A nursing experience in a patient with antipsychotics-induced overweight

The purpose of this article is to describe a nursing experience with a patient with schizophrenia who had antipsychotics-induced overweight. The authors assessed the patient's health condition and provided weight management to reduce her hallucinations as well as her body weight between May 1 and June 10, 2004. Three nursing problems had been identified as follows: disturbed sensory perception, imbalanced nutrition, and ineffective health maintenance. During the nursing process, the authors established a rapport relationship with the patient and her mother, educated them in skills for reducing hallucinations, and designed an individual body weight management program. After the interventions, the patient was able to positively face her illness, effectively use methods to reduce the impact of hallucinations, and successfully lose 5.5 kg. From this perspective, an individual body weight management program can be an effective intervention for nurses to care for this group of patients.     

Diet,exercise, and the challenge of combating obesity in primary care

Obesity has reached epidemic proportions in the United States and in most industrialized nations. More than 60% of US adults are now overweight or obese, predisposing over 97 million Americans to a host of chronic lifestyle diseases, particularly cardiovascular disease. Despite the existence of explicit evidence-based consensus reports on the health risks of obesity and the health benefits of even moderate amounts of weight loss, many patients do not receive advice from their health care providers to lose weight or on how to do so effectively. Even modest physical activity and small incremental healthy dietary changes when incorporated into one's lifestyle have a positive effect on weight loss and promote the maintenance of favorable body weight and body composition changes with advancing age. This article describes elements of effective counseling and practical guidelines for developing a healthy lifestyle approach for overweight and obese individuals.     

Nursing experience using motivational interview techniques in caring for an obese patient with type 2 diabetes

Global prevalence and incidence of diabetes for all age groups are increasing. Research evidence reveals that lifestyle modification can both significantly improve glycemic control and delay complications. Obese patients suffering from type 2 Diabetes Mellitus in particular require food therapy and weight reduction through behavior modification in order to regain a healthy quality of life. This article used motivational interviews and the transtheoretical model to develop a behavioral change strategy to set health behavior as well as to assist the patient to attain weight reduction and glycemic control goals. Over the study period (April 30, 2009 to June 10, 2009), the patient's weight declined from 93.4kg to 90kg. Also, her blood sugar is gradually stable. Because of the effectiveness of behavior modification, the patient exhibited sustained motivation to continue maintaining diet control, which reflects motivation is an important component for behavior modification. The authors would like to share this case report to provide nursing professionals with a reference for using motivational interview techniques and transtheoretical model.     

Obesity: assessment and management in primary care.

Obesity is a complex, multifactorial condition in which excess body fat may put a person at health risk. National data indicate that the prevalence of obesity in the United States is increasing in children and adults. Reversing these trends requires changes in individual behavior and the elimination of societal barriers to healthy lifestyle choices. Basic treatment of overweight and obese patients requires a comprehensive approach involving diet and nutrition, regular physical activity, and behavioral change, with an emphasis on long-term weight management rather than short-term extreme weight reduction. Physicians and other health professionals have an important role in promoting preventive measures and encouraging positive lifestyle behaviors, as well as identifying and treating obesity-related comorbidities. Health professionals also have a role in counseling patients about safe and effective weight loss and weight maintenance programs. Recent evidence-based guidelines from the National Heart, Lung, and Blood Institute, as well as recommendations from the American Academy of Pediatrics, American Association of Clinical Endocrinologists/American College of Endocrinology, American Obesity Association, U.S. Clinical Preventive Services Task Force, Institute of Medicine, and World Health Organization can be consulted for information and guidance on the identification and management of overweight and obese patients.     

The central role of lifestyle change in long-term weight management

Lifestyle change--most notably, modification of eating behavior, physical activity, and psychologic factors like attitudes, goals, and emotions--is the central determinant of whether people will lose weight and maintain the loss. Even when medical intervention appears to be the primary treatment, as with pharmacotherapy, behavior plays the determining role in successful weight loss. For example, the likelihood that a patient will take his or her prescribed medication is influenced by thoughts, attitudes, behaviors, and social environment. The patient who is dissatisfied with the moderate weight loss produced by most treatments, and hence is prone to relapse, is affected by the same factors. Methods are available to help people develop the self-management skills necessary to produce long-term lifestyle change (1-3). As individuals internalize a new set of attitudes and behaviors, resisting old habits and acquiring new ones become easier. Only then will there be any reasonable chance of long-term weight-loss success.     

