The prioritization of issues (from the least urgent to the most urgent) is as follows: skin rash, knee pain, hypertension, diabetes, and obesity. All of the identified problems are related to the patient’s weight. According to Dunphy, Winland-Brown, Porter, and Thomas (2015), joint pain, rashes, and hypertension, as well as diabetes, are common for patients with obesity. During the exam, skin rashes were identified under the breasts and in the groin, which is also typical in patients with obesity.
In this case, health promotion strategies should address all health problems the patient has. First, the patient should assess her weight regularly, but it is also important for her to be engaged in physical activity and exercise. It is also advised to review her dietary habits and work on the following: ensure that she does not eat too fast, avoids eating when not hungry, skips dessert from time to time, and does not eat while standing (CDC, 2015). Moderate-intensity aerobic activity at least three times per week (150 minutes per week ideally) is also recommended, although it would not be enough to lose weight (CDC, 2015). The patient should be aware of emotions that trigger overeating, and follow calorie restrictions (1,200 to 1,800 kcal daily), “evaluations of potassium, magnesium, and uric acid levels”, and an EGG to ensure there are no cardiac arrhythmias (Dunphy et al., 2015, p. 214). Appetite suppressants or surgical intervention if no progress is shown are suggested as well. The Circle of Caring can help the patient evaluate the objectives of her treatment, share her concerns with the nurse and gain support from her family, get useful advice from nurses, and track her progress together with the healthcare provider.
Healthy People 2020 objectives that are related to this patient: “increase the proportion of adults who meet current Federal physical activity guidelines for aerobic physical activity”, “increase the proportion of trips made by walking”, “Increase the proportion of trips made by bicycling”, “reduce the diabetes death rate”, “increase the proportion of persons with diagnosed diabetes whose blood pressure is under control” (Healthy People 2020, 2018). This is a third-level office visit, and the reimbursement for this visit is approximately $73.40 (EM University, 2018).
Frequent follow-ups with medical guidance, emotional support, weigh-ins, BP measurement, and progress monitoring are necessary (Dunphy et al., 2015). A weight loss plan should be prepared together with the patient to include diet and exercise modifications and recommendations. The patient should be educated about the importance of a balanced diet, regular exercise, and therapy or support groups to modify behavioral strategies (Dunphy et al., 2015).
Herbal supplements (garcinia Cambogia, camellia Sinensis, chromium picolinate, conjugated linoleic acid), acupuncture, and non-invasive body contouring methods are complementary therapies that can help the patient, although their effectiveness is yet to be proven (Esteghamati, Mazaheri, Rad, & Noshad, 2015). Lifestyle interventions can help reduce the risk of CVD, as voluntary weight loss and self-driven behavior change was related to lower rates of CVD incidence (Look AHEAD Research Group, 2016). Furthermore, voluntary weight loss also does not affect bone density, as it is sometimes assumed, and has other benefits (improvement in cognitive function, psychological and physical well-being) (Zibellini et al., 2015). According to Williams (2013), fostering “want to” behavior, making environments more fun, and creating valued experiences helps achieve a long-term commitment to fitness. The availability of free community-based programs that include group training, fitness, and infrastructure for exercise can be useful to this patient.
References
CDC. (2015). Strategies to prevent obesity. Web.
EM University. (2018). Level 3 established office visit. Web.
Esteghamati, A., Mazaheri, T., Rad, M. V., & Noshad, S. (2015). Complementary and alternative medicine for the treatment of obesity: A critical review. International Journal of Endocrinology and Metabolism, 13(2), 1-9.
Healthy People 2020. (2018). 2020 topics and objectives. Web.
Look AHEAD Research Group. (2016). Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: A post-hoc analysis of the Look AHEAD randomised clinical trial. The Lancet Diabetes & Endocrinology, 4(11), 913-921.
Williams, L. (2013). Commitment to sport and exercise: Re-examining the literature for a practical and parsimonious model. Journal of Preventive Medicine and Public Health, 46(1), 35-42.
Zibellini, J., Seimon, R. V., Lee, C. M., Gibson, A. A., Hsu, M. S., Shapses, S. A.,… Sainsbury, A. (2015). Does diet‐induced weight loss lead to bone loss in overweight or obese adults? A systematic review and meta‐analysis of clinical trials. Journal of Bone and Mineral Research, 30(12), 2168-2178.