Imbalanced Nutrition: More than Body Requirements | NCP Obesity

Nursing diagnosis: imbalanced Nutrition: More than Body Requirements related to Food intake that exceeds body needs, Psychosocial factors, Socioeconomic status

Possibly evidenced by
Weight of 20% or more over optimum body weight; excess body fat by skinfold or other measurements
Reported or observed dysfunctional eating patterns, intake more than body requirements

Desired Outcomes/Evaluation Criteria—Client Will
Knowledge: Diet
Identify inappropriate behaviors and consequences associated with overeating or weight gain.
Demonstrate appropriate change in lifestyle and behaviors, including eating patterns and food quantity and quality, and involvement in individual exercise program.
Nutritional Status
Display weight loss with optimal maintenance of health.

Nursing intervention with rationale:
1. Review individual cause for obesity—organic or nonorganic.
Rationale: Identifies and influences choice of some interventions.

2. Ascertain previous dieting history. Determine which diets and strategies have been used, results, and individual frustrations and factors interfering with success.
Rationale: Client may have tried multiple diets, with little lasting change in body weight and feel negatively about embarking on another plan.

3. Implement and review daily food diary, for example, total caloric intake, types and amounts of food, and eating habits and associated feelings.
Rationale: Provides the opportunity for the individual to focus on a realistic picture of the amount of food ingested and corresponding eating habits and feelings. Identifies patterns requiring change and a base on which to tailor the dietary program.

4. Determine client’s motivation for weight loss, for instance, health issues, own satisfaction, and to gain approval from others. Discuss client’s and SO’s view of self, including what being fat does for the client. Notice occurrence of negative feedback from SO(s).
Rationale: Helps to clarify client’s motivation and potential for success in weight reduction. Client’s family and cultural practices greatly influence client’s self-view regarding food and body image. Feedback from family may reveal control issues impacting motivation for change.

5. Formulate an eating plan with the client, using knowledge of individual’s height, body build, age, gender, and individual patterns of eating, as well as energy and nutrient requirements.
Rationale: An important factor in the success of any weight loss program is adherence to a sound nutritional plan. Although there is little basis for recommending one commercial diet plan over another, a good reducing diet should contain foods from all basic food groups, with a focus on low-fat intake and adequate protein intake to prevent loss of lean muscle mass. It is helpful to keep the plan as similar to client’s usual eating pattern as possible. A plan developed with and agreed to by the client is more likely to be successful.

6. Emphasize the importance of avoiding fad diets.
Rationale: Elimination of needed components can lead to metabolic imbalances; for example, excessive reduction of carbohydrates can lead to fatigue, headache, instability, weakness, and metabolic acidosis (ketosis), thus interfering with effectiveness of weight-loss program.

7. Discuss need to give self permission to include desired or craved food items in dietary plan.
Rationale: Denying self by excluding favorite foods results in a sense of deprivation and feelings of guilt and failure when individual “succumbs to temptation.” These feelings can sabotage weight loss.

8. Be alert to binge eating and develop strategies for dealing with these episodes, such as substituting other actions for eating.
Rationale: The client who binges experiences guilt about it, which is also counterproductive because negative feelings may sabotage further weight loss efforts.

9. Identify realistic incremental goals for weekly weight loss.
Rationale: Reasonable weight loss of 1 to 2 lb/week results in longer-lasting effects. Excessive or rapid loss may result in fatigue and irritability and ultimately lead to failure in meeting goals for weight loss. Motivation is more easily sustained by meeting “stair-step” goals.

10. Weigh periodically as individually indicated, and obtain appropriate body measurements.
Rationale: Provides information about effectiveness of therapeutic regimen and visual evidence of success of client’s efforts. During hospitalization for controlled fasting, daily weighing may be required. Weekly weighing is more appropriate after discharge.