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EATING DISORDERS: OBESITY Obesity is defined as an excess accumulation of body fat at least 20% over average desired weight for age, sex, and height or a body mass index (kg/m 2 ) of greater than 27.8 for men and greater than 27.3 for women. Obesity is a chronic condition considered by some to be a disability. The general prognosis for achieving and maintaining weight loss is poor; however, the desire for a healthier lifestyle and reduction of risk factors associated with life-threatening illnesses motivate many people toward diets and weight-loss programs. CARE SETTING Community level unless morbid obesity requires brief inpatient stay RELATED CONCERNS Cerebrovascular accident (CVA)/stroke Cholecystitis with cholelithiasis Cirrhosis of the liver Diabetes mellitus/Diabetic ketoacidosis Heart failure: chronic Hypertension: severe Myocardial infarction Obesity: surgical interventions (gastric partitioning/gastroplasty, gastric bypass) Psychosocial aspects of care Thrombophlebitis: deep vein thrombosis Patient Assessment Database ACTIVITY/REST May report: Fatigue, constant drowsiness Inability/lack of desire to be active or engage in regular exercise; sedentary lifestyle Dyspnea with exertion May exhibit: Increased heart rate/respirations with activity CIRCULATION May exhibit: Hypertension, edema EGO INTEGRITY May report: History of cultural/lifestyle factors affecting food choices Weight may/may not be perceived as a problem Eating relieves unpleasant feelings, e.g., loneliness, frustration, boredom Perception of body image as undesirable SOs resistant to weight loss (may sabotage patient’s efforts) FOOD/FLUID May report: Normal/excessive ingestion of food Experimentation with numerous types of diets (“yo-yo” dieting) with varied/short-lived results History of recurrent weight loss and gain May exhibit: Weight disproportionate to height Endomorphic body type (soft/round) Failure to adjust food intake to diminishing requirements (e.g., change in lifestyle from active to sedentary, aging) PAIN/DISCOMFORT May report: Pain/discomfort on weight-bearing joints or spine
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RESPIRATION May report: Dyspnea May exhibit: Cyanosis, respiratory distress (Pickwickian syndrome) SEXUALITY May report: Menstrual disturbances, amenorrhea TEACHING/LEARNING May report: Problem may be lifelong or related to life event Family history of obesity Concomitant health problems may include hypertension, diabetes, gallbladder and cardiovascular disease, hypothyroidism Discharge plan DRG projected mean length of inpatient stay: 5.1 days considerations: May require support with therapeutic regimen; home modifications, assistive devices/equipment. Refer to section at end of plan for postdischarge considerations. DIAGNOSTIC STUDIES Metabolic/endocrine studies: May reveal abnormalities, e.g., hypothyroidism, hypopituitarism, hypogonadism, Cushing’s syndrome (increased insulin levels), hyperglycemia, hyperlipidemia, hyperuricemia, hyperbilirubinemia. It is also suggested that the cause of these disorders may arise from neuroendocrine abnormalities within the hypothalamus, which result in various chemical disturbances.
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