OBESITY
3 Class Hours
OJECTIVES: At the end of this class, you will be able to:
1. State what “over weight” and “obesity” are
2. Detail some of the things that are used to decide if the person is over weight or obese
3. Describe some of the health problems that can happen when a person weighs too much
4. Detail some ways that a person can control and lose weight
INTRODUCTION
Obesity is a very big problem in the US. Some say that as many as 32.7% of U.S. adults (20 years of age and older) are overweight. 34.3 % are obese and 5.9 % are very, very obese.
Obesity among children has more than tripled in the past 30 years, according to the U.S. Centers for Disease Control and Prevention CDC. The % among children from 6 to 11 years of age has risen from 6.5 % in 1980 to 19.6 % in 2008. It is also known that one in five American teens have high levels of cholesterol, thus leading to heart problems as they grow older.
High blood pressure, other heart problems, diabetes, arthritis and a poor immune system can be the result of being over weight.
The Difference Between Overweight and Obesity
Obesity and overweight are somewhat similar but they are also different. Both of these terms mean that the person weighs more than they should for a healthy body. This means that the person does not have a normal weight for their height. A person is more prone to health problems when they weigh too much.
The range of weight for adults is based on the body mass index or BMI. The BMI for the person is based on the weight and height of the person. The BMI is an estimate of the amount of fat that the person has in their body but it does not directly measure the body fat. This can lead to some confusion, especially with people who are very active in sports. Many of these people have a high BMI but little body fat. Other ways of measuring body fat are skin fold thickness, waist size, waist-to-hip ratios, and things like ultrasound, CT scans and MRIs.
A BMI of more than 30 is obese. A BMI of 25 to 25.9 is overweight. A BMI of less than 18.5 is under weight and a BMI of 18.5 to 24.9 is considered a healthy weight.
This table shows different BMIs for a person that is 5 feet 9 inches all.
| Height | Weight Range | BMI | Considered |
| 5' 9" | 124 lbs or less | Below 18.5 | Underweight |
| 125 lbs to 168 lbs | 18.5 to 24.9 | Healthy weight | |
| 169 lbs to 202 lbs | 25.0 to 29.9 | Overweight | |
| 203 lbs or more | 30 or higher | Obese |
BMI is just one sign that the person may have health problems because they weigh too much. The 2 other signs are:
- The person’s waist measurment. This is because tummy fat is a sign of risk for health problems.
- Obesity diseases such as high blood pressure.
The Resulting Health Problems
The following health problems can occur when the person weighs too much:
- High blood pressure and other heart problems,
- Diabetes,
- Arthritis and,
- A poor immune system
Many heart problems can result from a person being over weight. The most common one is high blood pressure. This heart damage can lead to many problems and even death.
The signs of heart disease are:
· Chest pain
· Shortness of breath
· Feeling tired
· Heart palpitations
High blood pressure is a major problem. High blood pressure can lead to heart attack, stroke, kidney damage and other health problems. As many as 50 million Americans have high blood pressure. Blood pressure is considered high when:
- the systolic blood pressure is more than 140 at rest, and/or
- the diastolic blood pressure is 90 or more at rest.
A person can lower their high blood pressure by NOT using alcohol or cigarettes, by eating foods low in salt and cholesterol and by managing their stress.
Exercise and a healthy weight are also important in keeping the blood pressure at a good level. A patient's doctor may order medications, such as a diuretic (water pill), a heart medicine and other things like diet and exercise.
Some people may not have any signs of high blood pressure. Others do. Some of the signs of high blood pressure are:
- a headache,
- nosebleeds,
- nausea,
- vomiting
- dizziness,
- shortness of breath,
- a flushed face,
- restlessness
- fatigue, and
- blurry vision.
Heart attacks are also found more in people that are over weight.The risk of heart disease and heart attacks increase with high levels of LDL, or bad cholesterol. People that are over weight have high levels of LDL.
The signs of a heart attack are:
- shortness of breath, chest pain and a feeling of fatigue, sometimes for days before the heart attack,
- chest pain that spreads to the left arm, back and/or jaw and/or even the right arm,
- stomach pain that the person may think is just indigestion,
- feeling faint,
- heavy palpitations or pounding of the heart,
- sweating,
- restlessness,
- loss of consciousness,
- disorientation,
- a blue color on the lips, feet and/or hands.
