Investigated Disease Process
Obesity is a chronic multifactorial condition that is characterized by excessive adiposity or morbid body weight. It is clinically defined as having a Body Mass Index (BMI), which is the ratio between a person’s weight and height, of 30 kg/m2 or more (Jensen et al., 2013). In contrast, the BMI range for a pre-obesity condition called overweight is 25-29.9 kg/m2. The disease process (pathophysiology) follows an epidemiological model – an agent (not a microbe) is implicated in the development of obesity.
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Four modifiable risk factors are involved in the etiology of this condition: genetics, diet, exercise, and the environment (Jensen et al., 2013). They destabilize the energy balance in the body resulting in excess adiposity.
Food is a primary etiological factor. The intake of fatty food or sugar-sweetened drinks coupled with physical inactivity elevates the risk of obesity. The excess calories are deposited as fat primarily in the adipose tissue and in some cases in the body organs (Haslam, 2014). The lipids have inflammatory effects on the arterial and muscular tissues, liver, and pancreas, causing comorbidities, such as insulin resistance, type 2 diabetes mellitus (DM), endocrine disorders, and heart disease. Therefore, obesity is a significant risk factor for chronic conditions.
The rationale for selecting this topic relates to the significant socioeconomic and psychological costs of obesity, especially in children. Obesity is linked to poor health and social outcomes, including stigma, depression, chronic disease morbidity – DM and heart disease – and mortality (Haslam, 2014). The public health impact of this largely preventable condition especially in developed countries is high.
According to Myers, Slack, Martin, Boyles, and Heymsfield (2015), more than a third of the global population are either overweight or obese. Going by the present rate, it is projected that about 38% and 21% of adults will suffer from overweight and obesity by 2030, respectively (Myers et al., 2015). This paper analyzes the pathophysiology of obesity, available treatments, clinical guidelines, disease management, costs, and best practices.
Pathophysiology of Obesity
Obesity is associated with energy-balance dysregulation that impairs glucose and lipid metabolism. At a macro level, interactions between biological factors and the environment affect metabolic processes that increase the risk of obesity. Its pathophysiology is an intricate system that entails a central processing function – autonomous nervous system (ANS) – that controls caloric intake and satisfaction based on the signals it receives (Heymsfield & Wadden, 2017). Afferent signals originating from the endocrine system regulate appetite and satiety through their effects on the arcuate nucleus (ARC) of the hypothalamus and ANS, which control energy expenditure (Heymsfield & Wadden, 2017). Interactions between hormones affect this process.
At the hormonal level, circulating endocrine factors, including the Growth Hormone (GH) relin that is released by gastric tissues, are essential peripheral signals of the hypothalamic ARC. GH secretions is correlated with food intake. This hormone is produced by gastric and duodenal tissues and it promotes appetite (Heymsfield & Wadden, 2017). Serum GH levels rise when a person is expecting a meal. Physical activity and diet regimen have been shown to suppress its production.
Other signaling molecules include intestinal hormones (peptide YY and GLP-1) and insulin (Heymsfield & Wadden, 2017). Their level in the bloodstream rises or decreases depending on the concentration of adipocytes in the body.
The body’s response entails homeostatic control of serum glucose concentration. This regulatory system involved in controlling body weight and food intake is a subject of scientific investigation. Novel modulators and factors have been found to play a role in this process. Examples include afferent signals, which include food, neural impulses, and endocrine factors. Gastric enlargement induced by vagal afferent signals indicate satisfaction, while constriction initiates a sensation of hunger (Sheu, Lin, & Chen, 2017). Glucose absorption triggers a feeling of satiety. In contrast, a drop in blood sugar level induces a desire to eat. Various neurotransmitters and hormones regulate this process.
At the cellular level, adipocytes are involved in the development of obesity. They are fat cells that produce adipokines (proteins), which are implicated in the regulation of caloric intake and metabolic activities (Sheu et al., 2017). Adipokines also control adiposity and insulin activity. An example of this protein is leptin, which is linked to lipid mass in the body. Its production rises when more fat is deposited in the adipose tissue (Sheu et al., 2017). Its role is to reduce appetite through sympathetic nervous system stimulation. Persons lacking the leptin gene have been shown to lose weight on receiving this protein.
Standard of Practice
The standards of practice for obesity are used to guide the assessment, diagnosis, and management of this disease. Providers are required to utilize BMI and waist circumference to assess obesity/overweight in adults, regardless of gender (Jensen et al., 2013). BMI is a ratio of a person’s height and weight (kg/m2), and it can be used to indicate the severity of this condition. The facility (Allina Health System) protocol indicate that a clinical visit should begin with the measurement of a patient’s weight (in kilograms), which is divided by his or her height (in meters) to determine the BMI.
