Body Weight Management and Nursing Care

Nursing Care for Weight Management

Whats is Weight Management,Informal Weight Loss and BMI Calculation,Environmental Factors Influences Weight Management,Research On Weight Management,Failure to Weight Loss,Behavioral Weight Management,Goal of Weight Management.

Whats is Weight Management

     Weight management, defined as deliberate actions to reduce and maintain healthy body weight, is classified as formal and informal. Formal weight management consists of paying for organized services to assist individuals with weight reduction.

Informal Weight Loss and BMI Calculation

    Informal weight management includes personal weight loss methods without professional assistance. Weight management is usually targeted at reducing weight (versus gaining) because of societal pressures to be thin and current epidemic incidences of overweight, obesity, and their com morbidities. 

    Overweight is defined as 25 to 29.9 body mass index (BMI) and obesity is defined as BMI ≥ 30 (National Heart Lung and Blood Institute [NHLBI), 1998).

    In the United States, the incidence of being overweight increased from 25% to 33% between 1980 to 1991. In 1995, costs related to obesity were $99 billion and escalated to $117 billion in 2000 (NHLBI, 1998). 

    Currently, the Centers for Disease Control reported that almost two thirds of adult Americans and 15% of their children are overweight or obese. Obesity has remained more prevalent among women (33%) compared to men (28%). 

    The Third National Health and Nutrition Examination Survey (NHANES III) showed about half of minority women populations to be overweight or obese, namely African-American (50%), Mexican-American (40%), and non-Hispanic whites (30% ). 

    Overweight and obesity increase risk for mortality and morbidity from cardiovascular disease, which remains the number one killer of women in the US.

Environmental Factors Influences Weight Management 

    Experts agree that environmental influences, rather than biological reasons, explain the obesity epidemic over the past 3 decades. Four factors explain the environmental stimulus response nature of the rise in obesity in the US:

(1) a fast-paced eating style consisting of fatty, glycemic “fast foods” and super sizing

(2) excessive calorie intake

(3)) reduced physical activity and technological dependence

(4) heightened responsiveness to food as a stimulant (Hill, Wyatt, Reed, & Peters, 2003)

Research On Weight Management 

    To date, few studies focused on psychological, sociocultural, and spiritual aspects of weight management (Timmerman & Gregg, 2003). Long term habits of overeating without hunger and with little or no physical exercise in a fast-paced society must be examined as contributors to the growing weight problem among US citizens. 

    Most weight-loss treatments in the US have not helped reduce weight over the long term and have even contributed to the overweight problem (Hill, JO, Wyatt, Reed, & Peters, 2003). 

    As obesity increased, so did many associated comorbid conditions, including heart disease and hypertension, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems, cancers, and type 2 diabetes. Insulin resistance syndrome (metabolic syndrome) is estimated to affect about 25% of American adults. 

    The safest, most effective way to reverse insulin resistance, as most of the obesity comorbidities, is through physical activity, dietary intake (less glycemic, more fiber), and weight loss (Tuomilehto et al., 2001).

Failure to Weight Loss 

    Failure rates for weight loss treatments in the US are estimated to be as high as 90% to 95%. Even people listed in the National Weight Control Registry, those who reported maintaining an average weight loss of about 30% for 5.5 years, reported 91% failure rate before eventually succeeding. Treatments that fail to promote long-term weight management: 

(a) are restrictive in calories, choices, and when to eat

(b) are unit-dimensional using one major means to achieve weight loss and do not include regular exercise

(c) do not permit individuals to tailor weight management to their preferences and lifestyles

    Treatments that restrict calories, choices, and when to eat offer a temporary modification that is unrealistic for the long term. Diets can lead to weight loss but rebound weight gain and psychological consequences remain a concern. 

    Medical treatments (surgery and drugs) can yield short-term weight loss, but fail in the long term. Poston, Haddock, Dill, Thayer, and Foreyt (2001), in a meta-analysis of randomized clinical trials using lifestyle changes with pharmacotherapy, found that most trials used low calorie diets with pharmacotherapy (41%), low calorie diets alone (2.5%), and only 17% included any form of exercise with pharmacotherapy.

    Strategies that concentrate on modifying behavior by differentiating stimuli before, during, and after eating are a healthy start toward lasting weight management (ie, identifying stimuli other than hunger that trigger eating, monitoring amounts and conditions during eating, and rewarding appropriate actions). 

    One reason why behavioral techniques have limited success is because they seek to control the diet and environment without considering eating as a coping mechanism to manage unpleasant feelings (Popkess Vawter, Brandau, & Straub, 1998). 

    Few current weight management behavioral approaches, cognitive restructuring, or combinations therefore, directly address how negative beliefs about self and irrational perceptions of the world can trigger negative self talk with resultant overeating and no exercise responses.

Behavioral Weight Management 

    Most behavioral weight management programs that emphasize stimulus control of intake and output by dieting and behavior modification are usually one-dimensional and focus mainly on calorie reduction. 

    Few weight management programs take a holistic, multi dimensional approach to lifestyle changes using strategies to correct underlying overeating, lack of exercise, and poor self esteem. Most weight management programs place greater emphasis on eating, exercise, or psychosocial aspects, rather than holistic emphasis on all three dimensions.

    There is growing evidence that 5% of maximum weight lost contributes to positive changes in obesity comorbidities (Yanov-ski & Yanovski, 2002). The NHLBI weight-management treatment and programs like “America on the Move” are national initiatives that have accommodated people's busy lives by suggesting “real world, do-able” eating and exercise goals for arresting the obesity epidemic; more stringent recommendations of the past have only fueled the epidemic (Hill et al., 2003). 

    Studies are lacking that test the effectiveness of holistic approaches that accompany busy lifestyles. A few computer applications related to weight management have emerged, including treatments for smoking cessation, exercise, and food shopping, but Internet obesity studies are rare (Tate, Wing, & Winett, 2001).

Goal of Weight Management 

    The ultimate goal of weight management is to prevent obesity and its comorbidities (Serdula, Khan, & Dietz, 2003). Primary care clinics are frontline settings to approach people about weight management, but structured and practical treatments are still lacking. Many reasons have been reported to account for ineffective weight management lack of time, inadequate training, labor intensity, and pessimism that intervention is useless. 

    Patients were not satisfied with primary care physicians weight-loss recommendations (Wadden et al., 2000). Less than half (43%) of surveyed obese patients reported that providers actually advised them about weight loss, and almost 30% reported that they received no weight management counseling. 

    Providers may not be aware of their powerful influence in helping patients with weight management. To promote healthy weight among Americans, long-term, lifestyle change intervention studies are vital, using qualitative and quantitative measurements of physical and psychosocial weight-management strategies.