Introduction
Today’s world is fast paced, demands more time for work, which leaves less time to follow the natural cycle of eating and drinking. It has led to consumption of quick bite items or “Junk food” that is tasty, sweet and fat, but low in balanced nutrition. As a result, the excess fat gets accumulated into various parts of the body. The chronic consumption of imbalanced nutrition causes “Obesity”. In 2011, approximately 20% of adults in the US suffer from obesity and are at risk for derived diseases such as type 2 diabetes, hypertension, inflammation, cardiovascular diseases and cancer. There are diverse reasons, which affect the normal health of an individual and tend towards overweight and obese; lifestyle being one of them. In big cities, there is a space crunch and therefore there is less room to go around for an active exercise routine. Additionally, long working hours and professional stress leaves almost no time to exercise. In today’s business world, due to the heavy commercials, visual appeal and availability of fast-moving-consumer-goods (FMCG); fast food has become the obvious choice for most city dwellers. All these factors add-up towards more energy intake and less energy output, resulting in obesity (“CDC Overweight and obesity” n.d.).
Causes of obesity
Apart from the sedentary lifestyle, genes also take part in obesity development in human beings. There is evidence that certain genes can be responsible for a person to put on weight and become obese if his/her family members, especially mother or father is obese. Certain diseases are also responsible to predispose a person to obesity. People suffering from hypothyroidism – where the body does not make enough thyroid hormone, are often obese. This happens because thyroid hormones regulate our metabolism and in low levels, they slow it down. As a result, fat accumulates leading to obesity. Cushing’s syndrome – where the adrenal glands over-produces the hormone cortisol, and polycystic ovary syndrome (PCOS) – where the ovary develops multiple cysts and there is difficulty in periods, are also conditions were a person becomes obese. The reasons behind PCOS are not well understood, but there is evidence of overproduction of hormone androgen.
Sedentary lifestyle with high-calorie food, these coupled with smoking and alcohol consumption, significantly affects a person’s metabolic cycle, throwing it out of balance and leading to obesity. Probably, the most important reason for overconsumption of calorie-rich food is day-to-day stress, and evidence suggests that there is a positive relation between emotion-induced depression and reward-giving calorie-rich food. Personal and professional stress may lead to emotional imbalance, often resulting in sleep deprivation. When a person does not get enough sleep, the level of incretin hormones change – hunger-inducing ghrelin increases and satiety-inducing leptin decreases, thereby, driving a person to overeat and become obese (What are overweight and obesity? n.d.).
Effects of obesity
Being obese has many serious effects on the individual. The immediate effect of obesity is a pronounced increase in mental depression and anxiety. Due to the weight, obese people cannot match the physical level of energy and stamina, which their normal healthy colleagues have. There is a social stigma for obesity and obese people usually have low social circle, reduced support, low self-esteem, and heightened patterns of negative thoughts. In the long run, physically, the risk that obesity posse encompasses diseases ranging from bone disorders to heart failure and even cancer. The extra weight puts undue pressure on the joints of knees, lower back and even hips. This increases its wear and tear and can lead to Osteoarthritis, a very common inflammatory joint disease. Excess fat deposition, especially around the neck region, can put pressure on the trachea and lead to frequent pauses while breathing or shallow breathing. Sleep apnea has serious consequences as it makes the person tired quickly and puts stress on the lungs and heart.
The effects of obesity differ in every patient mentally and physically. Therefore, the treatment plan should be patient and family specific, and must consider all the factors, which made the individual obese, and how does he feel about it (4 obesity and nursing care plans 2014).
Gorge Mascaranus is referred to the clinic with breathing problems and fatigue after exercise. He is 56 years old, 5’ 9”, and weighs 223 pounds (101.2 kilograms). Gorge lives with his wife and two children – 20 and 17 years of age. He loves food, especially dishes with red meat and potatoes. He works for a software company as a senior manager which involves spending long hours on the work desk and meetings. Blood chemistry reports revealed that he has triglyceride levels of 210 mg/dL (normal values <200 mg/dL), LDL cholesterol of 155 mg/dL (normal value <130 mg/dL), and HDL cholesterol of 50 mg/dL (normal value >45 mg/dL). His calculated BMI is 32.9, blood pressure is 135/87 and his fasting blood glucose is 116.4 mg/dL (normal range 80-120 mg/dL).
