Graduate Student: Obesity Management Survey

Fruh, Sharon; Fruh, Sharon

Graduate Student: Obesity Management Survey

Abstract:

Background: Overweight and obesity account for one of the greatest health issues facing health care providers today. Overweight and obesity has escalated to epidemic proportions in the United States, two out of three Americans are overweight and approximately 35% and 37% of adult men and women respectively have obesity (Yang & Colditz, 2015). Obesity is associated with a significant increase in mortality with a decrease in life-expectance of 5-10 years (de Gonzalez et al., 2010; Kuk et al., 2011). Obesity, the most prevalent chronic disease, affects multiple systems and can lead to a large number of disease states (Dobbins, Decorby, & Choi, 2013). Given the high prevalence and complications of overweight and obesity, health care providers play a significant role in the management of obesity. Advanced practice providers need to be prepared to address this epidemic and provide the best possible obesity management care. A study cited that providers identified inadequate skill in weight-loss counseling as a barrier to obesity management (Brown et al., 2007). One of the most efficient and cost-effective ways to increase provider’s skills related to obesity management is to ensure that the next generation of providers are thoroughly prepared in their graduate advanced practice program.

Purpose: The purpose is to identify advanced practice graduate nursing students’ confidence, knowledge, and curriculum recommendations related to obesity management. This study provided an opportunity for students to list challenges as well as successful strategies they have identified with obesity management.

Methods: The research method included developing and administering a survey to graduate advanced practice nursing students enrolled in a university in the Deep South that has online students across the United States. Institutional review board approval was obtained, and the survey was administered online to provide students the opportunity to participate. The survey was developed with national experts and included questions with Likert-type responses as well as open-ended questions. The survey included information related to: a) demographics; b) confidence in best practices related to obesity management (obtaining accurate body mass index [BMI] measurements, initiating a conversation about obesity management with patients, assessing motivation, applying shared decision-making, educating patients with lifestyle modifications, assessing patients’ ability to safely participate in exercise, prescribing a dietary and activity plan for obesity management, prescribing medications if appropriate, identifying goals, scheduling appropriate follow-up appointments, and billing for visits); c) knowledge regarding guidelines related to pharmacological treatment and familiarity of anti-obesity medications; d) experience related to obesity management; d) challenges with obesity management; e) successful strategies related to obesity management; f) preparation to confidently manage patients with obesity from both their undergraduate and graduate programs; g) specific suggestions for including obesity management content in graduate curriculum to increase expertise and confidence; and h) self-reported height and weight.

Results: graduate advance practice students completed Ninety-eight surveys: 90 females, 7 males and 1 missing data. Participants ranged in age from 26-61 years. In terms of race, 16% were African American, 2% were Hispanic, 70% were White and 11.3% were other. The BMI ranged from 19.57 to 51.37 with a mean BMI of 27.92 and a median of 26.36. When students were asked how well their undergraduate nursing educational program prepared them to confidently manage patients with obesity, 30% indicated not well at all, 32% indicated slightly well, 26% indicated moderately well, and 11% indicated very well or extremely well. In terms of the quality to which graduate nursing educational programs prepared them:13.4% indicated not well at all, 26.8 indicated slightly well, 26% indicated moderately well, and 30.5% indicated very well or extremely well. When students were asked to list the FDA approved anti-obesity medications, only 48% percent were able to list some of the medications. The open-ended questions were tabulated and reported with common themes:

What could be included in graduate or undergraduate curriculum to increase your expertise and confidence in obesity management?

“How to broach the subject of weight loss.”
“A clinical based solely on obesity-management”
“Clear instruction on evidence-based diets and medication options.”
“Algorithm very detailed for pediatric obesity management for each age group would be a great tool to have walked out of NP school with.”
"A specific unit related to obesity management just like managing any other chronic disease.”
“Clinical practices and case studies.”
“Clinical time in bariatric facilities or outpatient weight management programs.”
“Discuss pharmaceutical obesity treatment.”
“Discuss psychological component of obesity counseling.”
“How exercise programs can be tailored based on age, health, and nutritional education.”
“Assignments specifically related to obesity management.”
“Nutrition and exercise planning for specific populations.”
“Cognitive behavioral therapy training and classes on motivational interviewing.”
“Obesity management deserves its own class.”
“Nutrition education, how to set caloric goals and different diet options.”
“Specific courses within primary care programs or a subspecialty certificate, such as that already exists for cardiology, etc.”

