Cutting the Fat

Nurses also face adversity when fighting the obesity epidemic

By Dana D. Sterner, RN

A few months ago some ADVANCE for LPNs readers inquired about overweight nurses pictured on certain covers. Some nurses said the photos were a poor representation of nursing, and that overweight nurses should be embarrassed or ashamed.

According to the Mayo Clinic, two thirds of American adults are overweight and one in three is considered obese, a number that would certainly include nurses.^1,2

I agree nurses should be good role models, but let's get real. Nurses live in the same society as everyone else. We work 8- or 12- hour, rotating shifts — during the week, at night, on weekends and even holidays. The lack of staffing and extreme workloads make it even more difficult for nurses to eat right while at work. How, in our fast-paced society, are nurses supposed to find time to eat right or exercise?

But it doesn't stop there. Trying to decipher the latest diet or choose a healthier plan that will actually fit a hectic schedule is next to impossible.

DECIPHERING THE DIET CODE

Deciphering diet information can be mindboggling to most individuals. It is even more difficult for the person with health-related issues. One source of information reveals that the average person wanting to lose weight has tried at least five different diets in their lifetime (www.thedietchannel.com/NHLBI-Review.htm).

If you scan the Internet or book stores, you'll find more than 100 diet plans. There is a smorgasbord of options from the "No Fat and Fit" diet to the Adkins all-you-can-eat fat diet. Some diets offer glowing results in weeks, others in months. You may be deprived of favorite foods or invited to indulge in foods you thought were forbidden.

Some very popular diets offer prepackaged foods and shakes while others emphasize counting calories. Some suggest "no exercise needed" while others suggest incorporating minimal to moderate exercise. But most importantly, there is a diet for everyone. There is even a diet for blood types.

So why, with all the diet information readily available, are we more overweight today than 20 years ago?² The reality is that one diet does not fit all. We are individuals. What works for some may not work for others. We are culturally different with unique lifestyles.

Instead of choosing the latest diet, we need to personalize plans that will create lasting results we can live by. While some individuals may want to change eating habits to lose weight, others may only want to incorporate healthier eating patterns to reduce risk factors.

Nurses can identify and educate those patients while helping themselves.

OVERWEIGHT VS. OBESE

A surprising 300,000 people die every year because of obesity-related illnesses.¹ But some of these high-risk individuals can reduce their risks significantly by changing basic health patterns and losing as little as 10 percent of their current body weight.³

Being overweight is defined as having an excess of adipose tissue. Adipose tissue is a storage unit for unused fat deposits. It is also an endocrine cell that works to release and regulate different hormonal and molecular reactions associated with energy balance, blood pressure, coagulation, and insulin sensitivity.⁴

Current studies suggest it's the amount and distribution of adipose tissue that is important. The extra adipose that accumulates around the midsection interferes with the body's normal hormonal and metabolic functions. Patients who carry this extra weight around their midsection are more likely to develop type 2 diabetes, hypertension, hyperlipdemia and gallbladder disease.⁵

There are several ways to measure adipose tissue. The most common is measuring waist circumference. Men with a waist greater than 102 cm (40 inches) and women with a waist greater than 88 cm (35 inches) are considered obese and more at risk.⁶ Statistically, these patients have higher chances of developing metabolic syndrome, certain cancers, stroke, respiratory complications and coronary artery disease.^3-5

NURSES TO THE RESCUE

A healthcare poll in 2004 conducted by the Harris Poll showed nurses are the No. 1 trusted healthcare professionals. This puts us in an incredible position to help people make healthier lifestyle choices. Education is the key. There are 5 basic concepts you can share with patients to help get them started:

First, a review of numerous diets emphasizes one significant point without saying it — eat less. Size, portion control, counting points, counting fat grams and carbohydrates is the same as counting calories. If the goal is to lose weight, energy intake must fall below energy expenditure.⁷ Eating less does not mean less nutrition. Nutritious foods in their natural states, like fruits and vegetables, are generally less in calories.

Second, teach patients to read labels. Pre-packaged foods often lack nutritional value and may be loaded with sodium, fats, sugars and preservatives that some patients, because of health reasons, should avoid.

Third, a plan or lifestyle change that does not incorporate exercise or activity is not an effective plan for long-term weight loss or healthier living. A decision to walk at least 10 minutes each day can reduce risk factors for obesity-related diseases.^4,7

Fourth, fad diets and pills are quick gimmicks to losing weight. They usually do not last and are often unhealthy.⁴

Fifth, offer handouts, instructions or Web site addresses where patients can gather information and learn how to incorporate or modify healthier ideas into their lives. Offer community seminars on balancing strategies for a healthier lifestyle. Address cultural influences, risk factors, medications, activity and good nutrition.

Support groups are also a good way to share information and get encouraged. Living in a multicultural society, it's important to gain an understanding of patients to assist with lasting lifestyle changes.

High-risk patients should be identified early and have nutritional assessments initiated to include questions about cultural and behavior influences related to eating and activity routines.⁴ Patients with acute or chronic diseases should have a complete physical exam along with specific lab testing before implementing a weight-loss program. The nurse can facilitate a collaborative process between the physician, dietitian and even the pharmacist in determining a patient's most prudent course.⁴

ARE YOU UP FOR THE CHALLENGE?

Nurses are the largest group of clinicians in the country. If we are not adhering to what we teach patients then more than the cover of a magazine will make nurses look bad.

For all of those nurses who want to make a difference, here are a few ideas. First, start by making a commitment — not another New Year's resolution — a deep desire to commit. Taking care of yourself allows you to take care of your family and patients.

Second, make it realistic. Decide on a plan that will fit your life, family, work schedule and budget. Write it down and discuss it with your family or friends.

Third, start slow, one thing at a time. Consistency will create permanent changes. Ask yourself the question "Can I eat like this for the rest of my life?"

Fourth, be flexible. Life is full of last- minute changes and surprises. Be ready to forgive yourself and not give up. Learn and readjust for the next surprise.

Fifth and final, find ways to incorporate physical activity, which reduces stress, in your life. Increased stress levels can hinder metabolic response and energy balance.⁴ Find an activity that fits you and your lifestyle.

REFERENCES

1. MayoClinic.com. (2005, May 9). Obesity. Retrieved Jan. 27, 2006 from the World Wide Web: http://www.mayoclinic.com/health/obesity/DS00314

2. The National Center for Health Statistics. (CDC). Prevalence of overweight and obesity among adults: U.S. 1999-2002. Retrieved Jan, 24, 2006 from the World Wide Web: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/obese/obse99.htm

3. Yanovski, S.Z. (2005, Nov. 17). Pharmacotherapy for Obesity - Promise and Uncertainty. The New England Journal of Medicine, 353, 2187-2189.

4. Kasper, D.L. et al. (Eds.). (2005). Harrison's principles of internal medicine (16th ed., pp. 412, 422-429). New York: McGraw Hill Medical Publishing Division U.S. America.

5. CDC. Overweight and obesity: Health consequences. Retrieved Jan. 26, 2006 from the World Wide Web: http://www.cdc.gov/nccdphp/dnpa/obesity/consequences.htm

6. CDC. Overweight and obesity: Defining overweight and obesity. Retrieved Jan. 26, 2006 from the World Wide Web: http://www.cdc.gov/nccdphp/dnpa/obesity/defining.htm

7. CDC. Overweight and obesity: Contributing factors, an overview. Retrieved Jan. 26, 2006 from the World Wide Web: http://www.cdc.gov/nccdphp/dnpa/obesity/contributing_factors.htm

Dana D. Sterner is a nurse and freelance writer living in Boonsboro, MD.