NCP Obesity

OBESITY

DSM-IV

316.00 Psychological factors affecting medical condition—maladaptive health behaviors

Obesity is defined as an excess accumulation of body fat at least 20% over average weight for age, sex, and height. Although considered to be a type of eating disorder, obesity is a general medical condition coded on Axis III, with psychological factors that adversely affect the course and treatment of the medical condition, creating additional health risks for the individual.

ETIOLOGICAL THEORIES

Psychodynamics

Food is substituted by the parent for affection and love. The child harbors repressed feelings of hostility toward the parent, which may be expressed inward on the self. Because of a poor self-concept, the person has difficulty with other relationships. Eating is associated with a feeling of satisfaction and becomes the primary defense.

Biological

These disorders may arise from neuroendocrine abnormalities within the hypothalamus, which cause various chemical disturbances. Familial tendencies have been identified, but obesity is not clearly identified as being hereditary. People who are overweight have more fat cells than thin people and are known to be less active. Although overeating has long been believed to be the cause of obesity, research has not borne this out. Another popular theory has identified carbohydrates as the fattening substance. Currently, a high intake of fat in the diet is being identified as the reason for weight gain/inability to lose weight. The set-point theory proposes that people are programmed to maintain a certain level of weight to protect fat stores. Studies reveal that leptin regulates body weight by telling the body how much fat is being stored. Obese individuals often have higher leptin levels, suggesting a failure of the body to respond to leptin. This may represent a deficiency of receptor sites or inadequate amounts of glucagon-like peptide-1 (GPL-1), which may impair the leptin signaling pathway.

In recent research, genetics, metabolic changes placing some people at risk, and the way the body stores fat all play a part in the problems of obesity. Rather than a single, simple cause, obesity appears to be the result of a complex system reflecting all these factors.

Family Dynamics

Parents act as role models for the child. Maladaptive coping patterns (overeating) are learned within the family system and are supported through positive (or even negative) reinforcement. Family systems may sabotage efforts at changing any part of the system to maintain the status quo.

CLIENT ASSESSMENT DATA BASE

Activity/Rest

Fatigue, constant drowsiness

Inability/lack of desire to be active or engage in regular exercise

Increased heart rate/respirations with activity; dyspnea with exertion

Circulation

Hypertension, edema

Ego Integrity

Weight may/may not be perceived as a problem

Perception of body image as undesirable

Cultural/lifestyle factors affecting food choices; value for thinness/weight

Eating relieves unpleasant feelings (e.g., loneliness, frustration, boredom)

Reports of SO’s resistance/demands regarding weight loss (may sabotage client’s efforts)

Food/Fluid

Normal/excessive ingestion of food

History of recurrent weight loss and gain

Experimentation with numerous types of diets (yo-yo dieting) with varied/short-lived results

Weight disproportionate to height; endomorphic body type (soft/round)

Failure to adjust food intake to diminishing requirements (e.g., change in lifestyle from active to sedentary, aging)

Pain/Discomfort

Pain/discomfort on weight-bearing joints or spine

Respiration

Dyspnea with exertion

Cyanosis, respiratory distress (sleep apnea, pickwickian syndrome)

Sexuality

Menstrual disturbances, amenorrhea

Social Interactions

Family/significant other(s) may be supportive or resistant to weight loss (sabotage client’s efforts)

Teaching/Learning

Problem may be lifelong or related to life event

Family history of obesity

Concomitant health problems may include hypertension, diabetes, gallbladder and cardiovascular disease, hypothyroidism

DIAGNOSTIC STUDIES

Metabolic/Endocrine Studies: May reveal abnormalities (e.g., hypothyroidism, hypopituitarism, hypogonadism, Cushing’s syndrome [increased cortisol or glucose levels], hyperglycemia, hyperlipidemia, hyperuricemia, hyperbilirubinemia). The cause of these disorders may arise out of neuroendocrine abnormalities within the hypothalamus, which result in various chemical disturbances.

Anthropometric measurements: Measures fat-to-muscle ratio.

NURSING PRIORITIES

1. Help client identify a workable method of weight control incorporating needed nutrients/healthful foods.
2. Promote improved self-concept, including body image, self-esteem.
3. Encourage health practices to provide for weight control throughout life.

DISCHARGE GOALS

1. Healthy pattern for eating and weight control identified.
2. Weight loss toward desired goal established.
3. Positive perception of self verbalized.
4. Plan in place to meet needs for future weight-control.