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What is Obesity
Obesity is a global pandemic where the population experience significant accumulation of body fat hence become extremely overweight. This makes obesity a medical problem associated with various health complications such as diabetes type2, hypertension, sleep apnea, osteoarthritis, cancers and digestive problems. In the United States, obesity has created a public health crisis with the condition, affecting every 1 out of 3 people. This means that about 35% of the total population in the U.S have obesity.
Obesity is also an issue of concern worldwide, with WHO indicating that about 650 people in the U.S have obesity. In addition, about 2 billion a adults are overweight. In addition, WHO raises concerns over the increased cases of childhood obesity with almost 340 million children between 5 and 19 years old being either obese or overweight.
Overweight and obesity are pandemics that require urgent attention to reduce the tool it has on economics, morbidity and mortality. Various factors could lead to the development of obesity. For instance, genetic factors, increased intake of high-calorie foods, physiological factors, increased physical inactivity due to increasing adoption of sedentary lifestyles, and environmental and social changes associated with lack of supportive policies. However, the good news is that lifestyle management and weight loss can improve and prevent complications associated with obesity.
Obesity is classified into different categories. According to WHO, obesity can be classified based on the body mass index (BMI). Obesity is classified into:
- Grade 1 or Class 1 (Overweight): A 25 to 29.9kg/m2 BMI indicates overweight.
- Grade 2 or Class 2 (Obesity): A BMI of 30 to 39.9kg/ m2 is considered obesity.
- Grade 3 or Class 3 (Severe obesity). This is a BMI of 40kg/ m2, which indicates morbid obesity.
Obesity Nursing Care Plans
The nursing care management of people with obesity identifies behaviors that lead to obesity, establishes the client’s nutritional knowledge, prepared a tailored diet plan, and provides the required information about the disease.
The Obesity nursing care plans and nursing Diagnoses include:
- Imbalanced Nutrition (More than required)
- Disturbed Body Image
- Impaired social isolation
- Deficient Knowledge
- Sedentary lifestyle
1. Imbalanced Nutrition
Obesity is increasingly raising concerns as a risk factor for various nutrient deficiencies. This is ironic given the increased overconsumption of calories among people with obesity. For instance, most of the calories consumed by these individuals are not from nutritious sources and hence fail to meet the recommended micronutrient levels through their diet.
- Imbalanced Nutrition (More than Required).
Could be Related to
- Intake of food exceeding body needs
- Socioeconomic status
- Psychosocial factors
Possible Evidenced by
- Observed or reported dysfunctional eating habits leading to the intake of more than the body requires.
- Increased weight by 20% of the required weight.
- Excessive body fat accumulation as measured by skinfold or other methods.
- The patient will identify dysfunctional eating behaviors.
- The client will verbalize weight-related complications/consequences.
- The patient will show a change in his/her eating habits
- The patient will be involved in a physical exercise program.
- The patient will show optimal maintenance of health through the display of weight loss.
Nursing Assessment and Rationales
The nursing assessment for an obese patient with nutritional imbalance includes the following:
|Review the organic and non-organic causes of obesity.
|This will provide a foundation for developing intervention choices. Various factors could contribute to the development of obesity in individuals, and each cause must be addressed.
|Review the patient’s eating habits (caloric intake and food portion size)
|This will help identify patterns requiring change and help tailor the dietary program. Recognizing the possibility of night-eating syndrome, lack of satiety, bingeing, and other abnormal eating habits should be identified to help develop a personalized weight-management program.
|Weigh the patient periodically as indicated and record body measurements as necessary.
|This will provide crucial information about the effectiveness of the intervention. Daily weighing is appropriate during hospitalization, and weekly weight after discharge.
|Assess the patient’s calorie requirements every 2 to 4 weeks and provide required support when a plateau occurs.
|Changes in metabolism occur as weight is lost. In this case, weight and exercise change requires a plan change and additional support to motivate the patient.
|Evaluate fat degree as indicated.
|Body fat degree is a routine clinical practice test involving calculating the BMI, waist circumference, abdominal ultrasonography and others.
