Study of Obesity Rates Increasing in America Peer Reviewed Jounral

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• Wiley-Blackwell Online Open
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J Am Assoc Nurse Pract. 2017 Oct; 29(Suppl 1): S3–S14.

Obesity: Risk factors, complications, and strategies for sustainable long‐term weight management

Sharon M. Fruh

¹ Higher of Nursing, University of South Alabama, Mobile, Alabama,

Received 2017 Apr 26; Revised 2017 Jul 20; Accepted 2017 Jul 25.

Abstract

Background and Purpose

The aims of this article are to review the effects of obesity on health and well‐being and the show indicating they tin can be ameliorated past weight loss, and consider weight‐management strategies that may assist patients achieve and maintain weight loss.

Methods

Narrative review based on literature searches of PubMed up to May 2016 with no appointment limits imposed. Search included terms such as "obesity," "overweight," "weight loss," "comorbidity," "diabetes," cardiovascular," "cancer," "depression," "management," and "intervention."

Conclusions

Over one third of U.S. adults have obesity. Obesity is associated with a range of comorbidities, including diabetes, cardiovascular disease, obstructive sleep apnea, and cancer; however, small weight loss in the 5%–10% range, and in a higher place, tin can significantly improve wellness‐related outcomes. Many individuals struggle to maintain weight loss, although strategies such equally realistic goal‐setting and increased consultation frequency can profoundly improve the success of weight‐management programs. Nurse practitioners take key roles in establishing weight‐loss targets, providing motivation and support, and implementing weight‐loss programs.

Implications for Practice

With their in‐depth understanding of the inquiry in the field of obesity and weight management, nurse practitioners are well placed to effect meaningful changes in weight‐direction strategies deployed in clinical practice.

Keywords: Obesity, nurse practitioner communication, weight management, health, furnishings

Introduction

Obesity is an increasing, global public health outcome. Patients with obesity are at major risk for developing a range of comorbid atmospheric condition, including cardiovascular disease (CVD), gastrointestinal disorders, type 2 diabetes (T2D), joint and muscular disorders, respiratory problems, and psychological issues, which may significantly affect their daily lives too as increasing mortality risks. Obesity‐associated conditions are manifold; however, fifty-fifty small-scale weight reduction may enable patients to reduce their risk for CVD, diabetes, obstructive slumber apnea (OSA), and hypertension amongst many other comorbidities (Cefalu et al., 2015). A relatively small and simple reduction in weight, for example, of around v%, tin can improve patient outcomes and may act as a catalyst for further change, with sustainable weight loss achieved through a series of incremental weight loss steps. In facilitating the process of losing weight for patients, nurse practitioners play an essential role. Through assessing the patient'southward risk, establishing realistic weight‐loss targets, providing motivation and support, and supplying patients with the necessary knowledge and handling tools to help achieve weight loss, followed by tools for structured lifestyle back up to maintain weight lost, the nurse practitioner is ideally positioned to assistance patient's achieve their weight‐loss—and overall health—targets.

The obesity epidemic

The World Health Arrangement (WHO) defines overweight and obesity as abnormal or excessive fat accumulation that presents a risk to health (WHO, 2016a). A body mass index (BMI) ≥25 kg/m² is generally considered overweight, while obesity is considered to be a BMI ≥ thirty kg/m^two. It is well known that obesity and overweight are a growing problem globally with high rates in both developed and developing countries (Capodaglio & Liuzzi, 2013; WHO, 2016a, 2016b).

In the United States in 2015, all states had an obesity prevalence more than than 20%, 25 states and Guam had obesity rates >xxx% and four of those 25 states (Alabama, Louisiana, Mississippi, and West Virginia) had rates >35% (Centres for Disease Control and Prevention, 2016; Figure ​ 1). Approximately 35% and 37% of adult men and women, respectively, in the U.s.a. take obesity (Yang & Colditz, 2015). Adult obesity is almost common in not‐Hispanic black Americans, followed by Mexican Americans, and non‐Hispanic white Americans (Yang & Colditz, 2015). Individuals are also getting heavier at a younger historic period; birth cohorts from 1966 to 1975 and 1976 to 1985 reached an obesity prevalence of ≥20% by xx–29 years of age, while the 1956–1965 cohort only reached this prevalence past age thirty–39 years (Lee et al., 2010). Additionally, the prevalence of babyhood obesity in ii‐ to 17‐year‐olds in the The states has increased from 14.6% in 1999–2000 to 17.4% in 2013–2014 (Skinner & Skelton, 2014). Childhood obesity is an increasing wellness upshot because of the early on onset of comorbidities that take major adverse health impacts, and the increased likelihood of children with obesity going on to get adults with obesity (50% run a risk vs. 10% for children without obesity; Whitaker, Wright, Pepe, Seidel, & Dietz, 1997).

