Nutrition, Altered: More than Body Requirements - Obesity;
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.
- Excessive intake in relation to metabolic need
- Lack of knowledge of nutritional needs, food intake, and/or
appropriate food preparation
- Poor dietary habits
- Use of food as coping mechanism
- Metabolic disorders
- Sedentary activity level
- Weight 20% over ideal for height and frame
- Triceps skin fold greater than 15 mm in men, 25 mm in women
- Reported or observed dysfunctional eating patterns
- Eating in response to internal cues other than hunger
- Eating in response to external cues such as time of day or
- Patient verbalizes measures necessary to achieve weight
- Patient demonstrates appropriate selection of meals or menu
planning toward the goal of weight reduction.
- Patient begins an appropriate program of exercise.
- (i) independent
- (i) Document weight; do not estimate.
- Patients may be unaware of their actual weight.
- (i) Determine body fat composition of skinfold
- Skin calipers can be used to estimate amount of
- (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
- (i) Assess ability to plan a menu, making
appropriate food selections.
- Cultural or ethnic influences need to be identified and
- (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
- 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.
- (i) independent
- (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
- 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
- (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
- (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:
- To realize the time needed for eating.
- Hurried eating may result in overeating, as satiety is
not realized until 15 to 20 minutes after ingestion of food.
- To focus on eating and to avoid other diversional activities
(e.g., reading, television viewing, telephoning).
- To observe for cues that lead to eating (e.g., odor, time,
depression, and boredom).
- To eat in a designated place (i.e., at the table rather than in
front of the television).
- This controls environmental stimuli for eating and
other impulse eating.
- To recognize actual hunger versus desire to eat.
- Eating when not hungry is a commonly recognized symptom
- (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
- 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
Education/Continuity of Care
- (i) independent
- (i) Review and reinforce teaching regarding
- Four food groups or the food pyramid
- Proper serving sizes
- Caloric content of food
- Many patients are unaware of the calories present in
- Methods of preparation, such as substituting baking and
grilling for frying foods
- (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
- (i) Encourage diabetic patients to attend
diabetic classes. Review and reinforce principles of dietary management of
- Obesity and diabetes are risk factors for coronary artery
- (i) Review complications associated with
- (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
Nutritional Monitoring; Nutrition Counseling; Weight Reduction
- See also:
Seeking Behaviors, Chapter 3, p. 107
Obesity, Chapter 7, p.
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