Obesity | 6 Nursing Diagnosis, Care Plans, & More

Obesity is a serious condition that affects millions of people worldwide. The estimated economic burden of obesity in the United States is $100 billion annually.

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Obesity | 6 Nursing Diagnosis, Care Plans, & More

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Additionally, 50 percent of people surveyed by Harvard University in January 2022 reported weight gain since the beginning of the COVID-19 pandemic, making this condition even more complex today. 

Obesity puts individuals at risk of severe health issues, including heart disease, stroke, and diabetes. In addition, those living with obesity can experience social and psychological problems along with physical health issues. Therefore, proper assessment of obese patients is essential to determine the best course of treatment. 

This article provides six obesity nursing diagnoses and care plans nurses can use when caring for patients living with obesity.

Understanding Obesity

Obesity occurs when one's body stores excess body fat. It happens over time and can be caused by other underlying conditions or illnesses if not treated. Managing obesity is a complex process that requires a comprehensive, multidisciplinary approach. Obesity doesn't just constitute a physical condition but also has psychological, emotional, and social aspects.

For example, shorter sleep durations of less than seven hours can cause metabolic and hormonal changes, leading to weight gain. And weight gain can negatively impact a person's body image, causing severe psychological and social problems. This continuous cycle might leave the patient dealing with physical, social, and psychological conditions that must be treated individually while also treating the underlying obesity.

Diagnosing Obesity

A medical provider diagnoses obesity by examining several factors during a physical exam. A thorough health history may reveal healthy and unhealthy habits concerning weight gain, weight loss, exercise, medications, stress, and appetite. The physician will ask about other conditions that may have caused the obesity before developing a treatment plan. This includes high blood pressure, diabetes, underactive thyroid disease, and high cholesterol. 

The patient's height, weight, and waist circumference provide data to diagnose obesity. One tool commonly used is the body mass index (BMI). This calculation is done by taking the patient's weight in kilograms or pounds and dividing it by the square of their height in meters or feet.

An individual with a BMI of 30 or higher is considered obese, and 40 or higher is categorized as severely obese. Obesity can onset due to genetic, behavioral, environmental, and medical factors. It's essential to understand that BMI isn't interpreted in the same manner for children and teens, even though the same calculation is used.

Causes of Obesity

Obesity is caused by several factors, including:

  • Eating more calories than the number burned
  • Lack of physical activity or exercise
  • Genetic predisposition
  • Medications
  • Medical condition

Risk Factors of Obesity

A patient's behaviors may place them at a heightened risk for obesity. Factors that put a person at a higher risk include:

  • Unhealthy eating habits, such as overeating or eating high-calorie, low-nutrient foods
  • Sedentary lifestyle
  • Over 45 years of age
  • Sleep deprivation
  • High or uncontrolled stress levels

Complications

Being obese is directly related to several comorbid conditions, including:

  • Asthma
  • Sleep apnea
  • Stroke
  • Heart disease
  • Diabetes type 2
  • Gout
  • Osteoarthritis
  • Gastroesophageal reflux
  • Fatty liver

Treatment and Prevention

The best treatment plan for obesity is to prevent it from happening. Preventative measures include establishing healthy habits such as a well-balanced diet, regular exercise, managing stress, and getting adequate sleep. 

Once obesity happens, it usually takes a multidisciplinary approach to treat the root cause of the disease. In addition, the treatment plan must include lifestyle changes such as improving eating habits, increasing exercise or physical activity, and learning how to manage stress levels. 

For some patients, behavioral changes alone won't be enough to treat obesity. In these situations, the patient might require medications or surgery. However, both treatment modalities have potentially serious risks, so this treatment regimen is usually reserved for severe cases only.

Nursing Care Plans for Obesity

Now that we've covered the basics of obesity let's dive into six obesity nursing diagnoses and care plans. It's essential to note that many care plans could be related to obesity based on the patient's specific situation. Therefore, this is not an all-encompassing list. 

Here are six obesity nursing diagnoses.

Imbalanced Nutrition: More Than Body Requirements

Overeating isn't the only reason people gain weight. Many people eat average amounts of food but gain weight because of the kinds of foods they consume. A healthy diet must consist of the right types and amounts of food combined with a healthy exercise regimen. 