His diet includes oatmeal with coffee in breakfast, a large cheese burger with bacon, chips, and soda during lunch, double egg omelet with garlic bread and coffee as afternoon snack, a glass of beer with cheese biscuits before dinner followed by meat, cooked vegetables in gravy and potatoes. He walks about one kilometer twice a week.
Learning needs
Gorge has a settled carrier, loves to live in leisure and does not like too much exercising. He lives in a metro city and his favorite pass time on weekends is watching television shows and trying out different restaurants for their specialties. He has a causal approach towards health. All these factors make him an ideal target for gaining weight. Since he is well educated and has support from the family, an eight point learning plan is built:
- Review of the causes of obesity: Mr. Gorge should be made aware that the reasons for his obesity are eating habits and non-exertion so that it could be corrected.
- Maintain a daily diary, which measures type, amount, and calories in the food: the diary will give him an idea of the amount of food consumed and the feeling attached with it.
- Make a formula of eating with respect to height, age and gender: this is required to maintain a balanced diet ensuring all nutrients are included in the diet, at the same time it should be low in salt and fat.
- Importance of avoiding fatty food with respect to weight gain: It is important to explain that the fat in the food is responsible for the high triglyceride and cholesterol levels.
- Importance of setting realistic goals for weight loss: rapid loss in weight results in mental frustration and loss of essential nutrients and salts and can actually back-fire, leading to binge eating. Significance of a steady loss of weight should be imbibed.
- Significance of checking weight and other parameters regularly as indicated with consultation: this is the most important step as regular checking will give a visual picture of success and effectiveness of treatment. Active participation in consulting with dietitian will help shape and re-design the health plan for better and lasting results
- Consequences of excess salt intake on blood pressure: it is pivotal to explain to Mr. Gorge that there is a positive correlation between salt intake and increase in blood pressure, so that he implements it seriously.
As Mr. Gorge is well educated, has access to technology, and knows computer, an audio-visual style of learning is most appropriate for him. He is encouraged to watch health shows and yoga practices on the television, search the web for presentations, audio lectures on obesity, heart diseases and healthy food. His family is also encouraged not to eat or prepare dishes containing lot of fat or salt when he is around, to give him tips on healthy food and if possible, accompany him during walks.
Expected outcome
- Weight loss of at-least one-two pounds per week until it comes <170 pounds
- Take a walk for at-least 30 minutes in the morning and evening, five day a week
- A positive attitude towards lifestyle modification by a shift towards healthy diet
- Mental support and care given by family and friends during the transition
- Maintaining a diary with everyday diet chart, weight chart and BMI
- Monitoring blood glucose and blood pressure at-least once a week
The effectiveness of the teaching plan can be seen by observing Mr. Gorge physical attributes like body shape, skin tone, waist size and weight. Also, observing the detailed inputs in his diary about the amount of type of food he is following, the BMI, and other parameters recorded can speak of the attitude and effectiveness of the teaching regimen. Three weeks post-plan, revealed that he has lost 2.5 pounds, he enjoys regular walks for at-least 45 minutes five days-a-week, has cut down on fatty and salty food by more than 50 percent. He plans short trips with this family at weekends to keep active. The diary recorded his fasting blood glucose to be 104.8 mg/dL at the end of week three and blood pressure of 127/80. He is also planning to go for treks in the near future with family and friends.
References
Barbara, E., McNeill. (n.d.). You "Teach" BUT Does Your Patient REALLY Learn? Basic Principles to Promote Safer Outcomes. Retrieved from http://www.ncnurses.org/dotAsset/111664.pdf
National Institute of Health (n.d.). What are Overweight and Obesity? Retrieved from http://www.nhlbi.nih.gov/health/health-topics/topics/obe/
Overweight and obesity. Centers for Disease Control and Prevention (n.d.). Retrieved from www.cdc.gov/nccdphp/dnpa/obesity
4 Obesity Nursing Care Plans. (2014, Feb 28) Retrieved from http://nurseslabs.com/4-obesity- nursing-care-plans/
