Obesity and Malnutrition

Courtney Zeigler
FN 4360
April 8, 2015

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Table of Contents
Introduction
..
3
Methods
.
6
Results
..
7
Discussion
.. 14
Works Cited
.........

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16

Introduction
In todays generation, obesity is a huge health problem. The Obesity
Action Coalition states that obesity is a condition that is associated with
having an excess of body fat, defined by genetic or environmental factors
that are difficult to control when dieting (1). Another way that obesity can
be classified is by looking at a patients BMI. If a patient has a BMI of 30
kg/m2 or greater, they are classified as obese. In the article Linking Obesity
and Malnutrition, Wrathall states according to the World Health
Organization, obesity is a condition of abnormal or excessive fat
accumulation to the extent of impaired health. In 2008, 1.4 billion adults
were overweight and 65% of the worlds population lived in countries where
overweight kills more people than underweight. Wrathall also finds that
obesity is more closely related with chronic malnutrition than it is to
unhealthy food choices (2). Each year, more studies are done, proving that
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obesity trends are drastically increasing in every country. Risks for being
affected by other conditions are extremely high when a patient is affected by
obesity. Some of conditions that are associated with obesity are high blood
pressure, high cholesterol, diabetes, heart disease, stroke, osteoarthritis and
other joint problems, and even respiratory problems. Many are unaware that
they even have another condition on top of obesity.
Behavior, environment, and genetics are the main factors that
contribute to obesity. In the average persons hectic schedule these days,
many unhealthy food choices are made to save time and/or money. This is
the behavior aspect that can lead to obesity. When one is in a rush or not
concerned with what foods they are eating, they may begin to make
unhealthy choices. Societys environment is much more sedentary than
previous generations. Instead of walking or riding a bike, people drive cars.
Instead of playing outside, people will sit on a couch and watch TV. This leads
to a decline in the amount of physical activity performed each week by the
average person, increasing the risk for obesity. Genetics also increase the
likelihood of one becoming obese if it is in their familys medical history or if
they have another preexisting condition that may cause obesity (1).
Not only is obesity a problem in itself, but it can cause many other
health issues if it is not properly taken care of. Hypertension is one condition
that is associated with obesity. For an overweight or obese person, the risk of
getting diagnosed with hypertension is up to five times higher than the risks
of a person of normal weight. Arthritis and other bone related issues can also
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arise from problems created because of obesity. This is due to all of the
weight and stress that is put onto the joints during long periods of time, such
as standing, walking or running long distances (3). These are just a few of
the many health conditions or diseases that can all stem from the problems
caused by obesity.
With an estimated number of 1.4 billion overweight adults in 2008,
shows that the numbers would be much higher now. The prevalence of
obesity is increasing in all age groups, even including adults 65 years and
older. In middle aged and elderly persons, obesity can even lead to more
negative effects on ones quality of life. In older persons, obesity will just
accelerate the decline of physical function and will lead to frailty (4). Aging
already causes a progressive decline in physical function and quality of life.
When aging is accompanied with obesity, it will just cause the decline to
occur at a faster rate, and impairments caused by obesity may start to effect
the activities of daily living.
As hormones change with age, certain hormone levels can cause fat to
accumulate in certain areas of the body and may become harder to get rid
of. With obesity being associated with so many other conditions, it can also
lead to premature death. If weight is not controlled at an early stage it will be
much harder to begin a diet to lose that weight. Patients will need to be
aware of any other existing conditions they may have that are due to
obesity, even if they might not even think that they had them.

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A main concern of the elderly is how obesity can affect their activities
of daily living. Elderly persons become frailer with age, and their level of
physical function will begin to decline with age. The more weight that is put
on a joint determines how stressed that joint will be. The more stressed it is,
the more likely it will begin to wear down and be damaged (5). Not only are
elderly people more at risk for arthritis and joint pain in the first place due to
bone loss, but obesity will increase their risks even more. If they are in pain
or are experiencing arthritis, they is going to decrease their physical ability
to perform necessary activities. This can become a huge problem if it is not
treated or controlled because they need to be able to perform the necessary
daily activities that they need to do to live a quality life. If the patient is
obese, then many additional health problems may arise. This health issues
include increased risk for hypertension, cardiovascular disease, diabetes,
arthritis, and others of the like. Goals should be made to help keep the
weight under control so that any other existing health conditions do not get
any worse.

