Obesity

Obesity and Overweight Obesity is an abnormal increase in the proportion of fat cells Primarily occurs in the visceral and subcutaneous tissues of the body Second leading cause of preventable death Third leading reason for liver transplantation

Classification of Body Weight and Obesity Body mass index (BMI) – see chart, p. 945 Waist circumference People with excessive visceral fat in waist are more prone to cardiovascular disease and metabolic syndrome Waist-to-hip ratio (WHR) Waist measurement is divided by hip measurement A WHR measurement >.08 is at risk for complications

Body Mass Index What is considered to be normal BMI? What is classified as overweight? What is considered obese?

Waist Circumference Health risks increase if the waist circumference is >____ in a female and >____ in a male?

Classification of Body Weight and Obesity Body Shape Pear shape have more sub-q fat Most fat is below the waist

Apple Shaped Body Apple shape have more visceral, abdominal fat and are prone to: Elevated triglycerides Metabolic syndrome Decreasing insulin sensitivity High levels of HDL cholesterol Increasing blood pressure Release of more fatty acids into the bloodstream

Etiology and Pathophysiology Genetic/Biologic basis Environmental factors Psychological factors

Health Risks Associated with Obesity Problems occur at higher rates for obese patients Mortality rate rises as obesity increases Especially with increased visceral fat Obese patients have a decreased quality of life Most conditions improve with weight loss

Health Risks Associated with Obesity

Metabolic Syndrome Also know as Insulin Resistance Diagnostic Criteria: Increased Waist circumference Elevated Triglycerides Elevated HDL Elevated Blood Pressure Fasting Blood Glucose > 110mg/dl These people are at risk for heart disease, stroke, Diabetes, renal disease

Goals of Care Modify eating patterns Participate in a regular physical activity program Achieve weight loss to a specified level Minimize or prevent health problems related to obesity

Treatment and Nursing Care

Start with Behavior Modification Patient must be ready for change in their lifestyle

Treatment and Nursing Care Nutritional Therapy Low calorie with adequate amounts of fruits and vegetables, bulk, and meets daily vitamin requirements Avoid fad diets Small Portions Exercise 30 minutes to 1 hour per day

Patients desire to change lifestyle + Exercise Diet control Weight Loss

Surgeries for Obesity

Bariatric Surgery Used to treat morbid obesity Currently the only treatment found to have a successful and lasting impact for sustained weight loss

Bariatric Surgery Must meet all of the following criteria to be considered an ideal candidate BMI ≥40 kg/m2 with one or more obesity-related complication 18 years or older Understands the risks and benefits Has been obese for >5 years Has tried and failed to lose weight

Bariatric Surgery Three broad categories Restrictive Malabsorptive Combination of restrictive and malabsorptive

What is different in the pre-op nursing care for the Obese Patient?

Preoperative Care Have room ready for patient prior to arrival making adjustments in equipment and supplies Skin Preparation Teach T,C, DB and exercises IV access

Postoperative Care Trained staff should assist transfer of unconscious patient . During transfer ensure that patient’s Airway is stabilized Pain is managed Assess of vital signs. What is of particular concern ? Keep bed at 300 – 450

Postoperative Care T,C, DB – being sure to splint incision. Why is so important? What is a complication if does not splint incision? Pain Management TED hose and pneumatic compression devices

Post op complications Rapid oxygen desaturation Wound evisceration and dehiscence Wound Infection

Post –op Complication Dumping syndrome – gastric contents empty too rapidly into the small intestine Symptoms – vomiting, nausea, weakness, sweating, faintness, and diarrhea Prevention – eat small meals; avoid high CHO foods/concentrated sweets and no fluids with meals Iron Deficiency anemia

What is the criteria for feeding this Patient? What type of diet are they placed on?

Evaluation Expected outcomes Long-term weight loss Improvement in obesity-related co-morbidities Integration of healthy practices into lifestyle Monitoring possible adverse side effects Improved self-image