Heart attacks are treated with rest, oxygen, a number of different medicines like aspirin, which thins the blood, and pain medications to help the pain and to ease the amount of work that the heart has to do as a result of the pain.
People who have had a heart attack are usually up in the chair after a couple of days. After, they will begin activity and cardiac rehabilitation. Many will also be instructed to change some things in their life. For example, they may be told to stop smoking, to lose some weight and to get some regular exercise.
Heart failure is a very serious condition that is seen in people that have high blood pressure as a result of their weight. The oxygen and nutrients pumped by the heart is not enough to keep the body and its parts in proper condition. The heart can not keep up with the body’s demands.
This cardiac disorder can be caused by a number of things, such as:
- coronary artery disease,
- heart valve disease,
- high blood pressure
- myocarditis, an infection of the heart muscle, and
- irregular beating of the heart
Some of the signs of heart failure are:
- fatigue
- swelling of the feet, ankles, abdomen and liver (right sided heart failure)
- fluid buildup in the lungs and shortness of breath (left sided heart failure)
This heart disorder is treated by treating the cause of it, by taking away some of the things that make the disorder worse, like losing weight, stopping smoking and lowering the amount of salt, or sodium, in the diet.
Take our “ Mini Med School: Heart Disease” course to learn more about heart disease.
Diabetes is also a big concern. More children have the “adult form” of diabetes than ever before. This happens because they are over their normal weight. The same thing is happening with adults.
This disease stops the body from changing the foods we eat into energy for the body. Think about the human body as a car. Gas does not go into the engine of the car for fuel until the car key is turned on. Gas will only be pumped into the car's engine when you turn on the key in a car as you start it.
When food is eaten, it turns into sugar (glucose). This sugar is the "gas" for the body. Insulin is the "key" that pumps the sugar into the cells for energy. When this key is not present, the body runs out of energy because the body's "gas" is not being pumped to the cells. Insulin does not change sugar into body fuel when a person has diabetes.
It is normal for the sugar to go from the blood to the cells for energy. When the sugar goes to the cells, the sugar does not stay in the blood. People without diabetes keep a low level of sugar in the blood because it moves from the blood into the cells, as it should.
When a person has no insulin or not enough insulin, the sugar is not sent to the body cells from the blood. The sugar will then build up in the blood. The sugar level of the blood gets high for the diabetic patient. Too much sugar in the blood is called "high blood sugar". High blood sugar is a sign of diabetes.
People with diabetes can develop blindness, poor vision, kidney failure, heart disease, strokes (CVA) poor circulation and other problems, such as foot infections, unless the diabetes is treated and kept under good control.
Health care workers should help these patients to control their disease. We must help them to eat a proper diet, to exercise and to follow their doctor's order for medicine, blood sugar testing and other care, including foot care, skin care and personal hygiene.
Some people with diabetes may have no signs at all. Others do. Some of the most common signs of diabetes are:
- Feeling very hungry
- Feeling very thirsty
- Wanting to drink a lot of water
- A dry mouth
- The need to urinate often
- Vision that is blurry and poor
- Weight loss
- Feeling weak and tired
- A tingling and numb feeling in the feet and hands
- Sores and cuts that do not heal at all or that take a long time to heal
- Itchy skin in the groin or vaginal area of the body
How Do People Develop Diabetes?
- Being overweight. People that are overweight get this disease more than those people that are thin or with a healthy body weight. Most people that weigh too much can lose some weight when they eat a proper diet and they exercise every day. Being overweight can be changed. People that lose weight can lower their chance of getting diabetes.
- Having high blood pressure. People with high blood pressure get diabetes more than those with a normal blood pressure. Many people can lower their blood pressure with stress management, exercise, a good diet and sometimes medicine.
- Having high cholesterol and/or high triglycerides. Like high blood pressure, high cholesterol and high triglycerides increase the chances of a person getting diabetes. These high levels can also be changed with medicine, a good diet and exercise.
Nursing assistants and others who take care of people with diabetes should:
- Help patients exercise on a regular basis, especially if they weigh too much, have high blood pressure or high cholesterol.
- Assist their patients and residents to eat a good diet. Some may have a diet that is low in salt when they have high blood pressure.