Association of obesity with mortality and comorbid affliction

Bloodshed

Obesity is associated with a significant increase in bloodshed, with a life expectancy decrease of five–10 years (Berrington de Gonzalez et al., 2010; Kuk et al., 2011; Prospective Studies Collaboration et al., 2009). At that place is evidence to bespeak that all‐cause, CVD‐associated, and cancer‐associated mortalities are significantly increased in individuals with obesity, specifically those at Stages 2 or 3 of the Edmonton Obesity Staging System (EOSS; Kuk et al., 2011; Figure ​ two). Mortality related to cancer is, however, also increased at Stage i, when the physical symptoms of obesity are marginal (Figure ​ 2). Recently, a large‐scale meta‐analysis that included studies that had enrolled over 10 meg individuals, indicated that, relative to the reference category of 22.5 to <25 kg/m², the risk ratio (HR) for all‐cause mortality rose sharply with increasing BMI (The Global BMI Mortality Collaboration, 2016). For a BMI of 25.0 to <thirty.0 kg/m², the Hr was 1.xi (95% confidence interval [CI] 1.10, one.11), and this increased to i.44 (1.41, one.47), 1.92 (one.86, 1.98), and 2.71 (2.55, 2.86) for a BMI of 30.0 to <35.0, 35.0 to <twoscore.0, and 40.0 to <60.0 kg/m^two, respectively.

Association between EOSS stage and take chances of all‐cause (A), CVD (B), cancer (C), and not‐CVD or noncancer bloodshed (D) in men and women. © 2011.

Source. Reproduced with permission from NRC Research Printing, from Kuk et al. (2011). CVD, cardiovascular disease; NW, normal weight.

Comorbidities

Obesity is a chronic affliction that is associated with a wide range of complications affecting many different aspects of physiology (Dobbins, Decorby, & Choi, 2013; Guh et al., 2009; Martin‐Rodriguez, Guillen‐Grima, Marti, & Brugos‐Larumbe, 2015; summarized in Table ​ 1). To examine these obesity‐related morbidities in detail is beyond the telescopic of this review and therefore only a cursory overview of some of the primal pathophysiological processes is included next.

Table ane

Morbidities associated with obesity (Hamdy, 2016; Petry, Barry, Pietrzak, & Wagner, 2008; Pi‐Sunyer, 2009; Sakai et al., 2005; Smith, Hulsey, & Goodnight, 2008; Yosipovitch, DeVore, & Dawn, 2007)

