Obesity is one of the most common and controversial epidemics across the United States. According to the National Health and Nutrition Examination Survey, 36% of adults in the United States are obese (Jarvis, 2016). Many factors influence health and well-being. Some risk factors are modifiable, where as other factors are not. Discussion to follow will focus on patient teaching and dietary modifications to promote a healthy weight and lifestyle, and in turn decrease healthcare associated costs and long-term health concerns in the adult patient.
Preventable Disease Overview
Obesity is a surplus of fat on an individual that has the potential or likelihood to influence their health (Obesity, 2014). Numerous causes, including genetics, social influence, pathology, psychological, and physiological routes are linked to the increased prominence of obesity. An individual may first note concerns with obesity if their clothing is no longer fitting appropriately or a weight gain is noticed. They may then voice a concern to their provider regarding unintentional weight gain.
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A provider should confirm obesity through numerous diagnostic factors and tests to rule out underlying disease processes that lead to weight gain. The major contributing factor associated with obesity is lifestyle choices such as excess calorie intake and lack of physical activity (Obesity, 2014). The provider should complete a physical exam, noting vital signs and assessment of the hearts, lungs, and abdomen. Measurements of a patient ’s height and weight should be obtained to calculate a BMI or body mass index. Additionally, a waste circumference, health history, current diagnoses and medication regimens should be obtained. Labs may be ordered to look at participants cholesterol, liver function, fasting glucose, and thyroid. Labs would rule out physiological cause for weight gain. Finally, it is important for the care team to inquire about dietary and activity routine (Obesity, 2015).
Participant is identified as at risk for obesity related to health history and dietary intake assessment obtained. She is a 49-year-old female with a history of obesity (not current), hypertension, degenerative disk disease, endometriosis, type 2 diabetes, and depression. The world health organization links the likelihood of these diseases to increase in patients with obesity (Obesity and overweight). It is additionally important to note that participant has a family history of obesity, maternal and paternal.
Evidence Based Intervention
Once a pathological condition is ruled out, treatment and prevention of obesity and obesity risk related disorders will focus on lifestyle modifications and interventions. Dietary intake is a completely modifiable factor that significantly influences health and well-being.
Evidence suggest that diets low in saturated fat and high in fiber promote weight loss and decreased morbidities associated with obesity. These diets, in combination with a regular exercise regimen, produce an even greater effect on results (Ma, et al., 2017).
Implementation: Teaching Plan
When providing patient education, it is vital to utilize a variety of different teaching methods to accommodate your patients learning abilities and style. I will provide both verbal and written instructions, as well as provide demonstrations and allow them to return demonstrations or verbalize steps or information as appropriate. Follow up is also a key to successful education and patient teaching. Participant will be instructed in the appropriate process to obtaining an accurate weight, use of a dietary journal, healthy choices for nutritional needs, and calculation of body mass index as related to obesity and dietary intake.
First, to measure progress, the patient must have a baseline. We will establish a baseline weight and measure her height. Participant should weigh at the same time each week, in the morning, after utilizing the bathroom using the same scale. Record weights weekly to track progress. A food journal will track everything, preferably including portion sizes that the participant eats or drinks to track loss and gain associated with specific choices. Next, I will teach participant the significance of body mass index and the appropriate way to figure her calculation. A BMI equal to or greater than 25 is considered overweight. (Obesity, 2015) A body mass index above 30, approximately 20% above the ideal weight of the individual, is indicative of obesity. A BMI over 40 is morbid obesity (Jarvis, 2016). Living in a technological based world, I would recommend use of a BMI calculator available at the National Institute of Health government website. If the patient prefers to manually figure their BMI, the formula is as follows: wt in kg (pounds/ 2.2) / ht in meters2 (39.4 inches is equal to 1 meter). Education on healthy dietary portions and choices for low fat high fiber food will be provided. Dietary emphasis will include drinking a minimum of 64 ounces of water a day, replacing high fat content meats like hamburger and hotdogs with low fat meets such as fish, chicken and turkey, and eating fresh fruits and vegetables throughout the day. Participant should also decrease or eliminate sugary drinks such as soda and fried foods with alternative choices. (Ells, Demaio, Farpour, 2018).
Evaluation
In evaluation of participants progress toward obtaining and maintaining a healthy weight and promoting a healthy lifestyle, I would recommend weekly assessment of weight, dietary and physical activity journal, follow up labs, and vital signs. A weekly weight will capture weight loss or gain over a period of one week and allow for accumulation of data to track pattern of loss or gain. A dietary journal will serve two purposes. First, it will make the participant accountable for their intake and activity. Second, it will allow the care team to gather data and associate loss or gain with patterns of lifestyle and choices. Labs would indicate a decrease LDL and normal glucose level. Vital signs are obtained to screen for general well-being of the participant. Weight loss can decrease need for pharmacological treatment for diseases such as hypertension or depression.
Summary
A fit diet is critical to wellness, healthy lifestyle, and longevity. Altering dietary habits to promote a healthy BMI decreases health risks and associated cost of treatment for conditions that develop related to obesity. Specific recommendations for dietary modifications should come at the recommendation of a provider based on patient specific conditions and needs. ?
