Obesity and Health Care Concerns for Nurses

Incidence rates of obesity are rising globally, with tremendous impacts to the cost and nature of healthcare intervention. As measured as body mass index (BMI) of 25 or over, being overweight affects as many as 67% of all American adults, while up to 40% can be classified as obese with a BMI of 30 or more. About 5% of Americans are classified as morbidly obese with a BMI of 40 or more. Obesity affects persons from all demographic groups, and has been on the rise in all demographic groups, even though some groups have higher rates of obesity than others. As many as 10% of all children worldwide are either obese or overweight. Being overweight and being obese are associated with a number of health conditions including cardiovascular disease, hypertension, and diabetes. Moreover, obesity may cause psychological and social issues ranging from depression and anxiety to stigma and prejudice, with resulting problems with employment or socioeconomic status.

Although BMI is a useful, inexpensive, and relatively reliable means of measuring prevalence and rates of obesity, it is not the most accurate measure due to the fact that many healthy muscular people may have high BMI scores. Other tools that may be used to measure obesity include ratios between waist and hip measurements.

There is no one cause of obesity. Rather, causes can be related to genetics, environmental conditions, and psychological disorders. The manifestation of the condition is excess fat stores in the body. Nutrition and physical activity are both factors that are linked to weight and obesity. Some research suggests that triggers for obesity may begin in utero, as the mother's food intake can affect the baby's metabolism. Environmental factors are certainly causal for many cases of obesity, with a preponderance of processed, high fat, and high caloric foods available at low prices in the United States and elsewhere obesity is a problem. Similarly, sedentary lifestyles are contributing to the increased incidences of the disease.

Health problems are common in persons who are overweight and obese, which is why nurses and healthcare workers need to understand how to address patients who are at risk. The majority of persons who are obese will develop osteoarthritis as a result of their bones bearing excess weight. Osteoarthritis is particularly problematic in persons with a BMI of 40 or more. Most persons with obesity are at risk for developing what is known as Metabolic Syndrome, a cluster of conditions including hypertension, insulin and glucose metabolism issues, and triglyceride/cholesterol concentration issues. Persons who are obese frequently develop cardiovascular problems due to the stress of excess weight on the body, such as increased blood flow and arterial pressure. Congestive heart failure, edema, sleep apnea, and other conditions may be linked to both obesity and cardiovascular illness. Other problems linked to obesity include intra-abdominal pressure, as fatty tissue in the area of the vital organs places undue pressure on the system and can lead to other problems like varicose veins, hemorrhoids, and even cancer. Obesity impacts the health and quality of the skin. Skin conditions like "pressure ulcers, candidiasis, delayed wound healing, incontinence dermatitis, and irritation in the intertriginous areas" are common in obese patient populations (Camden, 2009, p. 1).

Depression, particularly situational depression, is a psychiatric condition associated with obesity. Weight loss has been shown to reduce symptoms of depression in obese persons. Situational depression is the only psychiatric condition that is reported more frequently by obese versus non-obese persons. Stigma and social isolation contributes to the onset of depressive illnesses in obese persons. Body image is a problem for obese people, too, creating a vicious cycle in which the psychological trauma associated with negative body image fuels depression, which in turn prevents changes to diet and lifestyle that might help reduce weight and reduce the problems associated with obesity in the first place. Therefore, organizations like the National Association to Advance Fat Acceptance and the Council for Size and Weight Discrimination work to improve the self-acceptance levels of persons with obesity and help raise awareness in the general public about the problems associated with "fat shaming."

Nursing care is critical for obese patients, but obesity can complicate the nature and type of interventions offered. Sheer physical size can become an issue in some healthcare settings. Likewise, drug absorption rates, intravenous access, and other practical matters will be affected by obesity. Tubes and catheters need to be replaced more frequently in obese persons because of the way the skin folds encourage burrowing. Similarly, skin folds promote moisture accumulation, leading to potential for bacterial, viral, or fungal growth. Pressure ulcers are also a concern. Wounds may heal slowly and problematically in obese patients, as blood supply may be compromised. Dieticians can help with patient care, offering nutritional interventions that can help the body promote healing.

Many obese patients will have some type of respiratory impairment due to thickening of the airway walls and reduced lung function and capacity. Morbidly obese patients are especially at risk for sever respiratory impairments like obesity hypoventilation syndrome. Nurses can help who are obese by encouraging the use of the semi-Fowler's position, and possibly encourage the use of assistive technologies like a continuous positive airway pressure machine. Nurses treating obese patients do need to inquire about home treatment options. If trachea operations are warranted, nurses do also need to be aware of the difficulties inserting tubes during tracheostomy because of excess fatty tissue surrounding the trachea. Wider and longer tubes may help avoid complications, and pulmonologists should regularly be consulted in these matters.