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Caring for obese adult patients in primary care
Obesity is a complex chronic condition with numerous contributing and interconnected elements, including genetics, biology, metabolism, and neurobehavior. Society, economics, and culture all have an impact on it.
The health effects of excess body weight include heart disease, stroke, type 2 diabetes, and several malignancies, which are among the major causes of premature mortality. Obesity, like other chronic diseases, should be managed with skilled, complicated care informed by evidence-based practice standards. Current recommendations include screening all people for obesity and providing intensive, multicomponent behavioral therapies to patients with a BMI ≥30 kg/m2. Despite this advice and medicinal and surgical improvements, obesity rates continue to climb. Evidence-based therapies are rarely implemented.
Nurses and nurse practitioners have a unique chance to identify at-risk patients and skillfully intervene to improve the quality of treatment for people affected by obesity. But first, we must transform how we think about, discuss, and approach obesity therapy.
Assessment
The stigma associated with obesity may encourage people to avoid routine medical care. A study by Fruh and colleagues found that healthcare providers spend less time with patients who are overweight or obese. Nurses can help patients get age-appropriate screenings and other preventative medical care.
BMI is widely used to characterize overweight and obesity, although it is only one part of the problem. An elevated BMI (>25) should prompt a comprehensive evaluation, including a detailed weight history that investigates the rate of weight gain (lifelong vs. sudden onset), aggravating factors (such as eating habits, physical activity level, and access to healthy food options), previous weight-loss attempts, and family history. Also look for symptoms or a history of obesity-related problems, drugs that may impact weight, and markers of probable eating disorders. Don’t disregard family history, support systems, or socioeconomic background.
Medication-induced obesity
Many drugs can cause weight gain and loss.
Medications that may cause weight gain
- Amitriptyline
- Antihistamines
- Beta-blockers
- Clozapine
- Doxepin
- Gabapentin
- Glucocorticoids
- Imipramine
- Lithium
- Meglitinides
- Most insulins
- Olanzapine
- Paroxetine
- Sulfonylureas
- Thiazolidinediones
- Valproate
- Zotepine
Medicines that may cause weight loss
- Alpha-Glucosidase Inhibitors
- Bupropion
- GLP-1 agonists.
- Lamotrigine
- Metformin
- Sodium glucose co-transporter 2 inhibitors
- Topiramate
- Zonisamide
Consider conducting a 24-hour food recall to identify issue areas, and ask the patient where the food is purchased and who buys and prepares it. Food deserts (areas with little access to grocery shops and good food options), financial poverty, cultural background, maltreatment, and a lack of transportation can all influence dietary choices.
Inquire about the schedule and frequency of meals, where food is generally consumed, and what causes eating. Emotional eating, skipping meals, and evening eating are all possible signs of maladaptive eating disorders. Inquire about excessive overeating, purging, and other behaviors associated with eating disorders.
Your evaluation should also include questions on current physical activity, such as frequency, intensity, duration, type, and level of enjoyment. Mobility, equipment requirements, access to exercise facilities, and health dangers should all be addressed. Obesity-specific biomechanical hazards include joint stress, immobility, and tissue compression issues. Symptoms of compression problems include obstructive sleep apnea, skin friction, gastric reflux, and high blood pressure. Check for metabolic conditions, including dyslipidemia or type 2 diabetes. Your findings may justify further investigation.
Diagnosis
BMI cutoffs are often used for classifying weight-related information.
Overweight: BMI 25–29
Obese: BMI 30–35.
Morbidly obese: BMI 35–39 with a weight-related co-morbidity or BMI greater than 40
However, BMI is only one point of concern. Individuals with high muscle mass or stature may be incorrectly called overweight or obese. A “normal” BMI may indicate central or abdominal obesity (waist measurement >35 inches for women, >40 inches for males).
Correctly recognizing the underlying reasons or contributions to obesity is crucial for effective treatment. Many genetic diseases, including Prader-Willi syndrome, Bardet-Biedl syndrome, Turner syndrome, Trisomy 21 (Down syndrome), and Fragile X syndrome, are likely to have been previously diagnosed in adult individuals. However, if you suspect additional contributing factors, such as hypothalamic injury, insulinomas, untreated hypothyroidism, hypercortisolism (Cushing’s disease), or sleep difficulties, you should request tests to confirm or rule them out. Immobility, depression, anxiety, binge eating disorder, and other issues uncovered during the exam should be added as additional diagnoses and incorporated into the treatment strategy.
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