The Role of Nurses in Supporting Patients with Obesity

August 5, 2024|Lisa Maher

Obesity is a chronic disease that affects more than 80 million people in the US—more than 4 in 10 adults and nearly 2 in 10 children. The disease puts individuals at greater risk for type 2 diabetes, hypertension, obstructive sleep apnea, cancer, stroke, heart disease, dyslipidemia, and end-stage renal disease.[1],[2] With so much at stake, what is the role of nurses in obesity management?

The Pathophysiology of Obesity

The etiology of obesity is multi-factorial. Once thought to be solely due to lack of willpower, it is now understood to be a complex chronic disease. Along with individual health behaviors (e.g., diet, poor sleep, sedentary lifestyle), influences may include a combination of genetic and epigenetic factors, gut microbiota, and neurohormonal differences. Socioeconomic status, industrialization, and urbanization may also increase risk.[3],[4]

Additionally, research indicates a complex relationship between obesity and food security.[v] Other environmental, socioeconomic, and behavioral/psychological factors also affect levels of obesity.[vi] The risk of adult obesity is greater among adults who had obesity as children and ethnic disparities are apparent in children as young as age 2.[5]

Obesity has inflammatory components that alter circulatory levels of inflammatory cytokines. It increases the risk for cardiovascular disease (CVD) by changing the body’s composition, including hemodynamics and the structure of the heart.

Senior African American woman looking at tablet in hand of female doctor talking about test results in clinic office

Real and Hidden Costs of Obesity

An individual with obesity is at increased risk for heart disease, stroke, type 2 diabetes, and various cancers.[8] Obesity and related complications have significant financial impacts, and as the prevalence of obesity continues to increase, the costs of the disease are also rising.

The healthcare cost of obesity includes direct medical costs of comorbidities as well as the disease itself.[9] Obesity was associated with an estimated $260.6 billion in direct medical costs in the United States in 2016.[10] Inpatient costs are 46% higher, and spending on prescription medications is 80% higher among people with obesity than among those without overweight or obesity.[11] 

In addition to direct medical costs, other financial impacts involve those that are work-related (e.g., lost wages, short- and long-term disability and insurance claims, and lost productivity).

Biases Around Obesity

The World Obesity Federation defines weight stigma as ‘discriminatory acts and ideologies targeted towards individuals because of their weight and size.’ [12] Individuals with overweight/obesity face biases in personal relationships, public locations (stores and restaurants), public transportation, workplaces, and healthcare settings.[13]

There are no federal laws to prohibit weight-based discrimination. Weight-related discrimination can lead to social, psychological, and/or physical effects. Research suggests that anti-obesity bias and fat shaming can drive weight gain.[14] As an example, exposure to weight bias may trigger stress, which then inhibits self-control and may lead to unhealthy habits such as binge eating. The more people are exposed to weight bias and discrimination, the more likely they are to gain weight and become obese, even if they were thin to begin with—and they are more likely to die from any cause, regardless of their body mass index (BMI).

Consider some clinical implications for a patient with obesity:

  • The patient may be considered “non-compliant” by healthcare professionals, which may lead to less time spent with them during a clinical visit
  • Bias on the part of healthcare professionals may lead to less kindness, support, and compassion during a visit and lead to a lesser level of care for the individual
  • Perceived bias or discrimination by the health care professional may make a patient with overweight/obesity less likely to seek care, either for disease prevention or for health problems

Equity of Treatments: Who Has Access?

The adage ‘eat less and move more’ was long the prescription for addressing obesity. Research now supports that the difficulty that individuals have in weight reduction is linked to the body’s resistance to weight loss attempts, requiring strategies similar to those for other chronic, long-term conditions.4

There are now a number of treatment options that can help patients attain and maintain a healthy weight and, thus, reduce their risk for comorbidities and death. Yet, the application of these treatments is not equal in practice. Whether pharmacotherapy, bariatric surgery, or medical nutrition therapy, patients may have difficulty accessing these treatments due to a lack of understanding, or even stigma, among legislators, insurers, or healthcare professionals.

