Obesity and Hypertension:
Vulnerable Population Care Plan
Nicole Chan
GNRS 587
July 16, 2015
Vulnerability
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In California, 25.4% of adults and 15.8% of
adolescents are obese
o Obesity rates are significantly higher in lowincome children
Studies show that the relative risk (RR) for
hypertension increases sharply for those who are
obese
o Strongest relative risk seen in younger
individuals
o Hispanics and Blacks are the most likely to
be obese
Hypertension is the leading cause of death in the US
and California
o HTN also increases the risk for heart disease
and stroke, the two other leading causes of
death
The cost of obesity, and obesity-related diseases to
the state of California is estimated at $15.2 billion
Vulnerable Population Model
Flaskerud and Winslow
Resource Availability:
Lack of Education,
Poor Diet, Minimal to
Low Exercise, and
Lack of Support
Ethics: Beneficence
and Nonmaleficence
Practice: Reduce risk for obesity
and hypertension
Research
Practice,
Ethical, &
Policy Analysis
Health Status:
Hypertension,
Heart Disease,
Stroke, Morbidity and
Mortality
Relative Risk:
Low income, young,
Black, Hispanic
Policy: Legislative
Advocacy & Nursing
Influence
Patient Profile
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The obese and hypertensive patient
Priority health needs: reduce risk for obesity and hypertension
○ Primary Level of Prevention: Education
■ Prevent obesity and reduce the risk of hypertension by teaching
vulnerable populations (low-income, Hispanic and Black, younger
age) about diet, exercise, medication compliance
○ Secondary Level of Prevention: Screening
■ Make sure the patient is seen by PCP regularly and evaluate weight,
monitor BP, check blood levels, etc.
○ Tertiary Level of Prevention: Health Maintenance/Treatment
■ Weight loss programs, BP medications, change in diet, exercise plan
Interventions and Outcome Measures
Interventions
● Primary - Education
o Encourage a healthy lifestyle from infant through adulthood
o Educate regarding risks associated with obesity and HTN
o Educate regarding healthy lifestyle
 diet
 exercise
● Secondary - Screening
o Regular PCP visits to monitor weight and BP
● Tertiary - Treatment and Maintenance
o Weight loss programs
o BP Medications
Interventions and Outcome Measures
Outcome Measures
● BMI
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Normal or healthy weight: 18.524.9
Overweight: 35.0-29.9
Obese: 30.0 and above
● BP Levels
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Normal: Systolic ≤ 120 and Diastolic
≤ 80
Prehypertension: Systolic 120-139
or Diastolic 80-90
HTN Stage 1: Systolic 140-159 or
Diastolic 90-99
HTN Stage 2: Systolic 160+ or
Diastolic 100+
Resources
UCSD Weight Management Program
CDC.gov
NCLEX Question
A patient inquires if his blood pressure is normal. The nurse responds that
normal blood pressure is defined as less than:
A.
B.
C.
D.
160/70 mm Hg
128/60 mm Hg
139/89 mm Hg
130/85 mm Hg
NCLEX Question Answer
B.128/60 mm Hg
Rationale: Normal BP is defined as Systolic ≤ 120 and Diastolic ≤ 80
References
https://www.cdph.ca.gov/programs/cpns/Documents/ObesityinCaliforniaReport.pdf
https://www.cdph.ca.gov/pubsforms/Pubs/OHIRhypertensionDeaths2004.pdf
http://health.ucsd.edu/specialties/surgery/bariatric/non-surgical/Pages/default.aspx
Institute of Medicine. Evaluating obesity prevention efforts.
http://www.iom.edu/About-IOM/Leadership-Staff/Boards/Food-and-Nutrition-Board/ObesityReports.aspx.
Accessed March 28, 2015
Koebnick, C., Smith, N., Huang, K., Martinez, M. P., Clancy, H. A., & Kushi, L. H. (2012). The prevalence of obesity and
obesity-related health conditions in a large, multiethnic cohort of young adults in California. Annals Of
Epidemiology,22609-616. doi:10.1016/j.annepidem.2012.05.006
http://www.sandiegocounty.gov/hhsa/programs/phs/documents/CHS-EconomicBurdenofChronicDisease2010.pdf.