It also recommends measuring the blood pressure for children under three years, taking a family history and a physical exam, and evaluating the behavioral risk. Based on BMI, the individual is assessed as overweight (BMI = 25-29.9 kg/m2) or obese – class 1 (30-34.9 kg/m2), class 2 (35-39.9 kg/m2) and class 3 (≥40kg/m2) (Jensen et al., 2013). Other BMI classifications used in patient assessment include underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2) (Jensen et al., 2013). Thus, the evaluation groups people into six different BMI categories.
The provider should use clinical judgment when assessing muscular individuals, as BMI can overstate the body fat in such people. BMI is also recommended for use in evaluating the absolute risk of cardiovascular disease (CVD) or mortality risk in obese people. It is more accurate than weight in predicting the development of chronic comorbidities such as CVD and type 2 diabetes. Waist circumference indicates the level of abdominal fat.
Its assessment is useful in determining the risks related to obesity/overweight. Waist circumference (WC) is significant when evaluating individuals classified as normal or overweight, as it can predict the disease risk in this population. In general, a WC value (inches) of ≥40 (male) and ≥35 (female) indicates an elevated risk of DM, high blood pressure, and CVD (Jensen et al., 2013). These comorbidities are related to the high abdominal fat in people with large waist size.
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The diagnosis of this condition involves a physical exam and an evaluation of a patient lifestyle. The assessment is dependent on BMI measurement. A healthy person is one whose BMI is 18.5 kg/m2 and 24.9 kg/m2 (Jensen et al., 2013). An individual is diagnosed as obese if his or her BMI is ≥30 kg/m2 and overweight if the value is 25-29.9 kg/m2 (Jensen et al., 2013). The patient’s eating patterns and physical activity are also considered in the diagnosis.
The management of diabetes involves multiple interventions. Weight loss therapy is recommended to achieve the required BMI within a specified period. A reduction of 10% of the total body mass within a half a year (equivalent to 1-2 pounds a week) is considered a healthy lifestyle choice for obese individuals (Jensen et al., 2013). Subsequently, the focus should be on weight maintenance through diet and exercise.
A combination of caloric reduction and regular exercise can lower BMI in obese/overweight people. In the author’s state (Minnesota), a decrease in the daily calorie intake by 500 to 800 kcal/day is recommended to achieve the 1-2 pounds weekly weight loss (Minnesota Department of Health (MDH), 2017). Achieving this target would require a change in food choices. Diets providing 1,000-1,200 kcal/day and 1,200-1,600kcal/day are considered healthy for female and male obese patients (MDH, 2017).
The reduced caloric intake should be combined with exercise to achieve the weight loss target. In the author’s state, a minimum of two and three servings of fruit is recommended for obesity patients daily (MDH, 2008). Additionally, weekly moderate-intense aerobic training lasting over 300 minutes is considered effective in weight loss (MDH, 2017). Behavioral therapy is recommended to achieve a lifestyle change.
Pharmacological treatments for obesity in the author’s state are based on the Endocrine Society’s guidelines. Pharmacotherapy is recommended for use as an adjunct to diet, exercise, and behavior change to reduce weight. The therapeutic effect of obesity drugs includes increasing adherence to behavioral modification and physical training (Apovian et al., 2015). The medications are recommended for people struggling to reach a healthy BMI and maintain it.
To achieve long-term weight maintenance, FDA-approved drugs such as phentermine, topiramate, orlistat, lorcaserin, and diethylpropion, are recommended over non-pharmacological interventions for the management of obesity (Apovian et al., 2015). Such weight loss medications also reduce the risk of related comorbid conditions and enhance behavioral modification and physical functioning. Candidates for these drugs include those with a BMI of 30 kg/m2 or 27 kg/m2 and diagnosed with T2DM and high blood pressure (Apovian et al., 2015). The goal is to reduce the effects of the weight-related comorbidities.
Comorbid conditions are considered when prescribing drugs for managing obesity. Sympathomimetic compounds, such as phentermine, are contraindicated in obese individuals with hypertension or CVD (Apovian et al., 2015). The psychostimulant drugs suppress appetite, and therefore, can be used with diet and physical activity to manage obesity/overweight. Treatments for comorbidities should be carefully considered to prevent weight gain. Drugs for TDM should have antidiabetic effects in addition to promoting weight loss. They include glucagon-like peptide-1 agonist, metformin, and pramlintide (Apovian et al., 2015).
