While I'm not getting these diaries out as quickly as I'd like, I do plan to continue with them as a series. If you missed the first one, it's still available at Healthy politics starts with healthy people and was a sort of general introduction to how nurses are trained to view healthcare. (Not all nurses, perhaps, but most programs share many of the common processes and models of healthcare that showed up in that post.) So, as promised in that post, today I'm going to talk a bit about obesity, and the linked nursing diagnosis, 'Nutritional Imbalance: Greater than bodily requirements'.
Nutritional imbalance can be a bit misleading, because, of course, what you tend to see in such cases is simply too many calories, and most often those calories aren't particularly linked to much in the way of vitamins or minerals. As pretty much everyone knows, if you take in more calories than you burn, your body tends to store them so that if you suddenly can't find food you'll have them to tide you over. Your body burns calories that we'll consider in several ways - basal metabolism uses the energy to build and maintain the cells that make up the various organs and systems, and to heat you up to the body's preferred temperature. Beyond that, your body uses energy to move you around and to provide the acceleration to the metabolism that occurs when you are exercising (moving around), healing from wounds or fighting infections, or your system has been goosed into 'fight or flight mode'. So when you're taking in the calories and not burning them off, you gain weight. Gain enough, and you become what doctors (and nowadays everyone else) will refer to as 'obese'.
So, even though it's a medical diagnosis, and not a nursing one, today we'll talk about obesity and related problems it causes. Obesity is a sort of 'key' condition, in that it causes many other problems for the body, that result in damage over time, sometimes irreversible.
Because our bodies were not designed to carry around as much spare fat as they do when we become technically obese (And you say 'But how do I know if I'm obese? You go to the CDC website on obesity, which provides definitions, causes and consequences, a body mass index calculator and a ton of other resources...) systems all around the body are stressed beyond their usual limits.
Every living cell in your body requires a variety of ions and chemicals, which are transported around in your blood. So adding new fat cells requires added vascularity to 'feed' those cells, and to remove their metabolic wastes. We have to have more blood, as well, so as to maintain pressure throughout those new blood vessels. Now think about the plumbing in the building supplied by a well with a pump. If you only have one central pump to supply all of the water, and you add new taps that are always in use, the water pressure is going to go down, unless that single water pump works harder. That pump is your heart, which has to work ever harder the more fat you add to your body.
And since you're forcing it to work harder, you blood pressure can go up significantly, resulting in high blood pressure (hypertension) which increases the stress on your heart and major arteries, and can cause things like strokes and heart attacks, and can still wind up with decreased pressure and 'perfusion' (how much oxygenated blood is getting to cells) in your feet and lower legs. Now gravity is working to help you out in carrying blood to your feet and legs, but we've got another culprit in the mix. Fats and cholesterols also ride around in your blood, and can adhere to the walls of your arteries, forming a 'plaque' that creates a condition called 'atherosclerosis', in which these arteries are partially clogged up, resulting in the inability to carry that oxygenated blood the cells need so badly.
This can then lead to Peripheral Arterial Disease (PAD). Starving these cells of oxygen and food shows up in things like hair loss on your lower legs and thin, shiny skin that is easily damaged and heals very poorly, since healing takes extra energy. In extreme cases, cells simply die off, and can require amputations.
But let's talk about another biggee - Diabetes. Diabetes comes about because you wind up with too much sugar floating around in your blood. This can happen in several ways. Your pancreas produces a hormone called insulin, whose job it is to transfer sugar out of the bloodstream and into the cells. But, for one reason or another, you might be unable to produce insulin, might not be able to produce enough to keep up with how much you're eating, or your cells might have developed a resistance to the actions of insulin, something that more frequently happens to obese people.
So what's so bad about diabetes? Well, apart from the fact that having sugar control issues can cause you to appear drunk to cops who then tase you and cart you off to jail or send you into a coma, diabetes can lead to diabetic retinopathy, diabetic neuropathy, and diabetic nephropathy. Which are, you ask? Diabetic retinopathy is diabetes-related damage to the eyes and can result in blindness. Diabetic neuropathy is diabetes-related damage to the nerves, and can result in sexual dysfunction, constipation, diarrhea, shooting pains and loss of sensation in the hands or feet. Diabetic nephropathy is diabetes-related damage to the kidneys that can result in failure, so that you need to start dialysis or get kidney transplants.
While there are plenty of problems still left unsaid about obesity, I think by now maybe if you're overweight and have the ability to do something about it, you might be considering doing so a bit more seriously by now. Blindness, strokes, heart attacks or failure, numb or even amputated limbs, diarrhea or constipation, urinary problems, sexual dysfunction, kidney failure... all are a lot more likely in people who are obese.
And 'doing something about it' really only means two things. Take in fewer calories, and burn off some of the calories you're currently storing. Now everybody has different paths to the goal, and some of those paths will be easier for you than others. You're free to select the path that's easiest for you to follow. But remember the two components - limit your calories in, ramp up your calories out. Most folks will refer to it as 'diet and exercise', and that's as good a thing to call it as any.
My suggestions for diet are pretty simple. First, keep a journal. Record everything you eat or drink, and use one of the many online calorie-counting websites to help you keep a tally of your calories each day. You'll be surprised at just how quickly they mount up, especially if you eat out at fast food restaurants or eat a lot of processed foods. You can try to go cold turkey each day after a certain number of calories is hit, but that doesn't work too well for most people.
Better by far is to start modifying what you eat, so that you start eating more low-calorie yet filling foods. (Vegetables, surprise, surprise...) MyPlate.gov is now suggesting that fruits and vegetables make up roughly half of each meal, and carbohydrates (breads and whatnot) are a quarter or less. Once you start kicking more veggies into your diet, you'll find your calorie totals rise more slowly throughout the day, without you feeling like you're starving hours before bed.
As to exercise, spend less time in front of the TV or computer, more outside or in a home gym. Try to do things that build long term endurance, short term energy bursts, and strength and balance. Don't try to go too hardcore too quickly, or you'll wind up needing to be seen by those professional medical personnel. Walking or bike riding are excellent at building endurance, and can be done most days, depending upon the climate where you live. You can always put on short bursts of speed for a few minutes at a time to break things up and build your 'cardio' (strengthen your heart and lungs) If you've got weights, you can use them, but there are also plenty of exercises that don't require any special equipment. Be sure to work everything over the course of a week or so - legs, arms and chest, stomach and back, even if you only do some basic exercises for each. Imbalance can lead to injury.
If you've gotten this far, and if you or your family or friends are obese, I strongly encourage you to start taking some steps to remedy the situation. As I've noted above, obesity is a gateway to an awful lot of really bad health issues, and controlling your weight could be the single best thing you can do for your overall health. Don't be discouraged if you find yourself 'going in circles' either. Losing weight and keeping it off is about changing the habits of years or even decades, and almost no one is going to simply 'decide to be thin' and get there in one straight path and stay there. Change the habits successfully, and the weight will come off and stay off, but that means establishing new eating and exercise habits to replace the old. Good luck.
6:23 AM PT: Just got in the Sunday paper, and damned if 'For Better or For Worse' didn't fit right in with the diary today. (Spoiler alert) Dad and kids go shopping, bring it home to mom, who looks dismayed, Kid asks 'What's the matter, we got the groceries, didn't we?' To which mom replies, 'Yes, but you didn't buy any FOOD!'
1:30 PM PT: A second, and more to the point update. As many commenters have noted now, my simply using 'overweight' in places can be misleading, because muscle weighs more than fat, and you can be very healthy and muscular, and still be 'overweight'. What I'm really talking about is a high percentage of bodyfat.