Obesity is excessive body fat that presents a health risk. A body mass index (BMI) over 30 is considered obese. Obesity is a growing problem in nearly every country in the world.
Obesity has two main causes: increased intake of foods high in fat and sugar and a decrease in physical activity. As people continue to work in sedentary jobs, rely on transportation, and seek convenience through the delivery of products and processed foods, obesity is likely to worsen.
Obesity is linked to cardiovascular diseases, diabetes, cancer, and joint disorders. Childhood obesity, which continues to rise, is associated with a higher risk of premature death and disability in adulthood.
In this article:
- Nursing Process
- Nursing Care Plans
- Imbalanced Nutrition: More Than Body Requirements
- Overweight
- Sedentary Lifestyle
- Risk for Metabolic Imbalance Syndrome
Nursing Process
Obesity is a difficult topic to broach with many patients though it is a health condition that requires the same education as any diagnosis. Unlike some diseases, obesity is preventable and patients often have a choice in decreasing their body fat. Nurses can support patients through their weight loss journey by educating on diets, using motivational interviewing to spark behavior change, coordinating with dieticians and recommending resources, and monitoring patients before and after bariatric surgeries.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for obesity, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for obesity.
Disturbed Body Image
Obesity can cause patients to feel ashamed or unhappy with their physical appearance resulting in low self-esteem and depression.
Nursing Diagnosis: Disturbed Body Image
Related to:
- Societal views affecting the patient’s sense of self-worth
- Family or cultural values affecting how one should look
- Negative effect on sexual and intimate relationships
As evidenced by:
- Verbalization of unhappiness with appearance
- Fear of ridicule or rejection by others
- Preoccupation with losing weight
- Feelings of hopelessness
- Lack of follow-through with diet and exercise plans
- Not participating in activities where weight could be an issue
Expected outcomes:
- Patient will lose “X” number of pounds to achieve desired body weight.
- Patient will learn to accept themselves despite weight loss or gain.
- Patient will accept responsibility for making changes to improve self-image.
Assessment:
1. Assess the emotional effect of the patient’s weight.
Assess how the patient views themselves and any internal struggles they face due to their weight. Assess for signs of anxiety and depression and a sense of low self-worth.
2. Assess the effect of social systems.
Assess how the patient’s family and friends affect their weight. Patients with obese family members may feel outcasted by their desire to lose weight or may feel pressured to do so by friends or acquaintances.
Interventions:
1. Provide positive reinforcement.
Remain nonjudgmental and help the patient strive for success. Remind them they can lose weight but are worthy of love and acceptance regardless of their outward appearance.
2. Help set motivational goals.
Only the patient can decide they are ready for change and put in the effort. Help them come up with reasons that will keep them on track such as feeling confident in a swimsuit or being comfortable in an intimate relationship.
3. Teach positive reward systems.
Instead of treating oneself for weight loss with food, suggest buying newer, better-fitting clothing or a new hairstyle to improve body image.
4. Focus on the patient’s strengths.
A patient who is struggling with their physical appearance can be redirected to focus on their value as an individual with unique abilities. This can include intelligence, sense of humor, empathy, and ambition.
5. Encourage counseling.
Negative thoughts of one’s self can be deep-seated and may even be a result of abuse or years of negative self-talk. This requires the intervention of a mental health professional to unlearn trauma.
Imbalanced Nutrition: More Than Body Requirements
One cause of obesity is the overconsumption of food, often high-calorie food such as fats and sugar.
Nursing Diagnosis: Imbalanced Nutrition
Related to:
- Excess intake of food
- Unhealthy food choices
- Inability to afford nutrient-dense food
As evidenced by:
- Intake of more than daily recommended calories
- Eating in response to emotions (stress, boredom)
- Eating large portions
- Obese body mass index
Expected outcomes:
- Patient will identify times, settings, and emotions that induce overeating.
- Patient will verbalize healthier food choices in place of processed foods.
- Patient will reduce daily calorie intake by 20%.
Assessment:
1. Assess for conditions contributing to obesity.
Obesity is not always related to a patient’s choices. Assess for health conditions such as hypothyroidism, diabetes, polycystic ovarian syndrome, medication side effects, and family history that predispose the patient to weight gain.
2. Assess the patient’s average daily intake.
Have the patient provide a normal daily meal schedule so the nurse can understand how often the patient is eating, what types of foods, and an average amount of calories, fat, sodium, and protein intake.