Within the clinical setting, treatment approaches that account for racial, ethnic, and other disparities not only work to offset long-standing barriers to care but can also significantly impact individuals.

The Role of Nurses in Obesity Management

No matter the setting, nurses are well-placed to significantly impact the diagnosis and treatment of individuals with obesity/overweight. Compassionate, supportive care incorporating guideline-directed behavior change strategies and appropriate pharmacotherapy and surgical options allows patients to reduce their risk of cardiovascular disease and other disorders, decrease the financial burden on the individual and health systems, and improve overall health.

Clinical Takeaways: The Role of Nurses in Obesity Management

  • Nurses play a crucial role in ensuring access to quality care for patients, including those with obesity/overweight.
  • Nurses can assist patients in addressing not only obesity but also associated comorbidities in a systematic and supportive manner.
  • By understanding the pathophysiology of obesity, nurses and other healthcare professionals can collaborate to improve patient outcomes.
  • Nurses can recognize and address the impacts of health inequities on access to high-quality care and treatment for obesity to ensure that all patients have equitable opportunities to achieve optimal health.
  • Nurses have the opportunity to address personal, institutional, and societal biases of overweight/obese to aid in breaking the cycle of stress-induced unhealthy behaviors.

References

[1] McWhorter, K. (2020). Obesity Acceptance: Body Positivity and Clinical Risk Factors in Cardiac Diseases. Gaze, D.C. and Kibel, A. Eds. IntechOpen: London.

[2] Obesity Action Coalition. Get Educated: Measuring Weight. Accessed 12 April 2021.

[3] McWhorter, K. (2020). Obesity Acceptance: Body Positivity and Clinical Risk Factors in Cardiac Diseases. Gaze, D.C. and Kibel, A. Eds. IntechOpen: London.

[4] Centers for Disease Control and Prevention. Underlying Cause of Death, 1999–2018. CDC WONDER Online Database. Atlanta, GA: Centers for Disease Control and Prevention; 2018. Accessed March 12, 2020.

[5] Pan L, Sherry B, Njai R, Blanck HM. Food insecurity is associated with obesity among US adults in 12 states. J Acad Nutr Diet. 2012 Sep;112(9):1403-1409. doi: 10.1016/j.jand.2012.06.011. PMID: 22939441; PMCID: PMC4584410.

[6] Jukaku SA, Williams SRP. The cause of obesity is multifactorial but GPs can do more. BMJ. 2021 Apr 13;373:n956.

[7] Pan L, Freedman DS, Sharma AJ, Castellanos-Brown K, Park S, Smith RB, et al. Trends in obesity among participants aged 2–4 years in the Special Supplemental Nutrition Program for Women, Infants, and Children — United States, 2000–2014. MMWR Morb Mortal Wkly Rep 2016;65(45):1256–60. 

[8] National Institute of Diabetes and Digestive and Kidney Diseases. Health Risks of Overweight and Obesity. Reviewed 2023. Accessed July 29, 2024.

[9] STOP Obesity Alliance. Fast Facts: Costs of Obesity (PDF). Accessed July 30, 2024.

[10] Cawley J, Biener A, Meyerhoefer C, et al. Direct medical costs of obesity in the United States and the most populous states. J Manag Care Spec Pharm 2021;27:354-366.

[11] Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society. Circulation 2014;129:Suppl 2:S102-S138.

[12] World Obesity Federation. Weight Stigma. 2024. Accessed July 29, 2024.

[13] Vafiadis, D. How Do Weight Bias and Stigma Affect Patients With Obesity? National Council on Aging. 2024. Accessed July 29, 2024.

[14] Vogel L. Fat shaming is making people sicker and heavier. Canadian Medical Association Journal. 2019;191(23):E649. Doi: 10.1503/cmaj.109-5758.

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