NCP Nursing Diagnosis: Imbalanced Nutrition: More than Body Requirements Obesity; Overweight

Nursing Diagnosis: Imbalanced Nutrition: More than Body Requirements
Obesity; Overweight
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

* Nutritional Status: Food and Fluid Intake
* Weight Control

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

* Nutritional Monitoring
* Nutrition Counseling
* Weight Reduction Assistance

NANDA Definition: Intake of nutrients that exceeds metabolic needs

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 elderly patients are similar to those of younger individuals, except calories should be reduced because of their leaner body mass.

* Defining Characteristics: Weight 20% over ideal for height and frame
* Triceps skinfold 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 social situation

* Related Factors: 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

* Expected Outcomes Patient verbalizes measures necessary to achieve weight reduction.
* Patient demonstrates appropriate selection of meals or menu planning toward the goal of weight reduction.
* Patient begins an appropriate program of exercise.

Ongoing Assessment

* Document weight; do not estimate. Patients may be unaware of their actual weight.
* Determine body fat composition by skinfold measurements. Skin calipers can be used to estimate amount of fat.
* Calculate body mass index as a ratio of height and weight. Body mass index (BMI) is the person’s weight in kilograms divided by the square of his or her height in meters. A BMI between 20 and 24 is associated with healthier outcomes. BMIs greater than 25 are associated with increased morbidity and mortality.
* Perform a nutritional assessment. This includes types and amount of food, how food is prepared, intake pattern (e.g., time of day, frequency, other activities patient does while eating).
* 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.
* Assess knowledge regarding nutritional needs for height and level of activity or other factors (e.g., pregnancy).
* 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 calorie-free.
* Assess ability to plan a menu, making appropriate food selections. Cultural or ethnic influences need to be identified and addressed.
* Assess ability to accurately identify appropriate food portions. Serving sizes must be understood to limit intake according to a planned diet.
* Assess effects or complications of being overweight. 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.
* Assess usual level of activity. Patients may confuse routine activity with exercise necessary to enhance and maintain weight loss.

Therapeutic Interventions

* 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 (e.g., three balanced meals a day, avoidance of certain high-fat foods). 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.
* Establish appropriate short- and long-range goals. One pound of adipose tissue contains 3500 kcal. Therefore to lose 1 pound/week, the patient must have a calorie deficit of 500 kcal/day.
* 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 factors.
* 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 serving sizes.
* Encourage water intake. Water assists in the excretion of byproducts of fat breakdown and helps prevent ketosis.
* Encourage patient to be more aware of nutritional habits that may contribute to or prevent overeating:
o To realize the time needed for eating. Hurried eating may result in overeating because satiety is not realized until 15 to 20 minutes after ingestion of food.
o To focus on eating and to avoid other diversional activities (e.g., reading, television viewing, or telephoning).
o To observe for cues that lead to eating (e.g., odor, time, depression, or boredom).
o To eat in a designated place (e.g., at the table rather than in front of the television). This controls environmental stimuli for eating and other impulse eating.
o To recognize actual hunger versus desire to eat. Eating when not hungry is a commonly recognized symptom among overeaters.
* 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.
* Provide positive reinforcement as indicated. Encourage successes; assist patient to cope with setbacks.
* Incorporate behavior modification strategies. 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 alone.

Education/Continuity of Care

* Review and reinforce teaching regarding the following:
o Four food groups or the food pyramid
o Proper serving sizes
o Caloric content of food Many patients are unaware of the calories present in low-fat foods.
o Methods of preparation, such as substituting baking and grilling for frying foods
* Include family, caregiver, or food preparer in the nutrition counseling. Success rates are higher when the family incorporates a healthy eating plan.
* Inform patient about pharmacological agents such as appetite suppressants that can aid in weight loss. These drugs act by chemically altering the patient’s desire to eat.
* Encourage diabetic patients to attend diabetic classes. Review and reinforce principles of dietary management of diabetes. Obesity and diabetes are risk factors for coronary artery disease.
* Review complications associated with obesity.
* 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.
* Remind patient that significant weight loss requires a long period.
* Refer to community support groups as indicated.