Introduction
Obesity has long been viewed as a serious, chronic condition within the health care system of the United States. It has a substantial adverse impact on the health, well-being, and quality of life of the affected individuals and can present a significant societal burden, with obese persons being at an increased risk of developing various comorbidities and putting an additional strain on the health care system. Nevertheless, many barriers prevent patients from seeking and receiving critical obesity care. This project aims to examine co-occurring obesity and depression in the United States. The assessment will identify the patient with the two conditions, address the existing literature on the issue, examine how patients are affected by organizational and governmental policies, and propose strategies to improve the patient experience.
Defining the Problem and the Patient
Obesity and Depression: Prevalence and Significance
Obesity is a severe condition that can considerably affect the health and well-being of the patients independently and when co-occurring with depression. It is traditionally defined as a body mass index (BMI) ≥ 30 kg/m2 according to World Health Organization (WHO) criteria (Milaneschi et al., 2018). Centers for Disease Control and Prevention (2021a) states that excessive weight is associated with hypertension, high cholesterol, insulin-resistant type 2 diabetes, and various cardiovascular, pulmonary, and sleeping issues. These conditions can result in difficulties with general physical functioning and lead to high mortality rates among obese persons. The prevalence of obesity among adults in the United States was estimated at approximately 42.4% in 2017-2018 (Centers for Disease Control and Prevention, 2021b). Thus, obesity presents a significant health concern for almost half the population of the country.
Major Depressive Disorder (MDD) is a serious mental health concern in the United States. The condition can be defined as a mood disorder associated with persistent feelings of sadness, loss of interest in normal activities, anxiety, and impaired cognition (Mayo Clinic, 2018). According to LeMoulta and Gotlibb (2019), self-reported data indicates a 17% lifetime prevalence of depression, with this figure reaching 21.3% in women. Without treatment, MDD can lead to the development of other mental health conditions. Research shows a bidirectional relationship between weight problems and depression. Patients suffering from the disorder are at an approximately 37% increased risk of obesity, and overweight persons are at a nearly 20% risk of depression (Haregu et al., 2020). Thus, co-occurring obesity and MDD pose wide-ranging adverse health and mental health outcomes for the patient.
Defining the Patient
For this assignment, a client presenting with co-occurring depression and obesity was selected to work during practicum. The patient is a 38-year-old female living alone in a remote rural area, 15 miles from the nearest health care facility. The participant’s BMI was estimated at 34.5, with the height measured at 5 feet 4 inches and weight measured at 201 pounds. Thus, according to the WHO’s definition, the patient is obese with a BMI of more than 30kg/m2 (Milaneschi et al., 2018). The presence of MDD was assessed with the use of Patient Health Questionnaire-2 (PHQ-2) and Patient Health Questionnaire-9 (PHQ-9), with the patient yielding the result of 4 in both, indicating a depressive disorder (National HIV Curriculum, 2021). In four sessions spent with the participant, it was established that her health deteriorated in the last three years following a car accident and was exacerbated significantly by the COVID-19 pandemic and the imposed lockdowns. Recently, the patient’s blood sugar increased significantly, and she began experiencing sleep and breathing problems. Thus, it is crucial to evaluate and improve patient experience related to co-occurring obesity and depression.
Practice Relevance
Registered nurses encounter a wide variety of problems in their practice. It can be argued that co-occurring obesity and depression are pertinent to the nursing practice as patients exhibiting the two conditions can present to a health care facility with symptoms and outcomes of the described co-occurrence. For example, in their practice, nurses can encounter clients exhibiting the symptoms of obesity-related complications, such as sleep apnea, complicated by depression-associated sleep disturbances. Thus, it is critical to assess and address the problem and examine potential organizational or governmental barriers to care.
