Research Part B

Elisha Molyneaux 10709889 Page 1
In the face of the obesity epidemic, what are the health implications of obesity
and what practical approaches can nurses take to assist the older adult in the
management of weight loss?
Introduction and background
Increasing instances of obesity has become a major concern worldwide with general
hospitals seeing more cases of ill health related to significant weight on a daily basis.
Ireland has seen a dramatic increase of obesity in the past 20 years with two out of
five adults being overweight (45% of men; 33% of women) and one in four adults (24%
of men; 26% of women) suffering with obesity (Ward et al, 2009). The prevalence of
obesity is predicted to increase even further with 42% of men aged between 21 – 30
years and 30% of women of the same age suffering with obesity by the year 2050 (Mc
Pherson et al, 2007). As a result of this, the person is not only at an increased risk of
more serious illnesses and decreased quality of life, but it also has a huge financial
burden on health services. In 2003 alone, approximately €30 million was estimated
for in-patient costs connected to obesity in a number of Irish hospitals (National
Taskforce on Obesity, 2005).
Describe your clinical practice question/statement
Taking in to consideration this information, the question put forward is; ‘In the face of
the obesity epidemic, what are the health implications of obesity and what practical
approaches can nurses take to assist the older adult in the management of weight loss?’
As is clear in the information above, obesity is on the increase with a predicted two
thirds of all adults being obese in the year 2050. This not only impacts on a person
physically, but psychologically and psychosocially and can result in a greater number

of life years lost (up to 13 years)(Mc Pherson et al, 2007). People are becoming
immobile younger in life due to their weight (Peeters et al, 2004) and this sedentary
life leads to decreased muscle strength and cardiovascular fitness (Himes, 2000). Due
to the also increasing stigma concerning obesity, people are finding it more difficult to
address their weight problems with their healthcare providers, thus avoiding the issue.
However, once a patient does come forward with concerns about their weight, what
can a nurse do to help?
The literature review
The following search engines were used to identify appropriate studies for this
research enquiry: CINAHL, Medline, Google Scholar and Pubmed. The following
key search words were used to guide the search: obesity, adults, Ireland, statistics,
nursing, management, studies, barriers, cost. One of the main issues in finding
material for this assignment was the lack of information on obesity and the older adult.
Much of the material was focused on targeting obesity in children which, while
important, is not relevant to nursing in the general medical area. However, enough
research articles were sourced for this assignment with the main themes of this paper
focusing on; the health implications of obesity, the physical and psychological
barriers people are faced with to losing weight and the practical approaches nurses
can take to assist their obese patients in the management of their weight loss. The
classification of obesity must also be explained. To tell if a person is overweight, first
their body mass index (BMI) must be calculated. This is measured by dividing the
persons weight in kilograms by their height in meters squared. A person is then
categorised as overweight if their BMI is 25 or more, and obese at 30 or more (NHS
Choices, 2013).

Theme One: Health Implications
A major problem with obesity is the ever increasing negative effects it has on a
persons’ health, with excess health care costs related to overweight and obesity
estimated to account for 4% - 9% of total health care costs (Finkelstein et al, 2003).
Men and women suffer almost equally as a result of their weight with a large number
experiencing metabolic disorders due to the metabolically inactive fats in their body
(hips and thighs on women, abdomen on men) secreting a toxic combination of Free
Fatty Acids, and inflammatory chemicals. This leads to raised blood pressure,
abnormal lipid profile, and impaired glycaemic control which in turn leads to
hypertension, coronary heart disease, increased blood viscosity, hypercoagulability
and endothelial dysfunction (Després et al, 2001). Type II diabetes is also largely
connected to obesity with around 90% of sufferers being overweight or obese. Due to
hypertension in obesity, the chance of an ischaemic heart event and the chance of an
ischaemic stroke, especially in men, raise 8% to 9% for every unit change of BMI of
25 and above (Haslam, 2008).
The menstrual cycle and the fertility of women can also be impacted by
obesity and there is an increasing risk of complications during pregnancy. Women
are also at a higher risk of developing endometrial and post-menopausal breast cancer
when overweight (Lu et al, 2011). Major depression is also shown to coincide with
obesity in women with suicidal ideations and suicidal attempts increasing by up to 20%
each year (Onyike et al, 2003). A study by Gustafson et al (2003), has also found that
the likelihood of developing Alzheimer’s disease increases by 36% in women with a
higher than average BMI compared to those of a normal weight, however similar
results have not been found in men.

Another major comorbidity to obesity is sleep apnoea, which can be defined as
episodes of disrupted nocturnal breathing, recurring up to 30 times a night. The
person will have complaints of fatigue and tiredness but the issue may be overlooked
and put down to their excess weight. However, undiagnosed, sleep apnoea can lead to
pulmonary hypertension, right heart failure, stroke and arrhythmias (Haslam and
James, 2005).
It is widely known that, when it comes to obesity, it is not if, but when a
person will develop one or more of these serious health issues. The sooner a person
decides to lose weight and live a healthier lifestyle, the less these illnesses will affect
their lives. Data from the CARDIA study shows that the earlier in life a person
decides to lose weight, the risk of developing a metabolic syndrome or subclinical
atherosclerosis decreases significantly. The progression of cardiovascular disease
also decreases (Lewis et al, 2000). Nonetheless, some individuals find it difficult to
take the steps to lose weight thus leading on to the next theme.
Theme Two: Barriers to weight loss
There is still a lot of stigma surrounding overweight and obesity leading to people
being unwilling and embarrassed in bringing the issue up. A qualitative study
undertaken by Lewis et al (2011) questioned how people living with obesity perceived
and responded to the different types of stigma they encountered daily. Participants
explained how their weight would become the topic of conversations around them and
described how people would talk about them instead of with them making it difficult
for them to respond to the criticism. They also described how their weight was used
to question their roles and abilities. In the case of a student doctor, the participant was
told by family and friends that they would not be taken seriously by patients because

