Obesity can be defined as an excess of body fat that has accumulated to such an extent thereby creating possible harmful, adverse effects on health (Pearson, 2003). The prevalence of obesity in the United Kingdom is increasing rapidly. The National Obesity Forum (2001) stated that, in the year 2000, 24 per cent of women and 22 per cent of men were obese and an immense 60 per cent of men and 50 per cent of women were classed as overweight. Correspondingly, child obesity is also on the increase. Clinically, obesity is when a persons Body Mass Index (BMI) is greater than 30. BMI is an individuals weight to height ratio and a healthy BMI is between 20 and 25. Any measurement that is greater than 40 is classed as morbidly obese (Parsons, 2002). This essay will examine the holistic impact of obesity on health and well-being as well as exploring how nurses can support obese individuals in losing weight.
Physically, obesity has significant effects on health, both in terms of morbidity and mortality. Coronary heart disease, stroke, type 2 diabetes mellitus and cancer are all life-threatening complications of being obese. Furthermore, the risk of complications from obesity increases in accordance with increased weight gain (Crombie, 1999). In addition to these life-threatening conditions, obesity might be responsible for debilitating conditions such as joint and back pains, sleep apnoea, breathlessness, varicose veins and gall bladder problems. Even moving around undertaking everyday activities can become problematic for an obese individual (Drummond, 2000). It is suggested therefore that the quality of life for an obese person is less than optimal and this might lead to psychosocial problems.
Socially, obese individuals might experience significant distress within society caused by derision and discrimination. A perceived or real inability to fit into cars or aeroplane seats and worries about fitting through aisles or finding chairs strong enough to hold their weight will all add to an obese persons low self-esteem. Accordingly, on an emotional level, obese people might lose confidence, lack belief in themselves and fear rejection. Consequently, they could be unwilling to leave the security of their homes to socialise, thereby becoming isolated. Similarly, an obese individual might also fear discrimination from health professionals and therefore delay seeking medical advice, or not seek it at all (Munro, 2006). Debatably, these psychosocial worries might compound the urge to overeat by comfort eating to reduce stress and anxiety.
From the facts mentioned, it is debated that obese patients could be considered a vulnerable group. It is proposed that nurses, particularly those who work within primary care settings, are in a perfect position to take steps to help customise care to an obese individuals specific requirements. However, even nurses working within hospital settings can take the opportunity to promote healthier lifestyles to obese patients, that is if losing weight is what the patient wishes to do.
Due to the human cost of obesity and the financial cost obesity imposes on the National Health Service (NHS), the United Kingdom National Audit Office (NAO) 2001 Report into Tackling Obesity in England has proposed various guidelines for NHS professionals. The report suggests that all health service professionals should provide advice and support on weight control. Having said this, it is argued that clear guidelines on the management of obesity, especially at a local level, need to be given in order for an effective care pathway to be undertaken for an obese individual (NA0, 2001). Similarly, nurses need to be educated and perhaps motivated to help obese individuals lose weight and increase fitness.
It is proposed that nurses might need to be trained in behavioural counselling in order to be able to identify readiness to accept change in patients (Drummond, 2000). Debatably, if an individual is not emotionally ready to make changes to their lifestyle, then they are more likely to fail. Similarly, nurses will need excellent communication skills in order to raise the issue of weight loss and the uptake of exercise.
When raising the issue of changing to a lifestyle that will enable weight loss, it can be extremely difficult to talk to someone because it might make the patient feel uncomfortable and also imply blame. This could be damaging to the patient nurse relationship (Drummond, 2000). However, it is argued that nurses have a duty of care to provide information and support in relation to weight management. Pearson (2003) suggests that linking weight to a current health concern is often an appropriate way to introduce weight management issues. For instance if someone has type 2 diabetes mellitus, the nurse could suggest that managing ones weight will have a significant impact in controlling their diabetes. It is important to note that any advice offered should be specific for the individual. However, there are a few general principles that should be encouraged. Nurses should advise obese patients on the benefits of a low-fat, high-carbohydrate diet coupled with an increase in physical activity (Drummond, 2000). Weight loss is an individual experience and it is important to spend time discussing patients expectations and goals. Debatably, these measures might be difficult to undertake in a busy general practice or hospital where nurses often have an over-stretched workload. Individuals embarking on a weight-loss programme need to be regularly monitored. It is suggested that supporting obese individuals throughout their weight management programme is the key to success. Therefore, it is important to spend time discussing where and how they are best going to receive the help needed (Pearson, 2003). It is proposed therefore that the NHS, in line with government recommendations, might need to set up special weight-loss clinics supervised by nurses who specialise in obesity management.
Obesity is a chronic medical condition that morbidly affects a persons health in various ways. It is a problem that cannot be ignored and is costly in terms of human health and financial strain placed on the NHS. Therefore, it is medically and economically important to tackle obesity. Health professionals, especially nurses in primary care, need to play a part in tackling obesity and they are in an ideal position to do so. Nurses can offer continuous support to obese patients. However, putting advice into practice and sustaining the motivation needed for success requires additional resources such as specialised nurses and settings.
Crombie, N (1999) Obesity management, Nursing Standard, 13, 47, 43-46
Drummond, S (2000) Obesity in primary care, Primary Health Care, 10, 5, 43-49
Munro, J (2006) It’s time for nurses to get behind obese patients, British Journal of Nursing, 15, 14, 748
National Audit Office (2001) Tackling Obesity in England
National Obesity Forum (2001) National Obesity Forum Guidelines on Management of Adult Obesity and Overweight in Primary Care
Parson, T (2002) Weight management for health, Primary Health Care, 12, 6, 39�48
Pearson, D (2003) Weight management, Primary Health Care, 13, 10, 43�49