Obesity is excessive body fat that presents a health risk. A body mass index (BMI) over 30 is considered obese. Obesity is a growing problem in nearly every country in the world.
Obesity has two main causes: increased intake of foods high in fat and sugar and a decrease in physical activity. As people continue to work in sedentary jobs, rely on transportation, and seek convenience through the delivery of products and processed foods, obesity is likely to worsen.
Obesity is linked to cardiovascular diseases, diabetes, cancer, and joint disorders. Childhood obesity, which continues to rise, is associated with a higher risk of premature death and disability in adulthood.
The Nursing Process
Obesity is a difficult topic to broach with many patients though it is a health condition that requires the same education as any diagnosis. Unlike some diseases, obesity is preventable and patients often have a choice in decreasing their body fat. Nurses can support patients through their weight loss journey by educating on diets, using motivational interviewing to spark behavior change, coordinating with dieticians and recommending resources, and monitoring patients before and after bariatric surgeries.
Nursing Care Plans Related to Obesity
Imbalanced Nutrition: More Than Body Requirements Care Plan
One cause of obesity is the overconsumption of food, often high-calorie food such as fats and sugar.
Nursing Diagnosis: Imbalanced Nutrition
- Excess intake of food
- Unhealthy food choices
- Inability to afford nutrient-dense food
As evidenced by:
- Intake of more than daily recommended calories
- Eating in response to emotions (stress, boredom)
- Eating large portions
- Obese body mass index
- Patient will identify times, settings, and emotions that induce overeating
- Patient will verbalize healthier food choices in place of processed foods
- Patient will reduce daily calorie intake by 20%
Imbalanced Nutrition: More Than Body Requirements Assessment
1. Assess for conditions contributing to obesity.
Obesity is not always related to a patient’s choices. Assess for health conditions such as hypothyroidism, diabetes, polycystic ovarian syndrome, medication side effects, and family history that predispose the patient to weight gain.
2. Assess the patient’s average daily intake.
Have the patient provide a normal daily meal schedule so the nurse can understand how often the patient is eating, what types of foods, and an average amount of calories, fat, sodium, and protein intake.
3. Assess the patient’s BMI.
Calculate the patient’s body mass index using their height and weight to determine the severity of obesity.
Imbalanced Nutrition: More Than Body Requirements Interventions
1. Start with small changes.
Losing weight and changing diets isn’t easy and requires new habits. Do not overwhelm the patient with strict diets and food changes. Start with small, realistic goals such as adding in a new vegetable every week and reading food labels.
2. Educate on nutrient requirements.
Provide education and written materials to guide the patient in smarter food choices. Obese patients often lack required nutrients so the nurse can educate on reducing sodium, increasing vitamin D and protein, and swapping saturated fats for unsaturated fats.
3. Treat health conditions.
Underlying health conditions must be controlled to see weight loss. Ensure patients are on an effective regimen for hypothyroidism or diabetes. Patients with little improvement after adhering to weight loss guidelines may require the use of appetite suppressants.
4. Refer to a dietician.
Dieticians assist with goal setting, understanding food labels, meal and recipe planning, portion control, and making better food choices.
5. Weigh only weekly; measure body fat.
Patients should not obsess about the number on the scale as it may not correlate to fat loss. Patients may notice a reduction in their waist or hip size. Other tools such as calipers can measure the skinfolds that will show body fat vs. muscle.
Sedentary Lifestyle Care Plan
Along with the overconsumption of food, a lack of exercise is a major contributor to obesity.
Nursing Diagnosis: Sedentary Lifestyle
- Lack of interest or motivation to exercise
- Lack of access to a gym, equipment, or a safe area to exercise
- Lack of knowledge regarding proper exercise training
- Poor self-esteem prohibiting participation in physical activity
As evidenced by:
- Verbalizes a lack of interest or knowledge to start
- Physical deconditioning
- Dyspnea with minimal exertion
- Chooses low-intensity activities
- Patient will identify internal and external barriers to exercise and how to overcome them
- Patient will begin with physical activity twice per week and build up to meet goals
- Patient will participate in activities they enjoy and remain committed to
Sedentary Lifestyle Assessment
1. Assess physical barriers to movement.
Obesity often worsens or results from chronic conditions such as arthritis, chronic pain, and asthma which prevent activity. Assess for interventions to work around and ultimately improve these conditions.