Effects of a weight-loss program for obese children: a "mix of attributes" approach

Childhood obesity is an important global public health issue. There is a need for more effective, low cost and child-centered intervention programs for reducing body weight. In response to this need, we developed a mix of attributes approach (including content, interactivity, control, channel, and objectivity) to help obese children (weight-for-length index, WLI >/= 1.20) reduce their body weight and improve their knowledge, attitude, and behavior. The prevalence of obesity in our sample was 15.9 % (140 obese children out of 882 children studying in the fourth grade) . An experimental, randomized research design was conducted in this study. Anthropometric measurements (including Body Mass Index [BMI] , WLI, body fat percentage, triceps, and subscapular skinfold thickness) and questionnaires (including the Scale of Obesity and Body Weight Loss Knowledge, Attitude, and Practice) were evaluated at baseline (pretest) and after one month of the intervention (posttest) for all obese children. Of 140 obese children, 118 completed this study (66 in the experimental group, 52 in the control group). The mix of attributes approach significantly reduced the degree of obesity revealed in anthropometric measurements. (p < .05). This approach also significantly improved obese children ' s knowledge (p < .001) and slightly improved their behaviors (p = .057); however, this program did not change the children ' s attitudes so easily (p = .597). To more effectively lose weight, we suggest an additional attribute, " individuality, " as a means of increasing efforts to change attitudes in obese children.     

The Effect of a Lifestyle Intervention on Weight Loss for University Employees

ABSTRACT

Obesity is a major health issue. A community-based intervention was implemented on a college campus to help employees lose body weight and fat. Participants were scanned using the InBody device at pre- and post-intervention, measuring body weight, fat, and waist circumference. Participants attended 11 classes on healthy lifestyle education. A comparison of pre- and post-intervention measurements was made using a paired t-test, resulting in a statistically significant difference in outcome measures. Correlation between class attendance and pounds lost showed a moderate negative correlation. Findings support a community-based lifestyle behavior intervention for weight and fat loss for university employees.     

Using the Transtheoretical Model to Facilitate Behavior Change in Patients with Chronic Illness

Nurse practitioners spend a considerable amount of time encouraging patients with chronic illness to acquire positive behaviors such as exercising and self-monitoring, and to stop negative behaviors like smoking and intake of foods high in fat. These lifestyle changes can be facilitated through use of the transtheoretical model of stages and processes of behavior change. The significance is that it assists health care providers in developing interventions that are specifically focused for the patient depending on stage of readiness to change. The application of the model in the practice setting is discussed, and a specific example of activities developed for use in patients with asthma is given. The protocols can be adapted for any patient who needs to make lifestyle behavior changes.     

Too big to be seen: Weight‐based discrimination among nursing students

An educational intervention was conducted to determine the efficacy of an obesity sensitivity program to determine nursing students’ attitudes toward obese clients. As part of the clinical curriculum, nursing students (N = 103) received weekly obesity sensitivity education on weight‐based discrimination. Students’ completed a preproject and postproject attitudes toward obese persons scale (Barra, 2015) to evaluate discriminatory beliefs and actions. All clinical groups had a significant positive change in their own weight prejudices postobesity education intervention. Chi‐square analysis was utilized as a measure of association between pre‐ and postobesity education with clinical application concerning obesity size, body odor, appearance, and lifestyle, along with provider fear of a back injury. Promoting nursing student awareness of obese client bias can dissipate negative stigmas to promote a therapeutic patient–provider relationship.     

肥胖儿童代谢综合征65例临床护理

目的:探讨肥胖儿童代谢综合征(MS)的护理方法.方法:依据护理程序安排工作,以自理行为训练为核心方法,对65例10～12岁MS儿童进行为期6个月的以减轻体重为目的的护理干预.结果:49例肥胖MS儿童干预前后指标明显改善,有显著性差异(P＜0.05).结论:对MS儿童进行护理干预,培养良好的生活自理行为,通过合理膳食和适度运动,减轻体重,能够改善儿童代谢综合征各项指标,对防治儿童代谢综合征具有重要意义.     

A head-injured patient: caloric needs, clinical progress and nursing care priorities.

This case study explored literature on nursing care of the head-injured patient and identified outcomes of a head-injured patient in regard to nutritional status, skin breakdown and infection. Literature review revealed head-injured patients experience a hypermetabolism requiring increased nutritional support. Patient outcomes included mild skin breakdown, infection and a 12% loss in body weight. Inadequate nutrition was the patient's most significant outcome. The patient maintained an average daily intake of 915 calories and averaged a total energy expenditure of 2337 calories, thus, demonstrating an average daily deficit of 1422 calories. Top nursing care priorities noted in the patient's chart were: alteration in cerebral tissue perfusion, potential for injury and alteration in skin integrity. Results indicated more accurate assessment of the patient's needs and inclusion of more applicable nursing diagnoses were required to ensure greater continuity in care.     

