Marquette University
e-Publications@Marquette
College of Nursing Faculty Research and
Publications
Nursing, College of
1992
Nutrition, More Than Body Requirement
Marilyn Frenn
Marquette University, marilyn.frenn@marquette.edu
Follow this and additional works at: https://epublications.marquette.edu/nursing_fac
Part of the Nursing Commons
Recommended Citation
Frenn, Marilyn, "Nutrition, More Than Body Requirement" (1992). College of Nursing Faculty Research and
Publications. 341.
https://epublications.marquette.edu/nursing_fac/341
A state in which an individual is
experiencing an intake of nutrients
which exceeds metabolic needs
(NANDA, 1990, p. ]0).
.............
Marilyn Frenn, R .N., Ph.D.
DEFINING CHARACTERISTICS
Diet history (one to two day)
Expressed concerns regarding nutrition or body weight
Regular intake of nutrients in excess of body needs, (e.g., alcohol, caffeine, calories, cholesterol,
fat, salt)
Triceps skinfold greater than 15 mm in men, 25 mm in women
Weight 10% over ideal for height and frame = overweight
Weight 20% over ideal for height and frame = obese
Body mass index (BM! = wt in kglht. in m 2)
BM! 25--29.9 = Grade 1 obesity
BM! 30-40 = Grade 2 obesity
BM! >40 = Grade 3 obesity
CONTRIBUTING FACTORS
Pathophysiological
Diseases that predispose to weight gain (e.g., Type II diabetes mellitus, Cushing's syndrome,
thyroid deficiency)
Obesity in one (40% risk) or both (80% risk) parents
Psychosociobehavioral
Behavioral control deficiency
Dependence on prepared or fast foods
Depression
370
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NUTRITION, MORE THAN BODY REQUIREMENT
371
Dysfunctional eating patterns (contextual awareness deficiency)
1. Eating in response to external cues such as time of day, social situation
2. Eating in response to internal cues other than hunger, such as anxiety
3. Use of food as reward or comfort measure
Information deficiency
Less education for women, more education for men
Low income for women, high income for men
Sedentary life-style
EXPECTED OUTCOMES
Client will maintain weight at satisfactory level for height, frame, and genetic predisposition.
Nutritional requirements are accurately identified.
Nutritional intake is appropriate to body energy requirements and expenditures.
One to two pounds per week are lost until a level appropriate to height and frame
is achieved.
Client will demonstrate behaviors to balance intake with energy expenditure.
.
Behaviors that contribute to excess intake of nutrients are monitored.
Responsibility for eating and exercise patterns is acknowledged.
Contract for behavioral changes is reaHstic, measurable, and includes rewards for
accomplishments.
INTERVENTIONS
RATIONALE
Universal
Assess overaJI health history,
physical examination laboratory
data (thyroid function, electrolytes, hematocrit, electrocardiogram if positive cardiac history), weight history since birth,
weight of family members and
those in household, previous
attempts at diet maintenance,
one-to two-day current diet history (including likes, dislikes,
timing and frequency of meals
and snacks, pattern of eating
out), feelings about being overweight, pattern of exercise,
goals, and mood state.
Comprehensive assessment is necessary to
enable accurate planning.
/
372
SECTION TWO
RATIONALE
INTERVENTIONS
Assess congruence of actual
with perceived body weight to
height adequacy.
Perceptions of ideal weight may differ from
weight to height ratios recommended for health.
Assess attitudes and motivation
for change, as well as level of
social support.
Effective life-style changes require integration of
personal, behavioral. and social factors (also see
"Health Seeking Behaviors-[Specifyj").
Evaluate need for and interest
in information regarding basic
nutrition (e.g., four food groups,
balanced meals, food preparation, heart-healthy eating, risk
factors for obesity).
Education provided at a time of readiness may
prevent reliance on fad diets and allow incorporation of accurate, up-to-date information in
establishing a healthy diet.
Assist in choosing a weight
control program that provides
balanced nutrition and a plan
for main tenance.
People lose weight safely and most effectively
in programs that specialize in weight loss while
providing adequate nutrition.
Provide information about
Those who view themselves as overweight are at
risk for weight loss scams and unhealthy degrees
of weight loss.
community resources for safe,
effective weight loss and dietary
referrals as needed.
Provide information about ways
to avoid empty calorie foods,
healthy convenience foods, and
restaurants serving hearthealthy menus.
Major barriers to effective weight loss are found
in societal patterns of eating and ready availability of less nutritious foods.
Develop group health advocacy
programs fostering healthy
eating patterns as well as respect
for genetic predispositions that
may prevent some individuals
from achieving societally valued
degrees of slimness.
An informed group of clients may support each
other and foster improvement in societal
patterns of eating.
Teach proper administration and
side effects of anorectic drugs
(prescription and over-thecounter).
Certain drugs have been effective in promoting
weight loss but have important side effects.
I.
.
NUTRITION, MORE THAN BODY REQUIREMENT
RATIONALE
INTERVENTIONS
Inpatient
Follow specific protocols
associated with clinical trials
for gastric balloon placement.
Gastric balloons are recommended for use only
in clinical trials.
Assist clients who have elected
gastroplasty as a treatment for
morbid obesity (more than 100
lb. excess weight or refractory
to other methods) with preand post-operative recovery
according to American Society
for Clinical Nutrition (1985)
guidelines.
Although gastroplasty has not been shown
to reduce mortality associated with obesity, it
results in longer term weight loss than other
methods.
Very low calorie diets may be effective, but require
supervision due to possible severe physical and
psychological sequelae. Exercise helps to prevent
muscle wasting by preserving basal metabolic rate.
. Assist in maintaining exercise
program while hospitalized and
in monitoring potential side
effects of very low calorie diet.
Community Health/
Home Care
Conduct behavioral assessment
including motivational analysis,
problem identification and clarification, assets and limitations of
a behavioral program, environmental supports and restrictions,
and presence of psychopathology related to the obesity that
may require referral.
In addition to a nutritional assessment, an
information base is needed regarding use of
behavioral strategies.
Assist with behavioral strategies
for weight loss including selfmonitoring, stimulus control,
contracting, shaping, and
Behavioral strategies are most effective when
combined with a calorie-reduction diet and
exercise.
positive reinforcement.
I
373
2
374
SECTION TWO
RATIONALE
INTERVENTIONS
Collaborate with dietitian in
calculating optimal weight,
assessing calorie needs, and
planning balanced reduction
diet (SOOc/da less than prior
intake usually results in 1-21b
per week loss).
Reasonable goals promote weight loss that is
physically and psychologically feasible.
Assist to gradually begin
exercise program (20 min 3-4
times/wk) unless medically
contraindicated.
Regular exercise alone may lead to weight loss
in mild obesity. Exercise also promotes maintenance of weight loss by helping to sustain basal
metabolic rate.
Maintain patient, flexible, nonjudgmental, positive approach.
Losing weight often is frustrating and rapport
is important to success.
Develop maintenance program
including exercise, support
groups, financial contracts,
increased number of sessions,
and interpersonal problem
solving.
Obesity is a chronic health problem. Maintenance
programs with these characteristics have been
most effective in keeping off excess weight.
I
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