Obesity †case study and health promotion paper Essay

Obesity has reached global epidemic pro arrogates, and has become a major health problem of out society. According to Peeters et al. (2007), 32% or 60 million people ar now obese in the United States. The condition develops as a result of the interaction between genetics, lifestyle behavior, and ethnical and environmental influences. Fat accumulates when to a greater extent energy is consumed than expended. The National Heart, Lung, and Blood Institute (NHLBI) has adopted a classification system of body mass index (BMI). BMI, the confirmative measure of body change, identifies the over pack down and obese individuals. A BMI of 25-29 kg/m2 is considered over clog, 30-34 kg/m2 is mild obesity, 35-39 kg/m2 is moderate obesity, and above 40 kg/m2 is extreme obesity (Palamara, Mogul, Peterson, Frishman, 2006).Obesity develops due to senior high school-fat, high wampum diet coupled with a decline in carnal activity. Modern living conditions, eating habits, and quality of solid food lead to over-consumption of cheap, super sized portions. More cars, roads, and fast food restaurants at every corner, as well as quick, ready to eat microwavable dinners loaded with fat, salt, and easy carbohydrates atomic number 18 easier and often less expensive than nutritious, quality food products. Furthermore, the technology has made humans rely on mechanical devices. The automated inventions designed to irritate life easier, perform 1000s of tasks that in the past required physical labor. As a result of sedentary life and over-consumption, the excessive fat accumulates in the body, and whitethorn guide significant health consequences.Multiple research studies have revealed that excessive free encumbrance gain increases the risk of diabetes, high crease pressure, dyslipidemia, coronary shopping center disease, stroke, osteoarthritis, and many forms of cancer. In particular, type AB obesity has been recognized as strongly associated with the development of diabetes a nd cardiovascular diseases (Behn & Ur, 2006) (Chen et al., 2007) (Balkau et al., 2007) (Despres, 2007). Due to the dangerous health risks of obesity, it is considered a disease that requires treatment (Palamara et al., 2006). The Centers for Disease Control and ginmill (n.d.) estimated that medical exam expenses related to obesity cost $92.6 billion in the year 2002, and the condition causes 300,000 deaths per year.Nevertheless, prevention of the multiple health consequences of obesity is possible by clog reduction. Bardia, Holtan, Slezak and Thompson (2007) suggested that Even a sm any strike in a patients weight would result in better control of multiple diseases, enkindle quality of life, greatly improve a patients morbidity, and result in small(a)er health care use and medical costs. In addition to preventing many diseases, weight reduction can improve the already present disorders. Research indicates that weight loss of 4% to 8% is associated with a decrease of systolic a nd diastolic blood insistency by 3 mmHg (Mulrow et al., 1998). The main weight reducing interventions include diet, coif, psychological, behavioral, pharmacotherapy, surgery, and alternative therapies (Vlassov, 2001).However, the eagle-eyed call soundness of these interventions has non proven effective, as majority of people regain their weight after losing it (Biaggioni, 2008). Guidelines for weight reduction suggested by NHLBI involve the following initial reduction of 10% of body weight, low calorie diet (800-1 five hundred kcal/d) 30% calories from fat, 15% calories from protein, and 55% calories from carbohydrates, fooling deficit of 500-1000 kcal to lose one to two pounds per week during hexad months, long call weight maintenance, and physical activity for 30 to 45 minutes three to five days a week (Palamara et al., 2006). Health care providers are faced with the prevention and management of a major cause of morbidity and mortality for which effective life long interve ntions are desperately needed.CASE reputationbobsled is a 38 year old white male. Except for hypertension, he considers him ego healthy. He has seen his family doctor three months ago for regular blood pressure check up, as he does every six months. Bob is married, has four adolescent children, and works as an automobile dealer for fourteen years.Past medical history hypertension, obesity, hyperlipidemiaAllergies none to medications, latex, animals, foods, or environmentalHospitalizations / surgeries / injuries tonsillectomy in childhoodMedications lisinopril 20mg orally dailyFamily medical history mother and brother with hypertensionSocial history lives with wife and children, all very supportive of each other, get along well,drinks 2 glasses of whiskey socially on weekends, denies take in or illicit substance usePhysical activities walks on treadmill for twenty minutes once or twice a week, occasionally plays volleyball game with family on weekendsDaily aspiration patterns brea kfast four sandwiches with cheese and ham lunch home made soup, cooked or fried sausage dinner salad, practically of potatoes, 2 portions of steak or meatloaf or chicken, pickled vegetables supper pasta with sauce or pizza snacks chips, cookies, candy, pretzels and fruits, all throughout the day fluids 8 glasses of soda, juice, pissing or milk.Review of systems unremarkable, no complaints.Weight 280 pounds, Height 63, Waist circumference 52, BMI 35kg/m, BP 150/90 mmHgMost fresh abnormal laboratory tests total cholesterol 220, triglycerides 310All other results including glucose, blood