3. Assess the patient’s BMI.
Calculate the patient’s body mass index using their height and weight to determine the severity of obesity.
Interventions:
1. Start with small changes.
Losing weight and changing diets isn’t easy and requires new habits. Do not overwhelm the patient with strict diets and food changes. Start with small, realistic goals such as adding in a new vegetable every week and reading food labels.
2. Educate on nutrient requirements.
Provide education and written materials to guide the patient in smarter food choices. Obese patients often lack required nutrients so the nurse can educate on reducing sodium, increasing vitamin D and protein, and swapping saturated fats for unsaturated fats.
3. Treat health conditions.
Underlying health conditions must be controlled to see weight loss. Ensure patients are on an effective regimen for hypothyroidism or diabetes. Patients with little improvement after adhering to weight loss guidelines may require the use of appetite suppressants.
4. Refer to a dietician.
Dieticians assist with goal setting, understanding food labels, meal and recipe planning, portion control, and making better food choices.
5. Weigh only weekly; measure body fat.
Patients should not obsess about the number on the scale as it may not correlate to fat loss. Patients may notice a reduction in their waist or hip size. Other tools such as calipers can measure the skinfolds that will show body fat vs. muscle.
Overweight
Describes a condition where the patient gains abnormal or excessive fat for age and sex.
Nursing Diagnosis: Overweight
Related to:
- Average daily physical activity is less than recommended
- Disordered eating behaviors
- Altered eating perceptions
- Excessive consumption of processed or sugary beverages or food
- Portion sizes larger than recommended
- Frequent snacking
- High intake of fast food
- Sedentary lifestyle
As evidenced by:
- BMI 25 kg/m2 to 29.9 kg/m2
- Triceps skinfold >15mm in men, >25mm in women
- Waist circumference >40 inches in men, >35 inches in women
- Reported or observed dysfunctional eating patterns/behaviors
Expected outcomes:
- Patient will demonstrate two measures to reduce weight.
- Patient will select appropriate food choices to support weight loss.
Assessment:
1. Assess weight, waist circumference, and body mass index (BMI).
BMI >25 and waist circumference >40 in men or >35 in women are associated with obesity-related complications and increased morbidity and mortality.
2. Perform a nutritional assessment that includes:
- Daily food intake-type and amount of food
- Approximate caloric intake
- Activity and feelings at the time of eating
- Snacking patterns
- Social/familial/cultural considerations
3. Environmental factors contribute to obesity more than genetics.
A thorough nutritional assessment provides baseline data to identify causes and create effective interventions.
4. Assess the patient’s desire or motivation to lose weight.
Weight loss should not be pushed onto a patient not ready to receive information. Ask if the patient is interested in discussing or receiving education.
Interventions:
1. Instruct the patient to keep a daily food log.
The patient is likely unaware of the amount of food consumed and should begin by logging all food and beverages consumed to obtain a baseline of calories, fat, sodium, and sugar.
2. Instruct on avoiding distractions while eating.
Distractions such as watching tv, scrolling on social media, and eating while working, can result in eating too quickly and overconsumption.
3. Help the patient create realistic goals.
The nurse can assist the patient in choosing realistic goals. Losing weight is challenging, and not reaching goals can cause the patient to lose motivation.
4. Avoid fast food and restaurant meals.
High-fat, high-sodium foods are common in fast food items and restaurant meals. Patients who consume fast foods are two times more likely to develop insulin resistance.
Sedentary Lifestyle
Along with the overconsumption of food, a lack of exercise is a major contributor to obesity.
Nursing Diagnosis: Sedentary Lifestyle
Related to:
- Lack of interest or motivation to exercise
- Lack of access to a gym, equipment, or a safe area to exercise
- Lack of knowledge regarding proper exercise training
- Poor self-esteem prohibiting participation in physical activity
As evidenced by:
- Verbalizes a lack of interest or knowledge to start
- Physical deconditioning
- Dyspnea with minimal exertion
- Chooses low-intensity activities
Expected outcomes:
- Patient will identify internal and external barriers to exercise and how to overcome them.
- Patient will begin with physical activity twice per week and build up to meet goals.
- Patient will participate in activities they enjoy and remain committed to.
