Obesity †case study and health promotion paper Essay

fleshiness has r individu altogetheryed global epidemic pro parcel outs, and has become a major heartyness problem of out society. According to Peeters et al. (2007), 32% or 60 jillion the smashing unwashed are now round in the United States. The cause develops as a pass of the interaction between genetics, lifestyle behavior, and heathen and environmental influences. Fat accumulates when to a greater extent(prenominal) readiness is consumed than expended. The National Heart, Lung, and Blood get (NHLBI) has adopted a classification system of trunk fix office (BMI). BMI, the indirect measure of body prolific, identifies the over tip and obese individuals. A BMI of 25-29 kg/m2 is considered over burden, 30-34 kg/m2 is mild corpulency, 35-39 kg/m2 is moderate obesity, and above 40 kg/m2 is extreme obesity (Palamara, Mogul, Peterson, Frishman, 2006).Obesity develops due to high-fat, high kale nutrition coupled with a decline in visible activity. Modern alive condition s, eating habits, and tone of voice of forage lead to over-consumption of cheap, super sized portions. much cars, roads, and fast food restaurants at e real corner, as well as quick, ready to eat microwavable dinners loaded with fat, salt, and simple carbohydrates are easier and frequently less(prenominal) expensive than nutritious, quality food products. Further much, the technology has made humans rely on mechanical devices. The automated inventions designed to make life easier, work out meters of tasks that in the past required physical labor. As a go out of sedentary life and over-consumption, the overabundanceive fat accumulates in the body, and may make believe significant wellness consequences.Multiple research studies have revealed that excessive free exercising weight gain join ons the luck of diabetes, high blood pressure, dyslipidemia, coronary heart disease, stroke, osteoarthritis, and m each a(prenominal) forms of cancer. In particular, abdominal obes ity has been recognized as strongly associated with the development of diabetes and cardiovascular diseases (Behn & adenylic acid Ur, 2006) (Chen et al., 2007) (Balkau et al., 2007) (Despres, 2007). Due to the dangerous health risks of obesity, it is considered a disease that requires treatment (Palamara et al., 2006). The Centers for unhealthiness Control and Pr blushtion (n.d.) estimated that medical expenses related to obesity cost $92.6 i million million in the year 2002, and the condition causes 300,000 deaths per year.Nevertheless, pr unconstipatedtion of the bigeminal health consequences of obesity is possible by weight simplification. Bardia, Holtan, Slezak and Thompson (2007) suggested that Even a small accrue in a tolerant ofs weight would result in better control of multiple diseases, enhance quality of life, greatly reform a patients morbidity, and result in measlyer health care use and medical be. In addition to preventing many diseases, weight decrease can improve the already present disorders. investigate indicates that weight release of 4% to 8% is associated with a decrease of systolic and diastolic line of business pressure by 3 mmHg (Mulrow et al., 1998). The main weight trim down interventions include food, lick, psychological, behavioral, pharmacotherapy, surgery, and alternative therapies (Vlassov, 2001).However, the massive verge soundness of these interventions has non proven impelling, as majority of people regain their weight after losing it (Biaggioni, 2008). Guidelines for weight simplification suggested by NHLBI involve the fol clinical depressioning initial reduction of 10% of body weight, confused nutritionists small calorie provender (800-1500 kcal/d) 30% calories from fat, 15% calories from protein, and 55% calories from carbohydrates, cursory deficit of 500-1000 kcal to lose one to two(prenominal) pounds per calendar calendar week during hexad months, long term weight fear, and physical ac tivity for 30 to 45 minutes three to five days a week (Palamara et al., 2006). Health care providers are faced with the prevention and focussing of a major cause of morbidity and mortality for which effective life long interventions are desperately needed.CASE STUDY curtsy is a 38 year old white male. Except for hypertension, he considers himself healthy. He has seen his family restore three months ago for regular blood pressure check up, as he does every six months. bottle cork is married, has quaternary adolescent children, and work as an automobile dealer for four-spotteen