Nutrition and weight loss

Health Promotion and Disease Prevention Nutrition and Weight Loss

A brief literature review of two nutrition and weight loss-related articles

Health promotion and disease prevention:

A brief literature review of two nutrition and weight loss-related articles

While once under-nutrition was the primary concern of most nurses in regards to their patients, today the problem tends to be the opposite. There is an epidemic of obesity in America. Regardless of his or her field of specialty, almost every nurse will encounter a patient whose condition could be improved through weight loss. A nurse who specializes in nutrition will encounter the problem on a daily basis, and nurses in the field of cardiac care, diabetes treatment, and pediatrics must be particularly mindful of the importance of patients maintaining a healthy body weight as well.

However, no matter how conscientious the nurse, no nurse can exercise vigilance over a patient every hour of the day, with the exception of patients in a fulltime care facility such as a hospital or nursing home. Weight loss requires a lifestyle change, and the patient and his or her family must be committed to that change. According to Laura Shay's 2008 article "Self-monitoring and weight management" from the Online Journal of Nursing Informatics (OJNI), one commonly prescribed way for clients to motivate themselves to 'stay on track' with their diet and exercise plans is simply tracking weight loss and gain on a daily basis. "A number of studies in the literature clearly show a direct relationship between consistent self-monitoring and weight loss," writes Shay (Shay 2008).

Self-monitoring theoretically provides an easy and inexpensive way for patients on weight loss plans to engage in consistent behavioral modification strategies. The dieters are 'rewarded' with weight loss when they follow their program and are negatively 'punished' with demonstrable weight gain when they cheat. Additionally, new online databases enable clients to more accurately monitor the dietary composition of their meals and the calories they expend through exercise. However, studies indicate that access to nutrition data is less of a factor in accurate tracking of dietary intake than weight loss itself. Shay cites several studies that indicate that the more weight dieters lose over time, the more scrupulous they become about tracking their calories, regardless of how they record the information. It remains too soon to tell if more accurate online tracking is superior to less accurate paper-and-pencil diaries, states Shay.

There does appear to be a correlation between successful weight-loss and self-monitoring through both paper and electronic means. But Shay states that it is uncertain as to whether the patients who track their nutrition data are more conscientious and more determined, or if having the data and information on the page enhances the weight loss experience itself. Based upon Shay's findings, suggesting a food and exercise diet to clients would seem to be valuable, both for the client and for the nurse to gain a sense of the client's habits. But the nurse must be mindful of the fact that the records may not necessarily be accurate, even if online software is used.

Not noted by Shay, but important to remember is the frequent underestimation of portion size by dieters. Even if nutritional information about calories is available, dieters must still monitor how much they eat, as well as what they eat, with some degree of accuracy. Whether it is tabulated online or on paper, the dieter must take the time to weigh and measure, or at least estimate serving sizes. If he or she does not, portion sizes can easily wreck havoc upon weight loss even with a nutritionally balanced diet.

However, an admittedly small, recent 2010 pilot study, entitled "A community intervention on portion control aimed at weight loss in low-income Mexican-American women" reported by Mary Ann Faucher in the Journal of Midwifery and Women's Health questions the notion of whether detailed education in portion sizes, calories, or overall nutrition is really that valuable for the average dieter. The researchers unintentionally substantiated Shay's concept of self-monitoring being associated with weight loss, although self-monitoring was not part of the study's intention.

The study involved a historically disenfranchised group that has been shown to disproportionately suffer from obesity, due to the stressors of poverty and a lack of access to healthy food. The study attempted to determine if a community-based nutritional intervention program with an emphasis on portion control would lead to 'significant' weight loss amongst a trial group of nineteen Mexican-American women. The participants were divided through randomization into a control group, which received standard weight loss counseling, and another group which received instruction that stressed portion control. For twenty weeks, both groups received four 2-hour classes taught by a certified nurse-midwife (CNM) and a health advisor. The difference between the two groups was not statistically significant. The 'portion control' experimental group only lost a statistically insignificant amount more than the control group. The study was small, but what did emerge from the study was that "mean weight loss, regardless of group, was significantly greater when participants reported self-weighing" (Faucher 2010: 60).