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