Adult Obesity and Its Consequenses

Preventing Obesity Through Lifestyle Interventions

Obesity Facts and Statistics

What is obesity

According to the CDC, obesity is defined by weight that is higher than what is considered as a healthy weight for a given height.

Obesity risk measures:

Body Mass Index, or BMI
  • Underweight - Below 18.5.
  • Normal - 18.5 - 24.9.
  • Overweight - 25.0 - 29.9.
  • Obesity 30.0 - and Above.

Waist circumference measurement (Risk increases with waist size)
  • Over 40 inches in men.
  • Over 35 inches in women.

Obesity Contributing factors and Prevelance

Major contributing factors are behavior and genetics.


Obesity is a serious concern because it is associated with poorer mental health outcomes, reduced quality of life, and the leading cause of heart disease, diabetes and hypertension leading to strokes and many more deadly yet preventable illnesses.


Our nation has experienced a dramatic increase in obesity. Today, approximately 1 in 3 adults (33.9%) and 1 in 6 children and adolescents (16.2%) are obese.


  • No state had a prevalence of obesity less than 20%.
  • 5 states and the District of Columbia had a prevalence of obesity between 20% and <25%.
  • 23 states, Guam and Puerto Rico had a prevalence of obesity between 25% and <30%.
  • 19 states had a prevalence of obesity between 30% and <35%.
  • 3 states (Arkansas, Mississippi and West Virginia) had a prevalence of obesity of 35% or greater.
  • The Midwest had the highest prevalence of obesity (30.7%), followed by the South (30.6%), the Northeast (27.3%), and the West (25.7%).
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NCLEX Question

1. Which statement by the nurse is most likely to help a morbidly obese 22-year-old man in losing weight on a 1200-calorie diet?


a. "It will be necessary to change lifestyle habits permanently to maintain weight loss."
b. "You will decrease your risk for future health problems such as diabetes by losing weight now."
c. "You are likely to notice changes in how you feel with just a few weeks of diet and exercise."
d. "Most of the weight that you lose during the first weeks of dieting is water weight rather than fat."


2. The nurse is working with an overweight client who has a high-stress job and smokes along with making unhealthy food choices. This client has just received a diagnosis of Type II Diabetes. Which of the following goals for the client which if met, would be most likely to lead to an improvement in his health?


a. Tell him to comply with medication regimen 100% of the times only for 6 months.
b. Advise him to keep consuming large amounts of saturated fat.
c. Lose 5% or more weight until normal weight for height is achieved and exercise 30 minutes or more daily.
d. Consume at least 15g/1,000 kcal of fiber per day.


3. A client who has been hospitalized after experiencing a heart attack will most likely receive a diet consisting of:

a. Low fat, low sodium, and high carbohydrates.

b. Low fat, high protein, and high carbohydrates.

c. Plant based diet, that is high in fiber, low in fat.

d. Liquids for several days, progressing to a soft and then a regular diet.

Obesity and Type 2 Diabetes

Obesity has been linked to type II diabetes (T2D). Unlike type I diabetes (T1D) where the body does not make sufficient insulin to metabolize glucose, T2D is defined by insulin resistance.

Obesity causes the body to have excess adipose tissue.

Excess adipose tissue drives worsening insulin resistance which is central to the underlying cause of T2D.

Key facts:
  • 29.1 million people have T2D in the U.S.
  • 7th leading cause of death in the U.S.
  • 10.3% of the people in Ohio have T2D.
  • 2010 global health expense related to type II diabetes was $376 billion, with estimated cost in the U.S. of $245 billion ($13,700 per person, per year).

Obesity and Cardio Vascular Disease (CVD)

According to the American Heart Association obesity is the number one indicator of potential coronary diseases. Side effects of obesity include increased blood cholesterol and triglyceride levels and lower levels of HDL cholesterol (which is considered the good, or healthy cholesterol) all leading to heart disease hypertension.

Key facts:
  • 27.6 million adults with diagnosed heart disease is the U.S
  • Approximately 610 thousand people die of heart disease in the U.S. each year – that’s 1 in every 4 deaths.
  • Heart disease is the leading cause of death for both men and women in the U.S.
  • Coronary Heart Disease (CHD) is the most common type of heart disease, killing over 370 thousand people annually.
  • Every year about 735 thousand Americans have a heart attack. Of these, 525 thousand are a first heart attack and 210 thousand happen in people who have already had a heart attack.

