Obesity in the Adult Population and the Professional Nurse’s Role

Part 1: Obesity

Background

Obesity is a condition characterized by abnormal fat deposition with a BMI greater than or equal to 30. According to World Health Organization, the prevalence of obesity has increased to twofold from 1980 to 2014 (WHO, 2015). In 2008, the US government spent $147 billion in managing obesity and its comobidities, attracting an additional cost of $1,429 for treating obese individuals compared to their normal weight counterparts (CDC, 2015). Although preventable, mortality rates associated with obesity are higher than those from underweight. The situation is even more worrying with more children becoming overweight and obese; for instance, about 42 million children aged five years and below were reported to be obese in 2013. In 2014, more than 600 million adults were obese (WHO, 2015). According to the Center for Disease Control and Prevention (CDC), over 78.6 million adults (34.9%) in the United States are obese. Obesity is common among non-Hispanic African Americans (47.8%) trailed by Hispanics at 42.5%. Compared to other groups, non-Hispanic whites and non-Hispanic Asians have the lowest rates of 32.6% and 10.8% respectively (CDC, 2015).

Causes of Obesity

Obesity is a health condition with multifactorial causes including behavioral, environmental, and genetic factors. Behavioral factors include consumption of high calorie diet, physical inactivity, and medication use. Some individuals are addicted to fast foods high in calories; coupled with physical inactivity, these individuals are at an increased risk for obesity. Exposures to social environmental factors such as home, school, or occupational settings that promote sedentary life style also contribute to obesity (CDC, 2015).

For instance, most employees use elevators in their workplaces instead of stairs.  In most companies, employees would rather drive to work than walk or cycle to keep fit. Other individuals have family history of obesity as a result of predisposing genes passed down family members. However, the occurrence obesity along the family line is determined by a complex interplay of genetic and environmental factors. Obesity may also result from other physical health conditions and medication use. For instance, diseases such as polycystic ovarian syndrome and Cushing’s disease are among the illnesses that predispose individuals to obesity. Medications such as antidepressants and steroids have also been linked to rapid weight gain and obesity in some individuals (CDC, 2015).

Consequences of Obesity

Obesity is associated with several short-term and long-term physical health consequences. Compared with their counterparts with healthy weight, obese persons are predisposed to short-term health conditions and illnesses such as musculoskeletal pain and general fatigue, sleep apnea, and dyspnea. Long-term health consequences include hypertension, coronary heart disease, gallbladder disease, high low density lipoprotein (LDL), low high density lipoprotein (HDL), and elevated levels of triglycerides (dyslipidemia).  Osteoarthritis, some cancers including liver, colon, endometrial, breast, gallbladder, and kidney cancer are also common among obese people.  Moreover, it has been shown that obesity is a risk factor for stroke, type 2 diabetes, low-quality life, and increased mortalities from all-causes. Other physical conditions include high-risk pregnancy that is higher among overweight and obese women compared to women of normal weight.

Apart from the economic consequences evidenced by increased medical cost for managing obesity, there are also social consequences associated with high prevalence of obesity.  Obesity-related illnesses subject many persons to absenteeism from school and work thus lowering their economic productivity and social contribution. Studies have also pointed out cases of obese individuals who emphasize their recognition and boost their self-esteem by being ever-present at social places such as school and work.  This form of “presenteeism” is however marked by low productivity contributed to by the comorbid conditions affecting obese persons. Other social consequences of obesity include discrimination and prejudice in social places leading to lower employment, lower educational attainment, and fewer friends. Individuals who are overweight and obese tend to have poor concentration levels compounded by discrimination hence poor academic success.

In addition, obesity is linked to psychological conditions such as depression and anxiety. Despite the common attitude of “fat and happy,” depression is common among overweight and obese persons compared to individuals of normal weight.  Management of obesity is often complicated by clustering eating disorders (binge eating), low self-esteem, psychosomatic trauma, and depression among obese persons.

