CHAPTER 41: NURSING MANAGEMENT: OBESITY

OBESITY
 Obesity is the most common nutritional problem, affecting almost one third of the
population.

 Approximately 13% of Americans have a body mass index (BMI) greater than 35 kg/m2.

 Obesity is the second leading cause of preventable disease in the United States, after
smoking.

 The cause of obesity involves significant genetic/biologic susceptibility factors that are
highly influenced by environmental and psychosocial factors.

 The degree to which a patient is classified as underweight, healthy (normal) weight,

overweight, or obese is assessed by using a BMI chart.

 Individuals with fat located primarily in the abdominal area (apple-shaped body) are at a
greater risk for obesity-related complications than those whose fat is primarily located in
the upper legs (pear-shaped body).

 Complications or risk factors related to obesity include the following:

o Cardiovascular disease in both men and women
o Severe obesity may be associated with sleep apnea and obesity/hypoventilation
syndrome.
o Type 2 diabetes mellitus; as many as 80% of patients with type 2 diabetes are
obese
o Osteoarthritis, probably because of the trauma to the weight-bearing joints and
gout
o Gastroesophageal reflux disease (GERD), gallstones, and nonalcoholic
steatohepatitis (NASH)
o Breast, endometrial, ovarian, and cervical cancer is increased in obese women

 When patients who are obese have surgery, they are likely to suffer from other
comorbidities, including diabetes, altered cardiorespiratory function, abnormal metabolic
function, hemostasis, and atherosclerosis that place them at risk for complications related
to surgery.

 Measurements used with the obese person may include skinfold thickness, height, weight,
and BMI.

 The overall goals for the obese patient include the following:
o Modifying eating patterns
o Participating in a regular physical activity program
o Achieving weight loss to a specified level
 o Maintaining weight loss at a specified level
o Minimizing or preventing health problems related to obesity

 Obesity is considered a chronic condition that necessitates day-to-day attention to lose

weight and maintain weight loss.

 Persons on low-calorie and very-low-calorie diets need frequent professional monitoring

because the severe energy restriction places them at risk for multiple nutrient
deficiencies.

 Restricted food intake is a cornerstone for any weight loss or maintenance program.

 Motivation is an essential ingredient for successful achievement of weight loss.

 Exercise is an important part of a weight control program. Exercise should be done daily,
preferably 30 minutes to an hour a day.

 Useful basic techniques for behavioral modification include self-monitoring, stimulus

control, and rewards.

 Drugs approved for weight loss can be classified into two categories, including those that
decrease the following:
o Food intake by reducing appetite or increasing satiety (sense of feeling full after
eating)
o Nutrient absorption

 Bariatric surgery is currently the only treatment that has been found to have a successful
and lasting impact for sustained weight loss for severely obese individuals.
o Wound infection is one of the most common complications after surgery.
o Early ambulation following surgery is important for the obese patient.
o Late complications following bariatric surgery include anemia, vitamin
deficiencies, diarrhea, and psychiatric problems.

 Obesity in older adults can exacerbate age-related declines in physical function and lead
to frailty and disability.

METABOLIC SYNDROME
 Metabolic syndrome is a collection of risk factors that increase an individual’s chance of
developing cardiovascular disease and diabetes mellitus.

 Lifestyle therapies are the first-line interventions to reduce the risk factors for metabolic
syndrome.