These drugs prevent weight gain related to basal insulin therapy. ACE inhibitors and ARBs are suggested for managing high blood pressure in obese patients with T2DM (Apovian et al., 2015). Thus, the side effects of pharmacological agents on weight and blood pressure should be considered when prescribing them.
Pharmacological treatments combined with exercise and diet have had a significant impact on the number of obese people in Minnesota. However, the adult obesity rate grew by 0.7% to 28.4% between 2016 and 2017 (MDH, 2017). Nevertheless, compared to other states, Minnesota’s obesity rate is lower. The prevalence of obesity stood at 34.6%, 33.2%, and 32.0% in Iowa, North Dakota, and Wisconsin, respectively, in 2017 (MDH, 2017).
In Minnesota, the adverse outcomes have not improved significantly following the statewide implementation of Minnesota’s Obesity Plan that focuses on exercise, diet, behavior change, and pharmacotherapy. The slight increase in obesity rates implies that current interventions have not limited the progression of the disease. It also shows that hospitalizations due to comorbidities are high and patient compliance with treatment is low.
Practice guidelines focusing on assessment recommend the initial weight and height of a patient be obtained during a clinical visit. Subsequently, BMI is calculated to determine if the individual is obese or overweight. For children aged 2-17 years, a BMI percentile for age and sex is plotted to assess their risk of obesity (Haslam, 2014). The BMI is used to determine the weight category of the patient. The assessment should also involve a physical exam.
The patient’s blood pressure and vital signs are taken annually to identify related comorbid conditions. The screening also entails assessing family history of obesity, T2DM, stroke, and CVD, reviewing systems, and evaluating risky behaviors (Haslam, 2014). Behavioral risk assessment focuses on the diet – frequency of intake of sweetened drinks, fruits and vegetables, and portion sizes – and screening for binge eating disorder. It also involves an evaluation of physical activity and attitudes, including the readiness to change. Based on the assessment results, an individual is considered to be of healthy weight, overweight, or obese.
A physical exam is done to reveal predisposing problems. It helps identify dysmorphic features caused by genetic disorders and hepatomegaly that affects patients with nonalcoholic liver disease (Sheu et al., 2017). Obesity diagnosis involves various laboratory tests. The lab protocol entails age-specific panel for individuals with healthy weight (Sheu et al., 2017). Overweight persons for whom family history, physical examination, and behavior assessment has not revealed evidence for obesity risk are subjected to a fasting lipid panel.
For those assessed as obese based on BMI, further laboratory tests are recommended. The fasting lipid panel and comprehensive metabolic panel (CMP) are used to diagnose obesity. The specific CMP tests include aspartate aminotransferase (AST) and alanine aminotransferase (ALT) that screen for metabolic disorders that increase adiposity (Sheu et al., 2017). Screening for fasting glucose, lipids (LDL and HDL), and insulin can also indicate the obesity risk.
Patient education should focus on diet, physical activity, and behavior change. It includes information on the appropriate number of daily servings of fruits, vegetables, grains, proteins, and dairy products. The amount of food consumed varies depending on the age of the patient. It is recommended that obese children aged 6-11 years take 2-3 servings of vegetables, 3-4 servings of fruits, and 6 servings of grains per day (Haslam, 2014). Patients are also encouraged to replace high-fat food (snacks and drinks) with low-fat ones like whole grain pasta. Health care providers can work with obese individuals to identify nutritional and physical activity goals to achieve a healthy weight.
Standard Practice of Disease Management
The elements of the practice guidelines in my facility (Allina Health) are comparable to the National Heart, Lung, and Blood Institute (NHLBI) state recommendations for assessing, diagnosing, and managing obesity. Concerning disease assessment and diagnosis, the standard screening protocol is followed. The evaluation algorithm includes measuring a patient’s height and weight to calculate BMI, taking the family medical history (obesity and T2DM), and reviewing of the systems to identify possible causes (Haslam, 2014). The NHLBI BMI criteria are used to diagnose obesity (≥30 kgm2) and overweight (25-29.9 kgm2) in the facility.
Consistent with NHLBI guidelines, the behavioral risk is also evaluated at my facility to determine dietary, attitudinal, and physical activity factors contributing to the development of obesity or overweight. Thus, facility guidelines on obesity assessment are aligned with NHLBI practice standards.
Concerning obesity management, my facility offers different weight loss programs, such as medical and surgical interventions. Consistent with the general requirement for patient education, enrolled obese individuals are trained on diet and exercise to help them maintain a healthy weight (Allina Health, 2017). Unlike the NHLBI guidelines, Allina Health emphasizes a greater involvement of family in childhood obesity management. Its programs involve dietitians, physical therapists, and social workers working with patients/families to develop dietary and physical activity plans for the patient. It offers personalized and group weight management programs to obese patients.