Recommendations

Several preventive measures have been laid down to address high rates of obesity in the United States. According to the United States Department of Health and Human Services (2015) dietary guidelines, individuals are advised to desist from high calorie foods and maintain physical activity. Foods such as fruits and vegetables, and whole grains are recommended for weight reduction. Healthy People 2020 reports that physical activity and healthy diet are effective in curbing lifestyle diseases and conditions such as diabetes, heart disease, and obesity. Healthy weight and habitual physical activity also reduce the risk of depression and improve general health (Healthy People 2020, 2015).

Part 2: Teaching Plan

Background

Healthcare providers play an important role in providing health education to patients from varied backgrounds. The learning model chosen should assist the providers in assessing, diagnosing, planning, executing, and appraising of the learning process. According to McNeill (2012), healthcare personnel should be in a position to develop teaching plan for patients tailored toward the patients’ needs and approach of learning, including reliance on tactile, kinesthetic, auditory, or visual techniques. It is vital to set goals and assess the outcomes of the learning process.

Assessing the Patient’s Learning Needs

The assessment begins with a general communication with the patient to establish their objectives and goals, their main concern for learning, their readiness for the learning process, and their favorite learning style.  In assessing the patient’s learning style, I will enquire about what they learned of late and how they acquired such knowledge. This involves assessing whether knowledge, for instance, about obesity was gained from reading, listening to other people, or dealing with obesity firsthand. Barrier that will be mostly encountered in response will include different cognitive and recall abilities as determined by the patients’ age and educational level.

Expected Outcomes

From the teaching program, the patients are expected to make some achievements. I will expect my patients to lose at least one pound per week, increase their level of physical activity, for instance, walk 30 minutes each day for five days per week. The patients are also expected to verbally demonstrate their knowledge of the link between weight loss and physical activity, identify behavioral changes that are necessary for healthy eating, and recognize support systems that assist in behavior change.

Information Taught

To dispel misapprehensions about obesity and help my patients tackle obesity or prevent, I will emphasize on a several strategies. First, I will ensure that my patients learned that weight is not the main issue; the major focus is how much of that weight is contributed by abnormal body fat as calculated from the BMI. Obesity and overweight lie in the BMI category of ≥ 30.0 and 25.0-29.9 respectively.  I will emphasize on this point since many patients tend to believe that dieting is the best way of controlling overweight when in reality massive water lost through dieting only replenishes with rehydration (Green et al., 2013). This information is relevant mainly to female patients and young adults who value body image and are very gullible to dubious weight loss programs circulated in the media.

Second, the patients will be taught that the imbalance between energy consumption and energy expenditure is the determining factor of weight gain.  In addition, the patients will be reminded that their genetic makeup influences how fast they can lose body fat under any proposed weight loss program. The approach used should be able to increase energy expenditure and lower energy consumption.

Third, and most importantly, the patients will learn that focusing on behavior change and not weight is important in maintaining healthy weight. This strategy is important in emphasizing on how positive behavioral activity such as participation in physical activity, avoidance of sedentary lifestyle, and consuming healthy diet rich is important in managing weight. As such, I will advise my patients to walk more, jog, consume foods low in sugars and fat, and eat more fruits, vegetables, and whole grains. There are varied cultural and religious preferences influencing the choice of foods. Even patients who are not strict vegetarians or do not adhere to religions like Hinduism will be informed of the benefits of consuming vegetables, fruits, and whole grains as a preventive measure against obesity.

Evaluation of the Teaching Plan Effectiveness

One month after initiation of the teaching, the patient will be assessed on the amount of the weigh lost, for example, three pounds per month. Effectiveness of the program will also be verified based on the behavioral modification the patient has adopted such as walking for more than thirty minutes per day for five days in a week and commitment to eat a healthy diet. Patient will also be required to prove commitment to regular weight and blood pressure check at the nearest facility.

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