Nutritional Management in Obesity | CHAPTER 7 | Nutrition and Dietetics

Nutritional Management in Obesity – This book covers the entire syllabus of “Nutrition and Dietetics” prescribed by BNMC for all Diploma in Nursing Science and Midwifery students. We tried to accommodate the latest information and topics. This book is an examination-friendly setup according to the teachers’ lectures and examination questions.

At the end of the book previous university questions are given. We hope in touch with the book students’ knowledge will be upgraded and flourish. The unique way of presentation may make your reading of the book a pleasurable experience.

Nutritional Management in Obesity

Definition of Obesity:

Obesity can be defined as the generalized accumulation of excess adipose tissue in the body resulting in an increase of more than 20% of the desirable body weight,

(Ref: Sheilla John’s/1″/303)

Other definitions-nice to know

People who eat more than they need to cover their nutrient needs are likely to become overweight or obese, overweight means that the person is too heavy for their height. Their weight is above the range of weights of healthy people.

(Ref: Nutrition for Developing Countries/24/284)

Factors are Responsible for Obesity:

1. Genetic factors: Genetic inheritance influences a person’s chance of becoming obese by 50-70%. If both parents are obese, the chance in children is 80%.

2. Age and sex: It can occur at any and in either sex as long as the person is in a positive energy balance.

3. Eating habits: Nibbling between meals is a potential cause for obesity. Excessive consumption of relatively cheap carbohydrate-rich foods such as rice and potato is another predisposing factor (rather than low calorie fruits and vegetables). It is the total intake of calories rather than the frequency of meals that causes obesity.

4. Physical activity: Obesity is more common after the age of 35 when physical activity decreases and food consumption either remains the same or may increase with improved economic status.

5. Endocrine factors: Dysfunction of the thyroid and pituitary may result in obesity.

6. Trauma to hypothalamus: Damage to hypothalamus after head injury may result in obesity as the hypothalamus is not able to regulate appetite or satiety.

7. Psychological factors: Food becomes the focal point for people who are bored, lonely, discontented or depressed, leading to obesity.

(Ref: Sheilla John’s/1/303-304)

Type Of Obesity:

1. Grade I: These people have Body mass index (BMI) less than 29.9. The excess weight does not affect their health. They generally reduce on their own.

2. Grade II: The body mass index is between 30-39.9. Though they maintain good health but on little exertion they are fatigued. For reasons unknown they are more at risk for developing diabetes, atherosclerosis, hypertension, fatty liver, gall bladder diseases, hernias etc.

3. Grade II: The body mass index is above 40. They have very limited physical activity due to enormous weight. They are more susceptible to all the diseases of grade II.

BMI Chart:

(Ref: Molly Sam’s A text book of Nutrition for Nurses/24/134-135)

Complications of Obesity:

Obesity leads to the development of several complications such as:

1. Physical disability.

2. Metabolic disorders.

3. Cardiac disorders.

4. Proneness to accidents

5. Low life expectancy.

6. Obese persons suffer more often from metabolic disorders such as-

• Diabetes mellitus.
• Atherosclerosis.
• Heart diseases.

(Ref: T. K. Indrani/1/344)

Advice to Prevent Obesity:

1. Eat meal which contains plenty of fibers and not too much fat or sugar.

2. Eat snacks which are not energy rich. Eat foods such as fruit or maize cobs and avoid foods such as sweets, chips, crisps and cakes.

3. Do not drink too much alcohol.

4. Take regular exercise.

(Ref: Nutrition for Developing Countries/2/289)

Treatment of Obesity:

1. Reducing weight: Losing weight requires careful planning in diet. Reduced intake and regular loss of fat from body in the form of physical activity play a major role as a person grows old. A slight change in ideal weight is normal.

2. Exercise: Generally obese persons lead sedentary lives. A low calorie diet with moderate exercise such as walking would be the best in which the timespan can be gradually increased. The grade I type of obese patient can also take part in outdoor games like tennis, badminton, swimming, cycling, etc.-Among housewives, household activities like mopping, sweeping the floor, gardening, etc. also forms a pad of good exercise.

3. Drugs: Drugs-usually act as appetite suppressors which have their own side effects and are no substitute to low calorie diets.

4. Liposuction: This is a surgical procedure of removal of excess of fat but is associated with 1 recurrence and a few complications.

5. Gastric placation: By placing surgical staples, across the upper portion of stomach due to which intake capacity of food is reduced.

(Ref: Molly Sam’s A text book of Nutrition for Nurses/24/135-136)

Principles of Dietary Management of Obesity:

A low calorie, moderate protein, restricted fat diets are well preferred and carbohydrates and liberal fluid and high fibre

1. Energy: About 20 kcal body is prescribed for a sedentary person body weight for a moderately active person and about 25 kcal per kg

2. Protein: The normal protein requirement of 1 g/kg body is the best suitable.ne

3. Fat: Fats being concentrated source of energy it has to be restricted. Vegetable oils are permitted [except coconut and palm] to provide the required essential fatty acids.

4. Carbohydrates: High carbohydrate foods like potatoes, refined cereal products are to be avoided. To give satiety feeling and regular bowel movements, green leafy vegetables, fresh fruits and vegetables are preferred.

5. Fluids: Fluids should be taken in liberal amounts as they give a filling sensation. A glass of water consumed before a meal reduces the intake.

(Ref: Molly Sam’s A text book of Nutrition for Nurses/24/136)

Obesity can be assessed by:

• Body weight.
• Estimation of total body fat and
• Skin-fold measurements

A person whose body weight is higher than normal by 20 percent may be considered as obese. An approximate classification of different degrees of obesity based on body weight is given below:

(Ref: T. K. Indrani/1/344)

Prevention of Obesity:

A. Primary prevention:

1. Health education among community.

2. Management of risk factors.

• Exercise
• Diet control

3. Family support.

B. Secondary prevention:

1. Appetite depressing drug e.g. sibutramine.

2. Surgery (gastric banding, partial gastrectomy).

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