CHAPTER 9 obesity_240811_103931.pdf

CHAPTER 9: OBESITY & EATING DOSORDER Raed Ali Jaradat RN, MSc Lecturer of Nursing Mu'tah Univ...

CHAPTER 9: OBESITY & EATING DOSORDER Raed Ali Jaradat RN, MSc Lecturer of Nursing Mu'tah University 24/07/2024 Raed Ali Jaradat 1  Methods to evaluate body fat Underwater weighing (densitometry): involves submerging the person in water Computed tomography is an imaging technique to determine body fat composition The above 2 methods are impractical, expensive & not available BMI: inexpensive, nonthreatening, noninvasive, require minimal skill Skinfold thickness measurements Waist circumference 24/07/2024 Raed Ali Jaradat 2  Body mass index (BMI) an index of weight in relation to height calculated mathematically by dividing weight in kilograms by the square of the height in meters Weight (kg) / (weight in meter)2 may be the best method of evaluating weight status does not account for how weight is distributed 24/07/2024 Raed Ali Jaradat 3  SFT % Classification appearance men women 1. very low fat skinny 7-10 14-17 2. Low fat thin 10-13 17-20 3. Average normal 13-17 20-27 4. Above normal plump 17-25 27-31 5. Very high fat >25 >31 24/07/2024 Raed Ali Jaradat 4  Body mass index (BMI) Example: calculate BMI for a person 5ft & 10 inch tall & weighs 172 lb 1. convert weight into kg 172 lb/ 2.2 = 78.2 kg 2. convert height into meter 5'10" = 70" (5' * 12" =60 + 10=70) in 70 * 2.54 cm/in = 177.8 177.8cm /100 cm= 1.8 1.8 m squared = 3.2 m (1.8 * 1.8) 3. calculate BMI 78.2 / 3.2 = 24.43 24/07/2024 Raed Ali Jaradat 5  Overweight, obesity, morbid obesity underweight: < 18.5 normal: 18.5 – 24.9 Overweight: BMI 25 - 29.9 Obesity: BMI >30 Morbid obesity: BMI > 40 about 100 pounds excess weight for men 80 pounds for women 24/07/2024 Raed Ali Jaradat 6 Waist circumference Waist circumference is a tool to assess for visceral fatness “Apples” (people with upper-body obesity) appear to have more health risks than “pears” (people with lower-body obesity) 24/07/2024 Raed Ali Jaradat 7  BMI > 25 BMI > 25, the risk increases for development of certain diseases: CAD, atherosclerosis, type II DM, sleep apnea, osteoarthritis, gallstones, gynecologic abnormalities, stroke, cancer of colon, prostate, breast, endometrium morbidity from existing disorders 24/07/2024 Raed Ali Jaradat 8  Obesity Obesity is a chronic disease of multifactorial origin It is likely that a combination of genetic and environmental factors is involved in its development Obesity is more prevalent among women than men and in racial-ethnic minority groups with the exception of Asian-Americans 24/07/2024 Raed Ali Jaradat 9  Obesity (cont’d) Black and Hispanic women have the highest prevalence of obesity Is an imbalance between caloric intake & output. For instance 1 lb equal 3500 cal; therefore, eating 500 cal daily for 7 day will produce a 1-lb weight gain Nutritional factors (increase intake of fat food, activity is the fourth factor 24/07/2024 Raed Ali Jaradat 10  Etiologic factors 1. Genetics: family history increase obesity 15%-30%. Genetic defects of leptin (protein regulate metabolism & appetite ) 2. Nutrition factors: high fat diet, excessive eating 3. Level of activity 4. Environmental: 5. Sociocultural: ethnicity, race, gender, income, education 24/07/2024 Raed Ali Jaradat 11  Prevalence of obesity Less common after age 70 More prevalent in racial-ethnic minority population, especially African American & Hispanic women the exception is asian More prevalent among women with low income & education 24/07/2024 Raed Ali Jaradat 12  Obesity Obesity is resistant to treatment when success is measured by weight loss alone Rather than concentrating solely on weight loss to measure success, other health benefits, such as lowered blood pressure and lowered serum lipids, should also be considered A modest weight loss of 5 to 10% of initial body weight usually effectively lowers disease risks 24/07/2024 Raed Ali Jaradat 13  Weight loss A hypocaloric intake, increased activity, and behavior therapy are the cornerstones to weight-loss therapy Pharmacotherapy and surgery are additional options for some people Benefits of weight loss: Lower blood pressure Lower serum triglyceride levels Higher HDL, lower LDL Lower blood glucose levels 24/07/2024 Raed Ali Jaradat 14  Strategies for weight loss 1. Diet approach to weight management Calorie intake should be lowered by 500 to 1000 cal/day to promote a gradual weight loss of 1 to 2 pounds/week Calories should not be restricted below 1200 cal/d for adult women or 1500 cal/d for men. Calories may be determined on an individual basis by calculating the number of calories needed to maintain healthy body