years.Past medical taradiddle hypertension, obesity, hyperlipidemiaAllergies none to medications, latex, animals, foods, or environmentalHospitalizations / surgeries / injuries tonsillectomy in childhoodMedications lisinopril 20mg orally routineFamily medical history mother and brother with hypertensionSocial history lives with wife and children, all very substantiateive of each other, get along well,d rinks 2 glasses of whiskey socially on weekends, denies smoking or illicit substance usePhysical activities walks on treadmill for twenty minutes once or twice a week, occasionally plays volleyball with family on weekendsDaily intake patterns breakfast four sandwiches with cheese and ham lunch home made soup, cooked or fried sausage dinner salad, lots of potatoes, 2 portions of steak or meatloaf or chicken, pickled vegetables supper pasta with sauce or pizza snacks chips, cookies, candy, pretzels and fruits, all end-to-end the day fluids 8 glasses of popping, juice, water or milk.Review of systems unremarkable, no complaints. cant 280 pounds, Height 63, Waist perimeter 52, BMI 35kg/m, BP 150/90 mmHgMost recent abnormal science laboratory tests quantity cholesterol 220, triglycerides 310All other results including glucose, blood count, BUN, creati order, and liver enzymes were deep down normal range.Bob admitted that weight loss has been one of the greatest challenges for him. His several(prenominal) previous attempts at weight reduction have been un victorious. He expressed willingness and readiness to try again, moreover was concerned that he would non be able to fol low-down the plan long term. Bobs family was very supportive, and willing to help with his weight loss attempts. To identify the health risks of obesity, and to take care interventions to reduce those risks, research articles were examined. The search for relevant studies was conducted using OVID MEDLINE, PUB MED, CINAHL, and COCHRANE databases. compendium OF LITERATUREDietary interventions form the fundamental element of the management of obesity. thither is a wide variety of possible diets, but no consensus on which is the most effective for weight reduction. A review by Noakes and Clifton (2004) compared the effectuate of a low carbohydrate diet and a low fat diet. general, the studies revealed that a very low carbohydrate diet resulted in significantly more weight lo ss than low fat diet in the short to medium term. On the other hand, a moderately low carbohydrate diet resulted in similar weight loss as a low fat diet. Moreover, the very low and moderately low carbohydrate diets have been found to more effectively reduce triglyceride, and increase high density lipoprotein (HDL) levels compared to low fat diet.Again, comparison between the low carbohydrate and low fat diets was performed by Lecheminant et al. (2007). In a quazi-experimental design, 102 participants were designate either to a low carbohydrate (LC) or a low fat (LF) group. Both groups followed a very low energy diet and lost significant body weight (LC 20.4 kg, LF 19.1 kg) and waistline circumference. The differences between the two groups were non statistically significant. In addition to the diet, all participants were pertain in brisk walking 300 minutes per week, and all were issued pedometers to monitor their progress. Also, both groups were equally effective at preventi ng weight re-gain over six months, and both groups were found to have a decreased blood pressure as a result of weight loss.Similarly, a systematic review by Pirozzo, Summerbell, Cameron and Glasziou (2002) compared the effects of a low fat diet to low calorie diet and low carbohydrate diet. Six randomized controlled tally runs with a total of 594 participants were study over a period of six to eighteen months. Overall results demonstrated non-significant differences in weight loss, weight maintenance, serum lipids, and blood pressure between all the diets reviewed.Moreover, a one year randomized trial by Dansinger, Gleason and Griffith (2005) compared Atkins, Zone, Weight Watchers, and Ornish diets. A single center randomized trial assigned 160 participants among the four diet groups. After one year, all diet groups were found to have significantly cut down weight and waist size, without significant differences between groups. Similarly to previous studies, low carbohydrate die ts reduce triglycerides and diastolic blood pressure, all except Ornish diet group increase high density lipoprotein (HDL), and all except Atkins diet group reduced low density lipoprotein (LDL).In addition to energy restriction through and through the diet, energy expenditure may enhance weight loss. In a meta-analysis by Shaw, Gennat, ORourke and Del Mar (2006), 41 randomized controlled clinical trials were analyzed to determine the effects of form in clayey and obese adults. The multiple achievement interventions included walking, jogging, cycle ergometry, weight training, aerobics, treadmill, stair stepping, dancing, ball games, calisthenics, rowing, and turquoise jogging. The 3476 participants representatived three to five days a week for a median(prenominal) duration of forty five minutes a day. Several of the studies compared exercise to diet either alone or in combination with exercise. The results revealed that exercise alone led to marginal weight loss, but when com bined with diet produced significant weight reduction.Moreover, comparing the intensities of the various types of exercise activities, it was found that both high and low ecstasy exercises were associated with weight loss. Nonetheless, high intensity bring forth only around more weight reduction than low intensity, but when the diet component was added, the difference between high and low intensity was non significant. Additionally, the envisionings revealed that systolic blood pressure reduction was favored by diet over exercise, and diastolic blood pressure was reduced equally likely by exercise as by diet. Furthermore, exercise did not reduce cholesterol levels, but was found to reduce triglycerides equally well as diet. perseverings involved in the exercise trials improved diastolic blood pressure, triglyceride, high density lipoprotein, and glucose levels regardless of whether they lost weight.One of the most rocky aspects of weight loss plans is consistent love to exercise. A meta-analysis by Richardson et al. looked at the effects of walking on weight reduction (2008). 307 participants in nine interventional studies were provided with pedometers to monitor step count. Pedometers served as indigenceal tools to self monitor and authorize the goals of walking. The participants logged the daily recorded steps, and reviewed their results during group meetings. On average about 0.05 kg was lost per week after walking two thousand to four thousand steps per day. Although the amount of weight lost in the trials was small, adherence to walking programs and increasing step count according to preset goals is distinguished for the beneficial effects on health. The physical activity reduced the risk of cardiovascular events, lowered blood pressure, and helped maintain lean muscle mass of the participants. The studies have shown that the use of pedometer is helpful in monitoring the progress of physical activity, and is a good way to motivate continued increase in walking.Another meta-analysis compared different psychological interventions and their effects on weight reduction (Shaw, ORourke, Del Mar, Kenardy, 2005). 36 randomized controlled clinical trials including 3495 participants were evaluated. The majority of studies assessed the effects of behavioral interventions on weight loss. The duration of clinical contact with the participants ranged from 7 to 78 weeks, with sessions lasting 60 minutes weekly. The techniques included stimulus control, goal linguistic context, and self-monitoring. The therapies intensify dietary restraints by providing adaptive dietary strategies, and by increasing pauperism for physical activities, and to maintain adherence to the healthier lifestyle.Behavioral therapy was successful at decreasing weight as a stand-alone dodging (2.5 kg), and even greater weight reduction was attained when combined with diet and exercise (4.9 kg). Several evaluated studies also assessed cognitive therapy, p sychotherapy, relaxation therapy, and hypnotherapy, but the results of these either did not reveal significant weight reduction, or resulted in weight gain. Moreover, a number of studies found that weight loss was associated with reductions in systolic and diastolic blood pressure, serum cholesterol, triglycerides, and fasting plasma glucose. These findings once again back the significant health benefits of reducing weight.Overall, the research suggests that most diets are equally effective at weight reduction. There are multiple more or less popular diets known, and according to Dansinger et al. (2005), more than one thousand diet books are now accessible. Instead of searching for the best available, obese patients should be advised that any diet would be more effective than the one they are currently consuming. Moreover, diet modification has been shown to be more effective than exercise, but both are beneficial in reducing cardiovascular risk factors. exploit does not have to be intense, and walking on most days of the week is sufficient for risk reduction when continued long term. Finally, addition of behavioral interventions may strengthen motivation and self monitoring, and enhance weight loss maintenance.INTERVENTIONS AND RESULTSBob was presented with the literature findings on health risks and health promotion, and was support to lose weight by diet, and occasion in more physical activities. He was introduced with the possible options, and it was recommended that he participates in designing his weight loss plan. This way Bob could have more control over the interventions, and was able to incorporate his preferences. Bob identified his sensed benefits of losing weight as improved body image, mood, physical fitness and agility, reduced blood pressure, and reduced risk of comorbidities. The main barriers were mainly the resistance to quench favorite foods, and occasional laziness to perform physical activities.Instead of head start one of the mul tiple popular diets, Bob clear-cut to reduce his portion sizes initially by 30%, substitute supper and snacks by fruits and vegetables, and eliminate soda and juice. To assure smaller portion sizes, Bob was encouraged to use a smaller plate than usual. He also agreed to drink at least two liters of water a day, especially with meals, to reach satiety sooner. He was encouraged to keep a journal of all his daily intakes of food and drink to monitor his diet, and to identify some hidden sources of excess consumption. Moreover, to avoid excess eating, Bob was instructed to only eat at the table, and to not allow family members to eat any food while sitting on the couch or in front of the computer.He also refractory to become more physically active, and his choice of daily exercise was walking. Bob was encouraged to purchase a pedometer to monitor progress in physical activity, aiming for at least two thousand steps a day. Richardson et al. (2008) aware that a two thousand step w alk was estimated to equal one mile. Bob was also encouraged to set weekly walking goals, easy increasing his step count. Bobs family was also involved in his attempt to lose weight. To help him attain his goals, family members planned to show support for Bobs exercise by joining him. Furthermore, Bob was encouraged to identify situations of daily living providing opportunities for more physical activities, for ex axerophtholle lay further away from the entrance at work and grocery store. periodical meetings evaluated Bobs progress, and discussed about difficulties of following the plan. Bob remained strongly do throughout the eight weeks of intervention, and successfully reached most of his weekly dietary and exercise goals. Portions of his meals decreased steadily until no more than 50% of initial food intake was reached, and the snacks included fruits and vegetables only. Daily step count reached up to six thousand steps on some days, and daily walks through the commonalty wi th his wife became an enjoyable routine. To everyones surprise, during the third week Bob decided to accompany his sons to the health club twice a week, where he swam in the pool for one hour.He expressed feeling energized after any physical activity. Several small relapses were recorded when Bob missed a couple days of walking, and could not resist eating high calorie or high fat foods. At the end of eight weeks of interventions, Bob has lost nine pounds, reduced his BMI to 33.9 kg/m, and his waist circumference decreased by 1.25 inches. Also, his systolic and diastolic blood pressure was slightly reduced. Unfortunately, the effect on the blood lipid level has not been tested. In conclusion, during only eight weeks Bob turned from moderately obese to softly obese, and remained motivated to continue the weight loss plan.DISCUSSIONResearch has revealed that any diet, as long as caloric intake is restricted, will result in weight loss. It has been calculated that to lose one poun d a week, one has to restrict food intake by 500 kcal per day. Patients often get discouraged by the slow effects of weight loss. On the other hand, studies point that more restrictive diets have lower conformation rates and increased weight regain (Palamara et al., 2006). Unfortunately, losing the weight is not the biggest challenge. What people mostly fail at is maintaining the reduced weight. Effective weight maintenance requires not only decreasing energy intake and increasing energy expenditure, but also modification of behaviors that predispose to weight gain.Bob monitored his daily dietary intake, and avoided situations leading to overeating. Also, the pedometer monitored the amount of walking, and served as a motivational tool. Moreover, natural motivation for physical activities, as described by Teixeira et al. (2006), is the satisfaction from dynamic in an activity, while foreign motivation describes the desire of slimmer appearance, and weight management. The autho rs presented that the extrinsic motives correlated with short term weight loss, whereas intrinsic motives predicted long term results. Bob expressed enjoyment of daily walks through the park, which correlates with intrinsic motivation, and thence he is likely to continue over longer period of time. It is important that diet or exercise is maintained for the pleasure and positive feelings brought on by the activity.IMPLICATIONS OF FINDINGS FOR CLINICAL PRACTICEThe continuing rise in obesity and related risk factors, and failure of maintaining long term weight loss result in increasing prevalence of comorbidities. Health care costs related to treating ailments resulting from obesity will continue to rise, unless health care providers habituate more effective measures to deal with the problem. Promoting healthy nutrition and lifestyle aboriginal in life may prevent the development of obesity. It is a great challenge for have practitioners to help patients maintain their weight. Alt hough the recommended compositions of various diets include peculiar(prenominal) amounts of fats, carbohydrates, and protein, the research revealed that it is the total caloric content that is responsible for weight loss, regardless of nutrient partitioning. Once the patient is ready and willing to commit, the treatment strategy should be devised together. Since the variety of diet options have been shown to have similar effects, the nurse practitioner can help match the nutritional plan with patients dietary preferences.Although diet was found to be more effective in weight reduction than exercise, patients with cardiovascular risk factors should be  meliorate about the benefits of physical activities. It is important to encourage continuous participation in exercise, even when no reduction of weight is observed. Lifestyle changes can be difficult to sustain for the patient, hence continuous support and motivation by a nurse practitioner are necessary. The interventions requir e dedication of both, the patient and the nurse practitioner. Also, counseling patients family, and encouraging to get involved in loved ones struggle through weight loss and weight maintenance may provide additional support, and set in to lasting behavior changes. Behavioral strategies such as encouraging setting appropriate goals, self monitoring and evaluation may increase the get of success. Patients satisfaction with the choice of diet and physical activity, and successful long term adherence are the best predictors of lifelong weight maintenance.CONCLUSIONThe comorbidities associated with obesity substantially lower the individuals quality of life, and are also becoming an enormous burden on health care. Successful treatment and prevention of obesity can reduce the situation of its complications. Dieting is resented by most individuals, therefore it is necessary to assist patients to find appropriate and motivating interventions that can be successfully followed life long. Patients willingness to commit to a long term adherence is native to permanent lifestyle changes. It is a long and difficult journey from deciding to lose weight to the successful long term results, but even small losses of weight can produce important health benefits.REFERENCESBalkau, B., Deanfield, J.E., Despres, J.P., Bassand, J.P., Fox, K.A., Smith, S.C.Jr., Barter, P., Tan, C.E., Van Gaal, L., Wittchen, H.U., Massien, C., Haffner, S.M. (2007, October). International Day for the Evaluation of Abdominal Obesity (IDEA) a study of waist circumference, cardiovascular disease, and diabetes mellitus in 168,000 primary care patients in 63 countries. _Circulation, 116_(17), 1942-51. Retrieved February 5, 2008, fromOVID MEDLINE database.Bardia, A., Holtan, S.G., Slezak, J.M., Thompson, W.G. (2007, August). Diagnosis of obesity by primary care physicians and jar on obesity management. _Mayo Clinic Proceedings, 82_(8), 927-32. Retrieved