Responding to the obesity epidemic

obesity











This is a long-standing medical condition that has a profound and far-reaching impact on the health of millions of people around the world. As a nurse, it is essential to have a solid foundation in the science of obesity and advocate for patients who are battling obesity and seeking effective treatments.

Why is obesity so prevalent at the moment?

Thomas George, DNP, APRN, FNP-C, NASM-CPTis a family nurse practitioner, assistant professor at Frontier College of Nursing, clinic director, and obesity expert. Source weight and health conditiona medical startup located in rural Idaho. As an obesity expert, Dr. George is positioned to provide scientific and up-to-date information on obesity-related research.

When discussing why there are such alarming levels of obesity, Dr. George says: youththe prevalence among adults in the United States approaches 43%. It is estimated that nearly 80% of U.S. adults are pre-obese or obese, and these statistics gave rise to the term “obesity.” ”

He continues: “This is a complex, multifactorial disease. The world's food supply is shifting toward ready-to-eat, highly processed foods that are higher in calories and lower in nutritional value. At the same time, technology and automation are Energy consumption also started to decrease as the efficiency of our activities improved.”

“Obesity is highly genetic. gene is like the engine or basic design of a car, and our lifestyle is like how we drive, maintain, and operate that car. In obesity, genes contribute about 70% and lifestyle contributes the remaining 30%. ”

“An estimated 200 to 500 genes directly contribute to the development of polygenic obesity, and when obesity genes are turned on, they can cause increased appetite, cravings, overeating, and increased amounts of adipose tissue. There is.”

According to George, researchers have identified the following obesity phenotypes that allow health care providers to more accurately treat patients and improve outcomes:

1. hungry brain (Abnormal satiety): These people need to eat more calories than others to feel full.
2. emotional hunger (hedonic eating): These individuals eat in response to emotional cues and are characterized by negative mood, emotional eating, cravings, and reward-seeking behaviors.
3. hungry gut (Abnormal satiety): These people feel full with normal portions of food, but the feeling of fullness (feeling full) disappears quickly. It is characterized by a shortened duration of satiety, objectively quantified by rapid gastric emptying.
4. slow burn (decreased metabolic rate): People with this phenotype have a visibly reduced resting energy expenditure (REE).

George identifies other factors that may epigenetically “turn on” obesity genes.

1. poor sleep Good or insufficient sleep (less than 7 hours)
2. endocrine disrupting chemicals
3. stress
4. Microbiome changes
5. decreased physical activity
6. Drugs, foods, and drinks that cause obesity

Regarding comorbidities, George says, “Obesity has over 236 symptoms, including 13 cancers. ) and fat mass disease. While steatosis involves complex metabolic and inflammatory processes, fat mass disease is primarily associated with mechanical stress. .”

unhealthy adipose tissue, changes in endocrine and immune function, systemic inflammation, osteoarthritis due to excessive weight bearing on joints, organ compression, sleep apnea, gastroesophageal reflux disease, stress urinary incontinence, and Many other symptoms and conditions can result from unrelieved obesity.

What about medicine?

“Many medical professionals are surprised to learn that there are technically 11 types of anti-obesity medications (AOMs),” advises George. “Overall, AOMs have an excellent safety profile, but data are emerging regarding genetic differences that predispose some patients to side effects.”

Importantly, George said: “The biggest caveat about AOM is that it is never intended to be used as a standalone intervention.Evidence shows that AOM is a combination of regular physical activity, a nutritious diet, and cognitive It has been shown to be most effective when used in conjunction with behavioral health interventions such as function. behavioral therapy”

He further adds: One of the best ways to reduce potential side effects is to increase the dose to a therapeutic dose. And a final note is to individualize therapeutic interventions to the patient's predominant phenotype. ”

“The most widely discussed AOMs are the game-changing molecules semaglutide and tirzepatide. Semaglutide (Wegovy) and its early predecessor liraglutide are glucagon-like peptide-1 receptor agonists and GLP-1-like Also called incretin mimetics, this class of AOMs because one of their mechanisms of action involves slowing gastric emptying. is suitable for people with a hungry gut phenotype.”