Nursing Interventions and Rationales
The nursing interventions for an obese patient with nutritional imbalance include the following:
|Discuss the events and emotions associated with eating.
|This will help establish when the patient is eating to meet physiological hunger or an emotional need. For instance, negative emotions such as anxiety, stress and depression could affect food intake in take as a coping mechanism.
|Develop a meal and eating plan for the patient using gathered data about the patient’s eating patterns and nutrient requirements.
|The meal plan should include reduced calories, and increased proteins intake to help lose weight while maintaining lean muscle mass.
|Engage the patient in developing the eating plan.
|Developing a meal/eating plan together with the client while considering the client’s eating patterns can increase the likelihood of success.
|Instruct and emphasize the need to avoid fad foods/diets.
|Eliminating some of the needed nutrients, such as carbohydrates in foods, can cause metabolic imbalances and interfere with the weight loss program.
|Monitor and discourage binge eating.
|Binge eating could sabotage weight loss efforts due to caloric overconsumption.
|Develop realistic incremental weight loss goals.
|Excessive and rapid weight loss could be counterproductive due to irritability and fatigue. Reasonable weight loss, such as 1 or 2 lbs weekly, could have lasting effects. Individualize the weight-loss goal for each patient. Plan a progressive exercise program.
|Develop a reeducation plan for appetite.
|In most people with obesity or overweight, hunger and fullness signals are distorted or ignored.
|Encourage the patient to avoid tension during meals.
|This creates a more relaxed eating environment encouraging healthy eating patterns.
|Encourage the patient to only eat at an agreed eating place.
|This aims to avoid diet failure by modifying eating behavior for weight loss.
|Consult a dietician to establish nutrient and caloric requirements for the client.
|This will help tailor the weight loss program to an individual client.
|Administer medication as indicated.
|Weight loss medication may go hand in hand with other weight loss interventions to achieve success.
|Prepare the patient for surgical interventions as indicated.
|Surgical interventions may be necessary to achieve weight loss when obesity becomes life-threatening.
2. Disturbed Body Image
Dissatisfaction with body image is common among patients with obesity, especially morbid obesity. This also acts as a motivating factor for weight loss and weight loss surgery. The dissatisfaction with oneself could lead to the development of psychological distress, lower self-esteem, and lead to depression and anxiety., This could result in increased emotional eating, further worsening the situation.
- Disturbed Body Image
Could be related to
- Poor perception of self.
- Family or cultural encouragement of binge eating
- Sex, love, and control issues.
Possibly Evidenced by
- Reports or verbalization of dissatisfaction with self.
- Fear of other people’s reactions or rejection.
- Feeling powerless or hopeless.
- Lack of adherence to the diet plan.
- Preoccupation with body image changes through interventions such as attempts to lose weight.
- The patient will verbalize a realistic and positive self-image.
- The client will demonstrate acceptance of the real self rather than an idealized image.
- The patient will acknowledge individual control and responsibility over self.
- The patient will seek needed information and pursue a weight loss program.
Nursing Assessment and Rationales
Nursing assessment for obese patient with disturbed body image include the following:
|Assess the patient’s/client’s view of self in terms of being fat.
|In most cases, the mental image of self is usually the ideal image rather than the real up-to-date image.
|Determine and establish the patient’s relationship history, including the possibility of sexual abuse.
|This could lead to the development of self-esteem issues and coping patterns (overeating). People who experience childhood trauma have an increased risk of obesity during adulthood.
|Assess the patient’s/client’s goals and expectations.
|Understanding the patient’s goals and expectations will help change unrealistic expectations to realistic and attainable goals hence tailor the care plan to these goals.
