Nutritional Interventions for addressing the health disparities of Obesity

Taylor Johnson, Michelle Smith-Hawley, Avis P. Graham, PhD, RDN, Thomas V. Fungwe, Allan A. Johnson, Oyonomo E. Ntekim,
MD, PhD, Chimene Castor,EdD, RDN, LDN
1Howard

ABSTRACT

University, Department of Nutritional Sciences, Division of Allied Health Sciences, Washington DC 20059

Obesity: Prevalence of Age Adjusted Health Disparity by Sex,

Race and Hispanic Origin (CDC-2011-2012)

Nutrition Focused Physical Findings

Introduction: A dramatic rise in obesity rates and health disparities

across socioeconomic groups in the United States of America (USA)
have been progressively reported in the past three decades.
Objectives: To identify and address the etiologies and socioeconomic
health disparities that influences the ongoing; increase in obesity within
the United States of America and related altered nutritional status. To
address the health disparities of obesity using evidence-based guidelines
of Medical Nutrition Therapy; recommend nutritional interventions that
promotes weight improvements and BMI within healthy weight range.

NUTRITION ASSESSMENT
Study Population: A 52-year-old African American female with a PMH
of acute asthma/chronic obstructive pulmonary disease (COPD), high
blood pressure (HTN), acute kidney injury (AKI), avascular necrosis
(AVN) of the left hip 2/2 steroid use, awaiting hip replacement,
gastroesphageal reflux disease (GERD), h/o depression/bipolar disorder.
Methods: This case presentation involves an obese adult patient in a
clinical setting. Data collection via reviewing the patients electronic
and medical records; interview with the patients and/or the patients
caregivers and registered nurses to ascertain: usual dietary habits; food
preferences; food accessibility and availability; identification of
possible barriers to food security. Secondary data obtained via review
of literature on prevalence and incidence of obesity trends in the USA.
Intervention: Nutrition education was provided to patient on portion
awareness; the need for increased physical activity and a general
healthful diet of 1800-2000 kcal to promote weight loss(TLC diet).
Nutrition counseling via application of The Trans Theoretical ModelStages of Change was applied in nutritional counseling to impart
knowledge on the health benefits associated with making lifestyle
modifications.
Results: According to the Centers for Disease Control and Prevention
(CDC) Health Disparities and Inequalities Report (2011) the health
disparities in the USA include: race/ethnicity; gender; age;
socioeconomics status and geographic regions. Prevalence highest
amongst the following: African Americans and Mexican Americans;
females; low-income households ; amongst the WHO Regions of the
Americas increases ; also prevalence increases with age >20.
Outcomes from Application of NCP: Identification of 6 nutritional
problems; however 2 were selected as priority. Also, utilizing strategies
like the provision of nutrition education to promote lifestyle and
environmental changes such as healthy eating and active living; as well
as addressing the existing barriers to intervention such as food security;
and imparting information about ways to effectively utilize available
resources can help to reduce the health disparities of obesity.
Conclusion: The risks of Obesity, its comorbidities and associated
health disparities can be minimized through diet and lifestyle changes.

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No Food Allergies/Intolerances
Dislikes Pork
No Alcohol/Drug/Supplement Use
Occasional Caffeine use (soda/coffee)

PO Intake: 100% of meals

Pt. requesting double portions (as per nurses report)

Client History:
Pt. is a 52 Y/O AAF that was presented on 10/07/14 (2) from her
pulmonary care clinic. Admit Dx. multifocal atrial tachycardia (MAT),
with rapid ventricular rate on electrocardiogram and exacerbation of
COPD. Pt. had complaint of worsening shortness of breath; wheezing;
5-day history of worsening fatigue and dizziness due to malfunction of
nebulizer machine for over 1 week . Pt. reported compliance with other
medication regimen to include home O2 of 2L/min. She had a PMH of
acute asthma/chronic obstructive pulmonary disease (COPD),
hypertension, acute kidney injury (AKI), avascular necrosis (AVN) of
the left hip 2/2 steroid use, awaiting hip replacement, gastroesphageal
reflux disease (GERD), h/o depression/bipolar disorder. Past History of
tobacco abuse.

Anthropometrics Measurements
Ht.
(in.)

65

Wt. BMI
(lbs)

UBW 4
months
(lbs.)

210 34.08, 208

Obese
Class I

UBW
%

IBW
(lbs.)

IBW ABW
%
(lbs.)

