Provide responses to each of the following students

Student 4

Obesity, or conversations regarding an individual’s weight, can be uncomfortable or down right impossible to talk about with a patient from the practitioner’s standpoint. It can prove even more
troubling if the patient is resistant to the conversation or uncomfortable as well. There are potentially many factors affecting why an individual’s weight has reached the point of obesity. Obesity
can be classified as a BMI of 30-34.9, progressing through Class 2 to reach extreme obesity (Class 3), which is a BMI ≥ 40. (Uphold & Graham, 2013) The use of BMI is not without specific
considerations or limitations. For instance, one source indicates, “BMI does not take into account fat distribution or distinguish between lean and fat tissues. It should be used with caution in
assessing older people, children or athletes and is not sensitive to gender, racial or ethnic differences in body composition” (Kirk et al., 2009, p. 26). As for factors related to the rise in
obesity, it has been proposed that increased food energy supply and globalization of the food supply, increasing the availability of obesogenic ultra-processed foods, increasing motorization and
mechanization, time spent in front of small screens and a decrease in transport and occupational physical activity are things to be considered. (Vandevijvere, Chow, Hall, Umali, & Swinburn, 2015)
There could also be a number of physical or mental/brain related factors contributing to an individual’s weight control. The factors that can be controlled should be of prime importance to helping
a patient undertake a course of weight management, if they choose.
I tell myself, a conversation that doesn’t take place could be an opportunity missed to change a person’s path from one of potential disorder after disease to one that is completely different.
Again, the patient needs to be in a position that is accepting of the guidance and is willing to make the changes. This was a highly encountered issue in coaching patients upon searching articles.
This is why with as much empathy and sincerity as possible I tell the person as matter of fact, and objectively, as possible that on paper (BMI and BP, glucose etc.) your weight is a concern of
mine. Ideally, the issue would be addressed as early as possible in noticing a person’s weight is starting to increase, which could be as early as childhood. From there, addressing behavioral
factors and dietary factors have proven successful in helping patients control their weight. “Behavioral therapy [is] designed to help patients learn new patterns of behavior relating to food
intake and physical activity practices” (Uphold & Graham, 2013, p. 110). Behavioral therapy can be summarized as involving the steps of building a partnership with the patient either on an
individual basis or in a group setting, setting achievable goals, cultivating the partnership, and summarizing each visit. Regarding the dietary changes, most overweight patients require dietary
changes and should be instructed accordingly with the best advice being to avoid specific foods rather than nonspecific advice of simply eating less. (Uphold & Graham, 2013) “Food to avoid are
these: foods containing sugar, white flour, substantial amounts of solid fats, and all foods that are highly processed” (Uphold & Graham, 2013, p. 111). A clinic I have been a part of had a
seemingly successful approach in how the weight-loss programs were offered. It could be on the individual or group basis, like mentioned above. Ultimately, the services were offered and always
available, and depending on the setting, presented in a fun, exciting, new, innovative manner which was more than “eat less, exercise more” Steps are laid out and is made as easy as possible. A
manner similar to this could be used in future encounters.

References
Kirk, S. F., Cramm, C. L., Price, S. L., Penney, T. L., Jarvie, L., & Power, H. (2009, January 1). BMI: A vital sign for patients and health professionals. Canadian Nurse, 105 (1), 25-28. Retrieved
from http://web.a.ebscohost.com.prx-herzing.lirn.net/ehost/detail/detail?sid=f80d36df-d7af-45c9-9b06-4ad58a79a0e4%40sessionmgr4010&vid=7&hid=4206&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d
%3d#AN=105644556&db=rzh
Uphold, C. R., & Graham, M. V. (2013). Clinical guidelines in family practice (5th ed.). Gainesville, FL: Barmarrae Books, Inc.
Vandevijvere, S., Chow, C. C., Hall, K. D., Umali, E., & Swinburn, B. A. (2015, July 1). Increased food energy supply as a major driver of the obesity epidemic: A global analysis. Bulletin of the
World Health Organization, 93 (7), 446-456. http://dx.doi.org/http://dx.doi.org.prx-herzing.lirn.net/10.2471/BLT.14.150565

Student 5

Obesity is defined as a body mass index (BMI) ≥ 30 kg/m2. Obesity has a serious health impact on many medical conditions such as: such as: hyperlipidemia, asthma, hypertension, coronary artery
disease, and certain types of cancer. Risk factors include a sedentary lifestyle, family history of obesity, hormonal disturbances, eating disorders, excessive calorie intake, and use of certain
medications. Racial/ethnic minority groups and individuals with low income and/or education level are also more likely to be obese. Researchers in Ontario, Canada found that higher neighborhood
walkability is associated with decreased risk of obesity (Creatore et al., 2016).