Nursing Intervention and Rationales
Nursing intervention for an obese patient with a disturbed body image includes the following:
|Encourage open communication by avoiding judgement or criticism of patient behavior.
|This will be key to supporting the client in owning and taking control of the weight loss program. It creates the willingness to discuss setbacks and difficulties to solve problems.
|Outline and state the patient and nurse responsibilities clearly.
|This will help avoid misinformation and help assess the patient’s motivational level regarding behavior change.
|Develop a weekly weight graph
|This will provide ongoing visual data of weight changes to establish weight program progress.
|Encourage the use of imagery by the patient to help visualize their desired weight while encouraging the adoption of new behaviors.
|This aims to mentally prepare the patient for anticipated changes in self-image following the weight loss program.
|Provide the patient with crucial information about the use of makeup, different hairstyles and other approaches to improve figure assets.
|This will enhance self-esteem and improve body image (view of self).
|Encourage buying of new clothes as treats rather than food treats to reward weight loss progress.
|Wearing properly fitting clothes could enhance the patient’s view of body image, making them more positive and empowered.
|Suggest and encourage disposing of old clothes as weight loss occurs.
|This will help eliminate the safety value of having clothes available in case of regaining weight. Maintaining old clothes could create a perception that weight loss might not occur.
|Encourage the patient to get adequate sleep and maintain regular sleeping patterns.
|Adequate and regular sleeping patterns impact energy intake and maintenance of fat-free mass.
|Establish the patient’s/client’s weight loss motivation and help with goal setting.
|Improving appearance and self-esteem is well suited for lifestyle intervention.
|Develop strategies for engaging in activities other than eating to deal with feelings that lead to compulsive eating.
|This will help replace eating with other activities to help get rid of old patterns.
|Refer the patient to therapy or a community support group.
|Support groups offer companionship and motivate patients/clients by giving them practical solutions to common problems.
|Inform the client about cognitive behavior therapy.
|CBT can be combined with a weight loss program to help fix negative thought processes.
|Arrange and encourage the client to consult with a psychiatrist as indicated
|Psychiatric help may be necessary for clients/patients suffering from psychiatric disorders (obsessive and depressive disorders) that may be worsened by the weight loss program.
3. Impaired Social Interaction
Western societies have idolized the slender body. In this case, people with overweight or obesity face weight-related stigmatization and social exclusion. This exclusion has extended to areas including the labor market and other social areas. Since human bodies, sizes, and shapes are highly embodied in social interactions, teasing and discriminatory remarks affect interpersonal relationships significantly.
- Impaired Social Interaction
- Disturbed self-image.
- Reported discomfort in social engagements.
Possibly evidenced by
- Reported discomfort with others
- Reluctance to engage in social gatherings.
- The patient will state feelings that affect social interactions.
- The patient will be involved in improving social behaviors.
Nursing Assessment and Rationales
The nursing assessment for impaired social interaction in patients with obesity includes the following:
|Assess the family’s social behaviors.
|The family is the foundation of social interactions. In this case, the identification of inadequate social interaction patterns may create the need for action for change.
|Assess culture-related stigmatization of the patient.
|Stigma, rejection and exclusion affect a person’s emotions and behavior, including social interactions.
|Assess the presence of a history of psychological illness in the patient and the family.
|Research has shown that the use of antidepressants and depression increases obesity risk. In addition, obesity could cause depression, with people with obesity having a greater risk of lifetime/recurrent depression. Overweight status makes it challenging for patients to make friends since they are “physically unaccepted.”
|Assess the patient’s defense mechanism and coping skills.
|The patient could have a defense mechanism to protect oneself, including self-isolation and loneliness. In addition, the patient could have coping skills useful in the weight loss process.