Class of event	Comorbidities associated with obesity
Cancer/malignancy	Postmenopausal chest, endometrial, colon and rectal, gallbladder, prostate, ovarian, endometrial renal cell, esophageal adenocarcinoma, pancreatic, and kidney cancer
Cardiovascular	Coronary avenue affliction, obesity‐associated cardiomyopathy, essential hypertension, left ventricular hypertrophy, cor pulmonale, accelerated atherosclerosis, pulmonary hypertension of obesity, dyslipidemia, chronic heart failure (CHD), left ventricular hypertrophy (LVH), cardiomyopathy, pulmonary hypertension, lymphedema (legs)
Gastrointestinal (GI)	Gall bladder disease (cholecystitis, cholelithiasis), gastroesophageal reflux illness (GERD), reflux esophagitis, nonalcoholic steatohepatitis (NASH), nonalcoholic fat liver disease (NAFLD), fat liver infiltration, acute pancreatitis
Genitourinary	Stress incontinence
Metabolic/endocrine	Type 2 diabetes mellitus, prediabetes, metabolic syndrome, insulin resistance, and dyslipidemia
Musculoskeletal/orthopedic	Pain in back, hips, ankles, anxiety and knees; osteoarthritis (specially in the knees and hips), plantar fasciitis, dorsum hurting, coxavera, slipped uppercase femoral epiphyses, Blount disease and Legg‐Calvé‐Perthes affliction, and chronic lumbago
Neurological and central nervous system (CNS)	Stroke, dementia idiopathic intracranial hypertension, and meralgia paresthesia
Obstetric and perinatal	Pregnancy‐related hypertension, fetal macrosomia, very depression birthweight, neural tube defects, preterm birth, increased cesarean delivery, increased postpartum infection and pelvic dystocia, preeclampsia, hyperglycemia, gestational diabetes (GDM)
Peel	Keratosis pilaris, hirsutism, acanthosis nigricans, and acrochondons, psoriasis, intertrigo (bacterial and/or fungal), and increased gamble for cellulitis, venous stasis ulcers, necrotizing fasciitis, and carbuncles
Psychological	Depression, anxiety, personality disorder, and obesity stigmatization
Respiratory/pulmonary	Obstructive slumber apnea (OSA), Pickwickian syndrome (obesity hypoventilation syndrome), higher rates of respiratory infections, asthma, hypoventilation, pulmonary emboli risk
Surgical	Increased surgical risk and postoperative complications, deep venous thrombosis, including wound infection, pulmonary embolism, and postoperative pneumonia
Reproductive (Women)	Anovulation, early on puberty, polycystic ovaries, infertility, hyperandrogenism, and sexual dysfunction
Reproductive (Men)	Hypogonadotropic hypogonadism, polycystic ovary syndrome (PCOS), decreased libido, and sexual dysfunction
Extremities	Venous varicosities, lower extremity venous and/or lymphatic edema

The progression from lean state to obesity brings with it a phenotypic change in adipose tissue and the development of chronic low‐form inflammation (Wensveen, Valentic, Sestan, Turk Wensveen, & Polic, 2015). This is characterized past increased levels of circulating free‐fatty acids, soluble pro‐inflammatory factors (such every bit interleukin [IL] 1β, IL‐6, tumor necrosis factor [TNF] α, and monocyte chemoattractant protein [MCP] 1) and the activation and infiltration of immune cells into sites of inflammation (Hursting & Dunlap, 2012). Obesity is also usually allied to a specific dyslipidemia profile (atherogenic dyslipidemia) that includes small, dense low‐density lipoprotein (LDL) particles, decreased levels of high‐density lipoprotein (HDL) particles, and raised triglyceride levels (Musunuru, 2010). This chronic, low‐grade inflammation and dyslipidemia profile leads to vascular dysfunction, including atherosclerosis germination, and dumb fibrinolysis. These, in plough, increase the risk for CVD, including stroke and venous thromboembolism (Blokhin & Lentz, 2013).

The metabolic and cardiovascular aspects of obesity are closely linked. The chronic inflammatory land associated with obesity is established as a major contributing factor for insulin resistance, which itself is i of the key pathophysiologies of T2D (Johnson, Milner, & Makowski, 2012). Furthermore, key obesity divers by waist circumference is the essential component of the International Diabetes Federation (IDF) definition of the metabolic syndrome (raised triglycerides, reduced HDL cholesterol, raised blood pressure, and raised fasting plasma glucose; International Diabetes Federation, 2006).

Obesity is also closely associated with OSA. To start, a number of the conditions associated with obesity such every bit insulin resistance (Ip et al., 2002), systemic inflammation, and dyslipidemia are themselves closely associated with OSA, and meantime, the obesity‐associated deposition of fat around the upper airway and thorax may affect lumen size and reduce chest compliance that contributes to OSA (Romero‐Corral, Caples, Lopez‐Jimenez, & Somers, 2010).

The development of certain cancers, including colorectal, pancreatic, kidney, endometrial, postmenopausal breast, and adenocarcinoma of the esophagus to name a few, accept as well been shown to be related to backlog levels of fatty and the metabolically active nature of this backlog adipose tissue (Berth, Magnuson, Fouts, & Foster, 2015; Eheman et al., 2012). Cancers have shown to exist impacted by the circuitous interactions between obesity‐related insulin resistance, hyperinsulinemia, sustained hyperglycemia, oxidative stress, inflammation, and the production of adipokines (Booth et al., 2015). The wide range of morbidities associated with obesity represents a significant clinical issue for individuals with obesity. However, as meaning as this array of risk factors is for patient health, the risk factors tin can be positively modified with weight loss.