Loss of as little as 3–5% of bodyweight can provide clinically meaningful health benefits in obese patients, including decreased blood sugar levels. Obese patients who participate in nonsurgical
weight-management programs lose an average of 10% of their initial body weight over 12–24 weeks, but the majority of them regain two thirds of the weight lost within one year. The antiobesity
medications phentermine-topiramate, liraglutide, naltrexone-bupropion, lorcaserin, and orlistat result in loss of at least 5% of body weight in 75%, 63%, 55%, 49%, and 44% of patients,
respectively. About 179,000 bariatric surgery procedures were performed in the U.S. in 2013. Bariatric surgery results in an average loss of 60–70% of excess body weight in the short term and up to
50% at 10 years. Bariatric surgery results in remission of DM2 in up to 80% of patients at 2 years post-surgery and reduces all-cause mortality by 30–50% at 7–10 years post-surgery (Jensen et al.,
2014). The biggest complication found within the research is that most people seem to have a difficult time maintain weight loss.

In a future clinic I would try to use the most minimally invasive methods first. For example, first I would educate an obese patient regarding the significant health risks that are associated with
obesity and recommend diet and exercise modifications. If the patient continued to struggle with weight loss I would then recommend them to do some research regarding different programs that are
available, such as Weight Watchers, to see if they would be open to attend more group oriented weight loss program that may help with accountability. If this also did not work then would consider
medications and eventually surgical intervention if indicated.

References
Creatore, M. I., Glazier, R. H., Moineddin, R., Fazli, G. S., Johhs, A., Gozdyra, P., Booth, G. L. (2016). Association of neighborhood walkability with change in overweight, obesity, and diabetes.
JAMA: Journal of the American Medical Association, 315(20), 2211-2220. doi:10.1001/jama.2016.5898

Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A., … Tomaselli, G. F. (2014). 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in
adults: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation, 129(25), 102-138.
doi:10.1161/01.cir.0000437739.71477.ee

Student 6
Obesity is defined as having too much body fat. Obesity occurs with consuming more calories than are used. Genetics, eating habits, and physical inactivity are factors that impact obesity.
Complications related to obesity may include increased “risk for diabetes, heart disease, stroke, arthritis, and some cancers” (MedlinePlus, 2017, p. 1).
Strategies and methods that have worked in helping client reach their ideal weight have included evidence-based lifestyle approaches that include diet, physical activity and behavior change
therapies (phentermine-topiramate and lorcaserin), pharmacological agents, and bariatric surgery. Kushner (2014) explain bariatric surgery has been demonstrated to be the most effective and long-
term treatment for individuals with severe obesity or moderate obesity complicated by comorbid conditions that is not responsive to non-surgical approaches” (p. 1).
Methods that I will use in my future clinic will include a thorough physical assessment which include current lifestyle habits. Interventions will include determining the patient’s goals,
providing nutrition education, and identifying lifestyle habits that can be modified with healthier habits, increased activity, and a referral for counseling. If these interventions don’t work, a
referral for bariatric treatment will be the next step. My practice with include a multidisciplinary approach to support the success of the patient’s battle against obesity.
Complications found in the research studies includes the lack of efficacy with the treatment resveratrol in humans compared to rodents. Resveratrol is a type of polyphenol that has
antidiabetic / antiobesity properties. Carpene, Gomez-Zorita, Deleruyelle, and Carpene (2015) propose the use of combination of polyphenols to treat complications. “Multidisciplinary approaches are
recommended for future investigations, considering the wide range of polyphenol actions that induce body fat reduction, liver disease mitigation, muscle function improvement, cardiovascular and
renal protection” (p. 1).
References
Carpene, C., Gomez-Zorita, S., Deleruyelle, S., and Carpene, M.A. (2015). Novel strategies for preventing diabetes and obesity complications with natural polyphenols. Current Medicinal Chemistry.
Retrieved from http://www.ingentaconnect.com/content/ben/cmc/2015/00000022/00000001/art00013

Kushner, R.F. (2014). Weight loss strategies for treatment of obesity. Progress in Cardiovascular Diseases. Retrieved from http://www.sciencedirect.com/science/article/pii/S0033062013001588
Medline Plus. (2017). Obesity. Medline Plus. Retrieved from https://medlineplus.gov/obesity.html