Nursing Interventions and Rationales
The nursing intervention for impaired social interaction in patients with obesity includes the following:
|Acknowledge the patient’s feelings and perceptions about their situation.
|This will help establish patient difficulties and reasons for the lack of social interactions. For instance, the patient could feel unlovable or unloved and insecure.
|Encourage the patient to list the behaviors associated with discomfort.
|This will help identify patient concerns to develop actions to promote change. For instance, teasing and public display of negative emotions could create discomfort leading to social isolation.
|Practice and encourage the patient’s participation in role-playing to help address identified behaviors.
|Role-playing allows the patient to feel comfortable with the situation by creating a safe space to practice. This can help deal with weight stigma hence minimize the health effects of weight-based victimization.
|Discuss negative self-talk and self-concept with the patient.
|Self-talk and concepts such as “no one wants to be seen with a fat person” and “who would be comfortable talking to me?” Such concepts of self could impede positive social interaction. Self-directed weight stigma leads to weight bias internalization.
|Encourage the patient to use positive self-talk.
|Positive self-talk such as “I can be where other people are” and “What other people say or think should not control me” can help enhance comfort feelings and support positive cane.
|Refer the patient for individual or family therapy as indicated.
|The involvement of caregivers and parents/family is key to supporting, encouraging, and helping patients cope with weight-based stigma and bullying.
|Provide the patient with information on online support groups.
|Online support groups provide a sense of togetherness, purpose
4. Deficient Knowledge
Obesity has become a serious public health issue as the epidemic continues to worsen. An interprofessional team is necessary to effectively manage and prevent obesity. The key to effective obesity prevention and management is educating the client on the importance of changing a lifestyle and maintaining a healthy weight. This means educating patients about the disorder, its risk factors, disease process and associated harms. The intervention can only work if the client remains misinformed.
- Deficient knowledge.
- Lack of adequate information about the disease.
- Misinterpretation of available information about the disease.
- Limited learning interest.
- Incomplete information about the disease.
Possibly Evidenced by
- Verbalization of insufficient information about obesity.
- Seeking information about the disease.
- Lack of adequate follow-through with a previous intervention program.
- Reports of challenges in managing weight through weight reduction.
Desired Goals and Outcomes
- The patient will establish a personal weight loss goal and work towards attaining the goal.
- The patient will have a better understanding and improved knowledge about lifestyle changes required for effective weight control.
- The patient will start seeking information about managing and controlling weight.
Nursing Assessment and Rationale
The nursing assessment for deficient knowledge in patients with obesity includes the following:
|Establish the patient’s level of nutritional knowledge and the urgency of information.
|This allows the nurse to understand the additional knowledge the patient should be provided with. Listening to the patient’s views will improve knowledge delivery and understanding.
|Identify the patient’s health goals in the long term.
|An increased relapse rate may indicate the condition cannot be cured or reversed. In this case, shifting focus from weight loss to overall patient wellness can help enhance rehabilitation. Long-term strategies will be needed to prevent relapse.
Nursing Intervention and Rationale
The nursing intervention for disturbed body image in patients with obesity includes the following:
|Provide the patient with adequate information on how to eat healthy away from home.
|Encouraging smart eating while away from home can help the patient enjoy social activities while still managing weight. Encourage small portions of low-calorie diets.
|Identify other relevant sources of information to further patient learning.
|Different information sources such as tapes, books, groups and community classes further patient learning resulting in increased knowledge.
|Emphasize the need for counselling and follow-up care.
|Weight loss interferes with metabolism, which could lead to a plateau as the body activates its survival mechanism. In this case, continued support and follow-up care are crucial.
|Find alternatives to the intervention activity program.
|Accommodating for travel, weather, and other changes is crucial since this will promote program continuation.
|Discuss with the patient the need and importance of good skin care.
|Preventing skin breakdowns by controlling moisture, especially in skin folds, is crucial. In addition, using cleansers, mild soaps and drying the skin is crucial.
|Reward individual and family accomplishments.
|Non-food rewards can go a long way to reinforce positive achievements in terms of health behaviors and better outcomes.
|Encourage the patient/client to get involved in social activities that do not involve food, such as sports, biking, music, dancing, volunteering and other activities.
|This will give the client pleasure and relaxation away from food temptations. Sporting activities could also help the client further the weight loss journey to achieve the desired weight.
