Professional Nurse and Adult Obesity
Obesity is considered to be a rapidly growing problem, significant societal trend and one of the leading causes of death in the United States. Current paper addresses the topic of adult obesity and the important role the professional nurse plays in supporting obese adults. The first part of the paper discusses health problems of obese adults and examines psychological, social and physical causative factors and consequences of adult obesity. The second part is devoted to the development of a teaching plan to support the needs of an obese person. Firstly, the paper addresses the professional nurse’s assessment of the patient’s learning needs and identification of possible barriers to effective learning. Secondly, expected learning outcomes will be identified and realistic timeframes will be established. Thirdly, the nurse will explore the content of teaching that is relevant to the patient’s age, gender, cultural values, religious preferences and learning style. Lastly, professional nurse will evaluate the effectiveness of the teaching of a specific obese person. Investigation of the topic of adult obesity is important for providing rationale for creating a teaching plan that the professional nurse can employ to treat obesity.
Obesity among Adults
The adult obesity is not merely a condition, but a metabolic disease that is characterized by accumulation of fat to the point where it impairs a person’s health status. In order to identify whether an individual is obese, a body mass index (BMI) is evaluated. Patients that are considered obese have BMI that exceeds 30 kg/m2. According to statistics of the Center for Disease Control and Prevention (2014), more than one third of adults in the US (34,9%) suffer from obesity, while nearly another one third (31%) is overweight. Such data indicates that overweight and obesity are widespread problems that negatively impact health of the US population nationwide. Obesity accounts for 30% higher mortality rates, shorter lifespan and many associated disorders and diseases, such as asthma, cancers, chronic back pain, diabetes (type 2), hypertension, heart failure, osteoarthritis and others (An, 2014). Often, obese patients suffer from depression, impaired body image, low self-esteem and diminished quality of life. Hinkle and Cheever (2013) argue that obese adults are frequently viewed by others as lazy, lacking self-control and overindulgent. Furthermore, authors state some healthcare providers, including nurses, tend to view obese patients negatively.
Obesity affects some groups more than others. For example, non-Hispanic Asians have the lowest adult obesity rate (10,8%); non-Hispanic whites’ obesity rate is 32,6%, while non-Hispanic blacks have the highest obesity rate of 47,8%. While higher-income men are more likely to suffer from obesity than low-income men, higher-income women account for lower obesity rates than low-income ones. Interestingly, women with a college degree are less prone to obesity than less educated women (CDC, 2014). However, the obesity is becoming more prevalent in the US across all educational levels and incomes. The majority of obesity instances are the result of energy imbalance when consumption of excess calories occurs together with insufficient physical activity (An, 2014). Although lack of physical activity and poor eating habits are recognized as primary causes of obesity, the combination of socioeconomic, cultural, metabolic, genetic and environmental factors may lead to weight gain, as well.
Causative Factors that Lead to Adult Obesity
Physical factors. Physical factors that lead to obesity include unhealthy diet (poor eating habits), lack of physical activity (sedentary life style), quitting smoking, lack of sleep, medical problems and difficulties in loosing weight after giving birth (National Heart, Lung, and Blood Institute, 2012). Poor eating habits imply that a person consumes foods that are rich in calories and lacks vegetables and fruits. Also, the patient may be in the habit to consume in excess fast food and oversize portions, miss breakfasts and drink high-calorie beverages. The lack of physical activity leads to burning fewer calories than a person takes in, while the lack of sleep may increase appetite and trigger craving for foods rich in calories (CDC, 2014). Smoking cessation can lead to increasing appetite and weight gain. Factors related to physical behaviors and habits are the greatest areas for treatment actions and prevention (CDC, 2014). Therefore, professional nurse should focus on them for the effective treatment of obesity. The medical problem, such as arthritis, may limit a person’s physical activity and contribute to weight gain. Also, medications, such as antidepressants, beta-blockers and steroids can lead to weight gain. Lastly, some women find it hard to lose weight after the baby was born and have higher risk of becoming overweight and obese.