Obesity‐related morbidities in children and adolescents

As was referred to earlier, children and adolescents are condign increasingly affected by obesity. This is particularly concerning because of the long‐term adverse consequences of early obesity. Obesity adversely affects the metabolic health of young people and can consequence in dumb glucose tolerance, T2D, and early on‐onset metabolic syndrome (Pulgaron, 2013).There is likewise strong support in the literature for relationships between childhood obesity and asthma, poor dental health (caries), nonalcoholic fatty liver disease (NAFLD), and gastroesophageal reflux illness (GERD; Pulgaron, 2013). Obesity tin can besides affect growth and sexual development and may filibuster puberty in boys and accelerate puberty in some girls (Burt Solorzano & McCartney, 2010). Childhood obesity is also associated with hyperandrogenism and polycystic ovary syndrome (PCOS) in girls (Burt Solorzano & McCartney, 2010). Additionally, obesity is associated with psychological problems in young people including attending deficit hyperactivity disorder (ADHD), anxiety, depression, poor self‐esteem, and bug with sleeping (Pulgaron, 2013).

Modest weight loss and its long‐term maintenance: Benefits and risks

Guidelines endorse weight‐loss targets of 5%–10% in individuals with obesity or overweight with associated comorbidities, equally this has been shown to significantly ameliorate health‐related outcomes for many obesity‐related comorbidities (Cefalu et al., 2015; Figure ​ 3), including T2D prevention, and improvements in dyslipidemia, hyperglycemia, osteoarthritis, stress incontinence, GERD, hypertension, and PCOS. Further benefits may be evident with greater weight loss, particularly for dyslipidemia, hyperglycemia, and hypertension. For NAFLD and OSA, at least 10% weight loss is required to observe clinical improvements (Cefalu et al., 2015).

Benefits of modest weight loss. Lines demonstrate the ranges in which weight loss has been investigated and shown to take clinical benefits. Arrows indicate that additional benefits may exist seen with farther weight loss.

Source. Figure adapted from Cefalu et al. (2015).

Importantly, the weight‐loss benefits in terms of comorbidities are also reflected in improved all‐cause mortality. A recent meta‐analysis of 15 studies demonstrated that relatively small amounts of weight loss, on boilerplate v.5 kg in the handling arm versus 0.2 kg with placebo from an average baseline BMI of 35 kg/m², resulted in a substantial 15% reduction in all‐crusade mortality (Kritchevsky et al., 2015).

Cardiovascular health

Weight loss is associated with beneficial changes in several cardiovascular adventure markers, including dyslipidemia, pro‐inflammatory/pro‐thrombotic mediators, arterial stiffness, and hypertension (Dattilo & Kris‐Etherton, 1992; Dengo et al., 2010; Goldberg et al., 2014; Haffner et al., 2005; Ratner et al., 2005). Importantly, weight loss was establish to reduce the risk for CVD bloodshed by 41% upwards to 23 years after the original weight‐loss intervention (Li et al., 2014; Figure ​ four). Evidence including the biological furnishings of obesity and weight loss, and the increased hazard for stroke with obesity indicates that weight loss may be effective for primary‐ and secondary‐stroke prevention (Kernan, Inzucchi, Sawan, Macko, & Furie, 2013).

Reduction in cardiovascular mortality with modest weight reduction. Cumulative incidence of CVD bloodshed during 23 years of follow‐upwardly in the Da Qing study (Li et al., 2014). Figure © 2014 Elsevier.

Source. Reproduced with permission from Li et al. (2014).