count, BUN, creatinine, and liver enzymes were within normal range.Bob admitted that weight loss has been one of the greatest contends forhim. His several previous attempts at weight reduction have been unsuccessful. He expressed willingness and readiness to try again, but was concerned that he would non be able to follow the plan long term. Bobs family was very supportive, and willing to aid with his weight loss attempts. To identify the health risks of obesity, and to determine interventions to cut out those risks, research articles were examined. The search for relevant studies was conducted using OVID MEDLINE, PUB MED, CINAHL, and COCHRANE databases.SUMMARY OF LITERATUREDietary interventions form the fundamental element of the management of obesity. There is a encompassing variety of possible diets, but no consensus on which is the most effective for weight reduction. A review by Noakes and Clifton (2004) compared the effects of a low carbohydrate diet and a low fat diet. Overall, the studies revealed that a very low carbohydrate diet resulted in significantly more weight loss than low fat diet in the short to medium term. On the other hand, a moderately low carbohydrate diet resulted in similar weight loss as a low fat diet. Moreover, the very low and moderately low carbohydrate diets have been found to more effectively sign triglyceride, and increase high dumbness lipoprotein (HDL) levels compared to low fat diet.Again, comparison between the low carbohydrate and low fat diets was performed by Lecheminant et al. (2007). In a quazi-experimental design, 102 participants were designate every to a low carbohydrate (LC) or a low fat (LF) group. Both groups followed a very low energy diet and muddled significant body weight (LC 20.4 kg, LF 19.1 kg) and waist circumference. The differences between the two groups were non statistically significant. In addition to the diet, all participants were involved in brisk move 300 minutes per week, and all were issued pedometers to monitor their progress. Also, both groups were equally effective at preventing weight re-gain over six months, and both groups were found to have a decreased blood pressure as a result of weight loss.Similarly, a systematic review by Pirozzo, Summerbell, Cameron and Glasziou (2002) compared the effects of a low fat diet to low calorie diet and low carbohydrate diet. Si x disarrange controlled trials with a total of 594 participants were analyzed over a period of six to eighteen months. Overall results demonstrated non-significant differences in weight loss, weight maintenance, serum lipids, and blood pressure between all the diets reviewed.Moreover, a one year randomized trial by Dansinger, Gleason and Griffith (2005) compared Atkins, Zone, Weight Watchers, and Ornish diets. A single center randomized trial assigned 160 participants among the four diet groups. After one year, all diet groups were found to have significantly reduced weight and waist size, without significant differences between groups. Similarly to previous studies, low carbohydrate diets reduced triglycerides and diastolic blood pressure, all except Ornish diet group increased high density lipoprotein (HDL), and all except Atkins diet group reduced low density lipoprotein (LDL).In addition to energy restriction through the diet, energy expenditure may enhance weight loss. In a m eta-analysis by Shaw, Gennat, ORourke and Del louse up (2006), 41 randomized controlled clinical trials were analyzed to determine the effects of exercise in overweight and obese adults. The multiple exercise interventions included walking, jogging, cycle ergometry, weight training, aerobics, treadmill, stair measuringping, dancing, ball games, calisthenics, rowing, and aqua jogging. The 3476 participants exercised three to five days a week for a median eon of forty five minutes a day. Several of the studies compared exercise to diet either alone or in combination with exercise. The results revealed that exercise alone led to marginal weight loss, but when have with diet produced significant weight reduction.Moreover, comparing the intensities of the various types of exercise activities, it was found that both high and low intensity exercises were associated with weight loss. Nonetheless, high intensity bring forth only slightly more weight reduction than low intensity, but whe n the diet component was added, the difference between high and low intensity was not significant. Additionally, the findings revealed that systolic blood pressure reduction was favored by diet over exercise, and diastolic bloodpressure was reduced equally likely by exercise as by diet. Furthermore, exercise did not reduce cholesterol levels, but was found to reduce triglycerides equally well as diet. Patients involved in the exercise trials improved diastolic blood pressure, triglyceride, high density lipoprotein, and glucose levels regardless of whether they lost weight.One of the most difficult aspects of weight loss plans is consistent bond certificate to exercise. A meta-analysis by Richardson et al. looked at the effects of walking on weight reduction (2008). 