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
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
What is considered to be normal BMI?
What is classified as overweight?
What is considered obese?
Health risks increase if the waist circumference is >____ in a female and
>____ in a male?
Body Shape› Pear shape have more sub-q fat
› Most fat is below the waist
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
Genetic/Biologic basis
Environmental factors
Psychological factors
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
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
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
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
Used to treat morbid obesity
Currently the only treatment found to have a successful and lasting impact for sustained weight loss
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
Three broad categories› Restrictive
› Malabsorptive
› Combination of restrictive and malabsorptive
Have room ready for patient prior to arrival making adjustments in equipment and supplies
Skin Preparation Teach T,C, DB and exercises IV access
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
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
Rapid oxygen desaturation
Wound evisceration and dehiscence
Wound Infection
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
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