Social factors. Social factors are elements of a social environment that do not support healthy lifestyle, but encourage obesity. Such factors are lack of safe places for recreation and physical activity, busy work schedules, advertisements of unhealthy foods, lack of access to health foods, family life patterns, income and educational level (National Heart, Lung, and Blood Institute, 2012). For example, family members and acquaintances tend to have similar lifestyle and eating habits. Therefore, a person who has obese family members or friends has greater chances of becoming obese by adopting habits of parents, spouse or a friend. Living in an area with limited opportunities to engage in physical activities may contribute to obesity via restricting a person’s access to sports and recreation facilities. Lastly, low income (person’s ability to buy healthy foods or go to the gym) and lack of education (knowledge of healthy dieting and benefits of physical exercise) contribute to obesity, as well.
Psychological factors. Psychological factors that lead to obesity have emotional basis. Stressed, depressed, bored and angry people tend to eat more. For example, Schneider, Baldwin, Mann and Schmitz (2012) argue that the depression is positively associated with obesity. Over the prolonged period of time, overeating leads to weight gain and may be the reason of obesity.
Consequences of Obesity
Obese patients may have to cope with a wide range of physical, social, economic and psychological consequences of obesity.
Physical effects. As the person’s body weight increases to reach the level of obesity (BMI > 30 kg/m2), risks of negative health conditions increase significantly. Such conditions include coronary heart disease, some types of cancers, type 2 diabetes, high blood pressure (hypertension), gallbladder and liver diseases, stroke, gynecological problems (infertility, irregular periods), erectile dysfunctions, osteoarthritis, respiratory problems, poor wound healing and others. Additionally, a patient may be at a higher risk of or suffer from metabolic syndrome, abnormal blood fats, sleep apnea and others.
Social consequences. Adult obesity has far reaching social consequences. The quality of life of obese individuals may be significantly lower than that of people with healthy weight, since obese persons experience difficulties participating in enjoyable activities. At times, obese people suffer from social isolation, stigmatization and avoid public places to prevent discrimination. Since productivity and work achievement of obese people are lower, they are frequently subject to hiring prejudices or paid lower wages. Also, since work achievement of obese persons may be frequently impaired due to excessive weight, they experience longer time spans away from their jobs. Aforementioned factors impact their work, family and social life negatively.
Economic consequences. Obesity strains economic resources, burdens healthcare system and reduces incomes of obese people. Economic costs of obesity may be direct and indirect. Direct costs include drug therapy, laboratory tests, and inpatient/outpatient health services. Obesity-related illnesses are linked to indirect costs associated with lower wages, higher employer insurance premiums, costs of lost working days and subsequent lower incomes. Obese employees miss more days away from work due to obesity-related illnesses. Productivity and economy of countries with higher obesity rates suffer, as well. Additionally, high obesity rates lead to the significant increase in obesity-related national healthcare expenses.
Psychological consequences of obesity. One of the most painful aspects of obesity may be emotional sufferings of an ill person. Commercials and movie industry emphasize physical appearance and frequently associate attractiveness with slimness, in particular for females. Consequently, many overweight people become overly self-conscious and vulnerable to psychological traumas, since they commonly experience impaired body image, low self-esteem and feelings of rejection, anxiety, guilt and shame. Overweight people are often falsely perceived as lazy and subject to discrimination in different social situations. Thus, some turn to substance abuse or alcohol to reduce psychological discomfort. Schneider et al. (2012) claim that there is an association between mood and weight, and that obese people are more likely to suffer from depression than people with healthy weight. Notably, obesity increases risk of depression and depression increases risk of obesity (Schneider et al., 2012). Therefore, obesity affects psychological well-being negatively and significantly.
Long-term and short-term consequences. The majority of discussed effects of obesity tend to be long-term. For example, physical effects will last for as long as the person remains obese as it takes much time to overcome the problem and return to healthy weight. However, some accompanying diseases of obesity may be coped with long after the normal weight was regained. Also, considering that obesity is a significant societal trend, economic effects promise to be long-term, as well. Social consequences are how society views and treats obese people. Since societal attitudes are not easily changed, social consequences are going to be long-term, as well (Bacon & Aphramor, 2011). Lastly, psychological effects may be both long- and short-term depending on how successfully an obese person can cope with them and availability of support to deal with discomfort, depression or possible trauma.