The facility’s programs also differ from the NHLBI practices guidelines for specialized care. While the federal standards focus on primary care, the hospital uses specialists, including registered dieticians, exercise physiologist, and health coach, to manage obesity in patients. The aim is to develop a diet tailored to individual needs to reduce caloric intake. A personalized exercise program is also included to stimulate weight loss and maintain a healthy weight. Through health coaching, modifiable barriers to weight loss are addressed. Counseling is lacking in the NHLBI guidelines. Allina Health also offers a surgical weight management program.
Its goal is to achieve improved long-term healthy through bariatric surgery to remove excess fat. The specific surgical options available include sleeve gastrectomy, gastric bypass surgery, adjustable gastric band procedure, and duodenal switch (Allina Health, 2017). Thus, while the NHLBI clinical guidelines emphasize the use of a primary care provider, the facility’s standards of practice focus on specialist care to achieve diet, exercise, and behavioral modifications.
Managed Disease Process
Obesity/overweight is a long-term condition that requires a biopsychosocial or holistic approach to manage it. A vital feature of a patient who has managed his/her disease effectively is a BMI of 18.5-24.9. This BMI range indicates a healthy weight and a reduced risk of obesity-related comorbidities such as T2DM. Such a patient is exhibits health-seeking behavior. He works with a health care professional to lose weight and sustain it. He/she reviews his or her progress every week with the provider who offers support and education and assists with goal-setting (Heymsfield & Wadden, 2017).
The goal for the patient is to achieve improved outcomes through weight loss. He or she engages in counseling offered by a trained professional to reach a healthy BMI. Through the weight loss programs, the patient achieves improved control of blood sugar level and blood pressure, which reduces the risk of obesity-related complications such as T2DM, CVD, and hypertension. Thus, in this individual, obesity and its comorbidities are well managed.
A patient with managed obesity leads a healthy lifestyle. He or she has access to specialist care. The patient attends his or her appointments with a dietician who advises on diets that can help lose weight and maintain it. As a result, he or she makes healthier food choices and adheres to the recommended servings of fruits, vegetables, proteins, and grains. The patient also utilizes the services of a health coach who offers motivation and assistance to realize weekly weight loss targets (<2 pounds a week) through exercise and diet. Behavioral modification is another non-pharmacological intervention the counselor can use to help the patient manage obesity.
It entails identifying and addressing inappropriate behaviors – feasting on snacks and sugar-sweetened beverages and inadequate fruits/vegetables in a diet – and attitudes. The patient also uses medications as adjunctive therapies to diet and exercise in obesity management.
Unmanaged obesity is associated with a high mortality risk related to comorbid complications such as CVD and stroke. Therefore, an individual with a managed disease achieves normal concentrations of blood glucose and cholesterol, which is associated with improved liver and heart function (Sheu et al., 2017). As a result, the patient’s quality of life and life expectancy are improved. Adherence to dietary and exercise recommendations coupled with pharmacotherapy leads to better clinical outcomes – reduced hospitalizations and emergency admissions.
Disparities in obesity are significant in America. Limited health coverage and the failure to recognize obesity/overweight as a chronic condition have contributed to the high prevalence of this condition nationally. A disproportionate increase in obesity incidence has contributed to disparities between whites and minorities. Nationally, the prevalence of obesity is estimated to be 34.9% (Ogden, Carroll, Kit, & Flegal, 2014). However, this rate varies by socioeconomic areas, region, state, and ethnicity.
The social and economic environment in poor rural neighborhoods cannot promote healthy behaviors (exercise and diet). In Minnesota, low socioeconomic areas (such as Roseau County), a higher adult obesity prevalence (33%) than high-income ones like Hennepin (23%) (University of Wisconsin/Population Health Institute (UW/PHI), 2018). Disparities in access to care, ability to pay, and treatment received may account for these differences.
It is estimated that 9% of Roseau County residents are uninsured and only 48% have access to exercise opportunities and quality care compared to 7% and 99%, respectively, in Hennepin (UW/PHI, 2018). Thus, higher socioeconomic status is associated with better education, opportunities for exercise, healthier food, availability of primary care providers, and a lower number of the uninsured, which leads to improved obesity outcomes.
Regionally, Southern regions have a higher obesity rate than Western ones. According to Myers et al. (2015), adult obesity/overweight is lower in the West (25%) than in the South (32%). Differences in regional characteristics, including high unemployment and significant minority populations who have limited access to care and are uninsured account for this disparities. Similarly, obesity rates vary by state.