307 participants in nine interventional studies were provided with pedometers to monitor step count. Pedometers served as motivational tools to self monitor and reach the goals of walking. The participants logged the dai ly recorded steps, and reviewed their results during group meetings. On average about 0.05 kg was lost per week after walking two thousand to four thousand steps per day. Although the amount of weight lost in the trials was small, adherence to walking programs and increasing step count according to preset goals is definitive for the beneficial effects on health. The physical activity reduced the risk of cardiovascular events, lowered blood pressure, and helped maintain lean muscle mass of the participants. The studies have shown that the use of pedometer is helpful in monitoring the progress of physical activity, and is a good way to motivate continued increase in walking.Another meta-analysis compared dissimilar psychological interventions and their effects on weight reduction (Shaw, ORourke, Del Mar, Kenardy, 2005). 36 randomized controlled clinical trials including 3495 participants were evaluated. The majority of studies assessed the effects of behavioral interventions on weig ht loss. The duration of clinical contact with the participants ranged from 7 to 78 weeks, with sessions lasting 60 minutes periodical. The techniques included stimulus control, goal setting, and self-monitoring. The therapies enhanced dietetic restraints by providing adaptive dietary strategies, and by increasing motivation for physical activities, and to maintain adherence to the healthier lifestyle.Behavioral therapy was successful at decreasing weight as a complete strategy (2.5 kg), and even greater weight reduction was attained when combined with diet and exercise (4.9 kg). Several evaluated studies also assessed cognitivetherapy, psychotherapy, relaxation therapy, and hypnotherapy, but the results of these either did not reveal significant weight reduction, or resulted in weight gain. Moreover, a number of studies found that weight loss was associated with reductions in systolic and diastolic blood pressure, serum cholesterol, triglycerides, and fasting plasma glucose. The se findings once again confirm the important health benefits of reducing weight.Overall, the research suggests that most diets are equally effective at weight reduction. There are multiple more or less popular diets known, and according to Dansinger et al. (2005), more than one thousand diet books are now accessible. Instead of searching for the best available, obese patients should be advised that any diet would be more effective than the one they are shortly consuming. Moreover, diet modification has been shown to be more effective than exercise, but both are beneficial in reducing cardiovascular risk factors. Exercise does not have to be intense, and walking on most days of the week is sufficient for risk reduction when continued long term. Finally, addition of behavioral interventions may strengthen motivation and self monitoring, and enhance weight loss maintenance.INTERVENTIONS AND RESULTSBob was presented with the literature findings on health risks and health promotion, and was encouraged to lose weight by diet, and involvement in more physical activities. He was introduced with the possible options, and it was recommended that he participates in designing his weight loss plan. This way Bob could have more control over the interventions, and was able to incorporate his preferences. Bob identified his perceived benefits of losing weight as improved body image, mood, physical fitness and agility, reduced blood pressure, and reduced risk of comorbidities. The main barriers were mainly the resistance to eliminate favorite foods, and occasional laziness to perform physical activities.Instead of starting one of the multiple popular diets, Bob headstrong to reducehis portion sizes initially by 30%, substitute supper and snacks by fruits and vegetables, and eliminate soda and juice. To assure smaller portion sizes, Bob was encouraged to use a smaller plate than usual. He also agreed to drink at least two liters of water a day, especially with meals, to reach satiety sooner. He was encouraged to keep a journal of all his daily intakes of food and drink to monitor his diet, and to identify around hidden sources of excess consumption. Moreover, to avoid excess eating, Bob was instructed to only eat at the table, and to not allow family members to eat any food while seance on the couch or in front of the computer.He also decided to become more physically active, and his choice of daily exercise was walking. Bob was encouraged to purchase a pedometer to monitor progress in physical activity, aiming for at least two thousand steps a day. Richardson et al. (2008) informed that a two thousand step walk was estimated to equal one mile. Bob was also encouraged to set weekly walking goals, slowly increasing his step count. Bobs family was also involved in his attempt to lose weight. To help him attain his goals, family members planned to show support for Bobs exercise by joining him. Furthermore, Bob was encouraged to identify situations of dail y living providing opportunities for more physical activities, for example parking further away from the entrance at work and grocery store.Weekly meetings evaluated Bobs progress, and discussed about difficulties of following the plan. Bob remained strongly motivated throughout the eight weeks of intervention, and successfully reached most of his weekly dietary and exercise goals. Portions of his meals decreased steadily until no more than 50% of initial food intake was reached, and the snacks included fruits and vegetables only. Daily step count reached up to six thousand steps on some days, and daily walks through the park with his wife became an enjoyable routine. To everyones surprise, during the third week Bob decided to accompany his sons to the health club twice a week, where he swam in the pool for one hour.He expressed feeling energized