Introduction and Problem Statement
Obesity has been a growing concern for health professionals for the past few decades. Its prevention and management are difficult, especially because of the specifics of the lifestyles that are prevalent nowadays. In this paper, a specific case of chronic obesity will be considered. As an example of problem-solving, the case is consistent with the Doctor of Nursing Practice (DNP) requirements (Chism, 2018). Several theories can be applied to the case, including the health belief model (HBM), the theory of planned behavior (TPB), and Newman’s expanding consciousness theory of health (Glanz, Burke, & Rimer, 2018; Nelson, 2018).
This paper will utilize these theories for the entire scenario, and it will include a literature review, a case description, the merging of the two in a detailed explanation, and a solution proposal with a discussion of assessment tools. This analysis will show that well-established theories are valuable to nursing problem-solving as frameworks for analyzing issues and planning solutions.
Brief Literature Review
Condition-Related Literature
Obesity, which is generally associated with the body mass index (BMI) of over 30, is an increasingly prevalent condition all over the world. It is a risk factor for many disorders, which is why its healthcare costs are rather high (Eisenberg & Burgess, 2015; Ho & Sun, 2015). It is also a difficult condition to manage, and it tends to be chronic (Ho & Sun, 2015). As pointed out by Ho and Sun (2015), one of the major issues of obesity is that it is preventable, but even the people who are aware of preventative measures do not seem to be able to employ them effectively.
In recent years, the investigation of the concepts of weight bias, stigma, and internalized weight bias (IWB) has provided a potential explanation for one of the reasons for obesity’s persistence. Stigma is evidenced to reduce self-care behaviors in patients with excessive weight (Potter et al., 2016). Furthermore, IWB results in the development of eating disorders and might be associated with increased BMI (Pearl & Puhl, 2018). Finally, internalized stigma and self-esteem issues might not be reduced by weight loss; they require additional treatment, and they are often undertreated (Murray, Dordevic, & Bonham, 2017).
All these factors may contribute to a person with excessive weight (or perceived excessive weight) managing they’re weightless effectively. IWB is also dangerous on its own; it has multiple negative outcomes for a person’s mental health (Murray et al., 2017; Pearl & Puhl, 2018). The interventions that target IWB can reduce IWB and improve weight management efficacy (Dunaev, Markey, & Brochu, 2018; Pearl, Hopkins, Berkowitz, & Wadden, 2018). Therefore, IWB is an important factor to consider when planning to reduce obesity in an individual who suffers from stigma.
Theory-Related Literature
In this section, the theories that will be used for this case will be described, and their choice will be justified. The basic tenet of HBM and TPB is that certain factors determine human behavior, and they can be used to analyze, predict, and modify it. For TPB, rather broad categories are established; according to it, a person’s beliefs and attitudes (including the perceived ability to engage in a behavior), as well as intentions and values (or norms), determine one’s behavior (Glanz et al., 2018; Ho & Sun, 2015). HBM is more health-specific (Glanz et al., 2018); it focuses on a person’s beliefs regarding the likelihood of having or catching a disease, the understanding of its severity, and the perspectives on known preventative measures, including their benefits, barriers to them, and one’s ability to engage in them.
The idea of applying HBM and TPB to obesity is not very new. HBM was developed to explain the potential barriers to preventative health measures, which makes it suitable for the task (Glanz et al., 2018). For example, Rabiei, Masoudi, and Lotfizadeh (2017) employed HBM to develop an effective nutrition intervention for adolescents. Moreover, in a review of 14 studies that utilized the theory, TPB was proven to be useful for structuring programs for weight reduction (Chung & Fong, 2015). In other words, HBM and TPB are suitable for an obesity case.
As for Newman’s expanding consciousness theory, it is relevant due to its ability to encompass chronic conditions. According to Newman, health conditions are an element of the health continuum, and while they do not change what a person is, they may appear as a manifestation of an individual’s pattern (Nelson, 2018). The ability to recognize those patterns is achieved through forming trust-based relationships that involve listening to the patient and dialoguing with them to uncover their pattern (Rosa, 2016); this approach can be called “patterning.”
