Care of the Obese in Advanced Practice Nursing: Communication, Assessment, and Treatment

395 Pages·2015·11.21 MB·English

by  Lisa L.M. Maher

Care of the Obese in
Advanced Practice Nursing
Lisa L. M. Maher, DNP, ARNP, FNP-BC, received her BS in wellness from Waldorf
College in Forest City, Iowa, in 2003, her BSN from Allen College in Waterloo, Iowa, in
2005, and her MSN from Graceland University in Independence, Missouri, in 2008. In
2011, she received her DNP from the University of Iowa in Iowa City. She is board certi-
fied as a family nurse practitioner (FNP) through the American Nurses Credentialing
Center (ANCC). She is the current president of the Cedar Valley (Iowa) chapter of Preven-
tive Cardiovascular Nurses Association (PCNA) in Waterloo, Iowa.
Dr. Maher has been employed as a nurse practitioner (NP) at the Cedar Valley Cardio-
vascular Center since 2008. She specializes in treatment of general cardiology, sleep apnea,
weight loss, and risk factor modification. She started the Cedar Valley Center for Lifestyle
Medicine Clinic in 2008 and the Cedar Valley Cardiovascular Center Sleep Clinic in 2009.
Care of the Obese in
Advanced Practice Nursing
Communication, Assessment,
and Treatment
Lisa L. M. Maher, DNP, ARNP, FNP-BC
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ISBN: 978-0-8261-2357-2
e-book ISBN: 978-0-8261-2358-9
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Library of Congress Cataloging-in-Publication Data
Maher, Lisa L. M., author.
Care of the obese in advanced practice nursing : communication, assessment, and treatment /
Lisa L. M. Maher.
p. ; cm.
Includes bibliographical references.
ISBN 978-0-8261-2357-2 (hard copy : alk. paper) — ISBN 978-0-8261-2358-9 (ebook)
I. Title.
[DNLM: 1. Obesity—nursing. 2. Advanced Practice Nursing—methods. 3. Obesity—therapy.
WD 210]
RC628
616.3'980231—dc23
2015029702
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This book is dedicated to current and future advanced practice nurses.
Continue to educate with compassion.
This book is also dedicated to Brook, my loving husband.

Contents
Preface xi

Acknowledgments xv

Share Care of the Obese in Advanced Practice Nursing: Communication,
Assessment, and Treatment
PART I: INTRODUCTION
1. Obesity: The Epidemic, Trends, and Causes 3
The Epidemic 3
Trends 6
Causes 9
2. Definition of Obesity and Obesity Terms 19
3. The Many Roles of the Advanced Practice Nurse 27
Certified Nurse Practitioner (CNP) 28
Certified Registered Nurse Anesthetist (CRNA) 29
Certified Nurse-Midwife (CNM) 30
Clinical Nurse Specialist (CNS) 30
Case Study 1 33
PART II: COMMUNICATION
4. Addressing Pediatric Obesity 39
Risk Factors 39
Growth Charts 41
The Provider–Pediatric Patient Relationship 42
5. How to Initiate the Weight Conversation With Patients 43
Weight Discrimination—Provider 43
Weight Discrimination—Patient 45
The Provider–Patient Relationship 46
Therapeutic Communication 47
Ethical Principles 49
Addressing Legal Issues—Malpractice 49
6. Patients’ Stories 53
Case Study 2 85
viii ■ Contents
PART III: ASSESSMENT
7. Overview of Genetics and Pathophysiology of Obesity 91
Energy Balance 91
Environmental and Genetic Factors 92
Genetic Syndromes 93
Gene and Protein Function 93
Pathophysiology 94
8. Behaviors, Addiction, and Eating Disorders 99
Behaviors and Addiction 99
Eating Disorders 101
Unintentional Weight Loss 104
9. Which “Way” Is the Right “Weigh?” 107
Measuring Body Fat 107
10. Physical Assessment of the Adult Obese Patient 113
11. Physical Assessment of the Pediatric Obese Patient 123
12. Physical Activity, Exercise Assessment,
and Patient Recommendations 129
History of Physical Activity Recommendations 129
Key Concepts of Physical Activity 130
Patient Evaluation 130
Objective Methods to Assess Physical Activity 132
Effects of Exercise Response and Training 132
Exercise Testing 133
Exercise Programming 135
Special Considerations 156
13. Dietary Assessment and Patient Recommendations 157
Jennifer Roth
Starting With a New Patient 158
Nutrition Screening 158
Monitoring Patients’ Eating Patterns and Habits 158
Daily Food Record or Journal 159
Estimating Needs for Weight Loss 161
Diet Composition 162
Portion Control 163
Recommendations 163
Counseling to Improve Behavior Change 164
14. Psychological Assessment 167
Case Study 3 173
PART IV: DISEASE MANAGEMENT
15. Disease Management and the Role of the Advanced
Practice Nurse 179
16. Obesity-Related Diseases 183
Hypertension 183
Dyslipidemia 189
Contents ■ ix
Cardiovascular Disease 193
Diabetes Mellitus 198
Obesity and the Pulmonary System 201
Osteoarthritis 204
Polycystic Ovary Syndrome 205
Metabolic Syndrome 208
17. Obesity-Related Diseases: A Pediatric Focus 213
Hypertension 214
Dyslipidemia 216
Diabetes Mellitus 218
Obstructive Sleep Apnea 220
Asthma 222
18. Prevention 227
Prevention Guidelines 227
School Opportunities for Prevention Focus 228
19. Weight Cycling 233
Commonalities in Weight Cycling 234
Health Consequences of Weight Cycling 236
Case Study 4 241
PART V: TREATMENT
20. Treatment of Addiction and Eating Disorders 247
Food Addiction 247
Eating Disorders—Anorexia and Bulimia 249
21. Pharmacological Therapy 253
Pharmacotherapy for Obesity 253
FDA-Approved Obesity Medications 255
Off-Label Drug Use 259
Nonprescription Medications 262
FDA-Withdrawn Medications 263
22. Surgical Therapy 265
Candidates for Bariatric Surgery 265
Medical Clearance for Bariatric Surgery 266
Surgical Procedures 267
Postoperative Complications 269
Long-Term Follow-Up 270
23. Costs Associated With Obesity Treatment
and Insurance Coverage 275
Costs Associated With Obesity 275
Insurance Coverage 276
24. Treatment of the Obese Pediatric Patient 281
Medical Treatment 281
Pharmacological Therapy 283
Bariatric Surgery 284
25. What Is Lifestyle Medicine? 287