weigh & subtracting 500 to 1000 cal/d for a 1 – 2 lb /week 500 cal/d * 7 d/wk = 3500 cal/wk deficit (the equivalent of 1 lb of body wt ) 1000 * 7 = 7000 cal/wk deficit (the equivalent of 2 lb of body wt ) Lowering fat intake in conjunction with a hypocaloric intake not only promotes greater wt loss but also helps improve blood lipid levels 24/07/2024 Raed Ali Jaradat 15  Strategies for weight loss (cont’d) 2.Nondiet approach to weight management promotes self-regulated eating instead of restrained dieting is founded on the belief that the body will find its own natural weight as the individual eats in response to internal hunger and satiety cues focuses on enhancing total health, not achieving a specific weight 24/07/2024 Raed Ali Jaradat 16  Strategies for weight loss 3. Exercise (physical activity) An increase in activity helps to burn calories and has a favorable impact on body composition and weight distribution (by increasing lean body mass while promoting loss of fat) Even without weight loss, exercise lowers blood pressure and improves glucose tolerance and blood lipid levels Walking at least 30 minutes /day for 3 days a week 24/07/2024 Raed Ali Jaradat 17  Strategies for weight loss 4. Behavior therapy is essential to promote lifelong changes in eating and activity habits identifies behaviors that need improvement sets specific behavioral goals modifies “problem” behaviors reinforces the positive changes 24/07/2024 Raed Ali Jaradat 18  Behavior modification ideas 1. Keep food only in kitchen 2. Stay out of kitchen 3. Avoid tasting food while cooking 4. Place low caloric food in the front of fridge 5. Out of sight out of mind 6. Wait 10 minutes before eating when you feel urge 7. Serve directly from stave to the plate 8. Eat low caloric food first 9. Drink water with meals 10. Use small plate 11. Chew food thoroughly 12. Don’t eat within 3 hours of bedtime 13. Brush teeth immediately after eating 24/07/2024 Raed Ali Jaradat 19  Strategies for weight loss 5. Pharmacotherapy Pharmacotherapy is adjunctive therapy in the treatment of obesity with nutritional therapy, exercise, behavioral therapy Drugs are not effective in all people Drugs are only effective for as long as they are used Sibutramine is an appetite suppressant that works by inhibiting the reuptake of the neurotransmitters norepinephrine & serotonin. Side effect: constipation, dry mouth, headache, insomnia. Orlistat is inhibiting pancreatic lipase to reduce fat absorption from GIT 24/07/2024 Raed Ali Jaradat 20 Strategies for weight loss Option for a clients with severe obesity (BMI>= 40) who fail to lose weight by other methods, & who is experiencing complication from obesity Surgery to promote weight loss therapy involves limiting the capacity of the stomach Gastric restriction (stomach stapling) to limit the capacity of the stomach to 15 to 30 ml & delay gastric emptying. Complications include hypoalbuminemia, vitamins deficiency, vomiting, nausea Gastric bypass of the duodenum & the first portion of the small intestine to cause malabsorption of calories Both types effectively promote weight loss but have complications 24/07/2024 Raed Ali Jaradat 21  Eating disorders: Anorexia nervosa and bulimia nervosa are characterized by preoccupation with body weight and food are usually preceded by prolonged dieting although their cause is unknown, both are considered to be multifactorial in origin Risk Factors contribute to this problems are psychological, social, cultural, Occur before or after puberty, stressors are onset of puberty , parents divorce, death of family member 90% to 95% of cases occur in girls & women, with two peak ages at onset: 12 – 13 years, 19 – 20 years 24/07/2024 Raed Ali Jaradat 22 1. Anorexia nervosa Anorexia nervosa is a condition of severe self-imposed starvation, often accompanied by a frantic pursuit of exercise Although they appear to be severely underweight, anorexics have a distorted self-perception of weight and see themselves as overweight Anorexics may have numerous physical and mental symptoms, brain damage, sterility, heart failure. Anorexia can be fatal (one of every seven clients dies from complications 24/07/2024 Raed Ali Jaradat 23 2- Bulimia nervosa occurs more frequently than anorexia is characterized by binge eating (consuming large amounts of food in a short period) and purging (e.g., self-induced vomiting, laxative abuse, excessive exercise, emetics, diuretics or diet pills;) Bulimics usually appear to be of normal or slightly above-normal weight Bulimics experience less severe physical symptoms than anorexics Bulimia is rarely fatal 24/07/2024 Raed Ali Jaradat 24 THE END 24/07/2024 Raed Ali Jaradat 25