For example, Alabama has a higher number of adults who are obese (38%) than New England (23%) (Myers et al., 2015). Ethnically, 47.8% of the non-Hispanic black population are obese compared to 32.6% of whites (Myers et al., 2015). Variations in access to care, ability to pay (amount of coverage), type of treatment received, and clinical guidelines used could account for these disparities.
Differences in the management of obesity exist between countries. In low- and middle-income nations, obesity is an emerging problem. Therefore, national efforts are directed more on prevention than on management. Mexico introduced a soda tax to reduce caloric intake that increases the risk of obesity/overweight (Ford, Patel, & Narayan, 2017). Therefore, the approach adopted by this country to prevent this disease entails food subsidies to promote healthier dietary choices and taxation of unhealthy snacks and beverages.
In contrast, China’s guidelines for the prevention of obesity include health education, interventions that improve physical activity and supporting behavior change in households, schools, and social places (Ford et al., 2017). These strategies are similar to those used to manage this disease in the US – diet, exercise, and behavioral modification. However, they are less focused on access to healthcare and ability to pay for care compared to the American guidelines.
Managed Disease Factors
A range factors determine a patient’s success in managing his/her weight. The main barriers to obesity management include access to care, insurance status, education, federal/state support, cultural attitudes, and health literacy. These challenges affect health-seeking behavior in patients, resulting in poor outcomes, low quality of life, and high morbidity and mortality.
Access to care to weight-loss counseling and treatments – drugs or surgery – is critical to being able to manage overweight/obesity. Healthcare accessibility allows patients to receive advice from primary care practitioners on how to lose weight and maintain it. They can also frequent clinics offering treatments for secondary conditions related to their weight (Haslam, 2014). A high supply of primary care providers in an area improves access to weight-loss consultation and counseling. Therefore, obesity patients present for assessment and tests that measure baseline features during the initial stage of weight management.
They also benefit from follow-ups and screening for co-existing conditions that may be present, such as T2DM. Weight loss and maintenance is also dependent on access to care. Intensive weight-loss programs are more effective than community interventions or primary care (Haslam, 2014). A patient with well-managed obesity has access to advice on diet, exercise, and behavioral therapy. He or she works with a provider to set and achieve weight targets and avoid relapse. The patient also has access to pharmacotherapy, bariatric surgery options, and follow-up.
Insurance status is a strong predictor of obesity rates. Under the Affordable Care Act (ACA), obesity patients can receive “intensive behavioral interventions” funded by federal (Medicaid and Medicare) or private health plans to assist them in losing weight and maintaining it (Doshi, Bleich, & Gudzune, 2017, p. 387). The benefits to the people with insurance include regular assessment of BMI, dietary habits, and exercise.
They can also access multidisciplinary counseling from different health practitioners such as dieticians and psychotherapists, resulting in improved weight loss outcomes. Treatments for obesity-related comorbidities, such as diabetes, are also covered by most insurers. Thus, the patient receives care for obesity and secondary problems that affect the quality of life. In addition to covering intensive weight-loss counseling, some health plans pay for bariatric surgery (Doshi et al., 2017). Thus, an insured obesity patient benefits from multidisciplinary care, resulting in effective management of weight and related comorbidities.
Health literacy (HL) is another crucial factor in being able to manage obesity. It entails the ability to use health information to make informed choices related to disease prevention and treatment (Haslam, 2014). Obese people with high HL seek obesity diagnosis and weight-loss counseling services available in primary care facilities. They also utilize the health advice received from practitioners to manage their condition.
HL is associated with reduced hypertension and improved blood pressure and glycemic control in obese patients (Haslam, 2014). HL is also associated with better health choices. The patient can utilize health-related information to make better decisions regarding diet and exercise. He or she is likely to avoid dietary practices and sedentary lifestyles that lead to weight gain and chronic diseases.
Unmanaged Disease Factors
Unmanaged obesity is related to a lack of access to care, limited health insurance, and low health literacy. Its outcomes include high morbidity and mortality and reduced quality of life. A lack of access to care predisposes obese people to unmanaged weight and unhealthy BMI. They cannot receive physician advice and support that is crucial to the long-term management of obesity. In most cases, primary care providers do not offer weight-loss counseling and treatment with sufficient regularity or frequency (Doshi et al., 2017). Further, individuals with suboptimal access to these services are less likely to reduce their caloric intake and engage in frequent physical activity than those with a provider (Doshi et al., 2017).
