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Chapter 41 Nursing Management of Obesity

Terms in this set (27)

Body Mass Index
The most common measure of obesity is the body mass index (BMI). BMI is calculated by dividing a person's weight (in kilograms) by the square of the height in meters (Fig. 41-2). Individuals with a BMI less than 18.5 kg/m2 are considered underweight, whereas those with a BMI between 18.5 and 24.9 kg/m2 reflect a normal body weight. A BMI of 25 to 29.9 kg/m2 is classified as being overweight, and those with values at 30 kg/m2 or above are considered obese. The term severely (morbidly, extremely) obese is used for those with a BMI greater than 40 kg/m2 (eFig. 41-1 on the website shows individuals who are severely obese).
Waist Circumference
is another way to assess and classify a person's weight (see Table 41-1). People who have visceral fat with truncal obesity are at an increased risk for cardiovascular disease and metabolic syndrome (discussed later in this chapter). Health risks increase if the waist circumference is greater than 40 inches in men and greater than 35 inches in women.
Waist to hip ratio
is another tool used to assess obesity. This ratio is a method of describing the distribution of both subcutaneous and visceral adipose tissue. The ratio is calculated by using the waist measurement divided by the hip measurement. A WHR less than 0.8 is optimal, and a WHR greater than 0.8 indicates more truncal fat, which puts the individual at a greater risk for health complications.
Body Shape
is another method of identifying those who are at a higher risk for health problems (Table 41-2). Individuals with fat located primarily in the abdominal area, an apple-shaped body, have android obesity. Those with fat distribution in the upper legs, a pear-shaped body, have gynoid obesity. Genetics has an important role in determining a person's body shape. Weight and shape are influenced by genetics.
Healthy Impact of Maintaining a Healthy Weight
• Reduces the risk of developing type 2 diabetes mellitus • Increases chance of longevity and better quality of life • Lowers the risk of hypertension and elevated cholesterol • Reduces the risk of heart disease, stroke, and gallbladder disease • Reduces the likelihood of breathing problems, including sleep apnea and asthma • Decreases the risk of developing osteoarthritis, low back pain, and certain types of cancers
Obesity and Cultural Disparities
• African Americans and Hispanics have a higher prevalence of obesity than whites. • Among women, African Americans have the highest prevalence of being overweight or obese, and 15% are severely obese. • Among men, Mexican Americans have the highest prevalence of being overweight or obese. • African American and Hispanic women with low incomes appear to have the greatest likelihood of being overweight when compared with other socioeconomic groups. • Native Americans have a higher prevalence of being overweight than the general population. • Among Native Americans ages 45 to 74, more than 30% of women are overweight and more than 40% are obese. • Asian Americans have the lowest prevalence of being overweight and obese compared with the general population.
Primary and Secondary Obesity
The majority of obese persons have primary obesity, which is excess calorie intake over energy expenditure for the body's metabolic demands. Others have secondary obesity, which can result from various congenital anomalies, chromosomal anomalies, metabolic problems, or central nervous system lesions and disorders.
The two major consequences of obesity
The two major consequences of obesity are due to the sheer increase in fat mass and the production of adipokines produced by fat cells. Adipocytes produce at least 100 different proteins. These proteins, secreted as enzymes, adipokines, growth factors, and hormones, contribute to the development of insulin resistance and atherosclerosis. An increased release of cytokines from fat cells may disrupt immune factors, thus predisposing the person to certain cancers. Because visceral fat accumulation is associated with more alterations of these adipokines, people with abdominal obesity have more complications of obesity.
Obesity and cardiovascular problems
Obesity is a significant risk factor for cardiovascular disease in both men and women. 11 Android obesity is the best predictor of these risks and is linked with increased low-density lipoproteins (LDLs), high triglycerides, and decreased high-density lipoproteins (HDLs). Obesity is also associated with hypertension, which can occur because of increased circulating blood volume, abnormal vasoconstriction, increased inflammation (damaging blood vessels), and increased risk of sleep apnea (raises blood pressure [BP]). Altered lipid metabolism and hypertension can increase the long-term risk of heart disease and stroke. Excess body fat can also lead to chronic inflammation throughout the body, especially in blood vessels, thus increasing the risk of heart disease.
GI and Liver and Obesity
Gastroesophageal reflux disease (GERD) and gallstones are more prevalent in obese people. Gallstones occur due to supersaturation of the bile with cholesterol. Nonalcoholic steatohepatitis (NASH) is a condition in which lipids are deposited in the liver, resulting in a fatty liver. NASH is associated with elevated hepatic glucose production. NASH can eventually progress to cirrhosis and can be fatal. Weight loss can improve NASH.
MS problems and obesity
Obesity is associated with an increased incidence of osteoarthritis because of the stress put on weight-bearing joints, especially the knees and hips. Increased body fat also triggers inflammatory mediators and contributes to deterioration of cartilage. Hyperuricemia and gout are often found in people who are obese and in those who have metabolic syndrome (discussed later in this chapter).
Goals of obesity
(1) modify eating patterns, (2) participate in a regular physical activity program, (3) achieve and maintain weight loss to a specified level, and (4) minimize or prevent health problems related to obesity.
Assessing patients with obesity
• What is your history with weight gain and weight loss? • What is your motivation for losing weight? • Would you like to manage your weight differently? If so, how? • What do you think contributes to your weight? • What sort of barriers do you think impede your weight loss efforts? • Are there any major stresses that will make it difficult to focus on weight control? • What does food mean to you? How do you use food (e.g., to relieve stress, provide comfort)? • Are other family members overweight? • How much time can you devote to exercise on a daily or weekly basis? • How has your health been affected by your body weight? • What type of support do you have from family and/or friends for losing weight?
Health care provider are relucant to counsel patients with obesity
(1) time constraints during appointments make it difficult, (2) weight management may be viewed as professionally unrewarding, (3) reimbursement for weight management services is difficult to obtain, and (4) many providers do not feel knowledgeable about giving weight loss advice.
multifacted approach to weight loss
A multifaceted approach needs to be used, including nutritional therapy, exercise, behavior modification, and for some, medication or surgical intervention (Table 41-7). Focusing on more than one aspect provides for more effective weight loss and weight control efforts. While doing patient teaching, stress healthy eating habits and adequate physical activity as lifestyle patterns to develop and maintain.
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