OBESITY:A. OBESITY-excess amt of body fat

1. Primary- due to excess ingestion2. Secondary- due to genetic problems3. BMI indirect measure of total fat, uses height & weight

a. N=18.5-24.9, overweight=25-29.9, obese≥30-20% above IBW, Morbidly obese≥40-100% above IBW

4. Waist circumference better predictor CAD than BMI5. Gynoid (pear), android (apple)-more health risks

B. PREDISPOSING FACTORS1. Genetic predisposition2. Environmental factors- pre-packaged foods, inactivity, increased serving size, high fat diet3. Psychological factors4. Drug therapy

a. Corticosteroidsb. Estrogensc. NSAIDSd. Antihypertensives, antidepressants, antiepileptics, phenothiazines

C. COMPLICATIONS

1. CAD2. DM3. HTN4. Hyperlipidemia5. Sleep apnea6. Cholelithiasis7. Osteoarthritis8. Chronic back pain9. GERD, steatohepatitis

10. Breast, endometrial, ovarian cancer

11. Stroke12. Depression13. Gout, Hyperuricemia14. PCOS15. End-stage renal dx16.infection

D. MEDICAL/SURGICAL INTERVENTIONS1. LIFESTYLE CHANGES

a. Give list community resourcesb. Collab w/ nutritionist & provide health teachc. Encourage increase physical activityd. Establish normal eating pattern

2. NUTRITION THERAPYa. Restrict intake to below requirementsb. Weigh wklyc. Eat regularly & don’t skip mealsd. Measure portion sizee. Avoid concentrated sweetsf. Decease fat intake & avoid alcohol

3. EXERCISE PROGRAM4. DRUG THERAPY

a. Appetite suppressants- anorecticb. Nutrient absorbent-blocking agents- Xenical(Orlistat)

5. BEHAVIOUR MODIFICATION a. Reinforcement techniques- self-monitoring, rewards, stimulus control

6. SURGERY

a. Restrictive- VBG, LABGb. Malabsorption- BilrothI/II- increased risk gallstonesc. COMBINATION- Roux-en-y-DUMPING SYNDROME- increase fats & proteins

1. Post-opa. Maintain airway & manage painb. Maintain pt safetyc. Patency NG tubed. Assess Anastomotic leak – increased BAS pain, restlessness,

tachycardia, oliguriae. Abdominal binderf. Semi-fowlersg. Observe skinh. Absorbent padding between foldsi. Remove NG post-op day 3j. Give 1oz H20pureed foodsk. Observe DUMPING SYDNDROME

E. COMPLICATION SURGERY1. Wound infection2. Anemia3. Vit. Deficiency4. Psychiatric probs5. Anastomotic leak most common and life threatening