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Nursing Care Plans: Nursing Diagnosis and Intervention, 5/e
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Nutrition, Altered: More than Body Requirements - Obesity; Overweight
Audrey Klopp, RN, PhD, ET, CS, NHA

NANDA: The state in which an individual is experiencing an intake of nutrients, which exceeds metabolic demands

Obesity is present when body weight is 10% to 20% greater than normal for height or frame. Obesity is a common problem in the United States and accounts for significant other health problems including cardiovascular disease, insulin dependent diabetes, sleep disorders, infertility in women, aggravated musculoskeletal problems, and shortened life expectancy. Women are more likely to be overweight than men. African Americans and Hispanic individuals are more likely to be overweight than Caucasians. Factors that affect weight gain include genetics, sedentary lifestyle, emotional factors associated with dysfunctional eating, disease states such as diabetes mellitus and Cushing's syndrome, and cultural or ethnic influences on eating. Overall nutritional requirements of the elderly are similar to younger individuals, except calories should be reduced because of their leaner body mass.

Related Factors

Defining Characteristics

Expected Outcomes

Ongoing Assessment

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Document weight; do not estimate.
Patients may be unaware of their actual weight.
(i) Determine body fat composition of skinfold measurements.
Skin calipers can be used to estimate amount of fat.
(i) Perform a nutritional assessment.
This should include types and amount of foods eaten, how food is prepared, the pattern of intake (time of day, frequency, other activities patient is engaged in while eating).
(i) Explore the importance and meaning of food with the patient.
When food is used as a coping mechanism or as a self-reward, the emotional needs being met by intake of food will need to be addressed as part of the overall plan for weight reduction. In most cultures, eating is a social activity.
(i) Assess knowledge regarding nutritional needs for height and level of activity or other factors (e.g., pregnancy).
(i) Assess ability to read food labels.
Food labels contain information necessary in making appropriate selections, but can be misleading. Patients need to understand that "low-fat" or "fat-free" does not mean that a food item is calorie-free.
(i) Assess ability to plan a menu, making appropriate food selections.
Cultural or ethnic influences need to be identified and addressed.
(i) Assess ability to accurately identify appropriate food portions.
Serving sizes must be understood to limit intake according to a planned diet.
(i) Assess effects or complications of being overweight.
Medical complications include cardiovascular and respiratory dysfunction, higher incidence of diabetes mellitus, and aggravation of musculoskeletal disorders. Social complications and poor self-esteem may also result from obesity.
(i) Assess usual level of activity.
Patients may confuse routine activity with exercise necessary to enhance and maintain weight loss.

Therapeutic Interventions

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(c) Consult dietitian for further assessment and recommendations regarding a weight loss program.
Changes in eating patterns are required for weight loss. The type of program may vary: three balanced meals a day, avoidance of certain high-fat foods, and others. Dietitians have a greater understanding of the nutritional value of foods and may be helpful in assessing or substituting specific high-fat cultural or ethnic foods.
(i) Establish appropriate short- and long-range goals.
One pound of adipose tissue contains 3500 calories. Therefore to lose 1 lb per week, the patient must have a calorie deficit of 500 calories a day.
(i) Encourage calorie intake appropriate for body type and lifestyle.
Diet change is a complicated process that involves changing patterns that have been firmly established by culture, family, and personal factors.
(i) Encourage patient to keep a daily log of food or liquid ingestion and caloric intake.
Memory is inadequate for quantification of intake, and a visual record may also help patient to make more appropriate food choices and serving sizes.
(i) Encourage water intake.
Water assists in the excretion of byproducts of fat breakdown and helps prevent ketosis.
(i) Encourage patient to be more aware of nutritional habits that may contribute to or prevent overeating:
(i) Encourage exercise.
Exercise is an integral part of weight reduction programs. The combination of diet and exercise promotes loss of adipose tissue rather than lean tissue.
(i) Provide positive reinforcement as indicated. Encourage successes; assist patient to cope with setbacks.
(i) Incorporate behavior modification strategies.
Education as the sole intervention is unlikely to achieve and maintain weight loss. Multifactorial programs that include behavioral interventions and counseling are more successful than education alone.

Education/Continuity of Care

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Review and reinforce teaching regarding the following:
(i) Include family, caregiver, or food preparer in the nutrition counseling.
Success rates are higher when the family incorporates a healthy eating plan.
(c) Inform patient about pharmacologic agents such as appetite suppressants that can aid in weight loss.
These drugs act by chemically altering the patient's desire to eat.
(i) Encourage diabetic patients to attend diabetic classes. Review and reinforce principles of dietary management of diabetes.
Obesity and diabetes are risk factors for coronary artery disease.
(i) Review complications associated with obesity.
(c) Refer patient to commercial weight-loss program as appropriate.
Some individuals require the regimented approach or ongoing support during weight loss, whereas others are able (and may prefer) to manage a weight-loss program independently.
(i) Remind patient that significant weight loss requires a long period.
(c) Refer to community support groups as indicated.

NIC

Nutritional Monitoring; Nutrition Counseling; Weight Reduction Assistance

See also:
Health Seeking Behaviors, Chapter 3, p. 107
Obesity, Chapter 7, p. 728

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