A recent review by Rosa (2016) demonstrated that the concepts of this theory are frequently applied to chronic illness in adults, although obesity-focused Newman-based studies do not seem to be common. Still, a recent thesis by Riches (2017) used the theory as a framework for a survey-based inquiry investigating relationships between BMI and self-esteem. Therefore, the application of the theory to obesity is a feasible option.
Description of the Case from a Theoretical Perspective
This case describes a Caucasian 27-year-old woman who presented with an excessive weight problem. During her visit, it was determined that her BMI was 49.2. Tests demonstrate that the condition is unlikely to be secondary. According to the patient, she was first diagnosed with obesity at the age of 9; she does not recall her BMI at the time. In terms of HBM, the patient is aware of the fact that obesity can be a chronic problem.
Until the age of 22, the patient had been trying to lose weight by dieting. She reports never liking sports but occasionally attempting to set a running routine. In terms of HBM, she is familiar with solutions to the issue, but she might be limiting herself to the ones that are not very suitable for her. Her dissatisfaction with her choices is a barrier to their implementation. When the patient was 22, she experienced a nervous breakdown, which she attributes to the dissolution of a romantic relationship. Since then, she stopped trying to lose weight; she does not believe that she can achieve positive results. Due to a sedentary lifestyle (office work), she gained her current 49.2 BMI.
In terms of TPB and HBM, this event implies that she does not view continued self-care as feasible or necessary; she does not believe that she can lose weight, which is a case of a perceived lack of control.
The patient does not enjoy seeking advice from a healthcare professional; she believes that a person should be able to overcome weight problems on their own. In TPB terms, these norms may be problematic, and they contribute to the perceived lack of control. The patient frequently jokes in a self-deprecating manner, and she stated that she hated herself for failing to lose weight. This pattern is indicative of her not viewing her condition as a form of health, which Newman’s model would recommend. In general, the application of the information from the literature review would help to understand the case better.
Discussion: Detailed Explanation of the Synthesized Literature Findings
HBM and TPB can be applied to the patient’s prior and future attempts to improve her health. The patient is aware of the condition and views it as a significant, severe problem. For her, it is a chronic concern, which is common for people who used to be obese in childhood (Eisenberg & Burgess, 2015; Ho & Sun, 2015). The patient is familiar with common solutions, including dieting and physical activity (Eisenberg & Burgess, 2015; Ho & Sun, 2015).
However, she does not believe that she can apply them, which is a very significant barrier (Glanz et al., 2018; Ho & Sun, 2015). According to HBM and TPB, the intent and decision to perform an action are strongly associated with its perceived feasibility, as well as perceived and actual control. While the patient might lack actual control over her behavior in some respects (for example, her sedentary lifestyle is the result of her work), the main problem is her perceived control. It is the self-reported reason for her decision to give up her self-care activities, which worsened her condition.
Newman’s model would be helpful in the analysis of the patient’s perspective on herself. The failure to recognize her weight as a part of her current health has led her to hate herself. This outcome is not uncommon since overweight people tend to have self-esteem issues that stem from stigmatization and IWB (Pearl & Puhl, 2018; Potter et al., 2016). Importantly, this problem may have contributed to the patient’s decision to reject self-care behaviors, which is also a pattern in people with obesity who demonstrate IWB (Pearl & Puhl, 2018). In addition, women with greater BMI are more likely to avoid or delay visits to doctors (Riches, 2017), which is also a behavior that this patient demonstrated. In her case, the issue stems from a negative attitude toward weight management.