Type 2 diabetes

Three major long‐term studies, the Diabetes Prevention Program (DPP), the Diabetes Prevention Study (DPS), and the Da Qing IGT and Diabetes (Da Qing) report, take demonstrated that pocket-sized weight loss through curt‐term lifestyle or pharmacologic interventions can reduce the risk for developing T2D by 58%, 58%, and 31%, respectively, in individuals with obesity and prediabetes (DPP Research Grouping et al., 2009; Pan et al., 1997; Tuomilehto et al., 2001). Long‐term benefits were maintained post-obit the interventions; for example, in the DPP, the chance reduction of developing T2D versus placebo was 34% at 10 years and 27% at xv years post-obit the initial weight‐loss intervention (DPP Research Group, 2015; DPP Research Group et al., 2009). Weight loss increased the likelihood of individuals reverting from prediabetes to normoglycemia (DPP Research Group et al., 2009; Li et al., 2008; Lindstrom et al., 2003, 2006; Tuomilehto et al., 2001), and besides improved other aspects of glycemic command including fasting and postprandial glucose, and insulin sensitivity (Haufe et al., 2013; Li et al., 2008).

Sleep apnea

Data bespeak that weight loss is benign, although not curative, in patients with obesity who experience OSA. Meta‐analyses of patients who underwent treatment with either intensive lifestyle intervention (Araghi et al., 2013) or bariatric surgery (Greenburg, Lettieri, & Eliasson, 2009) demonstrated improvements in apnea‐hypopnea index (AHI) following treatment. In the starting time of these meta‐analyses, in randomized controlled trials, lifestyle intervention lead to a mean reduction in BMI of 2.3 kg/m², which was associated with a decrease in mean AHI of 6.0 events/h. Every bit expected, weight loss was much higher in the second meta‐analysis that investigated the effect of bariatric surgery on measures of OSA, and this was associated with greater reductions in AHI; the mean BMI reduction of 17.9 kg/mⁱⁱ resulted in AHI events existence reduced past a hateful of 38.2 events/h. Once these improvements in AHI have occurred, they seem to persist for some time, irrespective of a certain caste of weight regain. In i report, an initial mean weight loss of ten.7 kg resulted in a persistent comeback in AHI over a iv‐year catamenia despite weight regain of approximately 50% by Year 4 (Kuna et al., 2013).

Cancer

Intentional weight loss of >9 kg reduced the take chances for a range of cancers including chest, endometrium, and colon in the large‐scale Iowa Women's Health Study (Parker & Folsom, 2003). The overall reduction in the incidence rate of any cancer was 11% (relative take a chance, 0.89; 95% CI 0.79, 1.00) for participants who lost more than ix kg compared with those who did not achieve a more than ix kg weight loss episode. Additionally, weight loss in participants with obesity has been established to exist associated with reductions in cancer biomarkers including soluble E‐selectin and IL‐6 (Linkov et al., 2012).

Additional health benefits

The substantial weight loss associated with bariatric surgery has been shown to improve asthma with a 48%–100% improvement in symptoms and reduction in medication use (Juel, Ali, Nilas, & Ulrik, 2012); nonetheless, in that location is a potential threshold issue then that minor weight loss of 5%–10% may pb to clinical improvement (Lv, Xiao, & Ma, 2015). Similarly, modest weight loss of 5%–10% improves GERD (Singh et al., 2013) and liver office (Haufe et al., 2013). A written report utilizing MRI scanning to examine the effects of weight loss on NAFLD has reported a reduction in liver fat from 18.3% to thirteen.6% (p = .03), a relative reduction of 25% (Patel et al., 2015). Taking an active part in addressing obesity through behavioral modifications or exercise can also reduce the symptoms of depression (Fabricatore et al., 2011), better urinary incontinence in men and women (Breyer et al., 2014; Brown et al., 2006), and improve fertility outcomes in women (Kort, Winget, Kim, & Lathi, 2014). Additionally, weight loss tin can reduce the joint‐pain symptoms and disability caused past weight‐related osteoarthritis (Felson, Zhang, Anthony, Naimark, & Anderson, 1992; Foy et al., 2011).

Mitigating risks

Despite the array of benefits, weight loss tin can besides be linked with certain risks that may demand to be managed. One such instance is the gamble for gallstones with rapid weight loss, which is associated with gallstone formation in 30%–71% of individuals. Gallstone formation is particularly associated with bariatric surgery when weight loss exceeds one.5 kg/week and occurs particularly inside the first vi weeks following surgery when weight loss is greatest. Slower rates of weight loss announced to mitigate the hazard for gallstone formation compared to the general population only may non eliminate information technology entirely; as was noted in the twelvemonth‐long, weight‐loss, Calibration trial that compared liraglutide 3.0 mg daily use to placebo and resulted in gallstone formation in 2.five% of treated subjects compared to 1% of subjects taking placebo. For this reason, the risk for cholethiasis should be considered when formulating weight‐loss programs (Weinsier & Ullmann, 1993).

