What is Obesity and causes?
its a global epidemic and thought 2 be result from decreased physical activity, both in work and leisure time, but also from increased intake of kilacalories through larger food portions & high intake surgar-based beverages.
Its easier 2 prevent obesity then correct it.
Nurses: Assess current nutritional intake and family health history which helps in determing the best course of action 2 slow weight gain for peeps who are moderately overweight and help reverse the problem of obesity
What are health problems found with overweight & obese peeps?
Hypertension, elevated triglycerides, low level of high-density lipoprotein (HDL) cholesterol, gout, polycystic ovary syndrome, type 2 diabets, atherosclerosis, certain forms of CA, osteoarthritis, cholelithiasis or gallstones, sleep apnea, hypothyroidism, OBESITY impairs immune system and results in delayed wound healing, depression
Standards used 2 determine weight
- overweight = excess body weight 10% more than standard weight
- Obesity = body weight 20% or more than standard weight
- Extreme obesity = 30% more than standard weight
- Underweight = 10% below standard weight
- BMI is used preferred standard 4 determining appropriate body size.
- Ideal BMI 21-25 upper limit 27 underweight is a BMI less than 19 is and less than 15 is dangerously low and can result in death.
What are other body fat measurements?
More presise methods:
Nurse Alert - rapid weight loss is not advised 4 anyone, but especially 4 the elderly. Slow weight loss approx. 1/2 to 1lb per wk.
- Skinfold measurements
- Bioelectric impendance machine
- Underwater weighing
What are known causes & theories of obesity
- energy balance (weight gain occurs when calorie intake exceeds expenditure over extended period of time)
- eating habits, cooking methods, family customs, emotional problems, peer pressure, food advertising, and food availability, age, gender, heredity, body composition, hormonal makeup, physical activity
What is the Thrifty Gene Theory?
ability 2 preserve body mass during times of famine & 2 gain body mass easily during times of plenty.
What is Hyperinsulinemia?
high levels of insulin in the blood, often associated with obesity and insulin resistance. Explains the pattern of family obesity among those with family history of diabetes.
Nurse = Diabetics need lower carbohydrate intake 2 achieve desirable body weight.
What are some hormonal imbalances that lead to weight problems?
Adipokins = leptin (suppresses hunger and food intake), andiponectin (protein-based hormone helps regulate metablolism)
Dehydroepiandrosterone (DHEA) andrenal steroid = destroys body fat
Cortisol = promotes lipogenesis, but need adequate sleep 2 produce it
Thyroid function = low levels cause decrease in metabolic rate and equals weight gain
What is monosodium L-glutamate (MSG)?
MSG increases production of glucocorticoids (glucose), triglycerides, and insulin which equals in more body fat
Nurse = teach client fiber, exercise(aerobic) counteract production of glucocorticoids
What medications increase weight problems?
- Antipsychotic medications = clozapine, olanzapine
- Nueroleptic medications
- Tricyclic antidepressants and mood stabilizers
- Beta blocker = propranolol
- Contraceptives = subdermal implantable b/c
What are some ways 2 prevent obesity?
Promote healthy food choices and regular physical activity in childhood
Reduce intake of cokes, juice, fruit punch, high saturated fate and sugar. max limit 1cup of fruit juice 3 to 4 cups of milk daily,
Promote positive self esteem
Promote more vegetables, fruits, whole grains and other high fiber foods, lean meats, unsaturated fats (nuts, peanut butter)
Promote increase physical activity @least 30min adults 60mins kids per day.
Treatment strategies for obesity?
- Actively promote realistic weight loss goals
- Gender plays a role in treating weight problems. Men lose weight faster than women.
- Lifetime habits, not short-term diets should be promoted. Exception 2 short-term diets would be peeps w/ sleep apnea or surgery is imperative for rapid loss of body fat.Develop habit or routine of exercise by setting small achievable goals
- Slow down eatingDon't use food as a reward or comfort
Predicting Weight loss
- Reduce 500calories per day 2 lose 1lb of fat weekly. Safe weight loss is max of 1to2lbs per wk.
- Orlistat helps weight loss but has a/r GI problems like diarrhea.
- Meridia helps appetite suppressant but has potential side effects
- Topamax seizure med and migraine med helps reduce appetite but not approved 4 weight loss
Nurses: prescription meds are proven 2 be dangerous and herbal products Ma Huang(ephedra).
What is exchange lists 4 weight mgmt?
tool used in reducing calorie intake developed by American Diabetes Association and the American Dietetic Association. Aims 2 control carbohydrate and calorie intake in mgmt of diabetes.
Weight watchers and Richard simmons "deal-a-meal" used this exchange lists
What is MyPyramid.gov?
provides individual guidance 4 amts of food needed & provides nutritional assessment tools. Min of servings recommended provides about 1200 to 1500kcal, especially if only lean meats, fat-free milk and no added fats or sugars are consumed. Min amt of milk is 3cups.
Nurse = suggest a multivitamin and mineral supplement if kilocalorie intake is less than 1200daily.
What are Very-Low-Fat Diets?
- They are aiming their approach @ the concentrated kilocalories of fat.Possible to lose weight on this diet, but bcuz fat also helps with feeling full this leaves dieters still hungry and afraid of eating any fat.
Nurse = Teach client this type of diet causes reduction in essential fatty acid deficiency and causes hair loss, endocrine problems, this diet is ususally high in carbs which could lead to heart disease 4 a person w/ insulin resistance & hyperinsulinemia.
What is low in fat, high in fiber diet?
Referred 2 as "prudent diet". Promotes food high in fiber whichmakes u feel full and low coloric value allows person 2 trust their natural hunger and satiety cues.
