Nursing research: methods, evidence, and clinical application

Nursing Research

Self-Empowerment in the treatment of diabetes and obesity

Two increasingly common, but interrelated problems in clinical nursing practice are those of the increased BMIs (Body Mass Indexes) of patients and the increasingly common incidence of Type II Diabetes. Of course, obesity has always existed in patients, but the levels to which it has reached have forced nurses to examine how modern medicine should treat an ailment that has roots in lifestyle, genetics, culture, and socioeconomic status as well as biology. About one-third of the people in the United States are obese. The increase of Type II or insulin-resistant diabetes is connected to the rise of obesity. Type II Diabetes was once called adult-onset diabetes, because the lifestyle factors that contributed to the disease were thought mainly to exist in older adults. Now, however, because of the increasingly sedentary and high-caloric diet of many children and teenagers, obesity is being manifest in children, causing clinicians to rethink their epidemiological conception of the ailment. "The increasing prevalence of overweight and obesity among children and adolescents is a matter of great concern. The World Health Organization (WHO) regards obesity as an epidemic, equivalent in importance to traditional public health issues such as malnutrition or infectious diseases...A recent estimate of the prevalence of overweight and obesity in some 140,000 adolescents between 10 and 16 years of age in 34 countries revealed that the adolescent obesity epidemic is a global issue (Regber, Berg-Kelly, Marlid, & Staffen 2007).

The current medical literature stresses the need for patient empowerment for diabetics and pre-diabetics of all ages. When the ailment typically occurred in only older adults, insulin therapy was thought to be the first recourse of treatment. However, in younger adults and children the individual has greater power to reverse or mitigate the symptoms of the illness. Today's treatment protocols call for a combination of diet, exercise, and medications when treating diabetics. The aim is to maintain blood glucose levels as close to normal as possible through healthy diet and exercise, although when diet and exercise do not provide adequate control of blood glucose, medications may be added to the treatment plan. Although the layperson may associate a diabetic diet with a low-sugar diet, nutrition is no longer based on American Diabetes Association diets "but is individualized to patient need and associated with exercise and lifestyle" (Behr 2007). Medications can take the form oral agents, insulin, or a combination of both for Type II Diabetes but is not always required (Behr 2007). It is particularly critical that nurse see him or herself as a teacher to a patient with a new diagnosis of diabetes to teach survival skills (Behr 2007).

Transferring such survival skills is often easier said than done, however. Because of the difficulty in treating obesity, a contributing factor of insulin-diabetes, Type II Diabetes patients being prescribed bariatric surgery to treat their obesity at an increasing rate. A study of 136 weight-loss surgery studies done between 1990 and 2003 found that weight-loss surgery caused diabetes in the patients studies to completely disappear in 76.8% of the patients and was resolved or improved in 86% (Buchwald H, Avidor Y, Braunwald et al. 2004). This need for such extreme measures underlines the difficulty of patients to alter their entrenched lifestyle patterns. The sooner these patterns can be altered, the better.

Working with younger patients to modify their diets, setting realistic weight-loss and exercise goals, and creating a home and school environment where weight loss is rewarded are all important in lessening the chance that obesity will lead to long-term complications and require surgery. Nurses must take a multifaceted approach to treatment that accounts for: the biological, behavioral, and environmental influences that contribute to diabetes and obesity. The nurse must acknowledge that modern society often makes it easier to be obese than to be slim. Cheap calorie-concentrated foods seem attractive and it is easy to avoid physical exercise. Empowering the patient to show how they have a choice to select healthier and less processed foods, to take the stairs or take a walk is essential so that obesity in young people does not develop into a pre-diabetic condition. Self-guided treatment is essential and may be equally effective as regular counseling. "A study examining 12 weeks of behavior therapy for obesity found that augmenting treatment with computer-assisted therapy was a cost-effective way to improve outcomes at a 6-month follow-up. Viewers who watched on video the 8 sessions of an 8-week videotaped obesity treatment group lost as much weight as did participants in the live group"(Later 2007).