Strategies to help individuals attain and maintain weight loss

Rogge and Gautam have covered the biology of obesity and weight regain inside some other section of this supplement (Rogge & Gautam, 2017), so hither we focus on some of the clinical strategies for delivering weight loss and weight loss maintenance lifestyle programs. Structured lifestyle back up plays an of import role in successful weight management. A total of 34% of participants receiving structured lifestyle support from trained‐nursing staff achieved weight loss of ≥5% over 12 weeks compared with approximately 19% with usual care (Nanchahal et al., 2009). This particular structured program, delivered in a principal healthcare setting, included initial assessment and goal setting, an eating plan and specific lifestyle goals, personalized action program, and advice well-nigh managing obstacles to weight loss. Additionally, data from the National Weight Control Registry (NWCR), which is the longest prospective compilation of data from individuals who have successfully lost weight and maintained their weight loss, confirm expectations that sustained changes to both diet and activity levels are central to successful weight management (Tabular array ​ ii). Therefore, an understanding of different clinical strategies for delivery‐structured support is essential for the nurse practitioner.

Table 2

Lifestyle factors associated with achieving and maintaining weight loss

Activity	Pct
Modified food intake	98
Increased physical activitya	94
Exercised on average for 1 h each twenty-four hours	ninety
Ate breakfast every mean solar day	78
Weighed themselves weekly	75
Watched less than 10 h of boob tube weekly	62
Lost weight with the aid of a weight‐loss program	55

Realistic weight‐loss targets

From the start, a patient's approximate of their doable weight loss may exist unrealistic. Setting realistic weight‐loss goals is often difficult because of misinformation from a variety of sources, including friends, media, and other healthcare professionals (Osunlana et al., 2015). Many individuals with obesity or overweight have unrealistic goals of 20%–30% weight loss, whereas a more realistic goal would be the loss of 5%–15% of the initial body weight (Fabricatore et al., 2007). Promoting realistic weight‐loss expectations for patients was identified as a key difficulty for nurse practitioners, chief care nurses, dieticians, and mental health workers (Osunlana et al., 2015). Visual resources showing the wellness and wellness benefit of modest weight loss may thus be helpful (Osunlana et al., 2015). Healthcare practitioners should focus on open give-and-take most, and re‐enforcement of, realistic weight‐loss goals and assess outcomes consistently according to those goals (Bray, Look, & Ryan, 2013).

Maintaining a food diary

The 2013 White Paper from the American Nurse Practitioners Foundation on the Prevention and Treatment of Obesity considers a food diary as an important prove‐based nutritional intervention in aiding weight loss (ANPF). Consequent and regular recording in a food diary was significantly associated with long‐term weight‐loss success in a group of 220 women (Peterson et al., 2014). This group lost a hateful of 10.4% of their initial body weight through a vi‐calendar month group‐based weight‐management program and and so regained a mean of two.3% over a 12‐calendar month follow‐upwards menstruation, during which participants received bimonthly back up in person, by phone, or past eastward‐post (Peterson et al., 2014). Over the 12‐calendar month follow‐up, women who self‐monitored consistently (≥50% of the extended‐intendance year) had a hateful weight loss of 0.98%, while those who were less consistent (<50%) gained weight (5.1%; p < .01). Therefore, frequent and consistent nutrient monitoring should be encouraged, peculiarly in the weight‐maintenance stage of any program.

Motivating and supporting patients

Motivational interviewing is a technique that focuses on enhancing intrinsic motivation and behavioral changes past addressing ambivalence (Barnes & Ivezaj, 2015). Interviews focus on "change talk," including the reasons for modify and optimism almost the intent for alter in a supportive and nonconfrontational setting, and may help individuals maintain behavioral changes.

For patients that have achieved weight loss, the behavioral factors associated with maintaining weight loss include potent social support networks, limiting/fugitive disinhibited eating, avoiding rampage eating, avoiding eating in response to stress or emotional issues, being answerable for ane's decisions, having a strong sense of autonomy, internal motivation, and self‐efficacy (Grief & Miranda, 2010). Therefore, encouraging feelings of "self‐worth" or "self‐efficacy" tin help individuals to view weight loss as being inside their own control and achievable (Cochrane, 2008).