References
- Ells, L. J., Demaio, A., & Farpour-Lambert, N. (2018). Diet, genes, and obesity. BMJ : British Medical Journal (Online), 360doi:http://dx.doi.org.chamberlainuniversity.idm.oclc.org/10.1136/bmj.k7
- Jarvis, C. (2016). Physical examination & health assessment (7th ed.). St. Louis, MO: Saunders/Elsevier.
- Ma Chenhan, Avenell Alison, Bolland Mark, Hudson Jemma, Stewart Fiona, Robertson Clare et al. Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis BMJ 2017; 359 :j4849
- Obesity. (2014, September 05). Retrieved August 14, 2018, from http://www.who.int/topics/obesity/en/
- Obesity. (2015, June 10). Retrieved August 14, 2018, from https://www.mayoclinic.org/diseases-conditions/obesity/diagnosis-treatment/drc-20375749
- Obesity and overweight. (n.d.). Retrieved August 15, 2018, from http://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight
- Obesity Prevention. (n.d.). Retrieved August 16, 2018, from https://stanfordhealthcare.org/medical-conditions/healthy-living/obesity/prevention.html
Childhood And Adolescents Obesity Prevention
Obesity in children and adolescents is a serious and growing problem in America. Overweight children are becoming overweight adults and that is causing life-threatening, chronic diseases such as diabetes and heart disease. There are multiple reasons for childhood obesity. The most common reasons are genetic factors, lack of physical activity, unhealthy eating patterns, or a combination of all three factors (“Obesity in Children,” 2018). Today, there are many children that spend a lot of time being inactive and eating junk food, which many times they learn from their parents or other household members.
Obesity is determined by Body Mass Index (BMI). Body mass index is calculated by the child’s height and weight. This is usually plotted on a growth chart to calculate BMI and see where children are in relation to other children in their age category. Children who are obese are above the normal weight for their age and height. It is important for parents to regularly check in with their family doctor, especially if there are concerns on their child’s weight. Calculating a BMI does not take into consideration the child’s muscle mass or body structure, so the physician will consider the child’s history of growth and development as a factor as well. This can help determine if the child’s weight is in an unhealthy range (“Childhood Obesity,” 2018).
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Risk factors that contribute to childhood obesity are diet, lack of exercise, family factors, and socioeconomic status. Regularly eating high-calorie and sugary foods can cause weight gain. Fast foods are also typically unhealthy, yet regularly consumed because of convenience and price. Children are becoming more sedentary, due to video games, television, computers, etc. Children that are sedentary are not burning as many calories, and therefore are gaining weight. Children that come from overweight families are more likely to be obese. This is especially true in environments that have high-calorie meals regularly and don’t promote physical activity. People in communities with limited access to grocery stores may buy more convenience foods so they don’t spoil as quickly, instead of fresh fruits and vegetables. Individuals in low income communities may not feel safe going outside to play, which infringes on their exercise and physical activity (“Childhood Obesity,” 2018).
I am currently a school nurse in a rural school district. Over 50% of the children in the elementary school are considered obese based on their BMI. I have partnered up with KU Medical Research team to implement a program called iAmHealthy into our school district. This is an 8-month program that is a school-based and helps students and families learn about healthy lifestyles. To begin, I got the height and weight of all the students in our school. Their BMI’s were calculated and sent to the KU research team. Students with a BMI greater than 85% are eligible for the program. The parents of these students were contacted and asked if they were interested in participating.
This program requires the student and parent’s height and weight to be monitored monthly. In addition to the monthly weigh ins, the families are sent a newsletter that contains information on healthy recipes, ways to stay active, health tips, etc. Students are also required to wear an activity tracker for 7 consecutive days at the beginning of the program and at the end of the program. The last requirement is a food diary for 3 days. Students and parents must track and take pictures of all they eat. This program can be time consuming, which is why KU research offers families up to $400 of compensation for their time and commitment.
Not only does this program encourage a healthy lifestyle, but it encourages families to do it together. As the school nurse, I am here for any support that the students or parents need. I read over the educational materials that families receive so I can implement it to all families, even those that are not participating in the program. A large issue in our school is lack of education regarding a healthy lifestyle. In a rural town, the education materials are as readily available and people tend to raise their children the same way they were raised. I have found people are willing and excited to learn and make lifestyle changes, they just need the resources and guidance.
This program’s success is measured by monthly weigh ins and group chats over information learned. Although this program is not focused on losing weight, we still obtain weights monthly just as a check in. iAmHealthy is more focused on healthy living habits and becoming active. In our small groups, we review the newsletter and work on how that can be implemented into daily life and the small changes that can be made. It has been extremely helpful doing this in a group setting because parents are offering support to one another and students are creating friendships. This program has bonded families together and given them a common ground to grow as individuals and as a family.
Childhood obesity is not an issue that will be solved overnight. It is a continuing problem that currently does not have an end in sight. As nurses and nurse educators, it is our responsibility and duty to provide the education children, adults, and families need to make healthy lifestyle choices. There are many small changes parents can make to impact their child’s future. Limiting sugary drinks, increasing fruits and vegetables, getting active, and limiting screen time are just a few ways to set a child up for a successful future. Healthy and educated children today sets the foundation for healthy and educated adults in the future.
References
- Childhood Obesity. (2018). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/childhood-obesity/symptoms-causes/syc-20354827
- Obesity in Children. (2018). WebMD. https://www.webmd.com/children/guide/obesity-children#1
