4 Obesity Nursing Care Plans

February 28, 2014

Obesity is a complex disorder involving an excess accumulation of body fat at least 20% over average desired weight for age, sex, and height or a body mass index of greater than 27.8 for men and greater than 27.3 for women. Obesity isn’t just a cosmetic concern. It increases your risk of diseases and health problems such as heart disease, diabetes, and high blood pressure.

It is different from being overweight, which means weighing too much. The weight may come from muscle, bone, fat, and/or body water. Both terms mean that a person’s weight is greater than what’s considered healthy for his or her height.

Obesity occurs over time when you eat more calories than you use. The balance between calories-in and calories-out differs for each person. Factors that might affect your weight include your genetic makeup, overeating, eating high-fat foods, and not being physically active.

Nursing Care Plans

Nursing care management for patients with obesity includes identification of inappropriate behaviors that cause obesity, preparing a diet plan, determining nutritional knowledge, and providing information.

Here are four (4) nursing care plans (NCP) and nursing diagnosis for obesity:

Imbalanced Nutrition: More Than Body Requirements

Imbalanced Nutrition: More Than Body Requirements: Intake of nutrients that exceeds metabolic needs.

May be related to

Food intake that exceeds body needs
Psychosocial factors
Socioeconomic status

Possibly evidenced by

Weight of 20% or more over optimum body weight; excess body fat by skinfold/other measurements
Reported/observed dysfunctional eating patterns, intake more than body requirements

Desired Outcomes

Client will identify inappropriate behaviors and consequences associated with overeating or weight gain.
Client will demonstrate a change in eating patterns and involvement in individual exercise program.
Client will display weight loss with optimal maintenance of health.

Nursing Interventions	Rationale
Review individual cause for obesity (organic or nonorganic).	Identifies and influences choice of some interventions.
Carry out and review daily food diary (caloric intake, types and amounts of food, eating habits).	Provides the opportunity for the individual to focus on a realistic picture of the amount of food ingested and corresponding eating habits and feelings. Identifies patterns requiring change or a base on which to tailor the dietary program.
Explore and discuss emotions and events associated with eating.	Helps identify when patient is eating to satisfy an emotional need, rather than physiological hunger.
Formulate an eating plan with the patient, using knowledge of individual’s height, body build, age, gender, and individual patterns of eating, energy, and nutrient requirements. Determine which diets and strategies have been used, results, individual frustrations and factors interfering with success.	Although there is no basis for recommending one diet over another, a good reducing diet should contain foods from all basic food groups with a focus on low-fat intake and adequate protein intake to prevent loss of lean muscle mass. It is helpful to keep the plan as similar to patient’s usual eating pattern as possible. A plan developed with and agreed to by the patient is more likely to be successful.
Emphasize the importance of avoiding fad diets.	Elimination of needed components can lead to metabolic imbalances like excessive reduction of carbohydrates can lead to fatigue, headache, instability and weakness, and metabolic acidosis (ketosis), interfering with effectiveness of weight loss program.
Discuss need to give self permission to include desired or craved food items in dietary plan.	Denying self by excluding desired or favorite foods results in a sense of deprivation and feelings of guilt and failure when individual “succumbs to temptation.” These feelings can sabotage weight loss.
Be alert to binge eating and develop strategies for dealing with these episodes (substituting other actions for eating).	The patient who binges experiences guilt about it, which is also counterproductive because negative feelings may sabotage further weight loss efforts.
Identify realistic increment goals for weekly weight loss.	Reasonable weight loss (1–2 lb per wk) results in more lasting effects. Excessive and rapid loss may result in fatigue and irritability and ultimately lead to failure in meeting goals for weight loss. Motivation is more easily sustained by meeting “stair-step” goals.
Weigh periodically as individually indicated, and obtain appropriate body measurements.	Provides information about effectiveness of therapeutic regimen and visual evidence of success of patient’s efforts. (During hospitalization for controlled fasting, daily weighing may be required. Weekly weighing is more appropriate after discharge.)
Determine current activity levels and plan progressive exercise program (walking) tailored to the individual’s goals and choice.	Exercise furthers weight loss by reducing appetite; increasing energy; toning muscles; and enhancing cardiac fitness, sense of well-being, and accomplishment. Commitment on the part of the patient enables the setting of more realistic goals and adherence to the plan.
Develop an appetite reeducation plan with patient.	Signals of hunger and fullness often are not recognized, have become distorted, or are ignored.
Emphasize the importance of avoiding tension at mealtimes and not eating too quickly.	Reducing tension provides a more relaxed eating atmosphere and encourages more leisurely eating patterns. This is important because a period of time is required for the appestat mechanism to know the stomach is full.
Encourage patient to eat only at a table or designated eating place and to avoid standing while eating.	Techniques that modify behavior may be helpful in avoiding diet failure.
Discuss restriction of salt intake and diuretic drugs if used.	Water retention may be a problem because of increased fluid intake and fat metabolism.
Reassess calorie requirements every 2–4 wk; provide additional support when plateaus occur.	Changes in weight and exercise necessitate changes in plan. As weight is lost, changes in metabolism occur, resulting in plateaus when weight remains stable for periods of time. This can create distrust and lead to accusations of “cheating” on caloric intake, which are not helpful. Patient may need additional support at this time.
Consult with dietitian to determine caloric and nutrient requirements for individuals weight loss.	Individual intake can be calculated by several different formulas, but weight reduction is based on the basal caloric requirement for 24 hr, depending on patient’s sex, age, current and desired weight, and length of time estimated to achieve desired weight. Note: Standard tables are subject to error when applied to individual situations, and circadian rhythms and lifestyle patterns need to be considered.
Provide medications as indicated:
Appetite-suppressant drugs like diethylpropion (Tenuate), mazindol (Sanorex), Sibutramine (Meridia)	May be used with caution and supervision at the beginning of a weight loss program to support patient during stress of behavioral and lifestyle changes. They are only effective for a few weeks and may cause problems of addition in some people.
Hormonal therapy like thyroid (Euthyroid), levothyroxine (Synthroid)	May be necessary when hypothyroidism is present. When no deficiency is present, replacement therapy is not helpful and may actually be harmful. Note: Other hormonal treatments, such as human chorionic gonadotropin (HCG), although widely publicized, have no documented evidence of value.
Orlistat (Xenical)	Lipase inhibitor blocks absorption of approximately 30% of dietary fat. Facilitates weight loss and maintenance when used in conjunction with a reduced-calorie diet. Also reduces risk of regain after weight loss.
Vitamin, mineral supplements	Obese individuals have large fuel reserves but are often deficient in vitamins and minerals. Note: Use of Xenical inhibits absorption of water-soluble vitamins and beta-carotene. Vitamin supplement should be given at least 2 hr before or after Xenical.
Hospitalize for fasting regimen and stabilization of medical problems, when indicated.	Aggressive therapy and support may be necessary to initiate weight loss, although fasting is not generally a treatment of choice. Patient can be monitored more effectively in a controlled setting, to minimize complications such as postural hypotension, anemia, cardiac irregularities, and decreased uric acid excretion with hyperuricemia.
Prepare for surgical interventions (gastric partitioning or bypass) as indicated.	These interventions may be necessary to help the patient lose weight when obesity is life-threatening.