Strengthening relationships with patients with overweight or obesity to enhance trust may also better adherence with weight‐loss programs. Patients with hypertension who reported having "consummate trust" in their healthcare practitioner were more than twice as likely to engage in lifestyle changes to lose weight than those who lacked "consummate trust" (Jones, Carson, Bleich, & Cooper, 2012). It may be prudent to ensure the healthcare staff implementing weight‐loss programs have sufficient fourth dimension to foster trust with their patients.

Continued support from healthcare staff may help patients sustain the necessary motivation for lifestyle changes. A retrospective analysis of fourteen,256 patients in chief intendance identified consultation frequency as a cistron that can predict the success of weight‐management programs (Lenoir, Maillot, Guilbot, & Ritz, 2015). Individuals who successfully maintained ≥10% weight loss over 12 months visited the healthcare provider on average 0.65 times monthly compared with an average of 0.48 visits/month in those who did not maintain ≥x% weight loss, and 0.39 visits/month in those who failed to achieve the initial ≥10% weight loss (p < .001; Lenoir et al., 2015).

Educational and environmental factors

Information technology is important to consider a patient's education and environment when formulating a weight loss strategy as environmental factors may demand to be challenged to help facilitate weight loss. A family history of obesity and childhood obesity are strongly linked to developed obesity, which is likely to exist because of both genetic and behavioral factors (Kral & Rauh, 2010). Parents create their child'due south early food experiences and influence their kid's attitudes to eating through learned eating habits and food choices (Kral & Rauh, 2010). Families can also impart cultural preferences for less healthy food choices and family nutrient choices may be affected by community factors, such as the local availability and price of healthy nutrient options (Castro, Shaibi, & Boehm‐Smith, 2009). Alongside this, genetic variation in taste sensation may influence the dietary palate and influence food choices (Loper, La Sala, Dotson, & Steinle, 2015). For example, sensitivity to 6‐n‐propylthiouracil (PROP) is genetically determined, and PROP‐tasting ability ranges from super taster to nontaster. When offered buffet‐style meals over 3 days, PROP nontasters consumed more than free energy, and a greater proportion of free energy from fat compared with super tasters. So information technology is possible that a family unit's genetic contour could contribute to eating choices. To address behavioral factors, information technology is of import to ensure that families take appropriate support and data and that any early signs of weight proceeds are dealt with promptly.

A salubrious domicile food environment can assist individuals improve their diet. In children, cardinal factors are availability of fresh fruit and vegetables at home and parental influence through their own fresh fruit and vegetable intake (Wyse, Wolfenden, & Bisquera, 2015). In adults, unhealthy home nutrient environment factors include less healthy food in the dwelling and reliance on fast food (p = .01) are all predictors of obesity (Emery et al., 2015).

Family mealtimes are strongly associated with ameliorate dietary intake and a randomized controlled trial to encourage salubrious family meals showed a promising reduction in excess weight gain in prepubescent children (Fulkerson et al., 2015). Another study showed that adolescents with whatsoever level of baseline family meal frequency, 1–2, 3–4, and ≥5 family meals/week, had reduced odds of existence afflicted by overweight or obesity 10 years subsequently than adolescents who never ate family unit meals (Berge et al., 2015). Community health advocates take identified the failure of many families to plan meals or ready food as a barrier to healthy family unit eating patterns (Fruh, Mulekar, Hall, Fulkerson et al., 2013). Meal planning allows healthy meals to be prepared in advance and frozen for later consumption (Fruh, Mulekar, Hall, Adams et al., 2013) and is associated with increased consumption of vegetables and healthier meals compared with meals prepared on impulse (Crawford, Ball, Mishra, Salmon, & Timperio, 2007; Hersey et al., 2001).

