An Emerging Concern for Patients and Nurses. Susan Gallagher Camden Ph. D, MSN, MA, RN, CBNDownload pdf version. Abstract. The challenges of caring for larger, heavier patients arise in all healthcare settings. When an obese patient needs nursing care, physical size can complicate even the most basic interventions, regardless of the practice setting. In this article, definitions, etiologies, and long- term consequences of obesity are described. The nurse’s role in anticipating obesity- related issues, such as skin, pulmonary, resuscitation, drug absorption, intravenous access, and mobility challenges, is considered. Others believe that if the incontinence is severe and correctable. Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health. It is defined by body mass index. Strategies to address these issues in a size- sensitive manner are presented. Citation: Camden., S., (January 3. DOI: 1. 0. 3. 91. OJIN. Vol. 14. No. Man. 01 Keywords: bariatric, obesity, nursing care. The word obesity has its origins in the Latin language; it refers to the state of becoming “fattened by eating.” The term bariatrics, which serves as a functional definition of obesity, is derived from the Greek expression baros, referring literally to weight or measurement. This term is used today to refer to the providing of healthcare for weight and weight- related conditions, including medical weight management, weight loss surgery, reconstruction after massive weight loss, and other associated treatments. The specialty of bariatrics is becoming increasingly important as the number of obese and overweight persons continues to rise. In this article, the incidence, etiologies, and long- term consequences of obesity are described. The nurse’s role in anticipating obesity- related issues, such as skin, pulmonary, resuscitation, drug absorption, intravenous access, and mobility challenges, are considered. Strategies to address these issues in a size- sensitive manner are presented. Incidence of Obesity.
When obese patients access nursing care, physical size can complicate even the most basic intervention, regardless of practice setting. Overweight and obesity are common health conditions, and the prevalence of these conditions is increasing nationally and globally. Recent estimates suggest that over 6. United States (US) are overweight, as indicated by a body mass index (BMI) higher than 2. Camden, 2. 00. 8). Of all Americans between the ages of 2. US, 1. 0 - 4. 0% are obese (having a BMI greater than 3. BMI greater than 4. Ogden et al., 2. 00. From 1. 97. 6 to 2. US increased from 1. Flegal, Carroll, Ogden, & Johnson, 2. Although differences in obesity rates exist among certain groups, research indicates that some degree of increase has occurred among all groups regardless of age, gender, ethnicity, socioeconomic status, or race (Ogden, Carroll, & Curtin, 2. Worldwide nearly two billion individuals are overweight, equaling the number of individuals suffering from starvation (Buchwald, 2. I am fat and being fat sucks in so many ways. I found that I was an emotional eater who turned to junk food for comfort. Some people who are fat that I know have been.The World Health Organization (WHO) has projected that by 2. WHO: , 2. 00. 8). Although the US is often considered the world’s leader in the number of obese citizens, other countries are not far behind in this regard. Worldwide, 1. 0% of children are either obese or overweight (Yach, Stuckler, & Brownell, 2. In 2. 00. 2, Chinese researchers, who conducted a nation- wide survey of 2. Chinese people were overweight; and they more recently found that over 2. Chinese cities were either clinically overweight or obese (Wang, Kong, Wu, Bai, & Burton, 2. In India, Srinath Reddy, Shah, Varghese, and Ramadoss (2. They predicted that this burden would increase sharply by the year 2. Cardiovascular diseases and diabetes are especially prevalent in urban areas in India, as well as other obesity- related conditions, such as hypertension and dyslipidemia, all of which are currently either undiagnosed, underdiagnosed, or inadequately treated. Nurses will need to adjust their nursing care as the numbers of larger, heavier patients increase over time. When obese patients access nursing care, physical size can complicate even the most basic intervention, regardless of practice setting. Anticipating these issues and developing skills in addressing them will soon become part of the role of every nurse. Assessing Body Mass The Body Mass Index (BMI) is the most frequently used and widely accepted tool to measure obesity. Calculating BMI is relatively simple and inexpensive. The Body Mass Index is a mathematical formula based on height and weight, which assigns a number to an individual’s relative risk for morbidity and mortality. This assessment tool is not gender specific. It is the measurement of choice for obesity researchers and has been used extensively by healthcare professionals, including nurses, in recent years. Health organizations and policy makers use the BMI to measure and define obesity and to establish criteria for certain procedures. However, BMI as an assessment tool does carry certain limitations. One problem with using BMI as a measurement tool is that very muscular people may fall into the category of overweight when, in fact, they are very physically fit. Additionally, people who have lost large amounts of muscle mass may be in a healthy BMI category, when in reality they have diminished nutritional reserves. Therefore, the BMI has been most useful in tracking trends in the general population; it must be used in conjunction with other assessment criteria to determine the health status of an individual patient. In 1. 