Weight Management

Weight management and obesity are prevalent health concerns in the United States. Often physicians will attempt to address this in their patient’s care by ordering a calorie restricted or weight loss diet while the patient is hospitalized. There are multiple factors involved in successful weight management which cannot be or should not be addressed in the hospitalized patient. However, discharge instructions may highlight components of lifestyle and diet changes that can start patients off on the right foot when they return home. This information coupled with a listing of resources to explore in the outpatient setting (the dietitian’s phone number, a list of local weight management programs, etc.) can help you provide your patient with the best care possible to encourage his or her success.

The cause of overweight status and obesity cannot be attributed to a single problem or source. Genetics plays a strong role in overall body type and tendency to become overweight. Lack of exercise and a sedentary lifestyle can result in weight gain if a high caloric intake level is maintained. For example, eliminating 30 minutes of walking daily results in 100-150 fewer calories burned in a day. With no decrease in caloric consumption, this could lead to approximately a ten pound weight gain in one year. Compounding the potential risk from genetics and activity level is age and lifestyle. As people age, they tend toward changes in lifestyle which can affect eating habits. Examples of this include eating at restaurants rather than at home, schedule changes, and travel. There are some medical conditions that also contribute to weight gain. However, they are more appropriately discussed individually and are therefore beyond the scope of this educational activity.

One tool used to define obesity and its severity is correlated with disease risk - the Body Mass Index (weight in kilograms divided by height in meters squared).

National Institutes of Health Body Mass Index (BMI) Categories

25-29.9 is overweight
30-34.9 Obesity Class I
35-39.9 Obesity Class II
> 40 Obesity Class III (extreme obesity)

Progressively increasing BMI presents greater disease risk (diabetes, heart disease, cancer, etc.). Disease risk is further increased when abdominal obesity is present. The criteria for this includes a waist circumference greater than 35 inches for women and over 40 inches for men whose BMI is in the overweight to Class II obesity categories. It is not used for BMI’s greater than 39.9 as these people are already at high risk based on their BMI alone.

The relationship between diet and weight is a simple equation. More calories in than out causes a weight increase, while more calories out than in causes a weight decrease. Therefore, the goal is to create a negative caloric balance to achieve weight loss. This can be done using diet, activity/exercise, or a combination of both.

Diet and exercise can create a negative caloric balance to achieve weight loss.

Diet is a more realistic avenue for weight loss in most patients as it may be easier to restrict calories than to find a way (and time) to burn the equivalent number of calories through exercise. The best way to achieve initial and long-term weight loss is to apply both caloric restriction and increased exercise/activity. When you have a motivated, interested patient, a registered dietitian can create a plan that takes into consideration lifestyle, preferences, knowledge base, and activity ability. While nutrition planning is most successful in an outpatient setting where it is the focus of the patient’s visit, an initial introduction in the hospital via written or verbal information can "jump start" a patient’s desire for weight loss.

When discussing a diet plan patients should be encouraged to examine current eating habits by keeping a food record (what, when, how much, any emotional/environmental cues at the time). The record can be assessed by the patient with the help of a registered dietitian. For the patient, a visual record may make them more conscious of what and how much they are consuming. This may also help a patient identify low nutrition, high calorie foods they could eliminate from their diet. A food record is also useful in examining and readjusting portion sizes. The actual diet plan is very individualized and is the primary focus of the registered dietitian.

It is important to note that often a patient will tell you they have tried diets before that have failed. Often when you delve further into this statement you will find that they are referring to excessive restriction or fad diets. Both are unhealthy options because without proper management or information these diets can cause nutrient deficiencies. The difficulty in following some of these restrictive diets also may result in the patient’s loss of desire to make beneficial changes in eating habits. As a consequence, the patient may become frustrated and unwilling to engage in yet another weight loss attempt. By establishing a level of trust, the nurse can convey to such a patient that even small changes can yield big results. For long-term weight loss a dietitian and weight loss program are important resources. However, you can give your patient survival skills to get them thinking and trying to make changes on their own.

Weight Management Survival Skills