of their weight. Some participants described how they were overlooked for jobs and
promotions while some described how they were removed from clothing shops and
refused service due to their size.
Another qualitative study by Gunther et al (2012) found what the main barriers
were for obese people in losing weight. One of the primary issues found in this study
was the constant loop of failures in weight loss that patients had faced before. Many
of these patients had tried previously to lose weight with a variety of different
techniques but could never seem to either loose the weight or keep it off, resulting in a
reluctance to try again. The cost of services was also a main issue, with patients being
unable to afford the cost of seeing their general practitioner (GP). Lack of knowledge
or appropriate guidelines on the part of their health care providers in assisting an
obese patient was also a factor. They also explained that if their GP recommended
other services to them to assist in their weight loss that these services usually came
with a fee that they also could not afford. Cost of food was also a concern as healthier
options and a regular healthy diet would cost more than an unhealthy option full of fat
and sugar.
More barriers that have been found include the embarrassment felt by people
when they try to exercise. They have given examples of people staring or laughing at
them when at the swimming pool or local gym. They have also stated that some
exercise facilities and equipment are inadequate and inappropriate for a larger person
(Lewis et al, 2011). Patients, and in particular older people, have been found to lack
knowledge of the proper nutrition for weight loss and some do not have the ability to
prepare healthy meals (Wahlqvist and Saviage, 2003).

Understanding these obstacles, the following will outline the nursing care and
practical approaches a nurse can take in assisting their obese patient in taking steps to
lose weight.
Theme Three: Practical Nursing Approaches
One of the main practical approaches a nurse can take in aiding an overweight or
obese person is to give them information on the benefits of losing weight and
approaches that can be taken (Royal College of Physicians, 2003). The National
Institute for Health and Clinical Excellence (2009) have outlined some of the health
benefits of a weight loss of just 10%. These include; a fall in mortality of at least
20%; a fall in a diabetes-related death of at least 30% and a greater than 40% fall in
obesity-related cancer deaths. Blood pressure begins to decrease, fasting glucose and
chances of developing diabetes in those that do not yet suffer decreases by 50%, total
cholesterol falls by 10% and low-density lipoprotein and triglycerides fall by 15-30%.
Referral to a dietician can be made to assist the patient in forming and
implementing a healthier diet. If a patient is worried about the cost of their healthier
diet, the nurse can direct them to the British Heart Foundation (2010) website that
gives information on how to live a healthy lifestyle on a budget or print off a version
for those without access to the internet. As an older overweight person is at an
increased risk of dehydration due to reduced lean body mass and decreased thirst from
aging, a simple way the nurse can encourage weight loss is to promote a higher water
intake (Tabloski, 2009).
In some cases drug therapy may be necessary. However, some medications
used in obesity can result in further side effects such as depression and cardiovascular
disease (Shepherd, 2010). It is the role of the nurse to discuss with the patient the risk

of these side effects and if necessary, come up with a system to help the patient
remember what medications to take and when. They can recommend to the patient to
talk to their pharmacist about having their prescription distributed in a blister pack
which has their medications pre-packed to the time they are to be taken (Van
Onzenoort et al, 2012).
Some form of physical activity will be necessary if the patient is to have any
kind of significant weight loss. If the patient has found this difficult or embarrassing
in the past, a study by King et al (2006) has shown that exercising in a group with
people of similar circumstance has provided motivation and support and influences
the person’s activity level. The nurse can encourage the patient to get in touch with
and join a group in their area.
It has been shown, that after a certain amount of time, it is normal for people
to see a reduction in the rate of their weight loss and in some cases, a marginal level
of weight gain (Thomas and Morley, 2002). This is why encouraging patients to keep
frequent contact with their health care provider can encourage them to continue with
and provide possible changes to their weight loss regimen.
Discussion
It is evident from the research that obesity has become a major global problem and
impacts greatly on a person’s health and the health care system. Due to the ever
increasing incidences of obesity related illnesses seen in hospitals, it is more
important now than ever to tackle the obesity problem not only in Ireland, but
worldwide. Nurses can play a vital role in taking on this issue by assisting patients in
making the decision to lose weight and guiding them throughout their weight loss.
Making the initial decision to lose weight as easy as possible is one of the most

important first steps. Giving the patient basic and understandable information about
the health risks and simple tasks in tackling the problem should give patients more
confidence in their decision. The nurse should also be willing to refer the patient to
other specialised health care professionals to ensure the most effective plan. Health
checks should be done regularly to monitor illnesses already present and to establish
if any other illnesses have developed. This is important as the plan may need to be
altered if a new illness has developed or if an underlying illness is not controlled. It
can also be used to encourage the patient if improvements to their health have been
found due to their weight loss. Keeping this in mind, the following are just a few
recommendations for nurses in helping their patients in their weight loss.
Recommendations
Evidence based practice recommends the following:
 Referral of patients to registered dieticians that can facilitate with dietary
planning and development of individualised menus (Tabloski, 2009).
 Obese patients should be introduced to the ‘Eatwell Plate’ and given tips on
how to achieve a healthy diet on a budget (British Heart Foundation, 2010).
 The referral of high risk clients, such as those with cardiovascular disease, to
home health services, so that home health nurses can monitor weight, blood
pressure and heart rate and continue with nutrition education (Thomas and
Morley, 2002).
 It should be routine practice to check fasting blood glucose in all obese
patients to monitor for Type II diabetes (Haslam, 2008).

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