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Obesity-Related Problems Cardiovascular

atherosclerosis, heart failure, hypertension, stroke

Obesity-Related Problems Respiratory

sleep disorders, sleep apnea

Obesity-Related Problems Gastrointestinal

gallbladder disease, hiatal hernia, colon cancer

Obesity-Related Problems Genitourinary

cancer of breast, uterus, prostate, and colon; stress incontinence

Obesity-Related Problems Musculoskeletal

low back pain, osteoarthritis

Obesity-Related Problems Endocrine

diabetes mellitus

Obesity-Related Problems Reproductive


Increasing obesity in U.S.

Adult population
Young adults


25-29.9 kg/m2
30 kg/m2 or greater

Obesity 1

Caused by excess calories stored as fat

Obesity 2

May also be due to leptin resistance

Obesity 3

Significant risk factor for cardiovascular diseases

Obesity 4

Upper body obesity or central obesity have more abdominal fat and higher free fatty acids circulating; greater risk of hypertension, heart disease, stroke, diabetes

Obesity 5

Diagosis with body mass index- 25-29 overweight; greater than 30 obesity; thyroid profile, serum glucose and cholesterol; lipid profile, ECG

Medications (appetite suppressants)

used in combination with diet and exericse

A combination of diet, exercise, behavior modification

critical component of weight loss

Successful treatment is rarely achieved

treatment focuses on reducing the health risks by changing eating habits and exercise; to lose 1 pound must reduce diet by 500 kcal for 7 days or increase activity to burn the equivalent


restrictive procedures include banding which is safer and reversible (band placed around portion of the stomach; malabsorptive/restrictive surgeries include gastric bypass where food bypasses the stomach and goes into pouch created - absorption is limited and procedure is not reversible

Obese Client

Establish realistic weight goals
Identify factors that cause increased food intake
Behavior modification


inadequate dietary intake; after glucose for energy, protein and fats then used


cell and tissue breakdown

Protein-calorie malnutrition-

both protein and calories are deficient (marasmus); kwashiorkor is when there are adequate calories but not enough protein

Abdominal edema or peripheral edema-

low serum albumin


low serum albumin; may be below 3 in PCM

Postural hypotension impaired immune function-

cardiac output falls

Malnutrition Possible causes

Inadequate nutrient intake
Impaired absorption and use of nutrients
Loss of nutrients due to diarrhea, hemorrhage, or renal failure
Increased metabolic needs


Higher risk for infection


Affects many components of the immune system


supplemental vitamins/minerals

Gradual refeeding-

fluids and electrolytes repaired first; initial feedings are limited amounts of liquid to prevent diarrhea; gradual refeeding to prevent electrolyte imabalances

Nutritional supplements-

Ensure, Sustacal; 2 ounces with each medication given may be sufficient to increase calorie and protein intake

Enteral nutrition-

tube feeding in those unable to consume food; tube placement by checking the pH of aspirate; ph less than 4 indicates proper placement; greater than 6 in the jejunum; 1500 ml per day provides recommended daily intake of all vitamins and minerals

TPN hyperalimentatin is IV administration of carbs, protein, electrolytes, vitamins, minerals, and fat emulsions; administered through central line such as subclavian vein

mixed sterile by pharmacy; fluid overload risk in older adults; high glucose formulas can cause hyperglycemia- check glucose every 6 hours; long term use can lead to gallstone formation and liver disease; sterile technique for site and catheter care

Patient with Malnutrition

At great risk for other problems
Should be closely monitored
Have rest periods before and after meals
Hospitalized patient requires an interdisciplinary approach

Anorexia nervosa-

usually begins during adolescence; distorted body image and irrational fear of gaining weight; restricted calorie intake

Bulimia nervosa-

late adolescence or early adulthood; binge eating followed by purging; usually high calorie, high fat, and sweet foods; weight is often normal

Binge-eating disorder-

do not purge; binge eat only; eat even when not hungry and usually occurs when person is alone

Eating Disorders Anorexia nervosa

distorted body image and irrational fear of gaining weight. extreme weight loss

Eating Disorders Bulimia nervosa

following failed attempts to lose weight through dieting. weight stays the same

Eating Disorders Binge-eating disorder

similar to bulimia but without purging

Eating Disorders

Difficult to effectively treat
Community-based care is appropriate for most clients
Hospitalization for some clients may be necessary
A comprehensive treatment plan for eating disorders includes medical care and monitoring, psychosocial interventions, and nutrition counseling

Client with Eating Disorder

Anorexia nervosa, bulimia nervosa, binge eating disorder
Require hospitalization if weight is less than 75% normal; antidepressants my benefit with bulemia such as prozac to prevent relapse
Monitor weight
Observe client during and after meals to prevent disposal of meals; frequent small feedings
Multivitamin or supplements to replace losses

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