Nursing Implications When Diets Fail

Thursday, July 14, 2011: 8:30 AM

Lauren Outland, DrPH, MSN, APRN
School of Nursing, California State University, Carson, CA

Learning Objective 1: Define homeostasis as it relates to weight control

Learning Objective 2: Explain how tuning into homeostatic cues of hunger and fullness supports a holistic and homeostatic friendly approach to health and weight

Statement of the problem:  Overweight and obesity have become global health problems according to the World Health Organization. In many countries, high rates of dieting coexist with high rates of obesity.  A closer look at this apparent paradox reveals that the restraint required by dieting may actually lead to excess weight gain. Recent investigations into the physiology of weight control support this association.  Complex physiologic processes that exist to maintain energy homeostasis tend to resist “starvation” rather than promote weight loss. Under eating may therefore trigger a “famine response” leading to rebound weight gain.

Significance:  Dieting is neither supported by the evidence as an effective way to achieve a healthy long-term weight, nor is it compatible with nursing concepts of homeostasis and holism.  A homeostasis friendly alternative to dieting is needed.

Evidence-based nursing implementation:  The body has built in hunger and fullness cues that exist to guide the proper amount of food intake.  These cues need to be honored instead of ignored in order to avoid disrupting homeostasis.  Instead of restraint based practices that have individuals saying no meeting sustenance needs, intuitive eating has patients saying yes to fulfilling these basic needs.  This is reassuring physically and emotionally.  Having patients eat as soon as they get ideally hungry until they are full is the basis of a new paradigm, “intuitive eating”.  This new strategy is homeostasis friendly and holistic.

Implications of evidence-based nursing practice for the new millennium:  For the vast majority of people, a healthy lifetime weight is not achieved by dieting.  This fact is supported by long term studies as well as exploration into the effects of deprivation. When nurses have an understanding of the homeostatic phenomenon of rebound weight gain patients can be given advice that will help them avoid this undesirable side effect of dieting.