- Obesity develops from an energy imbalance.
- An excess amount of energy is stored in the body as fat for later use.
- This energy is consumed in calories. An abundance of calories causes the body to release excessive hormones such as adipokines responsible for appetite regulation and metabolism.
- Whenever obesity occurs, the patient consumes an excess of calories that contain insufficient healthy nutrients.
- Obesity is determined by measuring body fat using the body mass index (BMI).
- Body mass index (BMI) above 25 is considered overweight; BMI above 30 is considered obese; BMI over 40 is considered morbidly obese.
- Energy imbalance
- Medical conditions
- Unhealthy lifestyle
- Sedentary lifestyle
- Adverse eating habits (high-cholesterol, high-calorie diets)
- Sleep deprivation
There are multiple comorbidities associated with obesity.
- Cardiovascular system (heart disease, stroke)
- Respiratory system (obstructive sleep apnea, asthma)
- Endocrine (diabetes mellitus type 2 and gestational diabetes)
- Musculoskeletal system (osteoarthritis, gout)
- Immune system (cancer)
- Gastrointestinal system (GERD, fatty liver)
- Measuring BMI
- Medical history, family history
- Physical assessment (measurements of waist circumference, weighing)
- Testing (blood tests)
- Lifestyle changes
Nursing Diagnosis for Obesity
|Imbalanced Nutrition: More Than Body Requirements r/t calorie intake exceeding metabolic needs|
Impaired Physical Mobility r/t restricted movements secondary to excess weight
Disturbed Body Image r/t to excess weight
Deficient Knowledge r/t lack of interest in losing weight; decreased motivation to lose weight
Nursing Care Plans for Obesity
Imbalanced Nutrition: More Than Body Requirements r/t calorie intake exceeding metabolic needs
Expected Outcome: The patient will have balanced nutrition where calorie intake meets metabolic needs leading to weight loss.
|Measure height and weight. |
Current height and weight provide a baseline for future reference. Additionally, height and weight measurements are needed to calculate a body mass index (BMI). BMI can indicate high body fat and screen for different overweight, obese, and morbidly obese categories. BMI is calculated by dividing the weight in kilograms by the square value of the patient’s height in meters.
|Obtain other measurements such as waist circumference, arm and calf circumferences. |
These measurements serve as a reference point and decrease as the patient loses weight.
|Have the patient fill out a food diary over two to three days. |
A food diary provides information about the patient’s daily calorie intake. Precise documentation about each meal helps healthcare providers understand the patient’s eating habits. It also can help the patient realize how much food he or she eats.
|Perform a nutrition screen. Note |
Amount of food
Number of servings of fruits and vegetables per day
Activities before and after meal consumption
This information helps determine cues and other sources for overeating and weight gain. However, sometimes it is necessary to cross-reference this information with friends or family members because often, the patient’s point of view about eating habits might be distorted.
|Collaborate with a dietitian to educate about healthy food choices. Introduce the patient to the MyPlate food guide. |
The MyPlate food guide provides information about healthy food groups and recommendations about portion sizes. Baseline knowledge about food groups and portioning food is necessary to make dietary changes. A dietitian can help with creating an individualized meal plan.
|Remind the patient that slow and steady weight loss is healthier and longer-lasting. |
Losing one to two pounds per week is considered healthier and usually lasts in the long term.
|Teach the patient about appropriate portion sizes. |
Understanding portion control will help the patient only eat the calorie amount needed and avoid consuming calories the body will not use. In addition, portion control has many benefits, such as digesting food easier and losing or maintaining goal weight.
|Encourage the patient to eat a healthy diet containing several portions of fruits and vegetables. |
Lean meat, fruits, and vegetables contain many vitamins, and essential nutrients yet are low in calories.
|Encourage the patient to keep a food diary while dieting. |
Keeping a detailed record of food and calorie intake may help the patient stay focused and motivated. In addition, having a visual log of food consumed might make the patient feel more accountable and compliant with the diet plan.
|Teach patients and families about possible complications of obesity. |
Awareness of conditions such as diabetes mellitus and heart disease may increase compliance and help maintain long-term lifestyle changes.
Impaired Physical Mobility r/t restricted movements secondary to excess body fat
Expected Outcome: The patient will demonstrate increased physical mobility as evidenced by increased daily activities and reduced body fat.
|Assess mobility skills. |
Whether the patient can perform ADLs and other activities determines the starting point of treatment. Initially, the patient may be severely deconditioned. However, starting slow at an individual pace promotes long-term commitment to weight loss and compliance.
|Assess the patient’s willingness to lose weight. |
If the patient wants to lose weight, he or she is much more likely to stick to exercise routines.
|Engage the patient in an individualized exercise program. |
An exercise program tailored to the patient ensures that individual issues are taken into account. For example, the patient’s health conditions, lifestyle, and physical ability are considered when developing an exercise plan. Along with diet modifications, most patients can lose weight easier by increasing daily activity and burning more calories.
|Anticipate the patient starting with low-intensity and short-interval training. |
Most obese patients will be deconditioned when starting to exercise. Easier and shorter exercises will help improve endurance and tolerance. Gradual increase in intensity and duration of activities will help create a consistent and sustainable exercise regimen.
|Encourage exercises that are easier on the joints. |
Specific exercises (low impact) such as swimming, walking, cycling, and elliptical training can be softer on the joints while working out. Often excessive weight can wear on bones and joints.
|Encourage the patient to engage in different types of exercise training as possible. |
A combination of cardio, strength training, and stretching may help increase overall mobility.
|Teach about possible complications of inactivity. |
A sedentary lifestyle comes with a higher risk for heart disease, high blood pressure, high cholesterol, and diabetes mellitus type 2.