Assessment:
1. Assess physical barriers to movement.
Obesity often worsens or results from chronic conditions such as arthritis, chronic pain, and asthma which prevent activity. Assess for interventions to work around and ultimately improve these conditions.
2. Assess the patient’s perception of exercise.
Assess if the patient feels they need to exercise and if they have an interest in doing so. Changing habits is very difficult and will be futile if the patient is not motivated.
3. Assess the patient’s current activity level.
Determine if the patient participates in any physical activity to formulate a baseline. The nurse can assist in creating a safe exercise plan that incorporates activities or sports that the patient can physically participate in and will also keep them engaged.
Interventions:
1. Instruct on several types of fitness.
In order to keep the patient engaged and to promote the maximum benefits, the patient should participate in several types of fitness. Stretching, mobility practice, cardiovascular endurance, and weight training provide varied activities and complete body conditioning.
2. Keep a journal of activity and progress.
In an attempt to prevent stagnation or quitting, have the patient keep track of their progress. Visual evidence of weight loss, increasing time spent exercising, and improvements in mood provide encouragement to remain committed to goals.
3. Try a class or use a workout buddy.
Exercising with others is a huge motivator and will give the patient a reason to show up. Working out with a friend often helps with accountability and discipline.
4. Recommend personal training.
A personal trainer may be necessary to assist the patient with safe exercise and to instruct on proper form with movement. They can also encourage and motivate the patient. For older patients or those with physical limitations, physical therapy may be a better setting for instruction and education.
Risk for Metabolic Imbalance Syndrome
The patient is at increased risk of experiencing severe life-threatening diseases such as diabetes, stroke, and heart disease due to excessive buildup of adipose tissue and disruption in metabolism.
Nursing Diagnosis: Risk for Metabolic Imbalance Syndrome
Related to:
- Elevated blood glucose levels
- Low levels of HDL cholesterol (<40 mg/dL in men, <50 mg/dL in women) High levels of triglycerides (>150 mg/dL)
- Obesity
- Hypertension
- Insulin resistance/diabetes mellitus
- Sedentary lifestyle
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.
Expected outcomes:
- Patient will not experience metabolic syndrome as evidenced by the following:
- Patient will display a normal fasting glucose level of <100 mg/dL The patient will maintain blood pressure <130/80 mmHg
- Patient will demonstrate normal lipid profile results:
- HDL cholesterol: >40 mg/dL in men, >50 mg/dL in women
- Triglycerides: <150 mg/dL
- Patient will maintain a waist circumference <40 inches in men, <35 inches in women.
Assessment:
1. Monitor blood pressure.
Persistent hypertension and obesity place the patient at higher risk for metabolic disorders.
2. Monitor weight.
Excessive weight gain is a significant risk factor for metabolic disorders like insulin resistance and subsequent diabetes mellitus. Monitor the patient’s weight based on their age, height, and sex.
3. Monitor laboratory results.
Metabolic syndrome is confirmed through laboratory findings such as lipid profile and fasting blood glucose. Early identification leads to prompt treatment and prevention of life-threatening complications.
Interventions:
1. Instruct on diet considerations.
- Incorporate whole grains, fruits, vegetables, fish, skinless poultry, lean meats, nuts, and low-fat or fat-free dairy products.
- Limit processed foods, saturated and trans fats, red meat, sodium, and added sugars.
2. Instruct on exercise guidelines.
Lifestyle changes are the core of preventing the development of metabolic imbalances:
- Participate in at least 150 minutes of vigorous-intensity physical activity or 300 minutes of moderate-intensity physical activity.
- Add in strength training to reduce c-reactive protein levels and cardiovascular risk.
3. Screen for obesity in childhood.
Overweight or obese children have a higher risk of metabolic syndrome in adulthood.
4. Educate on necessary screenings.
Blood pressure should be assessed at all healthcare interactions. Screening for cholesterol can begin as early as age two if cardiovascular risks exist. Screening should occur every five years and then increase after age 35 for men and 45 for women.
References
- Ackley, B.J., Ladwig, G.B.,& Makic, M.B.F. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). Elsevier.
- American Heart Association. (2021). Prevention and treatment of metabolic syndrome. https://www.heart.org/en/health-topics/metabolic-syndrome/prevention-and-treatment-of-metabolic-syndrome
- American Heart Association. (2021). What is metabolic syndrome? https://www.heart.org/en/health-topics/metabolic-syndrome/about-metabolic-syndrome
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