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How FNPs can help in the fight against the obesity epidemic

Date: May 15, 2017

The obesity epidemic in the U.S. has reached a critical level. According to statistics from the U.S. Centers for Disease Control and Prevention (CDC), 36 percent of U.S. adults are classified as obese, equating to more than a third of the overall population. The American Heart Association noted that obesity also impacts children, with an estimated 13 million American juveniles living with the condition. Obesity is associated with multiple chronic health conditions, which threaten individuals’ lives and place a substantial strain on health care resources. The CDC remarked that some of the most common conditions tehat can be engendered by obesity include diabetes, heart disease, certain cancers and stroke.

While the growing obesity epidemic is difficult to manage, health care providers can help to fight the issue. Family nurse practitioners (FNPs), in particular, are in a prime position to make a positive difference given that FNP care involves a holistic approach to health care.

What is obesity?
When a patient has obesity, he or she is understood to have dangerous levels of adipose tissue, or body fat, as it is more colloquially known. According to Dr. George L. Blackburn of Harvard Medical School and FNP Laura C. Bevis of Wichita State University, in Medscape, obesity typically is diagnosed by health care providers using a metric known as the Body Mass Index (BMI). This measurement is calculated using a patient’s height and weight measurements. According to the National Heart, Lung and Blood Institute, a healthy weight, as determined by the scale, is represented by scores between 18.5 and 24.9. Obese patients register BMI scores in excess of 30. Individuals who are overweight, the stage prior to obesity, register scores in the 25-29.9 range.

What are some major causes of the obesity epidemic?
The primary cause of obesity, as explained by the Mayo Clinic, is the excessive intake of calories over an extended period. When the body receives more calories than it needs, it converts the energy into fatty tissue and stores it, leading to weight gain. Consequently, most people become overweight or obese if they consume too many calorie-rich foods and do not move around and exercise enough for the body to utilize the additional calories as energy. The Mayo Clinic elaborated that obesity, in some cases, also can be caused by factors such as issues with specific hormones, hereditary markers and certain diseases.

Why has the obesity problem turned into an epidemic not only around the world but especially here in the United States? Although there is no definitive answer to this question, an information sheet published by the American Heart Association highlighted some likely factors that can be attributed to modern lifestyles and western cultural norms. For example, in the U.S. and other industrialized nations, many working professionals spend their careers being relatively inactive, spending time in front of computers, often for more than eight hours per day. This inactivity was less prevalent in the past, which surely contributes to the spike in weight gain. Furthermore, the widespread availability of convenience and fast foods, typically high in saturated fat, calories, salt and sugar is likely a major contributor to the obesity epidemic, as well.

The digital age is another likely a factor, with excessive screen time not just a problem at work — it is common, for example, for both adults and children to spend a great deal of time watching television, surfing the internet and playing video games, curtailing the amount of time available for physical activity.

Why is weight management such a contentious issue?
As explained in an American Nurse Practitioner Foundation (ANPF) white paper, while health care providers such as FNPs can be enormously beneficial in helping patients tackle their obesity, there are a number of barriers that can make discussions about weight management between a provider and patient difficult, including the following:

  • Health care providers do not always feel comfortable advising obese patients to lose weight. The ANPF reported on a study finding that weight loss is advised for roughly less than half of obese patients visiting care providers.
  • Patients rarely seek medical attention exclusively to discuss weight loss strategies.
  • A 2012 study from S.N. Bleich, W.L. Bennett, K.A. Gudzune and L.A. Cooper found that a health care provider’s own weight can impact his or her approach to advising obese patients: It is far less common for obese or overweight health care providers to broach the topic of weight management with their patients.

The ANPF also explained that embarrassment and stigma over obesity, on the part of both parties, can lead to awkward, difficult or contentious discussions that ultimately can prove to be unproductive. Patients may be less likely to take weight-loss advice from a health care provider who they view as being either a bit heavy or especially thin. If the provider is viewed as being too heavy, then patients may feel the provider is hypocritical in discussing weight management. On the other hand, if the patient feels the provider is too thin, he or she may perceive that the thin provider can’t possibly know how difficult it is to lose weight.

Helping fight obesity: Strategies for FNPs
Despite potential barriers, it is important for FNPs to play an active role in the fight against obesity, both by advising patients and supporting initiatives designed to increase awareness around the issue. Below are some of the most effective strategies for FNPs helping combat obesity:

  1. Screening BMI
    As detailed in an article published by Medical Economics, reporting on advice extended by the AHA, an effective first step toward helping patients tackle obesity is to routinely monitor their BMI. This measurement can be done during regular checkups. By providing patients with their BMI information, FNPs can be sure that patients are aware of their obesity, which could increase the likelihood that they will seek help for a change. A fact sheet published by the National Institute of Diabetes and Digestive and Kidney Diseases emphasized that this process should be completed in a neutral way. Providers are encouraged not to stress the term “obesity” and instead focus on the concrete BMI number.
  2. Initiating conversations
    It is important that FNPs initiate conversations about weight management with patients experiencing obesity. As a fact sheet from the NIDDK explained, however, these conversations should be conducted with care. FNPs always should check whether their patients are comfortable moving forward with such a discussion before beginning one. If the answer is yes, FNPs should approach the conversation with sensitivity. An American Nurse Practitioner Foundation white paper advised that FNPs refrain from using potentially offensive and emotive terms — for example, “unhealthy” or “fat” — and instead focus on concrete data and objective facts. This approach means explaining how a high BMI can increase one’s risk of certain chronic conditions, such as heart disease or stroke, and that lifestyle adjustment, such as getting more exercise and reducing caloric intake, can positively impact long-term health.
  3. Developing weight loss plans
    If patients are receptive to weight loss and weight management assistance, FNPs can help patients devise a weight loss plan. In an article from Medical Economics, Dr. Adam Tsai explained that an effective weight loss plan contains three components: a strategy for altering behaviors that may lead to overeating — therapy or counseling, for example — a plan to change diet and reduce calorie consumption, and a schedule for introducing or increasing physical activity. FNPs are encouraged to work with patients to ensure a successful weight loss plan implementation. The article from the NIDDKD also advised health care providers to ensure patients are connected with external resources that also may help with weight loss, such as mental health professionals and dieticians.
  4. Supporting local initiatives
    As explained in the ANPF white paper, by supporting and promoting community programs and initiatives that can help with weight loss — exercise classes, sports clubs and green spaces designed for recreation — FNPs can make a positive impact in the fight against obesity on a wider scale.

Consider Bradley University
Are you eager to help patients fighting obesity find ways to live healthier lifestyles? Do you have an interest in preventative health care in general? If you are a nursing professional and the answer is yes, you could be well-suited to a career as an FNP. A helpful first step on the road to this career path is applying to Bradley University’s online Master of Science in Nursing (MSN) FNP program. To learn more, click here.

Sources

https://international.aanp.org/Content/docs/ObesityWhitePaper.pdf

http://www.medscape.org/viewarticle/441282

http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/american-heart-association/new-obesity-guidelines-help-physicians-and?page=full

http://www.mayoclinic.org/diseases-conditions/obesity/basics/causes/con-20014834

http://www.heart.org/HEARTORG/HealthyLiving/WeightManagement/Obesity/Understanding-the-American-Obesity-Epidemic_UCM_461650_Article.jsp#.WO_Do9TyuM8

https://www.cdc.gov/obesity/data/adult.html

https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

https://www.niddk.nih.gov/health-information/health-topics/weight-control/medical/Pages/medical-care-for-patients-with-obesity.aspx

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