The issues that are illustrated by this case and evidenced by the presented literature can be summarized with the help of the theories’ terminology. The potential causes of the problems with weight management in this patient’s case include the lack of perceived control, certain unhelpful norms and values (IWB), and an overwhelmingly negative focus on her condition instead of the pattern that makes her up as an individual. All these features contributed to the patient’s decision to reject self-care and affected her current attitudes toward herself, her health, and potential solutions. However, the fact that she visits a healthcare professional implies that she is still motivated to reduce her weight, which can contribute to her choosing to engage in weight reduction programs.
Case Summary
The case refers to an individual who has been experiencing weight problems since childhood. She does not believe that she can address the issue, which has already caused her to give up self-care behaviors. The lack of perceived control is the primary cause of her current BMI and general problems with weight management, which is in line with HBM and TPB. In addition, the patient has an unhealthy view of herself and the idea of visiting healthcare professionals for weight-related help. Newman’s approach and HBM/TPB can be used to propose a solution to this complex problem.
Proposed Solutions to Remedy Identified Gaps, Inefficiencies, and Other Issues from a Theoretical Approach
A DNP-prepared professional should consider a holistic intervention for this complex problem. A primary solution to issues that stem from internalized bias is therapy (Pearl et al., 2018), which is especially important since IWB and self-esteem issues do not recede with reduced weight (Murray et al., 2017). A DNP should provide a rationale for the choice and urge the patient to consider therapy. Furthermore, Newman’s approach to investigating patterns should be employed.
Patterning involves a discussion with the patient, in which a nurse asks about important events and factors in the patient’s life (Rosa, 2016). For this case of patterning, the HBM/TPB elements would be helpful. Specifically, it is necessary to investigate the patient’s beliefs about her condition and the solutions that she thinks are available. Her values, intentions, and attitudes require investigation as well. This approach will help the patient to critically reexamine what she knows and does not know about obesity and what options she has.
The next element of the intervention is education. Educational interventions for obesity reduction are well-established and researched (Mazloomy-Mahmoodabad, Navabi, Ahmadi, & Askarishahi, 2017), including a recent HBM-based one (Rabiei et al., 2017). The intervention should be used to close the gaps determined through patterning. The informed patient who has analyzed her condition and behavior should then be able to create a plan of treatment together with the nurse. Finally, it will be necessary to institute a form of monitoring since obesity is chronic.
Research Instrument for Evaluation
The monitoring system needs to employ relevant instruments. The patient will be encouraged to keep a journal of her nutrition and physical activity. This instrument will aim to be convenient rather than formal, and it will be evaluated based on the patient’s diligence in filling it. She will be instructed to keep the journal every day and mark any loss of data for that purpose. Furthermore, her weight will be measured; this approach is objective, and it does not require additional validation procedures.
However, very important outcomes are the patient’s IWB and self-esteem. The Rosenberg Self-esteem Scale (RSS) has been researched in large samples from 53 different nations; its highest Cronbach alpha score amounted to 0.87 (García, Olmos, Matheu, & Carreño, 2019). The Weight Bias Internalization Scale (WBIS) is more recently developed, but it has been researched as well, which proved its construct validity and reliability; its Cronbach alpha is 0.75 (Durso, Latner, & Ciao, 2016). Therefore, both instruments have already been evaluated and are likely to produce reliable findings for monitoring the case’s progress.
Conclusion
People tend to be aware of the causes of obesity but still fail to prevent and manage it. In this case, the application of Newman’s approach and HBM/TPB may have demonstrated one of the potential causes of this issue. A woman with persistent, chronic weight problems expressed negative beliefs and attitudes that prevented her from practicing self-care. The theories served as an analytical framework for a DNP, and they were also used to devise solutions.
Furthermore, they were embedded within the intervention to help the patient analyze her condition, attitudes, and potential interventions. The effectiveness of this approach would be assessed with multiple research tools, including RSS and WBIS, which were chosen for their ability to measure the outcomes identified by Newman and HBM/TPB models as the underlying issues of the case. Therefore, the theories are multifunctional in their ability to explain the case and propose solutions to it.
References
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