The part of the nurse practitioner

The initial and ongoing interactions between patient and nurse practitioner are keys for the determination of an effective arroyo and implementation of a weight loss program and subsequent weight maintenance. The initial interaction can be instigated by either the nurse practitioner or the patient and once the decision has been made to manage the patient's weight, the evaluation includes a risk assessment, a discussion about the patient's weight, and treatment goal recommendations (American Nurse Practitioner Foundation, 2013). Across this procedure, information technology may be advantageous to approach this using objective information and language that is motivational and/or nonjudgmental. Patients may struggle with motivation, and therefore, ongoing discussions around the health benefits and improvements to quality of life every bit a event of weight loss may exist required (American Nurse Practitioner Foundation, 2013). Information technology may be valuable to classify personalized benefits to the weight loss such every bit playing with children/grandchildren (American Nurse Practitioner Foundation, 2013). Treatment approaches comprehend nonpharmacological and pharmacological strategies; however, it is of import to recollect that whatsoever pharmacological agent used should be used as an offshoot to nutritional and physical activity strategies (American Nurse Practitioner Foundation, 2013). Pharmacotherapy options for weight management are discussed further in the commodity by Aureate in this supplement.

Conclusions/summary

The importance of obesity management is underscored both by the serious wellness consequences for individuals, only also past its increasing prevalence globally, and across age groups in particular. Obesity promotes a chronic, depression‐form, inflammatory state, which is associated with vascular dysfunction, thrombotic disorders, multiple organ damage, and metabolic dysfunction. These physiological effects ultimately lead to the development of a range of morbidities, including CVD, T2D, OSA, and sure cancers forth with many others, equally well equally causing a significant affect on mortality.

However, even small-scale weight loss of 5%–10% of total body weight can significantly meliorate health and well‐being, and further benefits are possible with greater weight loss. Weight loss can help to prevent development of T2D in individuals with obesity and prediabetes and has a positive long‐term impact on cardiovascular mortality. Beneficial, although non curative, effects have likewise been noted on OSA following >10% weight loss. In addition, weight loss reduces the risk for certain cancer types and has positive effects on nearly comorbidities including asthma, GERD, liver function, urinary incontinence, fertility, joint pain, and low.

Weight‐loss programs that include realistic weight loss goals, frequent check‐in, and meal/activity diaries may aid individuals to lose weight. Setting realistic weight‐loss goals tin exist difficult; however, visual resources showing the health and wellness benefit of weight loss may be helpful in discussing realistic goals, and help motivate the patient in maintaining the weight loss. Techniques such as motivational interviewing that focus on addressing resistance to behavioral change in a supportive and optimistic fashion may aid individuals in integrating these changes to permit them to get role of normal everyday life and thus help with maintaining the weight loss. Positive reinforcement in terms of marked early‐weight loss may also aid in improving adherence, so this should be a cardinal goal for weight‐loss programs. Encouraging feelings of "self‐worth" or "self‐efficacy" tin help individuals to view weight loss as being inside their own control.

Nurse practitioners play a major role in helping patients achieve weight loss through all aspects of the procedure including assessment, support, motivation, goal‐setting, management, and treatment. With their in‐depth understanding of the research in the field of obesity and weight management, nurse practitioners are well placed to upshot meaningful changes in the weight‐direction strategies deployed in clinical practice.

List of helpful resources

The Obesity Action Coalition (OAC): http://www.obesityaction.org	This site has educational resource for providers and patients. It also has information on advocacy for patients.
Terminate Obesity Alliance: https://stopobesityalliance.org/	This site has many helpful resources to help foreclose obesity bias and helpful educational materials for patients. It also has an excellent tool to help providers discuss the topic of obesity with patients.
UConn Rudd Heart: http://www.uconnruddcenter.org/weight-bias-stigma	This site is an first-class resource for providers in clinical practice. This site has modules to help providers ameliorate obesity management.

Acknowledgments

The authors are grateful to Watermeadow Medical for writing assistance in the development of this manuscript. This assistance was funded by Novo Nordisk, who as well had a role in the review of the manuscript for scientific accuracy. The writer discussed the concept, drafted the outline, commented in detail on the first iteration, made disquisitional revision of later drafts, and has revised and approved the final version for submission.

Notes

Disclosures

Dr. Sharon Fruh serves on the Novo Nordisk Obesity Speakers Bureau. In compliance with national upstanding guidelines, the author reports no relationship with business or industry that would postal service a conflict of interest.

Writing and editorial support was provided by Watermeadow Medical, and funded past Novo Nordisk.

The copyright line in this article was changed on ix August 2018 afterwards online publication.

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