1. Obesity

2. 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

3. 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

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

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

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

7. 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

8. Etiology and Pathophysiology
Genetic/Biologic basis
Environmental factors
Psychological factors

9. 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

10. Health Risks Associated with Obesity

11. 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

12. 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

13. Treatment and Nursing Care

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

15. 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

16. Patients desire to change lifestyle+
Exercise
Diet control
Weight Loss

17. Surgeries for Obesity

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

19. 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

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

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

22. 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

23. 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

24. 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

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

26. 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

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

28. 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