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Current teaching plan will address the needs of an obese person. Such person is the Afro-American 47-year-old male, George Daniels. He is married middle class adult male who holds a white collar job and reports being obese for the last four years. George started gaining weight about eight years ago when he received a new job. He works as chemical engineer at a manufacturing plant and frequently has night shifts. Thus, he feels that he does not get sufficient sleep on a regular basis. His income is higher than state’s average by 40 percent. He tries to eat healthy foods and does not smoke but does not like sports or physical activities.
Assessment of a Patient’s Learning Needs
Assessment of learning needs. In order to access the patient’s learning needs, professional nurse should evaluate the patient’s family dynamics, physical environment of the place where patient resides and where the teaching is going to take place, the patient’s literacy level, preferred learning style, physical disabilities, financial issues and emotional state. McNeill (2012) draws attention to the importance of accessing patient’s learning style as a part of assessing his learning needs. The assessment of the patient’s learning style requires determining learning style preference of a patient and whether he is a visual learner, auditory learner or kinesthetic/tactile learner. Another critical issue that professional nurse should consider is the level of George’s health literacy. During the assessment of health literacy, the nurse examines his ability to comprehend and act according to basic health information, make health-related decisions and follow instructions for administered medications and recommended treatment (Taylor, Lilis, LeMone & Lynn, 2011). Lastly, McNeill (2012) emphasized the importance of finding out what the patient would like to learn first and honoring the patient as a partner in education process, since attention to the patient’s learning preferences will make teaching and learning easier and more productive.
Assessment of George’s learning needs indicates that a professional nurse should focus on few issues simultaneously. Firstly, the patient should be taught the benefits of regular and moderate physical activities. Secondly, the patient should be taught about how lack of sleep contributes to weight gain. Thirdly, professional nurse should inquire whether George’s wife can assist him in losing weight. Lastly, nurse should determine George’s preferred learning style and health literacy level and examine his ability to understand and apply basic health information, make sound health-related decisions and follow recommendations and medication regimen.
Barriers to learning. Professional nurse should identify barriers that can make the patient’s learning ineffective. McNeill (2012) draws attention of nurses to how to indentify and overcome specific barriers. For example, incomplete or inaccurately completed registration forms may signal that the patient faces barrier to learning as a result of poor visual learning (reading) abilities or does not take written materials seriously enough. Also, if a patient misses appointments frequently, fails to comply with medication regimen and follow through with referrals to consultants or laboratory tests or refuses to take medication, he faces barrier of lack of self-discipline and may need supervision of a family member to assist him in learning. Furthermore, another barrier may be patient’s unwillingness to familiarize himself with written information. Such unwillingness and tendency to procrastinate indicate that the patient needs help to read, learn and implement the plan. Lastly, the nurse should access the patient’s ability to name medications, explain what they are for and timing of medication administration, since inability to do so presents a barrier to learning, as well.
In George’s case, some obvious barriers to learning and application of recommendations are his reluctance to engage in physical activity, demanding job responsibilities that leave little time for physical activity, insufficient sleep and lack of self-discipline. Therefore, nurse should encourage George’s wife to assist him in making needed lifestyle modifications.
Expected Outcomes and Realistic Time Frames
Professional nurse should not aim at too many learning outcomes, since it might be unrealistic and disorientating for the patient. Tailor et al. (2011) compare unrealistic planning with planning for failure. Following are the expected outcomes of patient learning.
- Learning to set goals. By the end of the teaching, the patient should realize that the best way to lose weight is slow and learn to set doable and safe weight-loss goals.
- Learning to balance energy intake and output. The patient will learn to achieve lifestyle changes by adopting healthy lifestyle habits via following healthy eating plan, being physically active and getting enough sleep.
