4 Obesity Nursing Care Plans

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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: 

  1. Imbalanced Nutrition: More Than Body Requirements
  2. Disturbed Body Image
  3. Impaired Social Isolation
  4. Deficient Knowledge
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Disturbed Body Image

Disturbed Body Image: Confusion in mental picture of one’s physical self.

May be related to

  • Biophysical/psychosocial factors such as patient’s view of self (slimness is valued in this society, and mixed messages are received when thinness is stressed)
  • Family/subculture encouragement of overeating
  • Control, sex, and love issues

Possibly evidenced by

  • Verbalization of negative feelings about body (mental image often does not match physical reality)
  • Fear of rejection/reaction by others
  • Feelings of hopelessness/powerlessness
  • Preoccupation with change (attempts to lose weight)
  • Lack of follow-through with diet plan
  • Verbalization of powerlessness to change eating habits

Desired Outcomes

  • Client will verbalize a more realistic self-image.
  • Client will demonstrate some acceptance of self as is, rather than an idealized image.
  • Client will seek information and actively pursue appropriate weight loss.
  • Client will acknowledge self as an individual who has responsibility for self.
Nursing InterventionsRationale
Determine patient’s view of being fat and what it does for the individual.Mental image includes our ideal and is usually not up-to-date. Fat and compulsive eating behaviors may have deep-rooted psychological implications (compensation for lack of love and nurturing or a defense against intimacy).
Provide privacy during care activities.Individual usually is sensitive and self-conscious about body.
Promote open communication avoiding criticism and judgment about patient’s behavior.Supports patient’s own responsibility for weight loss; enhances sense of control, and promotes willingness to discuss difficulties and setbacks and problem-solve. Note: Distrust and accusations of “cheating” on caloric intake are not helpful.
Outline and clearly state responsibilities of patient and nurse.It is helpful for each individual to understand area of own responsibility in the program so that misinformation do not arise.
Graph weight on a weekly basis.Provides ongoing visual evidence of weight changes (reality orientation).
Encourage patient to use imagery to visualize self at desired weight and to practice handling of new behaviors.Mental rehearsal is very useful in helping the patient plan for and deal with anticipated change in self-image or occasions that may arise (family gatherings, special dinners) where constant decisions about eating many foods will occur.
Provide information about the use of makeup, hairstyles, and ways of dressing to maximize figure assets.Enhances feelings of self-esteem; promotes improved body image.
Encourage buying clothes instead of food treats as a reward for weight loss.Properly fitting clothes enhance the body image as small losses are made and the individual feels more positive. Waiting until the desired weight loss is reached can become discouraging.
Suggest the patient dispose of “fat clothes” as weight loss occurs.Removes the “safety valve” of having clothes available “in case” the weight is regained. Retaining fat clothes can convey the message that the weight loss will not occur and be maintained.
Have patient recall coping patterns related to food in family of origin and explore how these may affect current situation.Parents act as role models for the child. Maladaptive coping patterns (overeating) are learned within the family system and are supported through positive reinforcement. Food may be substituted by the parent for affection and love, and eating is associated with a feeling of satisfaction, becoming the primary defense.
Determine relationship history and possibility of sexual abuse.May contribute to current issues of self-esteem and patterns of coping.
Identify patient’s motivation for weight loss and assist with goal setting.The individual may harbor repressed feeling of hostility, which may be expressed inward on the self. Because of a poor self-concept the person often has difficulty with relationships. Note: When losing weight for someone else, the patient is less likely to be successful and maintain weight loss.
Be alert to myths the patient and SO may have about weight and weight loss.Beliefs about what an ideal body looks like or unconscious motivations can sabotage efforts to lose weight. Some of these include the feminine thought of “If I become thin, men will pursue me or rape me”; the masculine counterpart, “I don’t trust myself to stay in control of my sexual feelings”; as well as issues of strength, power, or the “good cook” image.
Assist patient to identify feelings that lead to compulsive eating. Encourage journaling.Awareness of emotions that lead to overeating can be the first step in behavior change (people often eat because of depression, anger, and guilt).
Develop strategies for doing something besides eating for dealing with these feelings such as talking with a friend.Replacing eating with other activities helps retrain old patterns and establish new ways to deal with feelings.
Help staff be aware of and deal with own feelings when caring for patient.Judgmental attitudes, feelings of disgust, anger, and weariness can interfere with care and be transmitted to patient, reinforcing negative self-concept and image.
Refer to community support and therapy group.Support groups can provide companionship, enhance motivation, decrease loneliness and social ostracism, and give practical solutions to common problems. Group therapy can be helpful in dealing with underlying psychological concerns.
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