(see Chapter 6. Physiological Integrity)

1. Definition: body weight exceeding 20% above the norm for person's age, sex, and height constitutes obesity. Body mass index (BMI) is also used. Although a faulty adaptation, obesity may serve as a protection against more severe illness; it represents an effort to function better, be powerful, stay well, or be less sick. The problem may not be difficulty in losing weight; reducing may not be the appropriate cure.
2. Assessment—characteristics:
1. Age—one out of three persons under 30 years of age is more than 10% overweight.
2. Increase risks for stroke, MI, diabetes.
3. Feelings: self-hate, self-derogation, failure, helplessness; tendency to avoid clothes shopping and mirror reflections.
4. Viewed by others as ugly, repulsive, lacking in will power, weak, unwilling to change, neurotic.
5. Discrepancy between actual body size (real self) and person's concept of it (ideal self).
6. Pattern of successful weight loss followed quickly and repetitively by failure; that is, weight gain.
7. Eating in response to outer environment (e.g., food odor, time of day, food availability, degree of stress, anger); not inner environment (hunger, increased gastric motility).
8. Experiences less pleasure in physical activity; less active than others.
9. All people who are obese are not the same.
1. In newborns and infants who are obese, there is an increased number of adipocytes via hyperplastic process.
2. In adults who are obese, there may be increased body fat deposits, resulting in increased size of adipocytes via hypertrophic process.
3. When an infant who is obese becomes an adult who is obese, the result may be an increased number of cells available for fat storage.
10. Loss of control of own body or eating behavior.
3. Analysis/nursing diagnosis: defensive coping related to eating disorder. Contributing factors:
1. Genetic.
2. Thermodynamic.
3. Endocrine.
4. Neuroregulatory.
5. Biochemical factors in metabolism.
6. Ethnic and family practices.
7. Psychological:
1. Compensation for feelings of helplessness and inadequacy.
2. Maternal overprotection; overfed and force-fed, especially infants who are formula-fed.
3. Food offered and used to relieve anxiety, frustration, anger, and rage can lead to difficulty in differentiating between hunger and other needs.
4. As a child, food offered instead of love.
8. Social:
1. Food easily available.
2. Use of motorized transportation and labor-saving devices.
3. Refined carbohydrates.
4. Social aspects of eating.
5. Restaurant meals high in salt, sugar, trans-fats, and larger portions.
4. Nursing care plan/implementation:
1. Encourage prevention of lifelong body image problems.
1. Support breastfeeding, where infant determines quantity consumed, not mother; work through her feelings against breastfeeding (fear of intimacy, dependence, feelings of repulsion, concern about confinement, and inability to produce enough milk).
2. Help mothers to not overfeed the infant if formula-fed: suggest water between feedings; do not start solids until 6 months old or 14 pounds; do not enrich the prescribed formula.
3. Help mothers differentiate between hunger and other infant cries; help mothers to try out different responses to the expressed needs other than offering food.
2. Use case findings of infants who are obese, as well as young children, and adolescents.
3. Assess current eating patterns.
4. Identify need to eat, and relate need to preceding events, hopes, fears, or feelings.
5. Employ behavior modification techniques.
6. Encourage outside interests not related to food or eating.
7. Alleviate guilt, reduce stigma of being obese.
8. Health teaching:
1. Promote awareness of certain stressful periods that can produce maladaptive responses such as obesity (e.g., puberty, postnuptial, postpartum, menopause).
2. Assist in drawing up a meal plan for slow, steady weight loss.
3. Advise eating five small meals a day and increase exercises.
5. Evaluation/outcome criteria: goal for desired weight is reached; weight-control plan is continued.