Access to care depends on the number of physicians practicing in an area, which is a strong predictor of obesity/overweight rates. According to Doshi et al. (2017), increased supply of primary care providers is related to reduced obesity status. However, most practitioners would not choose to reside and practice in poor neighborhoods. Thus, high-poverty areas are more likely to experience a limited access to care than high-income ones, predisposing obesity patients to poor outcomes.
Inadequate health insurance accounts for the low number of people presenting for obesity diagnosis and management. Most health plans do not cover intensive weight-loss interventions and bariatric surgery that are critical in being able to manage obesity (Haslam, 2014). Further, provider reimbursement for obesity management is lacking. Thus, low-income patients in need of weight management services may not access them. They are unlikely to seek and utilize of obesity care in primary health care facilities due to cost barriers. Due to their insurance status, they cannot access intensive interventions – diet, exercise, and behavioral change – offered by specialists. They are also less likely to participate in weight management methods consistent with clinical recommendations.
Low health literacy (HL) is also a barrier to effective management of obesity. Obese/overweight people with low HL are at risk of morbidity and mortality related to T2DM, hypertension, and CVD (Haslam, 2014). Additionally, they are not likely to seek preventive care compared to their literate counterparts. Individuals with low HL cannot obtain and use health information to improve their health. They include people from economically disadvantaged areas and the uneducated. They exhibit reduced readiness to change unhealthy lifestyles and adhere to exercise and diet recommendations. As a result, they suffer from unmanaged obesity and secondary complications that affect the quality of life.
Unmanaged Disease Characteristics
Obesity/overweight is a physical and psychological issue. Patients with the unmanaged disease typically have a high BMI (>30 kg/m2). They are also at risk of chronic diseases, including T2DM, high blood pressure, sleep apnea, and CVD (Jensen et al., 2013). A morbidly obese person’s BMI is considered unhealthy for his or her stature owing to body fatness. Therefore, he or she will experience joint pains caused by weight.
Excessive fat is distributed in the abdomen and arms giving the individual a pear shape. The waist circumference, which is a measure of abdominal fat, is more significant in these individuals than in lean people. The WC for a male and female with unmanaged obesity is ≥40 and ≥35 inches, respectively (Jensen et al., 2013). Such an individual is unable to engage in physical activity and is dependent on family caregivers for his/her needs.
The emotional status of a person with unmanaged obesity includes various behaviors that show a variation in the general population. The individual has lower self-esteem related to the social stigma attached to body fatness. He or she also exhibits suppressed impulse control and a passive-aggressive personality (Jensen et al., 2013). Morbidly obese patients tend to complain of somatic symptoms such as pain due to anxiety. They suffer from eating disorders, such as binge eating, due to depression and body image dissatisfaction. They may also show hopelessness about their ability to lose weight and achieve a healthy BMI.
Patients, Families, and Populations
Obesity has significant health and social impacts on the patient, family, and community. Obese individuals who adhere to dietary, exercise and behavioral change recommendations can manage their condition to lead healthier and productive lives. Weight-loss interventions can help a patient to achieve a lower BMI, reduce the risk of chronic illnesses, and remain actively engaged in his/her occupation. Thus, managed obesity can significantly improve one’s quality of life and economic participation.
However, the morbid obesity predisposes a patient to limitations related to comorbidities. The excess weight strains the body. Thus, the patient has to rely on caregivers and emergency care to manage co-existing conditions. Morbid obesity also leads to reduced physical activity and strained social relationships because of the complex health needs of an obese person that require 24-hour care (Haslam, 2014). An obesity patient would need a support system (psychosocial and nutritional) to achieve behavioral change and cope with social stigma.
The disease indirectly impacts family dynamics, lifestyles, and roles negatively. A morbidly obese person requires constant care from a spouse or a paid caregiver. An adult family member caring for this patient will have to stop working because of the time-consuming care needed. Family roles and functioning may also change if a spouse or a child becomes obese. In this case, domestic chores have to be done by others, straining interpersonal relationships.
Caring for an obesity patient may also add financial and physical strain to the rest of the family. The individual has to make lifestyle changes in diet and physical activity to lose weight. Dietary modifications may not be acceptable to others. The burden of caring for an obesity patient increases if more than one family member suffers from the disease.
Obesity also has a significant indirect effect on the community. A high prevalence of this disease strains the available healthcare resources, as patients with this condition also need care for secondary complications. Funds have to be reallocated to establish treatment centers and increase the supply of physicians in the community to combat this disease. Exercise facilities such as gyms and walking tracks have to be created to encourage physical activity. Additionally, support groups would be required in a community with a high obesity rate to help patients deal with weight-related anxiety and depression.