GLP-1 receptor agonists have the following effects:

1. stimulates insulin release from the pancreas
2. block glucagon secretion
3. Stomach emptying is slow
4. Increases feeling of fullness after meals

Dr. Thomas describes the benefits of GLP-1 receptor agonists as “glycemic control, weight loss, and reduced cardiovascular risk in type 2 patients.” diabetesSide effects include nausea, vomiting, diarrhea, constipation, increased heart rate, indigestion, and abdominal pain. ”

Regarding dual-drug tirzepatide (Zepbound), the latest AOM approved for the treatment of obesity, George said: “When used in conjunction with other pillars, some patients report a loss of 20% or more in total body weight, and the results are astonishing.” Obesity Treatment (nutritionphysical activity, and behavioral interventions). [This medication] Improves insulin sensitivity and blood sugar control, reduces stomach acid production (slows down digestion and increases satiety); also suppresses appetite and food intake, reducing food cravings in some people )

Dr. George says there are many other anti-obesity drugs. However, these are well beyond the scope of this article, and nurses are encouraged to receive appropriate education on treatment plans, side effects, and contraindications.

Empathize, educate, encourage and empower

Dr. George has advice for nurses in broaching this difficult subject with struggling patients.

“First, we have to deal with our own internal biases. Unfortunately, obesity is highly stigmatized, and the bias among medical professionals has led to poor health outcomes for obese people. Consider the negative impact on your well-being. implicit bias test To explore your own attitude. Unfortunately, there are still medical professionals who believe that obesity is a lifestyle choice rather than a disease. ”

George added: “The evidence is staggering. Obesity is a real, complex, highly heritable, progressive and recurrent, but treatable disease. Something as simple as using human-first language. But it can help remove the stigma around obesity. For example, instead of calling someone “obese,” use “obese person.” ”

George says: Change agent We aim to contribute to the medical field so that patients receive competent and compassionate care. Would we judge someone with a different disease? Let's challenge the status quo and lead the effort to combat obesity stigma and promote compassionate and competent care. ”

Continuing his advice, he says: “We need to see real people struggling with real problems. Listen to their stories. Learn more about the pathophysiology and treatment of obesity, provide clinical insights, and even more importantly… Most importantly, it can offer hope to people who often experience obstacles and pushback from the health care system.Work with patients to access local resources, reputable websites, and obesity training. Find a clinician who is there to empathize, educate, encourage, and empower.”

“Patient care spaces should be inspected to determine whether furniture and equipment are suitable for obese individuals. Are oversized BP cuffs, wide chairs, and appropriately sized gowns available? Scales? Is it in a private area? Many obese patients avoid medical care because they feel embarrassed or shamed in the medical setting…and that’s terrible!”

George added, “Asking for permission is a great way to start a conversation about weight. 5 As” model was created. ”

1. Ask permission to talk about your weight and explore whether you're ready for a change
2. Assessing obesity-related risks and the “root causes” of obesity
3. Advice on health risks and treatment options
4. Agree on health outcomes and behavioral goals
5. Helping you access the right resources and providers

“Many of my patients are surprised to learn that obesity is a real disease. After sharing the basics of obesity, pathophysiologyOne patient said: “I've tried so hard and felt like I was doing something wrong or like I didn't have the willpower. But now I'm not fighting myself, I'm fighting the disease. I feel like I am!”

George concludes: “Nurses play a critical role in the competent, compassionate, and evidence-based treatment of obese patients. Look for opportunities to attend or attend obesity-focused conferences. Consider taking continuing education courses. Get others involved in policy and advocacy groups. Visit an obesity medicine specialist and see if you can be observed for a day. Spend time with people who are struggling and listen to their stories. Try to reduce obesity. prejudice and prejudice In the context of work. Become a change agent! ”

Keith Carlson, BSN, RN, NC-BC has been a nurse since 1996. As a holistic career coach, nurse podcaster, writer, blogger, and renowned motivational speaker, Keith empowers nurses when it comes to personal branding. Professional networking. Entrepreneurship; resume, job search, and interview strategies. Emotional and relational intelligence. personal health. and building a dynamic nursing career. Keith lives happily in Santa Fe, New Mexico with his wife Shada McKenzie, a talented and highly skilled traditional astrologer. He can be found on NurseKeith.com and on the podcast The Nurse Keith Show.

Latest posts by Keith Carlson (See all)