Bukidnon State University College of Nursing S.Y.

2013-2014 TEACHING LEARNING GUIDE Topic: Obesity Participants: 3rd year level student Venue: Anatomy and Physiology Rm General Objectives: At the end of 20 minutes the participants will be able to understand and discuss Obesity. Specific objectives At the end of 20 minutes, the participant will be able to discuss: 1. Introduction The definition Obesity and what it is all about 3min Content Time allotment Facilitator : Rellita, Jezza S.

Teaching and learning activities Teacher Student

Evaluation

References

2. Etiology and Risk factor 3. Clinical Manifestation/ Pathophysiology 4. Medical Management 5. Surgical Management 6. Nursing Care Plan

Know the possible causes of Obesity.

5min

Common clinical manifestations of Obesity and its Pathophysiology

3min

Q U E S T I O n

A N S W E R

http://www.who.in t/mediacentre/facts heets/fs311/en/ J. Black, J. Hawks, Medical Surgical Nursing, Vol 1, p709

2min Medical tests used to diagnose Obesity Treatments and drugs of adrenal insufficiency 2min Surgical Treatment to be done in Obesity 5min Nursing Diagnoses, goals and interventions provided to an individual

J. Black, J. Hawks, Medical Surgical Nursing, Vol 1, p714 http://womenshealt h.gov/publications/ ourpublications/factsheet/overweightweight-loss.cfm

OBESITY
Define as an abnormal increase of fat in the subcutaneous connective tissue. This means a lot of fat cells are gathered in the tissue under skin. Eating greater amounts of food than the body can use for energy causes this deposition. Defined worldwide by the body mass index (BMI) Body Mass Index (BMI) is measure of body fat based on height and weight that applies to both adult men and women. BMI does not differentiate between body fat and muscle mass. Therefore, body builders and people who have a lot of muscle bulk will have a high BMI but are not overweight or obese. Formula: BMI = weight(kg)/height(m)2 Proposed classification of BMI in adult Asians (WHO) BMI Classifications: BMI BMI Categories

Below 18.5

Underweight

18.5 to 24.9

Normal

25.0 to 29.9

Overweight

30.0 and above

Obese

Etiology and Risk Factors Obesity is multifactorial, making effective prevention and treatment a challenge. Environmental Genetic tendency Socioeconomic Factors An Inactive Lifestyle

Clinical Manifestation Obesity is a serious health risk and has been associated with increased risk of mortality and morbidity. Obesity is associated with a series of medical co-morbidities including: Type 2 Diabetes, Cardiovascular disease, hypertension, stroke, sleep apnea, arthritis, and some cancers. Pathophysiology

Excess Food intake rather than body can use for energy Type 2 Diabetes

With proper Diet, exercise and medications

Hypertension Cardiovascular Disease Hyerlipidemia

BP & Cholesterol decrease

Type 2 Diabetes improves greatly with weight loss Sleep Disturbances improve

Stroke

Sleep Apnea
Arthritis Cancers

Medical Management DIET

500-1000 kcal less than total daily energy expenditure should promote the loss of 1 to 2 pounds per week. Teach clients better diet management skills even if they use meal replacement formulas or very low-calorie diet regimen to prevent weight loss. More severe calorie restrictions are difficult to maintain for longer periods and require vitamin and mineral supplementation. Low Calorie intake, Low Carbohydrates, No to Trans fat

EXERCISE

It is important way to increase the energy expenditure and to facilitate weight loss. Diet restriction in combination with an exercise program, compared with diet restriction alone, is a more successful way to lose weight and maintain the weight loss. Medications The Food and Drug Administration has approved two medicines for long-term treatment of obesity: Sibutramine -suppresses your appetite. Orlistat- keeps your body from absorbing fat from the food you eat. If you take these medicines, you will need to follow a healthy eating and physical activity plan at the same time. Before taking these medicines, talk with your doctor about the benefits and the side effects. Sibutramine can raise your blood pressure and heart rate. You should not take this medicine if you have a history of high blood pressure, heart problems, or strokes. Other side effects include dry mouth, headache, constipation, anxiety, and trouble sleeping. Orlistat may cause diarrhea, cramping, gas, and leakage of oily stool. Eating a low-fat diet can help prevent these side effects. This medicine may also prevent your body from absorbing some vitamins. Talk with your doctor about whether you should take a vitamin supplement. Surgical Management Roux-en-Y (ROO-en-WEYE) gastric bypass. The surgeon uses surgical staples to create a small stomach pouch. This limits the amount of food you can eat. The pouch is attached to the middle part of the small intestine. Food bypasses the upper part of the small intestine and stomach, reducing the amount of calories and nutrients your body absorbs. Laparoscopic (LAP-uh-ruh-SKAWP-ik) gastric banding. A band is placed around the upper stomach to create a small pouch and narrow passage into the rest of the stomach. This limits the amount of food you can eat. The size of the band can be adjusted. A surgeon can remove the band if needed Gastric Restrictive Procedure/ Vertical-banded gastroplasty. Serve only to restrict and decrease food intake and do not interfere with the normal digestive process. In this procedure the upper stomach near the esophagus is stapled vertically to create a small pouch along the inner curve of the stomach. The outlet from the pouch to the rest of the stomach is restricted by a band made of special material. The band delays the emptying of food from the pouch, causing a feeling of fullness.

Nursing Care Plan Assessment

Digesting food with excess Aching in the back and knees Depression or other emotional problems Difficulty walking or moving around Heartburn Rashes in the folds of the skin Shortness of breath with exertion Snoring or sleep apnea (moments during sleep when breathing stops) Cyanosis

Nursing Diagnosis Imbalanced Nutrition more than body requirements r/t Food intake that exceeds body needs Desired Outcomes Identify inappropriate behaviors and consequences associated with overeating or weight gain. Demonstrate change in eating patterns and involvement in individual exercise program. Display weight loss with optimal maintenance of health. Interventions Implement/review daily food diary, e.g., caloric intake, types and amounts of food, eating habits. Discuss emotions/events associated with eating. Emphasize the importance of avoiding fad diets. Discuss need to give self-permission to include desired/craved food items in dietary plan. Be alert to binge eating and develop strategies for dealing with these episodes, e.g., substituting other actions for eating. Identify realistic increment goals for weekly weight loss. Weigh periodically as individually indicated, and obtain appropriate body measurements. Determine current activity levels and plan progressive exercise program (e.g., walking) tailored to the individuals goals and choice. Develop an appetite re-education plan with patient. Emphasize the importance of avoiding tension at mealtimes and not eating too quickly. Encourage patient to eat only at a table or designated eating place and to avoid standing while eating.

Prepared by: By: Jezza S. Rellita