- Learning to eat healthy. Although George strives to eat healthy foods, this area of learning should not be ignored. He should learn how to reduce the calorie intake. Such outcome will include learning to choose healthy foods, recognize foods that need to be limited, regulate portion size and replace high-calories food products with low-fat ones.
- Learning to engage in physical activity. George will learn to choose type and length of physical activities that are appropriate for his weight, enjoyable and fit into his daily life. Such learning outcome might be challenging to achieve considering George’s dislike for physical activities. Therefore, professional nurse should employ education and motivating techniques and get wife’s assistance to facilitate George’s engagement in physical activities.
- Learning to make environment-related behavioral changes and lifestyle modification. The patient should learn to recognize habits that help him or her overeat and lead inactive lifestyle (Hinkle & Cheever, 2013). Also, patient’s learning will aim at keeping record of progress, seeking support, rewarding successes and finding creative practical solutions and ideas to substitute former unhealthy habits with the new healthy ones. George should learn how to practically arrange his schedule so that he could get enough sleep and do exercises.
- Learning to adhere to medicine-loss medication regimen. After teaching session, the patient will realize the importance of regimen adherence and agree to regular checkups in order to avoid side effects and derive maximum benefit from medications.
It seems that four to five weeks should be a sufficient time to achieve expected teaching outcomes and make arrangement for putting into practice lessons learned.
The Content of the Teaching
The information that the professional nurse will teach the patient should be aligned with expected learning outcomes, as well as George’s learning style, gender, age and values. Therefore, the teaching information will include the following: (a) The patient should not attempt to lose more than five-ten percent of his weight over six months, in order to lower risk for coronary heart disease and other conditions (National Heart, Lung, and Blood Institute, 2012). George should learn that losing one-two pounds on a weekly basis is doable and safe. After losing ten percent of body weight and maintaining a new weight for half of a year, the patient may want to consider further weight loss (National Heart, Lung, and Blood Institute, 2012). Such information will help the patient have realistic expectations about weight loss. (b) Also, the plan should teach about daily required amount of calories to help the patient count his calories intake and output and plan meals accordingly. (c) Furthermore, the teaching should address the development of a healthy eating plan and knowledge of the portion size, healthy foods, foods to limit or avoid and foods with saturated fats and trans fat. (d) The patient should be taught the information about benefits of moderate-intensity physical activities, such as dancing, gardening, brisk walking etc., and required length and frequency of regular physical activity. (e) Teaching should include recommendations aimed at changing behaviors that lead to weight gain (how to get enough sleep, keep records, seek support and reward successes) (National Heart, Lung, and Blood Institute, 2012). (f) Lastly, the information about weight loss-medicines should be taught to help the patient adhere to medication regimen, prevent side effects and avoid medicines that may harm his health.
Evaluating the Effectiveness of the Teaching
The effectiveness of the professional nurse’s teaching may be appraised via several techniques. Firstly, the teaching is effective if George is able to repeat in his own words what he needs to do or know, or when he can demonstrate skills that nurse is trying to teach. Secondly, the effectiveness of teaching can be evaluated via asking the patient questions and listening to his responses (McNeill, 2012). Thirdly, the effectiveness may be checked by presenting George with sample situations (real-life scenarios) and finding out if he can function safely and find teaching-based safe and independent solutions (McNeill, 2012). Three discusses techniques allow to determine whether the professional nurse’s teaching was effective.
Analysis of adult obesity shows that it is a complex and widespread health problem associated with significant physical, social, economic and psychological consequences. Since obesity may be caused by a range of physical, socioeconomic and psychological factors, professional nurse should conduct thorough assessment of the patient, his circumstances, learning needs and barriers to learning in order to develop an effective teaching plan for losing weight. In order for the teaching to be effective, professional nurse should choose appropriate teaching content, set realistic time frame and identify expected learning outcomes. Prior to implementing the plan, the nurse should evaluate the effectiveness of teaching and make changes and adjustments to facilitate patient’s progress and success in combating obesity. Finally, it is important to remember that treating obesity is a long-term process that requires patience, determination and optimism both on the part of the patient and the nurse.