Nurse = Very-low-fat diet discourages use of monounsaturated fats which help peeps with metabolic syndromes. Weight watchers use this now.
Moderate in fat, high in fiber diet
National Cholesterol Education Program (NCEP) diet, aimed @ lowering saturated fat and cholesterol intake.
Therapeutic Lifestyle Changes (TLC)diet aimed @ lower total carb intake, high fiber, w/ higher proportion of protein and monounsaturated fat. Twice the weight loss of those on NCEP diet.
Nurse = Helps reduce risk of cardiovascular disease and improved cholesterol levels.
Low Glycemic Diet
This (GI) diet is similar to the TLC diet but differs by putting undue emphasis on food rankings based on predicted rise in postprandial blood glucose levels. Rule of thumb limit liquid carb intake to 15g per meal.
The Very-Low-Carbohydrate Diets
these diets have sprung from the belief, substained by growing research, tht insulin induces the gain of body fat. A 1lb steak is equivalent 2 a 1/2cup of lard, whereas 1lb of wild game contains about 1 to 2 tablespoons of fat.
Nurse = Tell client bcuz carbs is found primarily in plant-based foods, these diets can set a person up 4 vitamin and mineral deficiencies even if a vit/mineral supp is taken due to photochemicals and arsenic now considered essential 4 health but from plants but not in excess.
High protein, moderate carbohydrate, low saturated fat diet
12wk study showed that a higher-protein diet better reduced hunger than a moderate protein diet while allowing similar weight loss
Nurse = teach client high-protein diets over a long period of time may lead 2 problems with healthy kidney function. ALERT peeps w/ chronic kidney disease these diets can cause significant damage and symptoms are asymptomatic. Peeps wanting 2 do this diet should undergo serum creatinine lab test 2 chk kidney function and urinary dipstick test 4 proteinuria 2 chk protein in urine which is another sign of kindney problems.
Been around 4 yrs but suck cuz peeps usually can't last on them. ONLY good 4 peeps whose life is in imminent danger & needs 2 lose weight quickly but should be followed under DR supervision. Some peeps actually gained weight on this diet.
Nurse = Liquid diets have high GI and can cause hyperinsulinemia in persons with insulin resistance.
Prepackaged food diets
Useful 4 short-term weight loss, but weight gain often occurs after peeps get tired of same foods. Often expensive programs and dont' have long term success rates.
Nurse = tell client they can save money and develop long term food habits by purchasing prepackaged foods from local grocery stores.
Food restrictive Diets
Generally called fad diets popular @ the time but don't last. Ex: cabbage soup diet
Nurse = Teach clients these don't work cuz causes intense cravings 4 other foods set in and the person usually gains all weight back plus more.
these diets focus on eating in response 2 physical hunger and satiety cues, rather than solely focus on knowledge of what 2 eat. These diets promote emotional health and healthy habits while allowing weight loss.
Nurse = Tips 4 weight loss peanuts make u feel full and reduce intake of more calories, high-fiber foods w/ intake of lean proteins sources & unsaturated fats promote fullness, eat regular meals & snack every 2 to 3hrs 2 prevent feelings of hunger, eat slow.
What is behavior modification
This involves assisting the overweight or obese peep in identifying personal eating behaviors that have been promoting weight gain. Goal is 2 permanetly change negative habits.
Nurse = teach client example like lower-calorie snack or smaller portions and eating slower would help lose weight. PEEPS FROM GREAT DEPRESSION HATE WASTING FOOD SO PREPARE PORTION SIZES 4 THEM.
What is Dawn phenomenon?
Peeps are most insulin resistant on arising.
Bariatric Surgery and its impact?
- Usually 4 peeps with extreme obesity or class IIIobesity formally called morbid obesity. Surgery is meant 4 last option.
- Gastric banding = least inavasive of the bariatric surgeries most advisable 4 adolescents and women of childbearing yrs
- Roux-en-Y gastric bypass = high risk 4 dumping syndrome, nutritional deficiencies of iron, folate, and vitamin B12, anemia, nerve damage if not corrected, and osteoporosis from vitD deficiencies. CAUTION ESPECIALLY IN ADOLESCENTS, YOUNG ADULTS, WOMEN OF CHILDBEARING YEARS.
- Nurse = beaware of thiamin deficiency which causes polyneuropathy (disease involving nerves) s/s = degeneration of nerves in lower limbs, heart failure or Wernicke's encephalopathy, opthalmoplegia(paralysis of eye muscles) usally in adolescents. hair loss, severe malnutrition and diarrhea, deficiencies of vitamins A, D, K
What is the role of physical fitness in healthy weight mgmt?
- Exercise is important 4 weight management it burns kilocalories. Increases metoabolic rate as long as 24hrs after the activity stops especially in aerobic. Hypoglycemia is more likely 2 occur with increase in physical activity.
- Helps with:
- Decrease body fat and tone muscle
- Manage mental stress
- Increase energy levels
- Provide sense of control over health & lifestyle
- Control appetite
- Promote strong bones
- Help raise HDL-cholesterol levels
- Lower glucose levels 2 normal
- Promote normal b/p
NURSE = walking, swimming are safe exercises 4 all peeps, bedridden or wheelchair peeps can use upper-arm exercises 2 help maintain muscular strength and health. Tell client 2 seek medical clearance b4 starting exercise program especially peeps with diabetes who have complications
The Role of Nurse or other health care professionals in promoting healthy weight and physical activity
They help identify individuals @ high risk 4 developing obesity. Review kids growth records 2 rule out a trend of excessive gain in BMI. Assist in identifying appropriate weight 4 health and effective means 2 achieve changes in body composition.