2. Assess the patient’s perception of exercise.
Assess if the patient feels they need to exercise and if they have an interest in doing so. Changing habits is very difficult and will be futile if the patient is not motivated.
3. Assess the patient’s current activity level.
Determine if the patient participates in any physical activity to formulate a baseline. The nurse can assist in creating a safe exercise plan that incorporates activities or sports that the patient can physically participate in and will also keep them engaged.
Sedentary Lifestyle Interventions
1. Instruct on several types of fitness.
In order to keep the patient engaged and to promote the maximum benefits, the patient should participate in several types of fitness. Stretching, mobility practice, cardiovascular endurance, and weight training provide varied activities and complete body conditioning.
2. Keep a journal of activity and progress.
In an attempt to prevent stagnation or quitting, have the patient keep track of their progress. Visual evidence of weight loss, increasing time spent exercising, and improvements in mood provide encouragement to remain committed to goals.
3. Try a class or use a workout buddy.
Exercising with others is a huge motivator and will give the patient a reason to show up. Working out with a friend often helps with accountability and discipline.
4. Recommend personal training.
A personal trainer may be necessary to assist the patient with safe exercise and to instruct on proper form with movement. They can also encourage and motivate the patient. For older patients or those with physical limitations, physical therapy may be a better setting for instruction and education.
Disturbed Body Image Care Plan
Obesity can cause patients to feel ashamed or unhappy with their physical appearance resulting in low self-esteem and depression.
Nursing Diagnosis: Disturbed Body Image
- Societal views affecting the patient’s sense of self-worth
- Family or cultural values affecting how one should look
- Negative effect on sexual and intimate relationships
As evidenced by:
- Verbalization of unhappiness with appearance
- Fear of ridicule or rejection by others
- Preoccupation with losing weight
- Feelings of hopelessness
- Lack of follow-through with diet and exercise plans
- Not participating in activities where weight could be an issue
- Patient will lose “X” number of pounds to achieve desired body weight
- Patient will learn to accept themselves despite weight loss or gain
- Patient will accept responsibility for making changes to improve self-image
Disturbed Body Image Assessment
1. Assess the emotional effect of the patient’s weight.
Assess how the patient views themselves and any internal struggles they face due to their weight. Assess for signs of anxiety and depression and a sense of low self-worth.
2. Assess the effect of social systems.
Assess how the patient’s family and friends affect their weight. Patients with obese family members may feel outcasted by their desire to lose weight or may feel pressured to do so by friends or acquaintances.
Disturbed Body Image Interventions
1. Provide positive reinforcement.
Remain nonjudgmental and help the patient strive for success. Remind them they can lose weight but are worthy of love and acceptance regardless of their outward appearance.
2. Help set motivational goals.
Only the patient can decide they are ready for change and put in the effort. Help them come up with reasons that will keep them on track such as feeling confident in a swimsuit or being comfortable in an intimate relationship.
3. Teach positive reward systems.
Instead of treating oneself for weight loss with food, suggest buying newer, better-fitting clothing or a new hairstyle to improve body image.
4. Focus on the patient’s strengths.
A patient who is struggling with their physical appearance can be redirected to focus on their value as an individual with unique abilities. This can include intelligence, sense of humor, empathy, and ambition.
5. Encourage counseling.
Negative thoughts of one’s self can be deep-seated and may even be a result of abuse or years of negative self-talk. This requires the intervention of a mental health professional to unlearn trauma.
References and Sources
- Coleman, E. (2018, December 14). Recommended Grams of Nutrients Per Day for Healthy Weight Loss. Healthy Eating. Retrieved March 22, 2022, from https://healthyeating.sfgate.com/recommended-grams-nutrients-per-day-healthy-weight-loss-6294.html
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
- Elsalamony, D. (2022, March 11). How To Measure And Track Your Weight Loss. HealthMatch. Retrieved March 22, 2022, from https://healthmatch.io/weight-management/how-to-measure-weight-loss#why-your-scale-doesn-t-tell-the-whole-story
- Medical Nutrition Therapy for Weight Loss. (n.d.). Johns Hopkins Medicine. Retrieved March 22, 2022, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/medical-nutrition-therapy-for-weight-loss
- Obesity and overweight. (2021, June 9). WHO | World Health Organization. Retrieved March 22, 2022, from https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight