Introduction
Globally, obesity is increasingly prevalent. Nearly two billion individuals are estimated to be overweight across the world (Camden, 2009; Rowen, 2009). The obesity epidemic is one of the most pressing concerns for healthcare professionals in the U.S. About two-thirds of adults are overweight or obese, with a body mass index (BMI) that is higher than 25. 17% of children under age 18 in the U.S are overweight or obese (Camden, 2009). The economic costs for obesity are estimated to be greater than $117 billion annually in the US. Obesity occurs across all ages, gender, racial, and ethnic backgrounds, Obesity increases the risk of diabetes, stroke, heart disease, and cancer. The psychological burden of obesity includes shame, body image issues, and isolation (Rowen, 2009). This issue analysis looks at the impact of nurses in addressing obesity, how nurses can become more engaged in health policy related to this issue, as well as how nurses can impact future outcomes with regards to the provision of care for obese individuals.
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Impact of Professional and Advanced Nurses
Obese patients use more consultation time as well as generate higher prescriptions than people who have normal weight. Most obese patients are being treated in primary care settings due to the financial imperative to reduce costs and time burden, as well as the shifting of chronic disease management to primary care. Within the primary care sector, the practice nurse plays the role of health promoter as well as chronic disease manager. With respect to obesity, these roles include promoting weight maintenance, weight loss, as well as nutritional guidance (Nolan et al., 2012). However, most practice nurses are not familiar with national guidance on obesity or find current guidance to be of limited use for the advanced practice nurse and tend to rely on the internet or other colleagues for guidance. The level of expertise on non-persuasive and non-medical approaches to obesity management such as motivational interviewing is also low. The level of confidence among practice nurses with regards to expertise or specialist care is such areas as interviewing, nutrition, obesity assessment and child obesity is low (Nolan et al., 2012). Nurses also play key roles in providing health informataion that is weigth-related to the public. Nurses who work with schools and in the community use research evidence to design heath promotion for various poupulations. School nurses also play important roles in obesity prevention through the use of BMI assessment and nutritional assessment tools (Lazarou & Kouta, 2010).
Increasing Nurses’ Involvement in Health Policy
Nurses can play a critical role in addressing the obesity pandemic. They have the ability to be important agents of change in their areas of practice and can advocate for improved health for patients and communities. It is important that nurses participate actively policy creation and in the funding decisions to support comprehensive plans for addressing the pandemic at both national and local levels. Nurses have to actively participate in designing evidence-based interventions, (Rowen, 2009). Nurses can advocate for increase in physical activity at the governmental level and can support efforts to promote opportunities for physical activity for parents. Such opportunities can include the creation of bicycle paths, walkways, and parks for recreation. Nurses can also support policies that encourage parental lifestyles that model healthy weight as well as healthy dietary choices. Prevention, treatment and early detection continue to be important in practice settings, as well as the promotion of appropriate nutrition advice (Lazarou & Kouta, 2010).
Future Impact on Care Outcomes for Obesity
With the increasing trend in obesity, nurses will have to adjust nursing care to respond to increased numbers of heavier patients over time. Obesity complicates even the most basic interventions across all practice settings. It is therefore important to anticipate such issues and develop the skills to address them (Camden, 2009). Complications from obesity can include respiratory challenges, skin assessment, altered drug absorption, immobility, intravenous access, as well as resuscitation measures. Obese patients develop atypical pressure ulcers because pressure within their skin folds causes skin breakdown. Tubes and catheters can also burrow into soft tissue necessitating frequent repositioning of such equipment. Wound healing may be problematic due to compromise in blood supply. In terms of respiratory challenges, common abnormalities include reduced functional residual capacity and expiratory reserve volume. Morbidly obese patients also present with sleep apnea and obesity hypoventilation syndrome (OHS).
Where resuscitation measures are necessary for obese patients and cardio-pulmonary resuscitation (CPR) is necessary, a Doppler can help how effective compressions are through listening to blood flow through the patient’s carotid artery. Excess body fat can also alter drug absorption based on the medication being taken. The dosages for some medications are calculated based on actual body weight while some are based on ideal body weight. It is important to have the clinical pharmacist in such healthcare teams. Peripherally-inserted central catheter (PICC) or the midline catheter may be the best option for inserting intravenous lines where starting a peripheral IV is challenging. There are also hazards related to immobility in obesity. Common complications include cardiac deconditioning, skin breakdown, deep vein thrombosis, urinary stasis, muscle atrophy, pain management problems, constipation, and depression. Proper training is needed on how to lift and turn patients using appropriate equipment (Camden, 2009). Nurses can take action towards becoming more informed about the condition and so position themselves as educators for communities and patients (Rowen, 2009).
- Camden, S. (2009) “Obesity: An emerging concern for patients and nurses” OJIN:
The Online Journal of Issues in Nursing Vol. 14, No. 1. Manuscript 1. DOI: 10.3912/OJIN.Vol14No1Man01 - Lazarou, C. & Kouta, C. (2010). The role of nurses in the prevention and management of obesity.
British Journal of Nursing, 19 (10), 641-647. - Nolan, C. et al. (2012). Practice nurses and obesity: professional and practice-based factors
affecting role adequacy and role legitimacy. Primary Health Care Research & Development. 1-11. Doi: 10.1017/S1463423612000059 - Rowen, L. (2009). Overview and summary: Obesity on the rise: What can Nurses do? OJIN:
The Online Journal of Issues in Nursing, Vol. 14, No. 1, Overview. http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol142009/No1Jan09/Overview-and-Summary.aspx