Disturbed Body Image r/t to excess weight
Expected Outcome: The patient will exhibit an improved body image as evidenced by consistent self-care and successful weight loss efforts.
|Assess the patient’s thoughts and feelings about his or her body image. |
Often people’s body image is distorted or exaggerated. Feelings, thoughts, and remarks about appearance provide information about the patient’s relationship with his or her own body.
|Explore coping mechanisms associated with food. |
Coping strategies are often learned very early on. For example, being aware when food is used as a coping mechanism can help break that habit and replace it with strategies unrelated to food.
|Acknowledge the patient’s concerns about body image and convey a supportive attitude. |
Not feeling judged or criticized makes the patient feel comfortable in his or her environment. This feeling of comfort promotes a trusting nurse-patient relationship and facilitates honest conversations.
|Discuss expectations and the importance of the patient’s role and necessary contribution to the exercise and diet program.|
The patient needs to know that his or her commitment to the workout and diet plan is crucial to maximizing success and a positive outcome.
|Record weight weekly and encourage the patient to take pictures regularly for comparison in the future. |
Adding a visual component to the weight loss process serves as motivation to keep moving forward and helps provide proof of an actual change in body weight and shape.
|Encourage the patient to use visualization techniques to imagine him or herself with the desired goal weight and living a healthy lifestyle. |
Based on the theory that the subconscious mind cannot distinguish between reality and imagination, visualization methods help the patient mentally prepare for self-image changes and potentially challenging events about food such as gatherings or eating out in restaurants.
|Encourage the patient to keep a diary or do any form of journaling. |
Keeping up with thoughts and feelings that lead to unnecessary eating may be determined with this method. For example, the patient may identify thoughts or feelings such as anger, shame, or doubt that lead to overeating. Once this thought pattern is identified, the patient can change eating habits and avoid triggers.
|Suggest buying well-fitting clothes throughout the weight loss process. |
Wearing clothes that fit correctly may boost self-esteem and self-image and motivate the patient to continue the process. However, losing weight can be a very long journey in which patients may lose motivation.
|Offer resources and encourage to join support groups. |
It can be therapeutic to meet people going through similar experiences and struggles. In addition, support groups can increase motivation, help with stress reduction, feeling less judged, and improve coping skills.
Deficient Knowledge r/t to lack of interest in losing weight; decreased motivation to lose weight
Expected Outcome: The patient will verbalize a desire to learn new strategies to lose weight.
|Discuss the reason for the lack of motivation to lose weight. |
Often individuals may lose motivation after many failed attempts to lose weight. Other times people may not be aware of the possible health consequences of obesity. Knowing why the patient is not interested in losing weight provides a starting point for a treatment plan.
|Assess the patient’s knowledge about nutrition and how it relates to weight gain. |
The patient’s knowledge serves as a baseline for the healthcare team to build upon and provide additional information.
|Identify current misconceptions about weight loss. |
Clearing up any false beliefs about weight loss and dieting may help increase motivation and compliance.
|Assist the patient in setting long-term and short-term goals related to weight loss and diet changes. |
The patient needs to be aware that weight loss is an individual endeavor and that it may take a long time to reach desired weight goals. Starting this process with the appropriate mindset is crucial. A long-term approach to weight loss requires a holistic lifestyle change that entails more than just weight loss. Permanent changes in diet habits and activity habits are necessary to have long-lasting results.
|Teach ways to enjoy healthy food when not prepared at home.|
Knowledge of preparing healthy food at home is challenging, but choosing healthy meals when out to eat can be another difficult task. Eating healthy while eating out allows the individual to still enjoy gatherings without compromising lifestyle changes.
|Prepare the patient for phases in which weight loss becomes more difficult. |
Once a certain amount of weight loss has occurred, the body’s metabolism adjusts to diet and exercise changes, leading to a plateau in weight loss. Unfortunately, this stage makes it much harder to lose weight. In this phase, patients need stability and support to keep going. Support groups and help from family and friends are essential at this time.
|Discourage the patient to use food as a reward. |
Using food as a reward only worsens the patient’s relationship with food. The patient should not rely on food to be motivated to engage in activities.
|Teach about the health risks of obesity. |
Health risks include but are not limited to developing diabetes mellitus type 2, cardiovascular conditions such as CAD, atherosclerosis, hypertension, wear and tear on bones and joints, gastrointestinal disorders, and other problems. Knowledge about the possible risks may increase motivation to lose weight and make lifestyle changes.
More Care Plans
Ignatavicius, D., & Workman, M. (2016). Medical-surgical nursing (8th ed.). Elsevier.