Denielle Saitta

NCP
Obesity
I.
Introduction: Patient Profile
Patient 1 is a 43 year-old African American female. She was initially diagnosed
with mental illness in 2003. Pt is diagnosed with schizoaffective schizophrenia,
HTN, and asthma. Pt current nutrition-related problems are obesity, GERD, and
microcytic anemia.
II.

Disease Process
Obesity is an excess of adipose tissue or body fat. It is defined as a
proportion of body weight composed of adipose tissue (percent of body fat) that
exceeds a range that is considered healthy. The range to be considered obese for
adult men is 25% body fat. The range to be considered obese for women is
33% body fat. Body Mass Index or BMI is a more practical way to measure
obesity. The classifications for BMI are as followed:

Underweight: <18.5 kg/m2

Normal: 18.5-24.9 kg/m2

Overweight: 25-29.9 kg/m2

Obesity (Class I): 30-34.9 kg/m2

Obesity (Class II): 35-39.9 kg/m2

Extreme Obesity (Class III): 40 kg/m2

Obesity can lead to other medical and nutritional complications. The
complications include but are not limited to: type 2 diabetes, hypertension, lipid
abnormalities, hepatobiliary disorders, cancers, reproductive disorders, breathing
complications, arthritis, and premature death. Treatment for obesity involves both
assessment and management. Its important to treat Pts diagnosed with obesity as
a disease and assist these Pts with the appropriate treatment plan. Recommended
first line therapies include: diet, physical activity, and behavioral therapy. Other
therapies could be pharmacological or bariatric surgery.
Nutrition therapy for obesity is essential for treatment of obesity.
Anthropometric measures, client history and biochemical data, and
food-/nutrition- related history. Measure BMI and waist circumference. Waist
circumference is irrelevant for Pts with a BMI 35 because it doesnt materially
contribute to disease risk classification. Ask Pt about history of weight gain or
loss overtime to provide information about previous weight loss attempts. Pt
should be evaluated for diseases that put them at high risk of morbidity and
mortality: coronary heart disease, atherosclerotic diseases, type 2 diabetes,
impaired glucose tolerance, and sleep apnea. Blood pressure, fasting blood
glucose, and fasting lipid panel should be evaluated. Obese pts should be
evaluated for the presence of metabolic syndrome. Assess food and nutrient intake
and behaviors along with physical activity knowledge and beliefs about food and
nutrition, readiness for change, and factors affecting access to food. When
assessing diet, pts often times underreport energy intake. Obese pts underreport by
an average of 40% less of their actual intake. Using a 3-day intake record with at
least one weekend day, a food frequency questionnaire, and food diaries have

proven to be useful in assessing energy intake. When assessing physical activity,

pts can use a pedometer to record the intensity and duration of physical activity.
When assessing readiness for change, use the stages of change theory to help
determine potential barriers and external factors like social support and access to
food supplies.
Nutrition intervention for obese pts can be focused on dietary practices
and physical activity in order to achieve weight loss. Realistic and meaningful
weight loss goals need to be established. Current guidelines recommend initial
weight loss goal of 5%-10% baseline weight within 6 months. Desired rate of loss
for weight management is 1-2 lbs per week. Dietary interventions require a
reduction in energy consumption. Reducing 500-750 calories a day will result in
about 1-2 lbs per week. If an obese pt has a BMI that is considered to be Class II
or Class III, you would use the adjusted body weight. The calories for the adjusted
body weight will be 30 kcal/kg body weight. Restricting fat intake to <30% total
caloric intake.
III.

Patient History
Schizoaffective schizophrenia, hypertension, gastrointestinal reflux disease, asthma,
obesity, and microcytic anemia.

IV.

Course of Hospital Treatment

Pt has been admitted, discharged, and readmitted 17 times at GRHS (Georgia
Regional Hospital in Savannah). Weight of Pt is monitored weekly. Pt was 296# when
she was first admitted. She lost 20# in 5 months which is 6%vweight loss.

V.

Nutrition Care
a. Assessment
Weight: 279 lbs =126.81kg
Height: 54 = 64
BMI
o ((279)/((64)(64)) x 703 = 47.89 kg/m2
o Extreme obesity class III
IBW
o 100+(5x4)= 120 #
%IBW
o 279#/120#= 232.5%
AdBW
o 0.25(279-120)+120= 159.75 #= 72.61 kg
Lab Values
Lab Value
Normal Levels
Results
Na+
137-145 mmol/L
137
Potassium
3.5-4.5 mmol/L
4.5
Glucose
74-106 mg/dl
92
BUN
7.0-18.0 mg/dl
13.0
Creatinine
0.50-1.25 mg/dl
0.85

Ca
Hb
Hct
HbA1c
Cholesterol
Triglyceride
HDL
LDL
Chol/HDL Ratio
Current Drugs
Drugs
Advair Diskus 250/50
Carafate
Congentin
Miralax
Prilosec
Prolixin
Proventil

8.5-10.5 mg/dl
12.0-16.0 gm/dl
36.0-46.0 %
112-199 mg/dl
36-150 mg/dl
60-96 mg/dl
60-100 mg/dl
0.00-4.43

Reason
Asthma
Heartburn/indigestion/reflux
Sleep
Constipation
GERD
Psychosis
Asthma

9.4
9.9
34.8
8.2
111
96
28
64
3.96

Interaction with Food

Take with food

Causes constipation

Nutrition Needs
o Kcals: 76 kg x 30 kcal= 2280 kcals
o Protein: 76 kg x 1g PRO= 76 g PRO
o Fluids: 76 kg x 30 cc= 2280 cc
Other: Pt has been documented that she eats all of her meals.
b. Diagnosis (PES) Statement
o Excessive energy intake related to obesity as evidenced by BMI 45.3, per
HST records.
o Obesity related to physical inactivity as evidenced by medical records,
visual assessment, BMI 45.3.
o At risk for complications from GERD and HTN related to obesity as
evidenced by medical record, BMI 51.6.
o Food- and nutrition-related knowledge deficit related to mental status as
evidenced by dx of schizoaffective disorder.
o Self-monitoring deficit related to mental status as evidenced by dx of
schizoaffective disorder.
c. Intervention Plan & Implementation
Pt 1 will lose 1-2 # per week with while consuming a 2000 calorie restricted diet
with increased physical activity.
d. Monitoring/Evaluation
Will continue to monitor weights, reported intake, lab values, and physical
activity.

e. Documentation
Completed.