2Obesity and Overweight Obesity is an abnormal increase in the proportion of fat cellsPrimarily occurs in the visceral and subcutaneous tissues of the bodySecond leading cause of preventable deathThird leading reason for liver transplantation
3Classification of Body Weight and Obesity Body mass index (BMI) – see chart, p. 945Waist circumferencePeople with excessive visceral fat in waist are more prone to cardiovascular disease and metabolic syndromeWaist-to-hip ratio (WHR)Waist measurement is divided by hip measurementA WHR measurement >.08 is at risk for complications
4Body Mass Index What is considered to be normal BMI? What is classified as overweight?What is considered obese?
5Waist CircumferenceHealth risks increase if the waist circumference is>____ in a female and>____ in a male?
6Classification of Body Weight and Obesity Body ShapePear shape have more sub-q fatMost fat is below the waist
7Apple Shaped Body Apple shape have more visceral, abdominal fat and are prone to:Elevated triglyceridesMetabolic syndromeDecreasing insulin sensitivityHigh levels of HDL cholesterolIncreasing blood pressureRelease of more fatty acids into the bloodstream
8Etiology and Pathophysiology Genetic/Biologic basisEnvironmental factorsPsychological factors
9Health Risks Associated with Obesity Problems occur at higher rates for obese patientsMortality rate rises as obesity increasesEspecially with increased visceral fatObese patients have a decreased quality of lifeMost conditions improve with weight loss
11Metabolic Syndrome Also know as Insulin Resistance Diagnostic Criteria:Increased Waist circumferenceElevated TriglyceridesElevated HDLElevated Blood PressureFasting Blood Glucose > 110mg/dlThese people are at risk for heart disease, stroke, Diabetes, renal disease
12Goals of Care Modify eating patterns Participate in a regular physical activity programAchieve weight loss to a specified levelMinimize or prevent health problems related to obesity
14Start with Behavior Modification Patient must be ready for change in their lifestyle
15Treatment and Nursing Care Nutritional TherapyLow calorie with adequate amounts of fruits and vegetables, bulk, and meets daily vitamin requirementsAvoid fad dietsSmall PortionsExercise30 minutes to 1 hour per day
16Patients desire to change lifestyle +ExerciseDiet controlWeight Loss
18Bariatric Surgery Used to treat morbid obesity Currently the only treatment found to have a successful and lasting impact for sustained weight loss
19Bariatric SurgeryMust meet all of the following criteria to be considered an ideal candidateBMI ≥40 kg/m2 with one or more obesity-related complication18 years or olderUnderstands the risks and benefitsHas been obese for >5 yearsHas tried and failed to lose weight
20Bariatric Surgery Three broad categories Restrictive Malabsorptive Combination of restrictive andmalabsorptive
21What is different in the pre-op nursing carefor theObese Patient?
22Preoperative CareHave room ready for patient prior to arrival making adjustments in equipment and suppliesSkin PreparationTeach T,C, DB and exercisesIV access
23Postoperative CareTrained staff should assist transfer of unconscious patient . During transfer ensure that patient’sAirway is stabilizedPain is managedAssess of vital signs.What is of particular concern ?Keep bed at 300 – 450
24Postoperative Care T,C, DB – being sure to splint incision. Why is so important?What is a complication if does not splint incision?Pain ManagementTED hose and pneumatic compression devices
25Post op complications Rapid oxygen desaturation Wound evisceration and dehiscenceWound Infection
26Post –op ComplicationDumping syndrome – gastric contents empty too rapidly into the small intestineSymptoms – vomiting, nausea, weakness, sweating, faintness, and diarrheaPrevention – eat small meals; avoid high CHO foods/concentrated sweets and no fluids with mealsIron Deficiency anemia
27What is the criteriafor feeding thisPatient?What type of diet arethey placed on?
28Evaluation Expected outcomes Long-term weight loss Improvement in obesity-related co-morbiditiesIntegration of healthy practices into lifestyleMonitoring possible adverse side effectsImproved self-image