- Helping the person to lose weight
- Help their patients to use stress management tools such as sitting quietly and relaxing, deep breathing, prayer and meditation. Stress increases blood sugar levels. If you would like to learn more about stress and stress management, take the NursingAssistantEducation.com course entitled “Stress Management”. This course will help you and your patients to learn more about stress and how we can cope with it and live a better life.
How do People Find Out that They Have Diabetes?
The doctor usually diagnoses diabetes when the patient tells the doctor that they have the signs of this disease. Most tell the doctor that they are very thirsty or that they often have to go to the bathroom very often to urinate. When the doctor is told about these signs, lab blood tests are done. The doctor will then order lab tests to find out how much sugar, or glucose, is in the person’s blood. If the lab test shows that the sugar level is high, the person has diabetes.
The normal blood sugar from these tests should be from 70 to 115. If the blood sugar level is more than 126, when the person has not eaten any meals or food, the patient is told that they have diabetes.
The best way for the patient to control their diabetes is to follow the five keys of success. Nursing assistants, home health aides, personal care aides and other health care workers must help the person with these keys to success. The five keys of success are:
- Diet
- Exercise
- Knowing what the blood sugar is
- Personal care
- Medicine when the doctor orders it
Take the NursingAssistantEducation.com “Mini Med School: Diabetes” to learn more about diabetes.
Arthritis
Arthritis is an inflammatory disease of the joints that limits movement and leads to pain. It is the number one chronic disorder in our country. It also leads to disability. About 66 million people, that is, one out of every 3 adults in our nation, are affected by arthritis. About 300,000 children in our country have it. It costs the United States more than $86 billion every year. (Arthritis Foundation, 2009)
It can be caused by an infection in the joint, genes, a buildup of uric acid or simply with the breakdown of a joint as the person grows older and/or is heavy.
Osteoarthritis is the most common form of arthritis. It is a degenerative joint disease. The ends of the bones break down and they become very rough. They are no longer smooth. Bones rub against rough bones as a result of this break down. This movement is no longer smooth. The person has pain and a loss of movement in the area. This form mostly affects large and weight-bearing joints like the hip, knee and back but it is also seen in the hands.
There is no cure for this form but there are medicines that can help stop the pain and to help the person to able to move about. Exercise also helps. Some people may become so crippled that they only are able to stay in bed.
Osteoporosis is a general, progressive breakdown of the bones.
There are three types of osteoporosis:
- Primary osteoporosis Type 1
- Primary osteoporosis Type 2
- Secondary osteoporosis
Type 1 is six times more common in women than in men. This type appears between the ages of 51 and 75 years of age. Many women have it after menopause. Bone fractures happen very often. The cause of primary osteoporosis is not known.
Type 2 is two times more common in women than men and its onset is usually after 60 years of age. This type is a part of the normal aging process because there are fewer bone building cells. Neck fractures, fractures of the pelvis, the spine, the hip and the leg often happen. Some people, like women, can have both type 1 and type 2 at the same time.
Secondary osteoporosis can be caused by a number of diseases, like diabetes and hyperactive thyroid, some medicines, and things too much body weight and long periods of time when the person is not bearing weight or they are in space without gravity. Calcium leaves the bones when a person is not bearing weight.
People may have no signs at all in the early stage. The first symptom is usually a dull, aching, constant pain in the bones, mostly in the back. The pain may also go down the leg, and muscle spasm may be present. Later, the back pain may become chronic and never ending. The lower neck and below is the most common area for this disease. Bone fractures may also happen.
Other early signs and symptoms are:
- joint pain that can get worse with exercise or as the day, and its normal activities, goes on, and
- stiffness after a period of immobility
Some of the middle stage signs and symptoms include lessening joint motion as
well as joint:
- crackling sounds and feelings,
- tenderness,
- bone grating,
- flexion contractures, and
- enlarged joints.
The late signs and symptoms are:
- an increase in the duration and degree of pain,
- joint tenderness,
- pain with passive range of motion, and
- joint deformity.
Some of the complications are:
- deformities,
- immobility,
- spinal damage, and
- fractures.
Some of the things that can be done to prevent it are:
- exercise,
- calcium and vitamin D
- losing weight and
- bone density tests every 1 to 3 years after age 49 especially for women.
Take our course, “Mini Med School: Arthritiis” to learn more about arthritis and the care of the patient.