|Educate the patient about reading food labels.
|Food labels provide caloric information allowing one to make healthy food choices.
|Educate the importance of drinking fluids before meals.
|Drinking fluids such as water before meals helps in weight loss.
|Instruct and encourage the patient to get adequate sleep.
|Adequate sleep daily helps maintain fat-free mass;
4. Sedentary Lifestyle
This is an inactive lifestyle where individuals spend most of their time sitting, lying or leaning with little energy expenditure or exercise. A sedentary lifestyle is associated with increased waist circumference. People with obesity are less likely to move or engage in exercises making activity a crucial strategy for treating the condition.
- Sedentary Lifestyle
- Lack of knowledge on the need for exercises.
- Lack of resources, motivation and interest in physical activity.
- Fear of injuries.
Possibly Evidenced by
- Lack of daily physical exercise routine.
- Physical deconditioning
- The patient will verbalize the importance of regular exercises in achieving weight goals.
- The patient will identify safety concerns and precautions.
- The patient will develop a realistic physical exercise program.
Nursing Assessment and Rationales
The nursing assessment for a sedentary lifestyle in patients with obesity includes the following:
|Establish the current activity level of the patient.
|This helps develop an exercise program tailored to the patient’s needs.
|Plan and develop an individualized exercise program
|This ensures the client commits to realistic goals promoting adherence to the plan.
|Establish the barriers to exercise.
|Lack of safe walking spaces, financial resources and fear of ridicule or discrimination could limit the patient’s willingness to exercise.
|Determine the client’s heart rate in optimal exercise
|This aims to promote safety by ensuring exercise tolerance.
Nursing Intervention and Rationale
The nursing intervention for a sedentary lifestyle in patients with obesity includes the following:
|Review the benefits and importance of regular exercises with the patient.
|Regular exercises promote weight loss by enhancing cardiac health, increasing energy and reducing appetite.
|Educate the patient on how to reduce sedentary behavior.
|Limiting sedentary time is crucial in motivating the patient to engage in exercise.
|Discuss and instruct the patient about warm-up exercises and exercise techniques to prevent injury.
|This aims to prevent muscle injury to ensure the patient remains active. Injuries during exercise could lead to a relapse to a sedentary lifestyle. The nurse must discuss with the patient what precedes or follows a physical exercise session.
|Supervise the client during exercises.
|Seeking help from a knowledgeable trainer during the exercise program can help ensure proper exercising preventing injuries.
|Discuss with the patient the appropriate exercise types.
|For instance, obese people provide great value through the use of aerobic isotonic exercise. In addition, anaerobic exercises such as resistance training could be introduced after achieving the aerobic goal.
|Emphasize the crucial role exercises play in maintaining weight.
|Since weight gain is common, exercises are a crucial way of maintaining the recommended weight loss. The patient can only lose weight by maintaining 2621 Kcal of weekly exercises. This is about 35 minutes of vigorous activity or 60 minutes of moderate exercise.
|Discuss with the patient the mechanical equipment or tools for weight loss.
|Various tools/devices are useful for supporting weight loss in specific body parts. For instance, Gastric bands could be implanted to limit the amount of food taken and improve digestion. In addition, the client could have an endoscopic suturing device for suturing the stomach to reduce its size. Lastly, gastric balloons could be installed to fill stomach space and reduce food intake. These are FDA-approved tools that the patients should be made aware of during intervention to help them make an informed decision.
|Encourage the development of an activity graph to keep track of the exercise program.
|Keeping a visual record of physical activity is a crucial self-monitoring approach that can help one track whether they are achieving a minimal sedentary lifestyle.
|Recommend to the patient/client the need for an exercise buddy.
|This helps the client have a companion for motivation, increasing the likelihood of program adherence.
|Suggest the involvement of an exercise trainer or physical therapist to develop a tailored exercise program.
|This will help develop an exercise program tailored to the patient’s needs while considering safety concerns.