Literature Review
There is an extensive body of literature on the topic of obesity co-occurring with depression. The studies for the review were selected if they were relevant, published recently, and discussed obesity-related and policy issues within the scope of the outlined research topic. For example, Milaneschi et al. (2018) discuss the shared biological mechanisms between the two conditions, explaining why they often accompany each other. Fewer research studies investigating the existing barriers to implementing evidence-based practice in addressing the problem. Sapaugh (2018) discusses the barriers to the implementation of governmental guidelines to treating the conditions in rural areas. The author provides examples from the nursing practice that are difficult to dismiss as rural centers are known for having few resources, showing the reliability of the data (Sapaugh, 2018). Similarly, Smith et al. (2020) consider obesity and psychiatric disorders in children, noting that funding in rural health care facilities is a significant impediment, while societal stigma can prevent some patients from continuing treatment. Overall, there is a common theme of some hospitals not being well-equipped to deal with patients with co-occurring obesity and depression.
The existing literature also addresses the role of nurses in policymaking and the overall improvement of the outcomes for co-occurring weight issues and depressive disorder. Barzegar Safari et al. (2020) state that nurses only moderately participate in policymaking. This tendency may be correlated with long work hours and the lack of resources and support provided to the nurses by the local government. Nevertheless, research shows that nurse-assisted weight management and behavioral interventions are effective in helping patients with obesity and depression (Jones et al., 2021; Ma et al., 2019). During the practicum, Neuman’s Model will be implemented to allow for a holistic approach towards the patient and help account for physical and psychological factors contributing to the client’s health (Goodarzi et al., 2020). Overall, the literature review shows that despite the severity of the problem, implementation barriers still exist.
Nursing Standards and Policies Effect on Patients
The health and well-being of the patients with co-occurring obesity and depressive disorder can be affected by the nursing practice standards and organizational or governmental policies. For example, in rural areas, long traveling distances can be a barrier to providing care. Without an organizational or local policy on nurses or physicians paying home visits to patients with obesity and depression, an effective lifestyle change may be challenging to monitor and maintain. Nevertheless, the recently implemented Telehealth service improved patient outcomes for individuals living in remote areas using digital technology (Wheel, 2019). Thus, the nursing scope of practice can be broadened through Telehealth technology to include guiding and monitoring lifestyle interventions. Moreover, nurses can affect local legislation by engaging in the work of advisory boards for their city and propose policies on the local and state levels.
Another policy affecting obesity care in the United States is the Healthy People 2020 governmental plan. It requires medical professionals to measure patients’ BMI on every visit to prevent excessive weight gain (Bowen et al., 2018). In addition, in 2011, Medicare announced an extended coverage for obese patients, with the Affordable Care Act (ACA) covering additional lifestyle interventions (Bowen et al., 2018). These policies extend the nursing scope of practice related to obesity, allowing practitioners to recommend effective interventions to patients and monitor them throughout the obesity treatment.
Leadership Strategies to Improve Outcomes
Leadership and guidance are crucial in addressing the discussed health problem. Nursing leaders and managers are recommended to utilize transformational and authentic leadership strategies to promote higher nursing staff engagement in organizational policymaking that will affect their patients (Bergstedt & Wei, 2020). According to Bergstedt and Wei (2020), these strategies translate into lower burnout and turnover rates among staff and higher quality patient care. Similarly, Grumstrup et al. (2019) note that ACA led to fewer obese persons missing work days due to being able to manage their condition better and making meaningful lifestyle improvements. Nursing leaders should play the role of facilitators and enable interprofessional collaboration among medical professionals and community workers. For example, a team of nurses and social workers can be created within the hospital to help assess and support the weight loss intervention for patients living in rural areas. It is the role of a nursing manager to promote and collaborative environment by creating a common objective and providing resources or paths to obtaining resources for their staff. Overall, the transformational leadership strategy should be employed to improve patient outcomes for patients with weight issues and depression.
Conclusion
In summary, obesity and depression present significant health care issues. The co-occurrence of these two conditions adversely impacts the health and well-being of the affected persons, leading to the development of other comorbidities. Furthermore, it puts additional financial pressure on the health care system. Therefore, nurses need to adopt a more active leadership and policymaking role to promote new lifestyle interventions and changes in the treatment of patients presenting with co-occurring obesity and depression.
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