Potentially Related to:

  • Excess food intake
  • Lack of nutritious food due to socioeconomic status
  • Psychosocial factors, such as depression

Evidenced By

  • BMI of 30 or higher
  • Weighing 20% or more over ideal body weight
  • Excess body fat 
  • Observed or reported dysfunctional eating habits

Desired Outcomes:

  • Patient's calorie intake meets metabolic needs, which leads to weight loss.
  • Patient will make healthy food choices.
  • Patient will actively participate in their meal planning.

Assessment:

  1. Ask the patient about their diet and exercise habits. This question establishes if they have unhealthy habits contributing to obesity.
  2. Instruct the patient to keep a daily food diary noting caloric intake and the amounts and types of foods consumed. Then, review the food diary weekly with the patient. This activity provides clarity around poor eating habits. 
  3. Obtain the patient's height, weight, and abdominal circumference to evaluate the degree of fat by using the BMI calculation.

Interventions with Rationale

  1. Educate the patient about emotional eating. Talk to them about what triggers overeating or other poor eating habits.
    Rationale: Establishes if the patient eats to satisfy an emotional need rather than physiological hunger.

  2. Create a simple eating plan with the patient that considers their current weight and eating habits and patterns.
    Rationale: Involving the patient in creating the eating plan helps with compliance. 

  3. Instruct the patient to include craved foods in their eating plan. 
    Rationale: The patient shouldn't feel that any foods are off-limits. This strategy helps them create healthy limits on foods while knowing they still get to eat the foods they enjoy the most.

  4. Establish realistic weekly weight loss goals.
    Rationale: Losing a few pounds each week helps the patient see progressive improvement. This type of weight loss usually has a lasting effect. 

  5. Create an exercise plan that increases the time and difficulty of the activities weekly.
    Rationale: Exercise goals must be realistic to avoid feelings of defeat and premature quitting. Starting slowing and building a longer or more intense workout weekly increases the likelihood of success. 

Sedentary Lifestyle

According to the American Psychological Association, 50 million Americans live sedentary lifestyles. This means they sit or lean most of the day. A sedentary life increases individuals' risk of obesity and other health conditions. 

Potentially Related to:

  • Lack of motivation or interest
  • Lack of resources for classes or memberships
  • Inadequate knowledge about the importance of activity
  • Fear of injury
  • Comorbid conditions that limit activity levels
  • Safety concerns related to exercise

Evidenced By

  • Poor overall health and condition
  • Observed or reported a sedentary lifestyle

Desired Outcomes:

  • Patient will verbalize the importance of regular physical activity to obtain a healthy weight.
  • Patient will verbalize any needed safety precautions and monitoring techniques to ensure safety.
  • Patient will set realistic exercise goals that gradually increase activity.
  • Patient will participate in at least 30 minutes of physical activity per day.

Assessment

  1. Ask the patient about their current activity level.
  2. Ask the patient about their desired activity level.
  3. Ask the patient about perceived or actual barriers to exercise.
  4. Observe the patient's daily routine for activity or exercise.

Interventions with Rationale

  1. Educate the patient on the health benefits of regular exercise.
    Rationale: Educating the patient about the benefits increases compliance and motivation. 

  2. Provide ideas of ways to combat a sedentary lifestyle.
    Rationale: Patients may feel that leading an active lifestyle isn't possible if they work a desk job or have underlying conditions that make exercise challenging. Providing creative ways to increase activity slowly helps them see it's possible and adopt these practices. 

  3. Educate on an exercise plan, including any needed equipment.
    Rationale: By providing education on an exercise plan and working with the patient, you'll have the opportunity to answer any questions they might have and be able to demonstrate how to use exercise equipment. 

  4. Ask for a physical, occupational, or exercise therapy consult to help develop a progressive exercise plan.
    Rationale: A multidisciplinary approach to a sedentary lifestyle helps educate and implement a successful plan. The therapy team can provide exercises and parameters to ensure the patient's safety while increasing activity.

Disturbed Body Image

Body image is how a person thinks and feels about their body. It may or may not relate to what they look like. The people around them and societal standards can affect a person's body image. Research shows that a person living with obesity may be dissatisfied with their body even after losing weight. The most significant body image issues are seen in those with child or adolescent-onset obesity, females, and people with binge eating disorders.