Use of single-dose rasburicase in an obese female

OBJECTIVE: To report the use of single-dose rasburicase in an obese patient. CASE SUMMARY: A 53-year-old obese African American woman weighing 136 kg (ideal body weight [IBW] 55 kg) with new-onset chronic myelomonocytic leukemia in leukocytic blast crisis was treated with hydroxyurea 5 g daily. In addition, she received allopurinol 300 mg daily for prevention of tumor lysis syndrome (TLS). The following day, allopurinol was discontinued and rasburicase was administered at a dose of 0.2 mg/kg of IBW for a serum uric acid level of 11.9 mg/dL. The patient's serum uric acid level decreased to 1.9 mg/dL 48 hours after a single dose. DISCUSSION: Rasburicase is indicated for the initial management of elevated plasma uric acid levels in patients with hematologic and solid tumor malignancies who are at risk for TLS. This case is unique because the patient received one dose of rasburicase followed by allopurinol rather than 5 daily doses of rasburicase. Additionally, the dose was based on IBW rather than actual body weight. Efficacy of this approach is apparent from the uric acid levels and the lack of hemodialysis requirements. CONCLUSIONS: A single dose of rasburicase (based on IBW) followed by allopurinol can effectively prevent TLS based on serum uric acid concentration. This approach resulted in a substantial cost savings.     

Nutrition and exercise in overweight and obese postpartum women.

This secondary analysis of a longitudinal, nonintervention study describes the nutritional and physical activity behavior of overweight and obese postpartum women and the differences in nutrition and physical activity when participants are evaluated according to four weight categories: underweight, normal weight, overweight, and obese. The sample consisted of 67 postpartal women [40 (60%) African American and 27 (40%) White] who gave birth vaginally to healthy term infants. No differences were present when overweight and obese women were compared with underweight and normal weight women relative to nutrition and physical activity. Nutritional imbalances were present for overweight and obese women relative to protein and fat intake. Overweight and obese postpartum women can be encouraged to lose weight using a nutritionally balanced approach by decreasing fat and protein intake, maintaining an adequate carbohydrate intake, and increasing their folacin intake.     

Effect of a successful intensive lifestyle program on insulin sensitivity and glucose tolerance in obese youth

OBJECTIVE—To evaluate the impact on glucose metabolism of a lifestyle program (the Yale Bright Bodies Program) for obese children.RESEARCH DESIGN AND METHODS—Thirteen Bright Bodies and ten clinic-care control subjects who were part of a large randomized clinical trial had 75-g oral glucose tolerance tests at the beginning and end of the 12-month study.RESULTS—Bright Bodies subjects had significantly greater decreases in weight, BMI, and body fat than clinic-care subjects, and the Bright Body subjects’ changes in body composition were accompanied by marked improvements in insulin sensitivity (P = 0.009) and glucose tolerance (P = 0.04).CONCLUSIONS—An intensive lifestyle program that successfully reduces body weight and body fat can markedly improve insulin sensitivity and glucose metabolism in obese youth.In an attempt to respond to the childhood obesity epidemic, we developed Yale''s Bright Bodies weight-management program, a family-based lifestyle intervention that includes nutrition education, exercise, and behavior modification. Its efficacy was validated by a 12-month randomized clinical trial (RCT) with more than 170 overweight children and adolescents. In this RCT, Bright Bodies subjects had significant improvements in BMI and body composition, including a 9.2-kg difference in change in total body fat versus that in the clinic-care control group (1). To examine the impact of the Bright Bodies program on insulin sensitivity and glucose metabolism in obese children, a randomly selected subset of subjects from both groups underwent an oral glucose tolerance test (OGTT) at the beginning and end of the 12-month study.     

Management of obesity

We live in an overweight society. Although food consumption has not increased dramatically over the last two decades, physical activity has markedly diminished. However, recent studies suggest that weights up to 20% above ideal body weight do not carry a significant risk of increased mortality in the absence of other chronic diseases. A team approach helps maintain patient motivation, the key to an effective weight-loss program. An efficient weight-loss and weight-maintenance program in the moderately obese patient includes modification of eating patterns, an individualized balanced fuel-source diet, and an exercise program to allow caloric deficit of approximately 500 calories a day. We must realize that for morbidly obese patients in whom the amount of caloric restriction necessary to reach and maintain a desirable body weight may be incompatible with a reasonable quality of life, surgery is warranted. The aggressiveness of our therapeutic regimen should always depend on the risk of morbidity and mortality associated with the patient's degree of obesity.     

The adult living with diabetes mellitus

This article has presented a new holistic self-care approach as a solution to the problem of fragmented nursing care of the adult patient who has either type I or II diabetes. Physical and psychosocial needs are equally emphasized by the nurse when assisting the patient and his family to develop an optimal lifestyle. Approaches for dealing with common lifestyle problems were discussed.     

