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Obesity Nursing Guide

This course is intended as a Quick Reference for Obesity and will cover an overview and nursing considerations utilizing the nursing process.

Etiology and Epidemiology

Obesity Definition

Obesity is defined as the accumulation of an abnormally high proportion of body fat. People with a Body Mass Index (BMI) greater than 30 are considered obese. Body fat is used for storing energy and insulating your body. An increase in the size and number of fat cells can lead to weight gain. Weight loss decreases the size of fat cells but does not decrease their number (Mayo Clinic, 2020). 

Obesity, which can lead to diabetes, high blood pressure, and other serious health problems, is the second-leading cause of preventable deaths. According to the Centers for Disease Control and Prevention (2021), severe obesity is highest among adults aged 40–59 (42.4%), with no significant differences between gender or age group. 

Risk factors of obesity include: 

  • Familial 
  • Increasing age 
  • Medical problems 
  • Quitting smoking 

Conditions that may contribute to obesity include: 

  • Endocrine factors 
  • Environmental factors 
  • Excessive caloric intake 
  • Genetic factors 
  • Inactivity or sedentary lifestyle 
  • Medical conditions 
  • Medications 
  • Metabolic factors 
  • Pregnancy 
  • Psychological factors 
  • Socioeconomic factors 

Complications that may result from obesity include: 

  • Cancer 
  • Coronary artery disease 
  • Death 
  • Diabetes 
  • Fatty liver disease 
  • Fertility and pregnancy problems 
  • Gallbladder disease 
  • Hypertension 
  • Osteoarthritis 
  • Physical problems 
  • Psychosocial problems 
  • Renal disease 
  • Respiratory problems 
  • Sleep apnea 
  • Stroke 

 

Obesity ICD-10 Code (unspecified): E66.9

 

Obesity Diagnosis 

  • Overweight or an increase in weight with a BMI greater than 30 
  • Routine laboratory tests include: 
    • 24 hour urinary free cortisol test 
    • Cholesterol panel 
    • Glucose and insulin tests 
    • Hepatic panel 
    • Thyroid function tests 
  • Other diagnostic studies include: 
    • Anthropometric arm measurement 
    • BMI measurements 

 

Management 

Obesity management focuses on daily routines and maintenance to help reduce or control body weight. 

  • Develop a diet and exercise program. 
  • Discuss diagnosis and treatment. 
  • Discuss medications and potential adverse effects. 
  • Keep a food diary. 
  • Set realistic goals. 

 

Nursing Considerations 

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnosis, interventions, expected outcomes, and patient education for individuals with obesity are listed below. 

 

Assessment 

Assess the individual and develop a plan of care for weight reduction. 

  • Assess history of daily meals or eating habits. 
  • Assess daily activities such as exercise. 
  • Calculate BMI with the formula [weight (lb) ÷ height (in.)2] x 705. 
  • Identify emotions that may trigger overeating or indulging. 

 

Nursing Diagnosis/Risk For 

  • Altered nutrition: more than body requirements 
  • Chronic low self-esteem related to body image 
  • Disturbed body image related to obesity 
  • Ineffective coping related to alteration in diet 

 

Interventions 

A general approach to losing weight is to develop a diet plan and set realistic goals: 

  • Eat small, frequent meals; drink large amounts of water; keep a food diary. 
  • Develop a daily exercise routine. 
  • Encourage increased physical activity. 
  • Encourage lifestyle changes and behavior modification. 
  • Explain diagnosis, adverse effects and treatment. 
  • Give emotional support. 

In addition to diet and exercise treatments, medication and surgery (for severe cases) can be effective (OMA, 2020). 

 

Obesity Medication 

  • Adrenergic agonists 
    • Phentermine (Adipex-P®, Fastin®, Ionamin®, Obe-Nix®, Obephen®) 
    • Mazindol (Mazanor®, Sanorex®) 
    • Diethylpropion (Tenuate®, Tenuate Dospan®) 
    • Benzphetamine (Didrex®) 
    • Phendimetrazine (Bontril®, Plegine®) 
    • Ephedrine (Pretz-D®) 
      • Adult dose: 25 to 50 mg PO q3-4 hour prn or OTC products 12.5 to 25 mg PO q4h (not to exceed 150 mg qd) 
      • Child dose: >12 years old: 2 to 3 mg/kg/d (100 mg/m2) PO divided into four to six doses qd 
    • Caffeine 
      • Adult doses: anhydrous caffeine 100 to 200 mg PO q3-4 hour prn, citrated caffeine 65 to 325 mg (equivalent to 32-mg to 162-mg anhydrous caffeine) PO tid prn, or anhydrous caffeine extended- release (ER) capsules 200 to 250 mg PO q3-4h prn (not to exceed 1,000 mg/d) 
  • Anorexiants 
    • Orlistat (Xenical®) 
      • Adult dose: 120 mg PO tid ac (meals containing fat) may take up to 1 hour pc 
      • Child dose: 60 mg PO tid ac initially may titrate up to 120 mg tid as tolerated 

 

Weight Loss Surgery

Surgery is an option for weight loss, but not a magical cure. Individuals do not always lose weight or keep it off long term after surgery. But it can help some people lose up to 35% of their body weight (Mayo Clinic, 2020). 

Common weight loss surgeries include: 

  • Banded gastroplasty: The stomach is separated into two pouches with an inflatable band. When the band is pulled tight, like a belt, a tiny channel is created between the two pouches. The band keeps the opening from expanding and is generally designed to stay in place permanently. 
  • Gastric bypass: A small pouch is created at the top of the stomach. The small intestine is then cut a short distance below the main stomach and connected to the new pouch. Food and liquid flow directly from the pouch into this part of the intestine, bypassing most of the stomach. 
  • Biliopancreatic diversion with duodenal switch: A large part of the stomach is removed. The valve is left that releases food to the small intestine and the first part of the small intestine (duodenum). Then the middle section of the intestine is closed off and the last part is attached directly to the duodenum. The separated section of the intestine is reattached to the end of the intestine to allow bile and digestive juices to flow into this part of the intestine. 
  • Gastric sleeve: Part of the stomach is removed to create a small reservoir for food to pass through. 

 

Expected Outcomes 

  • After losing weight, weight must be maintained with behavior modification. 
  • Decrease anxiety and pain 
  • Prevent infection 
  • Develop and maintain a daily exercise routine 
  • Increase daily activities 
  • Develop moderate eating habits 
  • Increase water consumption: 64 oz. minimum 
  • Small, frequent meals 
  • Well-balanced, reduced calorie diet 

 

Individual/Caregiver Education 

  • Develop a diet-and-exercise program 
  • Discuss diagnosis and treatment 
  • Discuss medications and potentially adverse effects 
  • Keep a food diary 
  • Set realistic goals 
  • Eat healthy meals and snacks 
  • Exercise regularly 
  • Maintain normal body weight 
  • Notify provider of adverse reactions or complications 
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Additional Information

Content Release Date 

4/1/2022

Content Expiration

11/30/2027

 

Course Contributor 

The content for this course was created by Relias Subject Matter Expert Cassandra B. Shine, BSN, RN. Cassandra earned her Bachelor of Science Degree in Nursing from Winston- Salem State University. She has worked as a registered nurse for more than 20 years and has clinical experience, specializing in Nephrology Research, Critical Care with Cardiothoracic Surgery and Trauma, Med/Surg, Community Health Outreach, and Education. 

 

References