Potentially Related to:

  • Societal norms around weight 
  • Family or peers encouragement about the need to change eating habits

Evidenced By

  • Verbalizing a negative body image
  • Fear of others rejecting or reacting to one's body
  • Preoccupation with weight and the need to change or "fix" it
  • Verbalizing feelings of powerlessness or hopelessness related to their body or eating habits

Desired Outcomes:

  • Patient will verbalize a realistic self-image.
  • Patient will accept their body as is.
  • Patient will participate in a healthy exercise regimen and diet plan that helps them lose appropriate weight.

Assessment

  1. Ask the patient how they feel about their weight to determine their body image.
  2. Observe how the patient interacts with others concerning their body image.

Interventions with Rationale

  1. Provide privacy during care.
    Rationale: Patients who are sensitive or self-conscious about their bodies may need more privacy to feel safe and comfortable. Providing privacy shows respect and builds trust between the nurse and the patient.
  2. Promote open communication about their feelings and behaviors free of judgment.
    Rationale: This supports the patient and helps develop a trusting relationship to get to the root cause of their obesity. 
  3. Graph weight loss weekly.
    Rationale: Providing a visual account of weight loss based on data helps orient the patient to reality so they can set realistic and achievable goals.
  4. Educate on types of fitness, including those the patient can build up to.
    Rationale: Offering a variety of fitness ideas helps the patient stay engaged and motivated. You can offer weight training, mobility exercises, stretching, yoga, and endurance and strength training. 

Impaired Social Interaction

Obesity often comes with significant or severe psychological and social burdens. One study found that individuals living with obesity experience more discrimination in healthcare, are less likely to get married and earn less money compared to peers without obesity. Being treated differently can change the desire to be around others and even cause the person with obesity to resist relationships of all kinds and socially isolate to avoid being hurt. Addressing impaired social interactions in patients with obesity is a critical task that the nurse must do with care. 

Potentially Related to:

  • Verbalization or observed discomfort when in social situations
  • Disturbance of self-esteem or self-concept

Evidenced By

  • Reluctance or refusal to participate in social interactions
  • Verbalization of discomfort being around others in social settings

Desired Outcomes:

  • Patient will verbalize awareness of feeling uncomfortable in social situations.
  • Patient will verbalize possible actions to help feel more comfortable in social gatherings.
  • Patient will demonstrate improved interactions and behaviors when in social situations.

Assessment

  1. Assess for social stigmas around obesity in the patient's culture to better understand their feelings. 
  2. Assess for the presence of psychological illnesses that could be an underlying cause of obesity. 
  3. Assess the patient's defense mechanisms and coping skills used in social interactions that could be the cause of social isolation.

Interventions with Rationale

  1. Suggest using positive self-talk such as "I enjoy life" or "I enjoy social interactions" before attending social gatherings.
    Rationale: Positive self-talk promotes confidence and helps patients embrace the changes they need to take. 
  2. Refer the patient and family for therapy.
    Rationale: Impaired social interaction may be a long-standing behavior that takes time and special care. A licensed counselor can help patients create support systems and plans to help them feel better in social settings.
  3. Help the patient set motivational goals.
    Rationale: Helping the patient develop reasons to keep them on track with goals can increase compliance. Examples of motivational goals include feeling confident in a new outfit or swimsuit or being comfortable during intimacy.

Deficient Knowledge

Some patients may not fully understand the risks of being obese. Nurses help bridge the knowledge gap by educating the patient and giving them all the needed information to make informed decisions. 

Potentially Related to:

  • Lack of information
  • Misinterpretation of information
  • Lack of interest in learning needed information
  • Lack of receiving accurate or complete information

Evidenced By:

  • Verbalization of inability to lose weight
  • Requesting information about nutritional needs, obesity, and diet
  • Past inabilities to achieve diet and exercise modification

Desired Outcomes:

  • The patient will verbalize two to three lifestyle changes they can make to lose weight.
  • The patient will seek information about healthy nutrition and exercise regimens.
  • The patient will create a weight loss plan and accompanying goals.

Assessment:

  1. Assess the patient's understanding of healthy eating and the need for exercise.
  2. Ask the patient what resources they use when making diet and exercise choices. 