Early diagnosis and prevention of obesity are more cost-effective than treatment. Patients incur out-of-pocket expenses related to physician consultation, follow-up, laboratory diagnostic tests, dietary changes, drugs, counseling, and exercise equipment. A few health insurance providers cover some of these costs but charge high premiums. Most insurers have excluded intensive weight-loss counseling and bariatric surgery from their coverage plans (Doshi et al., 2017).
Thus, uninsured or inadequately insured obesity patient incurs direct costs related to diagnosis and management. He or she may also need to purchase assistive devices such as walking aids to help in mobility. There are also indirect costs associated with morbidity. As already stated, obese individuals are at risk of co-occurring conditions such as T2DM and hypertension. Increased hospitalizations and outpatient visits due to these health issues lead to additional costs to the patient.
The family also experiences financial strain related to caring for a patient with morbid obesity. Indirect costs may come from increased family spending on coverage. Insurance providers take into consideration obesity-related comorbidities in cost calculation, pushing insurance premium upwards (Doshi et al., 2017). Obesity is also linked to high mortality risk. Therefore, premiums payable to life insurance schemes may also increase, leading to a financial burden on the family.
Obese persons require constant care. Thus, caregiver responsibilities are likely to increase, resulting in physical and emotional strain on family members. Additionally, household disposable income will reduce due to increased expenditure on food, medications, and assistive devices. Additional financial cost could come from home renovations to allow the patient to lead a comfortable life. Household income will also decline because the obesity patient may be unemployed and the caregiver may not find time to work.
The financial strain is not limited to the patient and family, but it is also felt by the community. Outreach and education programs have to be initiated to promote healthier practices in schools and social institutions. Additional costs may come from establishing community gyms and walking paths to encourage exercise. High obesity rates would also increase the demand for support systems and adaptive equipment to assist in the mobility of obese individuals. More resources and funding would be needed to improve access to obesity treatment centers and specialists, such as dieticians. The primary care providers and facility capabilities also have to be expanded to cater for the complex needs of these patients.
Best Practices Promotion
The NHLBI guidelines for obesity management focuses on three areas: exercise, diet, and behavioral change. My facility, through its weight management program, also emphasizes behavior modification, proper nutrition, physical activity, and emotional wellbeing of patients. The aim is to achieve sustainable weight loss and to ensure appropriate management of comorbid conditions. A specific initiative I would introduce as an Advanced Practice Nurse is enhanced follow-up support. According to Haslam (2014), follow-up visits after weight loss or bariatric surgery can help prevent nutritional problems that may lead to a relapse. Additionally, I would maintain contact with the patients to promote adherence to dietary recommendations and behavioral change.
A patient-centered approach to obesity/overweight management is required at the facility. I would implement a holistic, practical intervention focusing on assessment and self-care. Height and weight measurement scales would be necessary calculating BMI.
I will provide charts to individuals diagnosed with obesity to help them track their BMI at home and booklets with nutritional information. My approach to obesity management would entail a patient-nurse partnership in service provision, which is a best practice guideline (Baillie, 2016). Working with patients to determine barriers to sustained weight loss is advocated for in obesity management. It would help identify and address maladaptive behaviors, attitudes, and dietary practices. Providing them with booklets with appropriate information would promote self-care, which is an evidence-based practice for improving an individual’s control over a disease.
My facility’s weight management program comprises of services tailored to medical, surgical, and children’s needs. Overweight patients’ records are kept in separate general practitioners’ offices, which makes searching of individuals eligible for follow-up difficult. Creating a single obesity register that captures each person’s BMI, comorbidities, metabolic syndromes, and clinic attendance can help address this gap. It will also be useful in monitoring patient progress. Assessing the readiness to start weight-loss counseling will promote weight loss maintenance and prevent relapse. The assessment will also provide an opportunity to address unrealistic patient beliefs and expectations that could hamper obesity management.
Implementing best practices in screening, assessment, and management of obesity at Allina Health will lead to better patient outcomes. The first intervention I will use to promote best practices in management of this disease at the facility is improving BMI measurement.
An accurate stadiometer will lead to precise BMI values to guide the diagnosis and assessment of obesity, especially in pediatric patients. A definitive diagnosis of this disease is essential in patient monitoring and evaluation of response to interventions (Haslam, 2014). Therefore, a useful measurement tool will avoid a misdiagnosis that could lead to suboptimal treatment. I will also provide a timeline chart to nurses describing how and when each task (from screening to management) should be conducted.