Methods
The background information was collected in a one-on-one interview
with the patient. The patient works with the researchers father at the Maple
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Heights Fire Station located in a suburb of Cleveland, Ohio. In order to obtain

the information, the researcher was allowed to visit their father and the
patient while they were on shift at the fire station. Sitting down face to face
with the patient allowed all of the necessary information to be gathered. The
patient was aware of the condition he was in, and knew why he was being
interviewed. The researcher explained what kind of questions would be
asked in the interview, and that no personal names would be used for
confidentiality reasons. The main types of questions asked consisted of: any
previously diagnosed medical conditions, normal diet pattern, usual body
weight/any changes, how much physical activity is performed in one week,
etc.
One thing that was necessary for the interview was a 24-hour diet
recall. This diet was then put into SuperTracker to be analyzed. After
obtaining all of the information needed for the interview, the researcher was
clearly able to state what the patient had to work on. The researcher
recommended putting some goals in place so that the patient can work on
keeping their health condition under control. These goals were formed once
the researcher reviewed the 24-hour diet recall. Forming the objectives for
each goal was very simple one the patient realized what had to be done.

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Results
In this study, the patient that was interviewed was a 55 year old male.
The patient is 510 and weighs 235 pounds. The patients ideal body weight
is 166 pounds, +/- 10%. That makes this patient 142% of their ideal body
weight, classifying the patient as obese. Furthermore, the patients BMI is
33.7 kg/m2 (Obesity Class II). With a BMI as high as this patient, there is a
very high risk for developing hypertension, diabetes, and cardiovascular
disease.
The patients full time occupation is being a firefighter. The patient is
currently married with two children, 20 and 16. With such a stressful work
schedule (works 24 hours straight, has 48 hours off), the patient claims there
is not a lot of free time left for exercising. Not only is it a time constraint, but
the patient has no strong desire to increase his amount of physical activity
with all of the stress and physical strains of the workday that he is under.
When the patients children were younger, he was very involved with their
activities. The patient was always willing to run around outside with his kids,
or play baseball, soccer, or other outdoor activities with them. Years ago
when the patient was in high school, he was on the football team along with
the baseball team. Although the patient is currently overweight, physical
activity was always a huge part of his lifestyle. The patient states that he has
always loved sports, including watching them on TV, and he would like to
regain some of his athletic abilities.

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The Maple Heights Fire Station is equipped with a full weight room. The
patient was able to show the researcher around and explain some of the
machines that the patient regularly uses. The weight room included multiple
sets of weights, along with a bike, a treadmill, and an elliptical, also with
different racks for squats, bench press, and dead lift. The patient explained
that with such a hectic job, there is not much free time at the station to take
the time to complete a full workout, which the researcher knew of already
because of her father. Even if there is down time, the patient states that he
has never done more than a half hour on the bike or elliptical, accompanied
by a few arm workouts on a machine. The patient was not happy with his
condition and how his heath has progressively declined since his early 40s.
During the interview, the researcher obtained a 24-hour recall on the
patients diet. This diet was then put into SuperTracker so that it could be
analyzed (see 24 hour recall and nutrient analysis below). Before the diet
was analyzed, the patient was aware that he was overweight and was aware
that he was taking in an excessive amount of calories each day. Along with
the excessive amount of calories consumed, the patient is also at extremely
high risk for hypertension, diabetes, and cardiovascular disease. Along with
the patient being overweight, he has already been diagnosed with
hypertension (blood pressure of 180/100) and high cholesterol (300 mg/dL),
making him even more at risk for cardiovascular disease. The patient also
suffers from the occasional acid reflux and heartburn. For these conditions,
the patient takes two different prescription medications and one medication
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that is available over-the-counter. Lipitor is taken for high cholesterol. Zestril

is taking to keep the patients hypertension under control. For acid reflux and
heartburn, the patient takes Zantac (over-the-counter) only as needed. The
patient stated that Zantac is taken once a day, whenever the heartburn
begins. It is never needed more than that since the medication runs its
course for eight hours, as it is usually taken after the patient eats lunch. It
was also discovered that the patients brother and father also have high
blood pressure. Along with high blood pressure, the patients father is also
overweight and has high cholesterol levels. The patients mother and sister
do not have any existing health conditions and have always had their weight
under control.
Patients 24-hour Diet Recall:
3 cups black coffee
(drank throughout the
morning)
3 egg whites, 2 egg
yolks (cooked
overeasy)