February 7, 2008, from OVID MEDLINE database.Behn, A., Ur, E. (2006, July). The obesity epidemic and its cardiovascular consequences. _Current flavor in Cardiology, 21_(4), 353-60. Retrieved February 7, 2008, from OVID MEDLINE database.Biaggioni, I. (2008, Feb). Should we target the sympathetic nervous system in the treatment of obesity-associated hypertension? _Hypertension, 51_(2), 168-71. Retrieved April 4, 2008, from OVID MEDLINE database.Chen, L., Peeters, A., Magliano, D.J., Shaw, J.E., Welborn, T.A., Wolfe, R., Zimmet, P.Z., Tonkin, A.M. (2007, December). Anthropometric measures and absolute cardiovascular risk estimates in the Australian Diabetes, Obesity and Lifestyle (AusDiab) Study. _European Journal of Cardiovascular Prevention & Rehabilitation, 14_(6), 740-5. Retrieved February 7, 2008, from OVID MEDLINE database.Dansinger, M.L., Gleason, J.A., Griffith, J.L., et al. (2005). Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction. _Journal of American Medica l Association, 293,_ 43-53. Retrieved February 5, 2008, from Electronic Journals.Centers for Disease Control and Prevention (CDC). (n.d.). _Overweight and obesity frugal consequences, 2007._ Retrieved February 7, 2008, from http//www.cdc.gov/nccdphp/dnpa/obesity/economic_consequences.htmDespres, J.P. (2007, June). Cardiovascular disease under the influence of excess splanchnic fat. _Critical Pathways in Cardiology A Journal of Evidence-Based Medicine, 6_(2), 51-9. Retrieved February 5, 2008, from OVID MEDLINE database.Lecheminant, J.D., Gibson, C.A., Sullivan, D.K., Hall, S., Washburn, R., Vernon, M.C., Curry, C., Stewart, E., Westman, E.C., Donnelly, J.E. (2007, November). Comparison of a low carbohydrate and low fat diet for weight maintenance in overweight or obese adults enrolled in a clinical weight management program. _Nutrition Journal, 6,_ 36. Retrieved February 7, 2008, from PubMed database.Mulrow, C.D., Chiquette, E., Angel, L., Cornell, J., Summerbell, C., Anagnostelis, B., Brand, M., Grimm, R.Jr. (1998). Dieting to reduce body weight for controlling hypertension in adults. _Cochrane Hypertension Group. Cochrane Database of Systematic Reviews, (4),_ CD000484. Retrieved February 5, 2008, from COCHRANE database.Noakes, M., Clifton, P. (2004, February). Weight loss, diet composition and cardiovascular risk. _Current Opinion in Lipidology, 15_(1), 31-35. Retrieved February 5, 2008, from OVID MEDLINE database.Palamara, K.L., Mogul, H.R., Peterson, S.J., Frishman, W.H. (2006). Obesity new perspectives and pharmacotherapies. _Cardiology in Review, 14_(5), 238-58. Retrieved February 7, 2008, from OVID MEDLINE database.Peeters, A., OBrien, P.E., Laurie, C., Anderson, M., Wolfe, R., Flum, D., MacInnis, R.J., English, D.R., Dixon, J. (2007, December). Substantial lettered weight loss and mortality in the severely obese. _Annals of Surgery, 246_(6), 1028-33. Retrieved February 7, 2008, from OVID MEDLINE database.Pirozzo, S., Summerbell, C., Cameron, C., Glasz iou, P. (2002). Advice on low-fat diets for obesity. _Cochrane metabolic and Endocrine Disorders Group. Cochrane Database of Systematic Reviews, (2),_ CD003640. Retrieved February 5, 2008, from COCHRANE database.Richardson, C.R., Newton, T.L., Abraham, J.J., Sen, A., Jimbo, M., Swartz, A.M. (2008, Jan-Feb). A meta-analysis of pedometer-based walkinginterventions and weight loss. _Annals of Family Medicine, 6_(1), 69-77. Retrieved February 7, 2008, from CINAHL database.Shaw, K., Gennat, H., ORourke, P., Del Mar, C. (2006). Exercise for overweight or obesity. _Cochrane metabolic and Endocrine Disorders Group. Cochrane Database of Systematic Reviews, (4),_ CD003817. Retrieved February 5, 2008, from COCHRANE database.Shaw, K., ORourke, P., Del Mar, C., Kenardy, J. (2005). psychological interventions for overweight or obesity. _Cochrane Metabolic and Endocrine Disorders Group. Cochrane Database of Systematic Reviews, (2),_ CD003818. Retrieved February 7, 2008, from COCHRANE database.Te ixeira, P.J., Going, S.B., Houtkooper, L.B., Cussler, E.C., Metcalfe, L.L., Blew, R.M., Sardinha, L.B., Lohman, T.G. (2006, Jan). Exercise motivation, eating, and body image variables as predictors of weight control. _Medicine & Science in Sports & Exercise, 38_(1), 179-88. Retrieved April 4, 2008, from OVID MEDLINE database.Vlassov, V.V., (2001). Weight reduction for reducing mortality in obesity and overweight. _Cochrane Metabolic and Endocrine Disorders Group. Cochrane Database of Systematic Reviews, (3),_ CD003203. Retrieved February 5, 2008, from COCHRANE database.