The second intervention will be staff training on the screening of obese individuals, including children, to improve adherence to guidelines and processes of care. Adult and childhood obesity is associated with an elevated risk of comorbid conditions, such as high blood pressure and T2DM (Haslam, 2014). Thus, adequate diagnosis by providers is essential in being able to manage this disease. Training on current obesity assessment and treatment protocols will help achieve this goal. Additionally, nurses will receive medical education on dietary and exercise recommendations for overweight/obesity patients. The training will also focus on lab tests (lipid panel, AST, and ALT), available treatments for comorbidities, and behavioral therapy options.
The third intervention will involve readiness assessment of patients before weight-loss counseling. This strategy will help gauge their commitment to lifestyle change. Clinical visits will provide an opportunity to assess one’s readiness to lose weight. The nurse can also identify and address unrealistic patient beliefs, attitudes, and other barriers to effective obesity management. Thus, the strategy will ensure obese individuals lose weight and maintain it even after completing the weight-loss program.
The success of the intervention to improve the accuracy of BMI measurement during the initial consultation will be evaluated by computing its sensitivity and specificity. BMIs of patients will be calculated by dividing individual weight by height measured by an accurate stadiometer. The percentage specificity of the BMI will be calculated before and after the intervention to determine its diagnostic performance. Measurements will be repeated twice, and consistency in the values will confirm the accuracy of the tools. Improved response to treatment – diet, exercise, and medications – will indicate the validity of the BMI and weight and height measurements. Further, body fat and lean mass will be calculated to determine if BMI can discriminate between the two variables.
The evaluation of the staff training intervention will involve pre- and post-intervention surveys. Baseline knowledge levels of practitioners will be evaluated to identify gaps in obesity management. This initial survey will assess the participants’ comprehension of screening, assessment, diagnosis, and management guidelines for this disease. They will also demonstrate how to measure height and weight accurately and calculate BMI, especially for obese children. Their interpretation of the BMI percentile to diagnose obesity or overweight will also be evaluated.
Additionally, using a scientific instrument (survey questionnaire), the practitioner’s knowledge of weight-loss counseling and nutritional recommendations and exercise plans for losing weight will be measured. Subsequently, the participants will receive training to improve their skills. Their post-implementation understanding of screening, assessment, and management of obesity will be compared with baseline data to determine the efficacy of the intervention.
The third intervention will be readiness assessment before a weight loss program. Successful implementation of this strategy will be indicated by low dropout rates, adherence to dietary recommendations and exercise routine, and adaptive behaviors and attitudes. Readiness assessment will be done during the initial clinical consultation. An interview tool will be used to measure this variable.
The questions will focus on the date the individual began experiencing weight problems, weight-loss history and the methods used, and the desired BMI. The individual’s reasons for delaying weight loss will also be explored. The dropout rates from the intensive weight-loss program will be compared with baseline values to determine the success of this intervention. Additionally, the patient’s self-reported adherence to the recommendations and behavioral modifications will be measured to determine the success of the intervention.
Allina Health. (2017). Weight management. Web.
Baillie, L. (2016). Working in partnership with patients and carers. Nursing Standard, 31(15), 42-45. Web.
Doshi, R. S., Bleich, S. N., & Gudzune, K. A. (2017). Health Professionals’ perceptions of insurance coverage for weight loss services. Obesity Science and Practice, 3(4), 384-389. Web.
Ford, N. D., Patel, S. A., & Narayan, K. M. V. (2017). Obesity in low- and middle-income countries: Burden, drivers, and emerging challenges. Annual Review of Public Health, 38, 145-164. Web.
Haslam, D. (2014). Obesity in primary care: prevention, management and the paradox. BMC Medicine, 12(149), 1-4. Web.
Heymsfield, S. B., & Wadden, T. A. (2017). Mechanisms, pathophysiology, and management of obesity. The New England Journal of Medicine, 376, 254-266. Web.
Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A., … Yanovski, S. Z. (2013). 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults. Circulation, 129(25), S102-S113. Web.
Minnesota Department of Health (MDH). (2018). Minnesota obesity plan. Web.
Myers, C. A., Slack, T., Martin, C. K., Broyles, S. T., & Heymsfield, S. B. (2015). Regional disparities in obesity prevalence in the United States: A spatial regime analysis. Obesity, 23(2), 481-487. Web.
Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. The Journal of the American Medical Association, 311(8), 806–814. Web.
Sheu, N., Lin, Y., & Chen, C. (2017). Mechanism, pathophysiology, and management ofobesit y. The New England Journal of Medicine, 376(15), 1490-1492. Web.
University of Wisconsin/Population Health Institute (UW/PHI). (2018). Minnesota: Adult obesity. Web.