99. 5, WHO recommended using BMI to establish three grades or levels of overweight. Two organizations within the National Institutes of Health (NIH, n. National Heart, Lung, and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases, concurred with this system, with the caveat that cutoff points are used only as a guide for obesity- level definitions and for comparative purposes across populations over time. This caveat is important because an overweight individual with a BMI of 2. BMI of 3. 0. Health risks, though, do increase gradually as BMI increases. The above organizations have agreed that Classification I corresponds to a BMI 3. Classification II corresponds to 3. Classification III corresponds to a BMI equal to or greater than 4. NIH, n. d. b). Other tools can also be used to measure weight and weight–related conditions. Like BMI, some tools are based on mathematical calculations of the relationship between height and weight, while others are based on measurements of body fat. Some assessment tools establish certain risk factors for co- morbidities, such as the waist- to- hip ratio (Gallagher, Langlois, Spacht, Blackett, & Henn, 2. Studies have suggested that individuals with a high waist- to- hip ratio are at risk for certain cardiac and metabolic disorders, and that the presence of central obesity exacts greater tolls on this segment of the population (Rexrode, 1. The value of using standardized measurements and definitions is that all stakeholders are speaking the same language. Reimbursement, guidelines, and protocols are generally defined by these standardized assessment tools. Etiologies of Obesity. The National Institutes of Health describes obesity as a complex and multifactoral condition. It is often considered a condition of excess energy stores in the form of fat (NIH, 1. Obesity can be related to emotional, environmental, and genetic situations. Nurses often face difficulty in caring for overweight and/or obese patients because of inadequate education and widespread misunderstanding. From an emotional perspective, some authors contend that prejudice and discrimination aimed at larger people fuel emotional issues that lead to a further threat of obesity. The Rudd Center for Food Policy and Obesity (2. US, where two of three adults and one of two children are overweight or obese. Weight discrimination was reported by 7% of U. S. In the years of 2. Andreyeva, Puhl, & Brownell, 2. Furthermore, in the landmark meta- analysis conducted by Brownell and Puhl (2. Social and economic consequences of this discrimination included social rejection, poor quality of relationships, inferior academic outcomes, and lower socioeconomic status (Puhl & Brownell, 2. This discrimination continues today; failure to ensure empathetic care affects access and quality in the care of complex, high- risk, obese patients (Camden, 2. Nurses often face difficulty in caring for overweight and/or obese patients because of inadequate education and widespread misunderstanding (Camden, Brannan, & Davis, 2. Environmental etiologies of obesity are closely related to nutrition and physical activity (Falkner, Neumarksztainer, & Story, 2. From a nutritional perspective even before the child is born, the mother’s nutrition plays a part in the child’s predisposition toward obesity, as intrauterine over or under nutrition can lead to weight issues. For example, Dutch men who faced “winter hunger” during the first trimester of their in utero life, during the winter of 1. World War II, have frequently become obese as adults (Yajnik, 2. Many people in the US today consume a largely high- fat, low- protein diet taken in the form of large meals and/or snacks that include high sugar, and often supersized drinks. Limited physical activity is due to lifestyle changes often associated with frequent sitting in front of television sets and/or computers, along with labor saving devices that decrease the amount of energy expended to accomplish a given task (Phillippas & Lo, 2. Research has suggested that as more hours are spent with electronic media, the overall BMI among children rises (Davison, Francis, & Birch, 2. Genetic conditions are also thought to play an important role in obesity. Some ethnic groups are predisposed to obesity by what has been described as the “thrifty gene.” This theory, proposed in 1. James Neel, helps to explain why many individuals of Pima descent are overweight.
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