Poor Immune System
Extra fat can turn your body's defense system (immune system) against you. This system keeps us healthy as it fights of germs and other illnesses. Many people with too much fat are no longer able to fight off germs. They may get colds and flus and other things more than a thin, fit person does.
What Causes A Person to Weigh Too Much
A number of things may lead to being too heavy. Some of these things are:
· Behaviors like eating too much and the lack of exercise
· The environment
· Genes or heredity and
· Other things
Eating Too Much and the Lack of Exercise
All foods have calories. You will gain weight if you eat more calories than you burn. You will gain weight if you do not exercise enough to burn them off. You will lose weight if you burn more calories than you eat. Your weight will stay the same when you burn off the same number of calories that you eat. You must balance the number of calories that you eat when the number of calories that you burn in order to manage your weight.
| If you are… | Your caloric balance status is …. |
| Maintaining your weight | "in balance." You are eating the same number of calories that your body is using. Your weight will remain the same. |
| Gaining weight | "in excess." You are eating more calories than your body is using. You will store these extra calories as fat and you'll gain weight. |
| Losing weight | "in deficit." You are eating fewer calories than you are using. Your body is pulling from its fat storage cells for energy, so your weight is getting lower. |
The Environment
The environment also affects our weight and health status. Many people make choices based on what they see in their family, in their home area and in their place of work. For example, people will make good decisions when they work in a place that has a café with healthy foods and a gym so the workers can exercise. Likewise, children will make poor choices when their school only serves high fat and high calorie lunches.
| Location | Steps to Lose Weight |
| Home |
|
| Schools |
|
| Work |
|
Genes
Genes may play a role but probably not as big a role as some think. Based on the fact that more and more people are obese despite the fact that genes have NOT changed, leads us to know that diet, exercise and the environment play a much bigger role. Also, genes plus eating too much are both needed for a person to be over weight.
Other Things
Some health problems and drugs can lead to weight gain. For example, steroids can lead to weight gain and illnesses like Cushing’s disease can lead to weight gain.
How to Lose Weight and Prevent Obesity
Simply said, eating less with a healthy diet and doing more exercise are the best ways to lose weight and to prevent oneself from being obese. Fad diets and other “get thin quick” things do NOT work.
Diet
The United States and other groups have food pyramids. One is pictured below. It tells you what foods you should be eating every day. It also tells you how much of each food you must eat every day in order to have a healthy, balanced diet. For example, you should eat 6 to 11 servings from the bread, cereal, rice and pasta group and you should only have 2 to 3 servings of the milk, yogurt and cheese group.
All of these food pyramids tell you to:
· Eat lots of fruit, vegetables and whole grains
· Cut down on sweets, snacks, fast foods, prepared foods, empty calories and salt
· Avoid saturated fats and trans fats
· Cut down on foods that are high in cholesterol
· Select a number of foods from each major food group on a daily basis. This gives you a balanced diet.
You should avoid sweets, snacks, fast foods, prepared foods, empty calories and salt. Sweets do not give you good nutrition. Instead, they will cause you to gain weight. Keep wholesome snacks and drinks on hand, like fresh and dried fruit, yogurt, nuts and nut butters, cut-up vegetables, low-fat cheese, hummus, fruit and vegetable juices and herbal teas.
Fast foods and prepared foods tend to be high in fat, high in salt content and high in calories. They also are not as nutritious as home cooked foods. Things that have no nutrition value but have calories are called empty calories. For example, candy, tea and coffee are empty calories.
Salt will cause you to gain weight and also will affect your heart and blood pressure. Table salt should not be used. A small amount of salt should be used for cooking only. Other spices should also be used instead of salt. Salt is hidden in many foods. It is found in all canned vegetables, frozen foods and other prepared foods including most cold cuts that you use on a sandwich. Even fresh fruit has salt, or sodium, so it is very important to avoid salt on the table and when cooking.
Many busy people eat too much fast food. Working families find take out and fast foods much easier than cooking a meal after a hard day at work. Here are some suggestions to help you to avoid fast foods and take out foods as you drive home from work:
· Fast foods and take out foods are more expensive than cooking the same or better foods at home. Stop eating these foods and use the extra money for something else like a vacation.