Prevention

Many research supports the fact that all these illnesses are preventable via life style interventions.


The Finnish Diabetes Prevention Study (The first controlled randomized study to show T2D is preventable with life style interventions) recommends the following:


  • Weight reduction of greater than or equal to 5%.
  • Moderate intensity physical activity of greater than or equal to 30 minutes a day.
  • Dietary fat intake of less 30% of total energy intake.
  • Saturated fat of less than 10% of total energy intake.
  • Fiber of greater than or equal to 15g per 1,000 kcal.


The study supports that making these life style changes reduces risk of developing T2D by 58%.

This study also suggests in addition to preventing T2D, these intervention improved several CVD risk factors including dsylipidemia, hypertension.

Along with lifestyle intervention, other research suggested that the DASH diet and the Mediterranean diet can be used as preventative measures.

The DASH diet
has been shown to reduce systolic and diastolic blood pressure in not only patients with hypertension but also among the general population. Research showed that eight weeks after starting the DASH diet, participants had a decrease in systolic blood pressure by 5.5 mm Hg and diastolic blood pressure 3.0 mm Hg.

DASH diet mostly composed of:
  • Plant-based foods, such as fruits and vegetables, whole grains, legumes and nut.
  • Limiting dairy.
  • Use of lean meats, fish and poultry.

Mediterranean diet was associated with lower risk of MI, HF and ischemic stroke. The Mediterranean diet is most likely to be beneficial in primary prevention of all major types of atherosclerosis-related CVD.

The Mediterranean diet mostly composed of:
  • Plant-based foods, such as fruits and vegetables, whole grains, legumes and nut.
  • Replacing butter with healthy fats, such as olive oil.
  • Using herbs and spices instead of salt to flavor foods.
  • Limiting red meat to no more than a few times a month.
  • Eating fish and poultry at least twice a week.

Healthy People 2020 Objecive

One of the objectives of Healthy People 2020 is to reduce the proportion of adults (20 years or older) who are obese from 33.9% to 30.5%, a 10% improvement overall.

How do we achieve this goal:

  • Eat a well-balanced diet by reducing the amounts of saturated and total fats and increase fiber, fruits and vegetables.
  • Reduce weight by at least 5%.
  • Increase physical activity to at least 30 minutes a day.
  • Participating in lifestyle interventions not only reduces your risk for obesity but also the comorbidities that accompany it.

References

Appel, L. J., Moore, T. J., Obarzanek, E., Vollmer, W. M., Svetkey, L. P., Sacks, F. M., . . . Karanja, N. (1997). A clinical trial of the effects of dietary patterns on blood pressure. The

New England Journal of Medicine, 336(16), 1117-1124. doi: 10.1056/NEJM199704173361601


Centers for Disease Control and Prevention. (2015). Obesity Prevalence Maps. Retrieved from http://www.cdc.gov/obesity/data/prevalence-maps.html


Centers for Disease Control and Prevention. (2016). Heart Disease. Retrieved from http://www.cdc.gov/nchs/fastats/heart-disease.htm

Centers for Disease Control and Prevention. (2015). Heart Disease Facts. Retrieved from http://www.cdc.gov/heartdisease/facts.htm


Lindström, J., Louheranta, A., Mannelin, M., Rastas, M., Salminen, V., Eriksson, J., Uuitupa, M., Tuomilehto, J. (2003). The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care 26(12), 3230-3236. doi: 10.2337/diacare.26.12.3230


Liu, A., Silvestre, M., & Poppit., S. (2015). Prevention of Type 2 Diabetes through Lifestyle Modification: Is There a Role for Higher-Protein Diets? Advances in Nutrition 6 665-673. doi: 10.3945/ an.115.008821


Ray, Linda. (2013, August 16). How Does Obesity Cause Heart Disease?. Livestrong Foundation. Retrieved from http://www.livestrong.com/article/17809-obesity-cause-heart-disease/


Tektonidis, G. T., Åkesson, A., Gigante, B., Wolk, A., & Larsson, S. C. (2015). A Mediterranean diet and risk of myocardial infarction, heart failure and stroke: A population-based cohort study. Atherosclerosis, 243(1), 93-98. doi 10.1016/j.atherosclerosis.2015.08.039