Breakfast

Lunch

Snack
Dinner

1 piece multigrain
toast w/margarine
2 sausage links
1 cup skim milk
Pulled Pork on
hamburger bun (extra
bbq sauce)
1 cup baked beans
1 cup potato chips
1 cup skim milk
1 cups light
cottage cheese
1 peach fruit cup
Baked chicken breast
- 6 oz
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1 cup steamed green

beans

Snack

1 cup angel hair pasta

w/ oil and salt
1 cup skim milk
1 slice cherry pie
1 cup vanilla ice
cream

The patient easily recalled diet in the last 24 hours when asked. The
patient also stated that his everyday meals are quite similar to the ones
listed above. The patient always consumes three meals during the day;
breakfast, lunch, and dinner. Two or three snacks are consumed each day,
where dessert is always eaten after dinner each day. The patient states that
his diet has always been like this, it is not unusual for him to eat this much,
especially because he is not very concerned with watching his daily intake of
calories. The patients mindset is that he still believes he can eat whatever
foods he was eating 20 years ago. Patient is classified under Obesity Class II
with his BMI, but confirms that he has always been on the larger size for his
age, especially when he was younger with his friends.
SuperTracker Nutrient Analysis based off of Patients 24-hour Diet Recall:

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Nutrients

Target

Average Eaten

Status

Total Calories

2200 Calories

3021 Calories

Over

Protein (g)***

56 g

190 g

OK

Protein (% Calories)***

10 - 35% Calories

25% Calories

OK

Carbohydrate (g)***

130 g

352 g

OK

Carbohydrate (% Calories)***

45 - 65% Calories

47% Calories

OK

Dietary Fiber

30 g

39 g

OK

Total Sugars

No Daily Target or
Limit

152 g

No Daily Target or
Limit

Added Sugars

No Daily Target or
Limit

36 g

No Daily Target or
Limit

Total Fat

20 - 35% Calories

29% Calories

OK

Saturated Fat

< 10% Calories

8% Calories

OK

Polyunsaturated Fat

No Daily Target or
Limit

7% Calories

No Daily Target or
Limit

Monounsaturated Fat

No Daily Target or
Limit

11% Calories

No Daily Target or
Limit

Linoleic Acid (g)***

14 g

22 g

OK

Linoleic Acid (% Calories)***

5 - 10% Calories

6% Calories

OK

-Linolenic Acid (% Calories)***

0.6 - 1.2% Calories

0.6% Calories

OK

-Linolenic Acid (g)***

1.6 g

2.1 g

OK

Omega 3 - EPA

No Daily Target or
Limit

26 mg

No Daily Target or
Limit

Omega 3 - DHA

No Daily Target or
Limit

90 mg

No Daily Target or
Limit

Cholesterol

< 300 mg

785 mg

Over

Minerals

Target

Average Eaten

Status

Calcium

1000 mg

1799 mg

OK

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There was many different aspects of the diet that need to be looked at
when it comes to obesity. Not only how many calories are being consumed,
but how many of the calories are coming from fats, proteins, or added
sugars. After looking at the nutrient analysis from SuperTracker, it is
apparent that there are many areas that need to be changed. Some intakes
that the patient has not met were the recommended levels for Vitamins C, D,
E, and K. The only Vitamins that were under the target level in an excessive
amount were vitamins C and K. Vitamins D and E were just barely below the
target level, as shown above in the nutrients report. The patient was also
consuming excess in multiple areas. The patients estimated calorie needs
are 2870 kcal/day. The patients actual intake was 3021 kcal/day, 105% of
the recommended intake. Along with an excess consumption of calories, the
patient also consumed an extreme amount of sodium. The average target
level for sodium is 1500 mg or lower. In the patients nutrient analysis of the
24-hour diet recall, there was a consumption of 5717 mg of sodium in just
one day. The recommended intake levels for cholesterol are 300 mg/dL or
lower, and the patient consumed 785 mg of cholesterol. With high
cholesterol, cholesterol intake is one thing that needs to be carefully
monitored. Sodium intake is also extremely important, as for patients with
hypertension, sodium intake should be kept at a very minimum value, as it
will just increase blood pressure. Like previously stated, the patient was
aware of the excess calories he had been consuming. The patient was not
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aware that his sodium and cholesterol levels were that high, since he
thought he ate rather healthy. Before the interview, the patient believed that
all he would have to fix was portion control.