Is accuracy of weight perception associated with health risk behaviors in a diverse sample of obese adolescents?

Current evidence is equivocal as to whether adolescent's perception of weight status is linked to both healthy and risky behaviors. This study examined the association between accurate and inaccurate perception of weight and self-reported health and risk behaviors among a diverse sample of obese, urban adolescents. Data were analyzed from 1,180 participants in the 2009 Philadelphia Youth Risk Behavior Survey. Health behaviors of obese students self-identifying as very or slightly overweight were compared to obese students who underestimated their weight status. Accurate self-identifiers of weight status were significantly more likely to report trying to lose weight, bullying victimization, and suicide attempts as compared to obese students underestimating their weight status. Findings suggest that it is important for school nurses to understand that perceived weight status confers distinct risk profiles and differing needs for health-related services related to the physical, mental, and social health of adolescents.     

Behavioral intervention for the obese client

Nurse practitioners usually follow obese clients in outpatient settings. The behavioral approach to treating obesity has been demonstrated to help clients lose weight and maintain their weight loss. This article presents one such behavioral approach to treating obesity. Utilizing the nursing process as a framework, the components of a behavioral program are explored. Assessments of motivation, assets and limitations and target behaviors are described. Coverage of treatment planning includes contracting, problem lists and realistic commitments. Intervention techniques such as stimulus control, shaping, pairing and problem solving are presented. Evaluation using objective data gathered through monitoring is stressed. The characteristics of the practitioner which might positively or negatively affect a behavioral program for the obese client are discussed.     

Obesity: a risk factor in the burn patient

Obesity is seldom recognized as a risk factor for the patient with burns. However, the overweight patient with burns presents major problems for the burn team, especially in the areas of wound care, pulmonary care, and general nursing care. One-hundred eighty adults (9.1% weighed more than 45 kg above ideal body weight or more than 100 kg in total weight. Mean weight was 110 kg, with 155 patients heavier than 100 kg. Mean age was 38 years with a mean burn size of 26% (11% full-thickness). The mortality rate was 21%, and respiratory and cardiovascular complications occurred in 33% of these patients. The obese patient presents problems disproportionate to burn size, burn location, and age. The obese patient's problems are related to weight. Care is often compromised by the physical constraints of a patient's size.     

Effects of lifestyle intervention and metformin on weight management and markers of metabolic syndrome in obese adolescents

PURPOSE: The purposes of this study are threefold: to determine what components of the metabolic syndrome are present in obese adolescents, to determine what differences exist in the effects of lifestyle intervention versus lifestyle intervention plus metformin on weight management and select markers of metabolic syndrome in obese adolescents, and to determine which factors predict weight loss in obese adolescents treated with lifestyle changes and metformin. DATA SOURCES: The study was a secondary data analysis utilizing a retrospective chart review of 63 obese adolescents aged 11 through 18 who were treated for obesity at the LeBonheur Youth Lifestyle Clinic from January 1, 2000, through June 30, 2005. Lifestyle interventions included diet, exercise, and counseling. The medication utilized was metformin. Outcomes evaluated included body mass index, relative body mass index (RBMI), weight, waist and hip circumference, blood pressure, serum lipid levels, fasting plasma glucose, 2-h oral glucose tolerance tests, and insulin levels. Changes in mean values between groups were evaluated using the General Linear Models procedure. Logistic regression was utilized to determine which factors might predict weight loss. CONCLUSIONS: The metformin group (N= 37) tended to be heavier, older, and had more components of the metabolic syndrome than the nonmetformin group (N= 26). All components of the metabolic syndrome were present in both groups (overall prevalence 55%). Both groups had a downward trend in RBMI, a surrogate marker for weight loss, but only the metformin group had a significant loss in RBMI points from baseline to end. There was a trend toward better diastolic blood pressure at 6 months in the metformin group (p= 0.06), which was not seen in the nonmetformin group. The only predictors of weight loss were higher RBMI (those who were heavier lost more) and the absence of type 2 diabetes mellitus (type 2 DM) (those with type 2 DM were less likely to lose 10 or more points in RBMI). IMPLICATIONS FOR PRACTICE: All components of the metabolic syndrome are present in obese adolescents. The use of lifestyle changes and lifestyle changes plus metformin both produce some degree of weight loss, but subjects on metformin in this study lost significantly more RBMI points than those on lifestyle changes alone. Subjects with type 2 DM are less likely to lose weight than those without type 2 DM. Larger studies and studies with subjects more representative of the general population need to be carried out to assist in the development of evidence-based practice guidelines.