Interventions with Rationale

  1. Educate the patient on healthy eating and exercise habits to create a healthy lifestyle. 
    Rationale: Helping the patient focus on wellness instead of weight loss may increase the likelihood of losing and keeping it off. 
  2. Provide a list of resources for books, community classes, online websites, and groups.
    Rationale: Providing various resources helps the patient explore options to choose the right resources for themselves.
  3. Educate on a variety of non-food rewards the patient can use for accomplishments. 
    Rationale: This intervention helps reduce the likelihood of emotional eating. 
  4. Encourage the patient to get involved in non-food-related activities, such as hiking or walking. 
    Rationale: This strategy allows the patient to have fun in a controlled environment without the risk of being tempted by poor food choices. 

Impaired Physical Mobility

Patients living with obesity may struggle to make independent and purposeful physical movements. This limitation can place them at a higher risk of continued weight gain, making losing weight more challenging. Therefore, the nurse must address this problem with practical ways the patient can increase physical mobility, even if it's small incremental changes. 

Potentially Related to:

  • Sedentary lifestyle
  • Comorbid conditions
  • Poor overall health

Evidenced By

  • Verbalization or observation of the lack of ability to move independently and purposefully

Desired Outcomes:

  • The patient will increase mobility, as evidenced by increased daily activity and weight loss.
  • The patient will participate in 10 minutes of physical activity daily for one week and then increase the movement by 5 minutes daily up to a maximum of 60 minutes.
  • The patient will lose at least three pounds each week for four weeks. 

Assessment

  1. Assess the patient's mobility to establish a baseline for treatment. 
  2. Assess the patient's motivation and willingness to increase mobility to lose weight. 

Interventions with Rationale

  1. Create an individualized plan that considers the patient's baseline mobility status. 
    Rationale: Tailoring a plan to the patient makes the goals realistic and attainable, which will help with compliance. 

  2. Educate the patient on the importance of starting with a low-intensity, short-interval exercise plan. 
    Rationale: It's critical to consider that the patient may be deconditioned due to lack of movement. Short and easy exercises will improve endurance over time.

  3. Educate the patient on the possible complications of obesity.
    Rationale: A sedentary lifestyle puts the patient at a higher risk of high blood pressure, diabetes mellitus type 2, and heart disease.  

More Obesity Diagnoses

  1. Hopelessness related to the inability to lose weight
  2. Fatigue related to deconditioning and excess weight

Obesity NCLEX Test Questions

You may encounter questions on the NCLEX about obesity. Below is a sample question to help you prepare. 

  1. Which nursing action should the nurse take when coaching obese adults enrolled in a behavior modification program?
    a. Ask the adults about situations that usually increase their appetites
    b. Instruct the adults to write the caloric intake of every meal in a food diary
    c. Encourage the adults to eat small frequent meals 
    d. Encourage the adults to reward themselves with sugarless candy to achieve goals

Correct Answer: A 

Rationale: Behavior modification programs help the patient identify the cause of negative behaviors. By asking the adults to tell you about situations that increase their appetites, you are identifying behaviors they can modify. 

Additional Readings and Resources:

Wrapping Up Nursing Diagnosis for Obesity Care Plans for Obesity

Obesity is a significant health issue affecting millions of people worldwide. It can disrupt the patient's quality of life, increase the risk of serious conditions, and cause emotional and psychological distress.  

Nurses can make a difference in the lives of patients living with obesity by providing education, setting realistic goals, and helping them develop healthy behaviors. With proper care and support, patients can set realistic weight loss, exercise, and diet goals that they can achieve. 

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Melissa Mills

About Melissa Mills, BSN

Workforce Development Columnist

Melissa is a nurse with over two decades of experience in leadership and workforce development. She loves to help other healthcare professionals advance their careers.

126 Articles   376 Posts

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Specializes in Nurse Practitioner.

Excellent article! There needs to be more options for obesity treatment and access to care. Living in Massachusetts, many patients on MassHealth and Medicare are not able to receive insurance coverage for weight-loss medications since their insurance plans exclude coverage. However, many private insurers do recognize obesity as a chronic disease that affects many other aspects of someone's health.

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

Very thorough, and a great job organizing the information and highlighting the key points! 

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