly. She should adjust the patient’s usual eating pattern by starting with small portion sizes at meals and then working up to more significant amounts. The nurse can help the patient access healthy foods (e.g., vegetables and fruits) at an affordable price by asking his food stamps provider or local community agency for resources to provide food.
In addition, the nurse should support the patient through this process of change by conveying understanding, empathy, reassurance, and encouragement. The nurse should be a good listener and try to understand what the patient is going through.
For example, if the patient has not been motivated in the past because of embarrassment or shame, then showing that you can relate may help him feel more comfortable talking about it. The nurse could say, “I understand how embarrassed you must have been when kids made fun of your weight,” or “I know this isn’t easy for you, but I think it’s great that you’re trying to make changes.” By showing empathy and encouragement, the patient will feel more comfortable disclosing feelings and experiences.
Lastly, the nurse should also educate the patient on ways in which he can get more exercise. By helping the patient find strategies to increase his physical activity, the nurse helps him explore other avenues of support, such as a weight loss program or a community-based resource center to help with weight management and healthy eating.
In addition to educating patients and providing emotional support, nurses can also find ways to provide good lab values through facilitating healthy dietary habits. The nurse should discourage binge eating and develop a meal plan with the patient.
This plan can include healthy snacks and meals that are nutritionally balanced, such as fruits or vegetables, dairy products (if tolerated), grains, lean meats, eggs, fish, tofu; healthy fats such as nuts and seeds; extra-virgin olive oil or avocados; fruit juices without sugar; herbal and other teas; coffee or water.
The nurse should ask about any concerns or fears patients have and address them as negative feelings may sabotage their progress. Nurses in a variety of practice settings have the opportunity to educate patients and facilitate behavior change. By doing so, nursing can help individuals lead healthier lives by living a more active lifestyle and eating healthier foods.
The goal of nursing intervention for obesity is to aid the patient in achieving realistic goals of weight loss and an increase in physical activity.
The nurse should emphasize both healthy eating and physical activity because they are both critical for health during weight-loss programs. Encourage the patient to walk as much as possible. Set short-term goals of walking around the neighborhood or other safe areas, and then slowly increase distance by walking a little farther each time. This will help by increasing energy and toning muscles. After exercising, the patient should replenish his fluid and electrolyte balance through drinking water or other non-caloric fluids that are appropriate for weight loss.
A medical practitioner should encourage the patient to set realistic goals to avoid disappointment and develop negative feelings. This may mean setting realistic goals for losing weight over time, such as 1-2 pounds per week, rather than trying to lose an unrealistic amount of weight in a single week.
Nursing Interventions -having a Positive Attitude about Weight Loss.
The nurse should be respectful of the patient’s concerns about weight loss, resist criticism, provide support, and establish an environment that fosters high expectations for success. The nurse can do this by praising the efforts the patient is already making to lose weight and helping him to create a vision of how he wants to be. The nurse can help the patient see himself in his ideal weight and encourage him by telling him that this image can become a reality. Provide support, but avoid criticism. The nurse should provide encouragement and support that will enable the patient to lose weight by helping him see himself as capable of reaching his goals while avoiding making judgments or criticisms.
The nurse should help the patient learn about how to eat better and how to make healthy food choices. The nurse should teach him about the types of foods that are healthy (e.g., vegetables and fruits) as well as unhealthy (e.g., fast-food burgers). At the same time, the nurse should let the patient know the consequences associated with overeating. They may find it helpful to keep a food journal with the nurse’s help to track what he is eating.
- Avoid food intake that exceeds the body’s needs.
- Encourage water intake and diuretic drugs to increase the excretion of excess sodium.
- Encourage the person to weigh periodically as individually indicated and obtain feedback about progress.
Pharmacological therapy for obesity should be considered as a treatment option after weight loss attempts utilizing non-pharmacologic interventions have failed. Medications that are commonly used in the treatment of obesity include:
Orlistat- It prevents fat breakdown and absorption, which limits calorie intake.
Acarbose- it stops the breakdown of starches and sugars, which limits calorie intake.
Rimonabant- blocks cannabinoid receptors (CB1), preventing the release of appetite-stimulating substances in the body. It’s approved for use in Europe and South America for therapy of obesity.
Obesity is a growing public health problem that can significantly lower life expectancy and increase the risk of certain diseases. Nurses must treat obesity in their patients through diet, exercise, and medication interventions because they are capable of helping them achieve lasting weight loss.