The greatest challenge with obesity management:

“Not having a deep history in nutrition really limits the conversations I can have.”
“Gaining confidence in approaching this subject in a respectful manner.”
“My own struggle with weight. Presenting myself as an authority when I am overweight.”
“Ways to positively affect compliance.”
“Non-compliance.”
“Patient motivation.”
“Not comfortable with prescribing anti-obesity medications.”

Describe some successful strategies that you have identified regarding managing a patient with obesity:

“Being honest. Having them develop their plan of care.”
“Create several short-term goals. Buddy system is also helpful.”
“Creating a diet plan together, based on what the patient likes and is willing to eat.”
“Carbs only for breakfast and lunch. Protein and veggies for dinner.”
“Encourage movement of any kind, food diary, write out measureable goals.”
“Encourage a patient to make small changes, such as just walking for 5 minutes a day at first and then slowly building up.”
“Helping college students make wiser choices on campus and at preferred fast food places.”
“Focusing on small achievements versus the long-term goal.”
“Group classes or other forms of adjunct treatment that provides for patient accountability.”
“Meal prep with opportunities to log in intake and activity with an APP or other electronic methods.”
“Logging with a journal.”
“Encouraging patients to watch Jamie Oliver’s Food Revolution, as it’s a personal favorite of mine.”
“Treat underlying depression.”

Discussion:

With the obesity identified as an epidemic in today’s society, it is critical that nurse educators appraise graduate curriculum to ascertain that relevant, up-to date, comprehensive obesity-management education is in place. It is essential to identify appropriate clinical experiences that provide opportunities for students to provide appropriate obesity management.

It is important to identify that, just like the general population, many advanced practice nurses struggle with issues of overweight or obesity. This study identified that the mean and median BMI were in the overweight range. It has been well documented that advanced practice nurses who are overweight or obese are often reluctant to address the topic of weight management with patients (Bleich, Bennettt, Gudzune, & Cooper, 2012). Providers who are overweight or obese were much less likely to discuss weight loss with patients who are obese than providers with a normal BMI (Bleich et al., 2012). It is important that the curricula used to educate advanced practice healthcare providers includes effective strategies to help individuals struggling with weight issues identify the fact that they can be a compassionate and effective provider for obesity management.

Students need to be guided on addressing negative attributes related to obesity stigma and bias. Providers need to be aware of their own personal biases and beliefs related to individuals with obesity. Studies have found that providers with personal bias against someone who is overweight or obese are much less likely to participate in obesity management (Brown et al., 2007; Puhl & King, 2013; Ward-Smith & Peterson, 2016). Incorporating opportunity for students’ self-evaluation into an obesity management module may help students to overcome the stigma associated with obesity and the biases toward providing management of the chronic condition.

Conclusion:

With the high prevalence of overweight and obesity, one of the best ways to enhance patient care is to prepare advanced practice nurses to be highly skilled in obesity management. Students strongly desire to learn strategies on how to start conversations about obesity management and, therefore, should be taught best practices related to obesity management. It is important to prepare students to address all age groups related to obesity management.

Educators need to be aware that graduate students who struggle with their own weight issues may be reluctant to engage in obesity management. It is important to encourage these students that, like any other chronic disease, having the disease does not disqualify the provider. These students can be encouraged to share their own journey which can be perceived as comforting and motivating to patients.

Educators need to take the lead as they play an essential role in preparing advanced practice nurses to provide the best possible obesity management care to their current and future patients. Care must also be taken to ensure that a comprehensive curriculum is in place related to obesity management. The coursework needs to include evidence-based management for all populations.