Of the patients diet recall, 190 g of protein were consumed. Using the
patients body weight of 106.8 kg, only 85.4 g of protein were needed. Out of
calories consumed, 25% of these daily calories were from protein, which is
completely normal because protein consumption should be within 10-35% of
intake. Of the 3021 calories consumed, 47% of these were from
carbohydrates. This percentage is also normal, since the carbohydrate intake
should be within 45-65% of calories consumed. Lastly, 29% of the patients
calories were from total fat. Total fat consumed should make up 20-35% of
the calories consumed, also making the 29% consumption of fat normal.
No problems were encountered when giving the patient the interview.
The patient seemed a bit overwhelmed by the end of the interview because
the researcher put all of the values into SuperTracker as the patient gave his
diet recall. The patient knew about his existing blood pressure and
cholesterol conditions, but he believed his medications kept it under control.
There was not much thought put into the fact that a healthy lifestyle can
greatly impact his health conditions in a positive way. The patient
exemplified strong motivation to work on changing his diet to begin getting
his health conditions under control.
Discussion

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After the interview with the patient, it is apparent that many things
need to be changed. Not only does this include diet changes, but also
lifestyle changes. The hypothesis was that if the patient is obese, then the
risks for many additional health conditions will greatly increase. Some of
these conditions included hypertension, diabetes, and cardiovascular
disease. This hypothesis was proven to be true, especially since the patient
already had existing diagnoses of hypertension and high cholesterol. High
cholesterol greatly increases the patients risk for also developing
cardiovascular disease. The patient also occasionally suffers from heartburn
and acid reflux, which is most likely associated with the foods the patient is
consuming. The patients sodium intake is at an all-time high, and that is one
thing that needs to be changed immediately. The recommended intake for
sodium should be 1500 mg or less per day, and the patients intake in the
24-hour diet recall alone was 5717 mg, which is extremely high. The patient
has hypertension, and if sodium intake is not drastically decreased, then
many more problems will occur. Having high cholesterol also means that
cholesterol intake needs to be very closely monitored, which the patient
clearly did not exhibit. Cholesterol intake should be kept under 300 mg per
day, and the patient consumed 785 mg. The patient needs to much more
carefully monitor sodium and cholesterol intake and not just rely on the
medications to keep it under control.
Not only does the patient already have hypertension and high
cholesterol, but those conditions can lead to many other problems such as
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cardiovascular disease and stroke. Diet is one thing that is extremely

important when it comes to controlling obesity. Other lifestyle changes need
to be put into place, also. Physical activity needs to increase to help keep the
patients weight at a stable number. If the patient works consistently to
increase physical activity levels, and decrease sodium and cholesterol intake,
he will begin to lead a much healthier life. The patient is currently 55 years
old, and still has most of his life ahead of him. Now that the patient realizes
where he has gone wrong and what he needs to fix immediately, he can
begin to plan the changes he will make to get his health back on track.

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Works Cited
1. Obesity Action Coalition. What is obesity. OAC. January 2015.
http://www.obesityaction.org/understanding-obesity/obesity
2. Wrathall J. Linking obesity and malnutrition: two forms of nutritional
stress in developing countries. Int J Sociol. June 2014; 44(2): 63-86.
3. Haslam D, James W Philip. Obesity. NOF. October 2005; 366: 11971209.
4. Villareal D, Apovian C, Kushner R, Klein S. Obesity in older adults:
technical review and position statement of the American Society for
Nutrition and NAASO. Am J Clin Nutr. November 2005; 82(5): 923-934.
5. Kane A. How fat affects arthritis. Arthritis Foundation. March 2011.
http://www.arthritistoday.org/about-arthritis/arthritis-and-yourhealth/obesity/fat-and-arthritis.php

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