Typical Daily Intake: 2,007 kcal/ day

Breakfast

Lunch

Dinner

- 2 French toast, 2
egg, 1 muffin, and 8
oz. orange juice
(other options:
cereal with 2%
milk)

- 4 oz. chicken with

gravy, cooked
collard greens and
juice.
(Other options:
turkey, fish,
hamburger, salads,
sandwiches, fruit,
sauted vegetables
ex: broccoli,
cabbage)

Takeout chicken
dinner with
starchy vegetable
and biscuit
(other options:
fish)

Estimated/Recommended Nutrient Needs:

99%

125

168 146

Lab Value

Ref. Range

10/9/
14
137
31

10/8/1
4
105
21

10/7/
14
81
24

Glucose
Blood Urea
Nitrogen (BUN)
Creatinine

70-110 mg/dL
7-25 mg/dL
0.6-1.2 mg/dL

1.6

1.3

1.5

Magnesium
CPK
Sodium

1.7-2.5 mg/dL
10-120 mcg/L
135-148
MEQ/L
3.2-5.5 gm/dL

2.4
138

519
137

3.0
868
138

3.8
51

62

4.0
54

Excessive energy intake (NI-1.5)

Goals for PES 1:
To reduce daily caloric intake by 500 kcal/day to promote 1-2 lbs wt.
loss/week.
To promote 2-4 lbs weight loss/month until goal weight of 10% actual
body weight; 20 lbs. weight loss in ~180 days is achieved.
To decrease future risks of : Asthma/COPD exacerbation; sleep apnea
and CVD through weight loss.
Interventions for PES 1:
Recommended Food & Nutrient Delivery of 1800-2000 kcal/day.
Provided Nutrition Education on: portion awareness/control; a general
healthful diet TLC diet; meal planning. Printed material provided.
Provided Nutrition Counseling to facilitate lifestyle changes using the
Cognitive Behavior Theory to help pt. better understand the factors that
influence her behaviors .
Drug nutrient interaction NC-2.3
Goal for PES 2:
To maintain bone health and prevent further risks of osteoporosis.
Interventions for PES 2:
Increase intake of Vitamin D:
Encouraged increase consumption of calcium and vitamin D rich
foods.
Diet Supplement: 1200 - 1500 mg/day of calcium (*if needs not met
via diet) and recommend 400 IU of vitamin D.
Recommend continued coordinated care with physical therapy to
increase mobility.
Recommend collaborated care with occupational therapy for weight
bearing physical activity for upper body strength.

NUTRITION MONITORING AND EVALUATION

Indicator: Weight
Criteria: Gradual weight loss of 2-4 lbs./month

1880-2040 kcals; 80-96 g pro; 1800-2000 ml/fluids/day

NUTRITION DIAGNOSIS

Biochemical Data

Albumin
GFR AA
RESEARCH POSTER PRESENTATION DESIGN 2012

Patient Centered Goals and Interventions :

Obese AA Female
No N/V/C/D
O2 2L NC
Fatigue, generalized weakness
High Blood Pressure
Shortness of breath, wheezing
Rapid Ventricular rate

Food/Nutrition Related History

Design: Application of the Nutrition Care Process (NCP) to collect,

organize and evaluate data using the Assessment; Diagnosis;
Intervention; Monitoring and Evaluation (ADIME) format.

NUTRITION INTERVENTION

PES Statement 1
Nutrition Problem: Excessive energy intake (NI-1.5)
Nutrition Etiology: related to portion control, lack of physical
activity, and food-nutrition related knowledge deficit
Nutrition Signs and Symptoms: as evidenced by registered nurse
(RN) reported requesting double portions with meals, BMI 34.08,
and %IBW 168% (obesity)
PES Statement 2
Nutrition Problem: Drug nutrient interaction of
glucocorticosteroid use (solu-medrol) NC-2.3
Nutrition Etiology: related to COPD
Nutrition Signs and Symptoms: as evidence by avascular necrosis
of left hip, hip replacement surgery, glucose lab value of 137 H

Indicator: PO intake
Criteria: 24 hour food recall with compliance to dietary
recommendations of TLC diet, 2 gm Na and increased vit. D and
Ca recommendations
Indicator: Lab values (*Glu/Alb/Cre/BUN)
Criteria: Values close to ref. range; Hydration, skin integrity,
electrolytes, complete blood count, lipid panel, urinalysis

REFERENCES
CDC. (2011). Fact sheet: Health Disparities in Obesity. Retrieved on November,
14, 2014, from:
http://www.cdc.gov/minorityhealth/reports/CHDIR11/FactSheets/Obesity.pdf
Farlex. (2012). Medical dictionary. Retrieved October 26, 2012, from
http://medical- dictionary.thefreedictionary.com/dictionary
Nelms, Marcia. Nutrition therapy and pathophysiology. 2nd ed. Belmont, CA:
Wadsworth, Cengage Learning, 2011. Print.
Mahan, L. Kathleen. Krause's Food & the Nutrition Care Process. 13th ed. St.
Louis, Mo.: Elsevier/Saunders, 2012. Print.
Rolfes, S. R., Pinna, K., & Whitney, E. (2012). Understanding normal and
clinical nutrition (9th ed.). Belmont, CA: Wadsworth.