Nursing diagnosis: disturbed Body Image/chronic low Self-Esteem related to Biophysical factors—changes in health status, Psychosocial factors—client’s view of self; changes in body image, personal identity, Family or subculture encouragement of overeating—slimness is valued in this society, and mixed messages are received when thinness is stressed, Perceived failure at ability to control weight, Control, sex, and love issues
Possibly evidenced by
Verbalization of negative feelings about body—mental image often does not match physical reality
Fear of rejection or reaction by others
Feelings of hopelessness, powerlessness
Preoccupation with change—attempts to lose weight
Lack of follow-through with diet plan
Verbalization of powerlessness to change eating habits
Desired Outcomes/Evaluation Criteria—Client Will
Body Image
Verbalize a more realistic self-image.
Demonstrate some acceptance of self as is rather than an idealized image.
Self-Esteem
Seek information and actively pursue appropriate weight loss.
Acknowledge self as an individual who has responsibility for self.
Nursing intervention with rationale:
1. Determine client’s view of being fat and what it does for the individual.
Rationale: Mental image includes our ideal and is usually not up-to-date. Fat and compulsive eating behaviors may have deep-rooted psychological implications, such as compensation for lack of love and nurturing or a defense against intimacy. In addition, chronically obese client may report long-term discrimination in family, social, and professional settings. She or he may experience mixed feelings of fear and shame or compensate for psychological trauma by developing a strong or “big” personality.
2. Promote open communication, avoiding criticism or judgment about client’s behavior.
Rationale: Supports client’s own responsibility for weight loss, enhances sense of control, and promotes willingness to discuss difficulties and setbacks and to problem-solve. Note: Distrust and accusations of “cheating” on caloric intake are not helpful.
3. Outline and clearly state responsibilities of client and nurse.
Rationale: It is helpful for each individual to understand area of own responsibility in the program so that misunderstandings do not arise.
4. Graph weight on a weekly basis.
Rationale: Provides ongoing visual evidence of weight changes, reinforcing reality.
5. Ensure availability of properly sized equipment, including gowns; blood pressure cuff; wider and strong wheelchair, bed, commode, and transfer devices, when providing inpatient care.
Rationale: Healthcare providers have a moral and legal obligation to meet the client’s needs for comfort and safety.
6. Encourage client to use imagery to visualize self at desired weight and to practice handling of new behaviors.
Rationale: Mental rehearsal is very useful in helping the client plan for and deal with anticipated change in self-image or occasions that may arise, such as family gatherings or special dinners, where constant decisions about eating many foods will occur.
7. Provide information about the use of makeup, hairstyles, and ways of dressing to maximize figure assets.
Rationale: Enhances feelings of self-esteem and promotes improved body image.
8. Encourage buying clothes instead of food treats as a reward for weight loss and life successes.
Rationale: Properly fitting clothes enhance the body image as small losses are made and the individual feels more positive. Waiting until the desired weight loss is reached can become discouraging.
9. Suggest the client dispose of “fat clothes” as weight loss occurs.
Rationale: Removes the “safety valve” of having clothes available “in case” the weight is regained. Retaining fat clothes can convey the message that the weight loss will not occur or be maintained.
10. Be alert to myths the client and SO may have about weight and weight loss.
Rationale: Beliefs about what an ideal body looks like or unconscious motivations can sabotage efforts to lose weight. Some of these include the feminine thought of “If I become thin, men will view me as a sexual object”; the masculine counterpart, “I don’t trust myself to stay in control of my sexual feelings”; as well as issues of strength, power, or the “good cook” image.
