After studying this chapter, you should be able to:
• understand the underlying pathophysiology of chronic obesity and the associated risk factors
• describe health promotion and prevention strategies appropriate for individuals who are overweight and obese
• understand the nurse's role in the management of the chronically obese individual
• appreciate the impact chronic obesity has on the future of health care
• recognise the importance of advanced nursing practice in the management of obesity.
The worldwide prevalence of chronic obesity is rising and Australia is no exception with approximately 60 per cent of adults and 25 per cent of children classified as either overweight or obese (Grima & Dixon, 2013). The public health burden of obesity is significant as it is closely associated with other chronic conditions including cardiovascular disease and diabetes mellitus (Schuklenk & Zhang, 2014). Chronic obesity has not only physical implications for the individual – excess weight is closely associated with a reduced quality of life and an increased risk of morbidity and mortality (Grima & Dixon, 2013).
Obesity is defined as an excessive accumulation of adipose tissue with potentially negative health consequences (Townsend & Scriven, 2014). There are a number of methods that can be used to measure obesity. The more commonly used methods include the body mass index (BMI), a weight-for-height calculation which determines weight status (Townsend & Scriven, 2014), and abdominal circumference measurements, both of which are simple and cost-effective assessment tools (Schuklenk & Zhang, 2014). However, the limitation of BMI measurement is that it fails to consider additional factors that can influence weight, including gender, age, bone structure, fat distribution and muscle mass (Schuklenk & Zhang, 2014), and is therefore an inaccurate reflection of adiposity (Townsend & Scriven, 2014). Abdominal circumference measurements, which indicate central obesity, are considered to more accurately reflect total body fat (Townsend & Scriven, 2014). This specific type of obesity measurement takes into consideration not only the degree of adipose tissue which is present but also where the fat is distributed, and suggests that greater levels of adipose tissue around the midsection are linked to poorer health outcomes (Rossen & Rossen, 2012).
The nursing workforce spans an assortment of clinical settings, therefore placing nurses at the forefront of health promotion and obesity prevention.