Focus on Obesity NUR 171 Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

2 Body Shape Classification Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Two general classifications used to classify people by body fat distribution are (A) pear shape and (B) apple shape. Health risks are associated with each classification (see Table 41-3).

3 The problem! The problem! Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

DIETARY GUIDELINES FOR AMERICANS Control total calorie intake to manage body weight. Eat less than 300 mg per day of dietary cholesterol. Increase intake of fat-free or low-fat milk and milk products or fortified soy products. Choose a variety of protein foods [seafood, lean meat & poultry, eggs, beans and peas, soy products, & unsalted nuts and seeds. Reduce the intake of calories from solid fats and added sugars. Reduce daily sodium intake to less than 2300 mg and further reduce intake to 1500 mg among persons who are 51 years or older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. Limit the consumption of foods that contain refined grains, especially refined grains that contain solid fats, added sugars, and sodium. Increase vegetable and fruit intake. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

5 Nursing Implementation When no organic cause can be found for obesity, it should be considered a chronic, complex disease. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

6 Nursing Implementation Multipronged approach ought to be used with attention to multiple factors. Dietary intake, physical activity, behavior modification, and/or drug therapy Restricted food intake is a cornerstone for any weight loss or maintenance program. A good weight loss plan should contain foods from the basic food groups Diets may be classified as low calorie (800 to 1200 calories per day) or very low calorie (less than 800 calories per day). Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

7 Behavior Modification Assumption behind behavior modification Learned disorder Critical difference between an obese person and a nonobese person involves cues that regulate eating behavior. Useful basic techniques Self-monitoring: Show what and when foods are eaten Stimulus control: Separate events that trigger eating from the act of eating Rewards: Incentives for weight loss Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

8 Support Groups Encouragement can be offered to join a group of other obese persons who are receiving professional counseling to help modify eating habits. Many self-help groups are available. o Take Off Pounds Sensibly (TOPS) o Weight Watchers Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

9 Drug Therapy Appetite-suppressing drugs Decrease food intake through nonadrenergic mechanisms in the central nervous system (CNS) Phentermine Diethylpropion Phendimetrazine Not recommended because of the potential for abuse Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

10 Drug Therapy Nutrient absorption–blocking drugs o Work by blocking fat breakdown and absorption in intestine o Inhibit action of intestinal lipases o Undigested fat is excreted in feces. Orlistat (Xenical, Alli) Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

11 Bariatric Surgery Used to treat obesity Currently the only treatment found to have a successful and lasting impact on sustained weight loss for severely obese individuals Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Roux-en-Y Gastric Bypass

12Evaluation Expected outcomes o Long-term weight loss o Improvement in obesity-related co-morbidities o Integration of healthy practices into lifestyle o Improved self-image o Must monitor for possible adverse effects Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

13 Nursing Diagnoses Imbalanced nutrition: More than body requirements Impaired skin integrity Ineffective breathing pattern Chronic low self-esteem Health-seeking behaviors Readiness for enhanced knowledge Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

14Exercise An essential part of a weight control program Should be done daily for 30 minutes to an hour Sensible forms of exercise should be encouraged. o Walking, swimming, cycling Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.