after any physical activity. Several small relapses were recorded when Bob missed a couple days of walking, and could not resist eating hi gh calorie or high fat foods. At the end of eight weeks of interventions, Bob has lost nine pounds, reduced his BMI to 33.9 kg/m, and his waist circumference decreased by 1.25 inches.Also, his systolic and diastolic blood pressure was slightly reduced. Unfortunately, the effect on the blood lipid level has not been tested. In conclusion, during only eight weeks Bob turned from moderately obese to mildly obese, and remained motivated to continue the weight loss plan.DISCUSSIONResearch has revealed that any diet, as long as caloric intake is restricted, will result in weight loss. It has been calculated that to lose one pound a week, one has to restrict food intake by 500 kcal per day. Patients often get discouraged by the slow effects of weight loss. On the other hand, studies point that more restrictive diets have lower meekness rates and increased weight regain (Palamara et al., 2006). Unfortunately, losing theweight is not the biggest challenge. What people mostly fail at is mai ntaining the reduced weight. Effective weight maintenance requires not only decreasing energy intake and increasing energy expenditure, but also modification of behaviors that predispose to weight gain.Bob monitored his daily dietary intake, and avoided situations hint to overeating. Also, the pedometer monitored the amount of walking, and served as a motivational tool. Moreover, intrinsic motivation for physical activities, as described by Teixeira et al. (2006), is the satisfaction from participating in an activity, while outside motivation describes the desire of slimmer appearance, and weight management. The authors presented that the extrinsic motives correlated with short term weight loss, whereas intrinsic motives predicted long term results. Bob expressed enjoyment of daily walks through the park, which correlates with intrinsic motivation, and and then he is likely to continue over longer period of time. It is important that diet or exercise is maintained for the pastim e and positive feelings brought on by the activity.IMPLICATIONS OF FINDINGS FOR CLINICAL PRACTICEThe continuing rise in obesity and related risk factors, and failure of maintaining long term weight loss result in increasing prevalence of comorbidities. Health care costs related to treating ailments resulting from obesity will continue to rise, unless health care providers utilize more effective measures to deal with the problem. Promoting healthy nutrition and lifestyle early in life may prevent the development of obesity. It is a great challenge for nurse practitioners to help patients maintain their weight. Although the recommended compositions of various diets include specific amounts of fats, carbohydrates, and protein, the research revealed that it is the total caloric content that is responsible for weight loss, regardless of nutrient partitioning. in one case the patient is ready and willing to commit, the treatment strategy should be devised together. Since the variety of d iet options have been shown to have similar effects, the nurse practitioner can help match the nutritional plan with patients dietary preferences.Although diet was found to be more effective in weight reduction than exercise, patients with cardiovascular risk factors should beeducated about the benefits of physical activities. It is important to encourage continuous participation in exercise, even when no reduction of weight is observed. lifestyle changes can be difficult to sustain for the patient, hence continuous support and motivation by a nurse practitioner are necessary. The interventions require fealty of both, the patient and the nurse practitioner. Also, counseling patients family, and encouraging to get involved in loved ones struggle through weight loss and weight maintenance may provide additional support, and contribute to lasting behavior changes. Behavioral strategies such as encouraging setting impound goals, self monitoring and evaluation may increase the chance of success. Patients satisfaction with the choice of diet and physical activity, and successful long term adherence are the best predictors of lifelong weight maintenance.CONCLUSIONThe comorbidities associated with obesity substantially lower the individuals quality of life, and are also adequate an enormous burden on health care. Successful treatment and prevention of obesity can reduce the occurrence of its complications. Dieting is resented by most individuals, therefore it is necessary to assist patients to find appropriate and motivating interventions that can be successfully followed life long. Patients willingness to commit to a long term adherence is essential to permanent lifestyle changes. It is a long and difficult journey from deciding to lose weight to the successful long term results, but even small losses of weight can produce important health benefits.REFERENCESBalkau, B., Deanfield, J.E., Despres, J.P., Bassand, J.P., Fox, K.A., Smith, S.C.Jr., Barter, P., Tan, C.E ., Van Gaal, L., Wittchen, H.U., Massien, C., Haffner, S.M. (2007, October). International Day for the Evaluation of Abdominal Obesity (IDEA) a study of waist circumference, cardiovascular disease, and diabetes mellitus in 168,000 primary care patients in 63 countries. _Circulation, 116_(17), 1942-51. Retrieved February 5, 2008, fromOVID MEDLINE database.Bardia, A., Holtan, S.G., Slezak, J.M., Thompson, W.G. (2007, August). 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