· Fast foods and take out foods have empty calories and they have a high degree of fat and salt. Stop eating these foods and you will be much thinner and you will have a healthier heart.
· Form or join a family food exchange with your neighbors and friends. Each group member could agree to making one meal per week for all of the other members. If you have 5 members in the group, you will have 4 meals per week that you did not cook. This saves you a lot of time and it also gives you a variety of meals for the entire family.
· Get organized. Plan your shopping list for the week and prepare and freeze your meals for the week on one day. This gives you the other 6 days of the week to have your meals ready to eat. Use the extra time you have on these 6 days to help the children with their homework, to exercise or to just relax.
Exercise
Another way to control your weight is to exercise. You must exercise regularly. Regular physical activity helps improve your health and fitness, and reduces your risk for many chronic diseases like obesity.
Fitting regular exercise into your busy day may seem not to be possible but give it a try. The new Centers for Disease Control and Prevention (CDC) guidelines are easier than you think. People of all ages must exercise. Even people with a disease or in a wheelchair must exercise. The amount of exercise and the type of exercise that you should get is based on the age of the person. Exercise yourself and encourage your children and other members of your family to exercise according to what the CDC says they should.
Encourage your children to exercise doing things that they like to do. For example, if the child likes to ride a bicycle, encourage them to do so. lf the child likes to do push ups, encourage it. Children and teenagers should do three kinds of exercise. A child should do the following kinds and amounts of exercise each day.
· Aerobic exercise. The child should do at least one hour of this kind of exercise each day. Running and walking are two examples of this type of exercise. This type of exercise accounts for most of the exercise that the child should get.
· Muscle strength exercise. Push ups, climbing rocks and other gymnastics are examples of this type of exercise.
· Bone strength exercise. The child should do this type of exercise 3 times a week as part of the 60 minutes or more exercise per day. Running and jumping rope are examples that most children enjoy doing.
Adults need the following kinds and amounts of exercise each day:
· Aerobic exercise. 2 ½ hours of moderate aerobic activity every week. Brisk walking is an example.
AND
· Muscle strength exercise for all muscles at least 2 times per week.
OR
· Aerobic exercise. 1 ¼ hours of brisk aerobic activity every week. Running and jogging are examples.
AND
· Muscle strength exercise for all muscles at least 2 times per week.
All of these exercises can be spread out over the week. You do not have to do it in one day. Break it up into shorter times, like 10 minutes, several times a day when you have the time. If you never have the time, you must make the time to do it. Skip an hour of TV watching and use it to exercise. You will feel the benefits. You will sleep better. You will feel more fit. You will be happier. You will tone up your muscles and you will lose some body fat. In the long term, your heart, lungs, muscles and balance will remain healthy and your bones will become stronger.
Give it a try. Go for a 10-minute brisk walk 3 times a day, 5 days a week. Do one walk in the morning, one during your lunch hour at work and one after work. This will give you a total of 150 minutes activity each week.
When you are able to do the above, increase your time for even better health benefits.
These are some examples of activities that require moderate effort:
· Walking fast
· Doing water aerobics
· Riding a bike on level ground or with few hills
· Playing doubles tennis
· Pushing a lawn mower
These are some examples of activities that require vigorous effort:
- Jogging or running
- Swimming laps
- Riding a bike fast or on hills
- Playing singles tennis
- Basketball
These are some examples of activities that make your muscles stronger:
- Weight lifting
- Working with resistance bands
- Push ups
- Sit ups
- Heavy gardening (i.e., digging, shoveling)
- Yoga
Summary
The US has many children and adults that are obese and overweight. This course will help your patients and YOU to maintain a healthy body weight for a healthy life.
Copyright © 2010 Alene Burke
References
Centers for Disease Control and Prevention. (2010). “Overweight and Obesity.”http://www.cdc.gov/obesity/index.html
Lifescience. (2010). “How to Eat Less: Don’t Put Food on the Table.” http://www.livescience.com/health/eat-less-serve-food-on-counter-100427.html
Lifescience. (2010). “Losing Weight Helps Immune System.” http://www.livescience.com/health/obesity-weight-loss-immune-system-100422.html
Radford, Benjamin. (2010). “Michelle Obama on Obesity: Good Diet vs. Fad Diet.”http://www.livescience.com/health/michelle-obama-childhood-obesity.html