- 1.Obesity Epidemic: Nursing's Role Shirley K. Comer RN,MS,JD.
Nursing 430 Governors State University
2. Prevalence
- Most common chronic disease in the United States.
- Responsible for over 300,000 deaths per year.
- $ 70 billion cost to society each year.
- $ 40 billion spent on treatment annually.
- Has lead to increased morbidity and mortality.
3. Trends
- Number of cases has increased 30 percent in the past 10
years.
- Average weight is up 7.9 pounds.
- Obesity rates could double in 30 years.
4. Obesity
- Obesity: a person is considered obese when the percentage of
body fat, according to age and sex, exceeds 5% of the average
percentage for that age and sex classification. -BMI is a common
measure expressing the relationship (or ratio) of weight-to-height.
It is a mathematical formula in which a person's body weight in
kilograms is divided by the square of his or her height in meters
(i.e., wt/(ht)2. It is more highly correlated with body fat than
any other indicator of height and weight. -Standard weight is based
on sitting height and upper arm length.
5. BMI Graph 6. Definition
- Obesity = body weight (relative to body height) > 20%
IBW
- Morbid Obesity = > 50% or 100 lb > IBW
7. Incidence
- 1/3 to 1/2 of American Adults meet criteria for overweight or
obesity
- 25% of men and 45% of women are trying to lose weight
- Expenditure for weight loss products and services exceeds $33
billion.
8. Etiology:
- i) Enzyme deficiency- responsible for alpha-glycerophosphate
oxidation.
- ii) Differences in thermogenesis- thin people are better able
to dissipate excess calories through heat production.
- iii) Reduced ATPase activity- results in decreased ability to
burn calories.
- iv)"Hibernation response"- relic of human evolutionary past
initiates overeating .
9. Etiology
-
- inheritance of increased # and size of fat cells
-
- child with one obese parent has 40% chance
-
- two obese parents has 80% chance
- vi) Socioeconomic factors
-
-
- children & adults from lower socioeconomic grps
- vii) Psychological -psychogenic component in 90% of cases,
however, it is NOT primary cause.
10. Obesity Is an Increasingly Common Childhood Condition Age 6
to 11: 4%13% Age 12 to 19: 5%14%Growth in Childhood Obesity Over
Three Decades If obese at age 650% chance of life-long obesity If
obese at age 1375% chance of life-long obesityBlacksMexican
Americans Age 619 50% more likely to be obese than whites 11. A few
statistics on childhoodobesity: -4% overweight in 1982, and 16%
overweight in 1994 -25% of all white children overweight in 2001
-33% African American and Hispanic children overweight 2001
-Hospital costs associated with childhood obesity rising from $35
Million (1979) to $127 Million (1999) Why this is a problem? -New
study suggest one in four overweight children is already showing
early signs of type 2 diabetes-60% already have one risk factor of
heart disease 12. TV watching and Obesity People who watch T.V.
weekly become more obese, the graph shows people who are
underweight, and acceptable weight watch T.V. less then people who
are overweight and obese. Therefore T.V. Watching has an effect on
obesity!! 13. 14. Obesity Related Diseases -80% of type 2 diabetes
related to obesity -70% of Cardiovascular disease related to
obesity -42% breast colon cancer diagnosed among obese individuals
-30% of gall bladder surgery related to obesity -26% of obese
people having high blood pressure Surge in childhood Diabetes
-Between 8%-45% of newly diagnosed cases of childhood diabetes are
type 2, associated with obesity -4% of childhood diabetes type 2
has risen 20% -Type 2 is most frequent in ages 10-19 -Of children
diagnosed with type 2 diabetes, 85% are obese 15. Obesity Loves
Inequity BMI >40: Morbidly Obese Male 60% 29% 4% Female 78% 50%
15% BMI >30:Obese BMI >25: Overweight Obese 27% 23% 21% 16%
Diabetic 13% 8% 8% 6% Black Mex. Amer. Male 74% 29% 2% Female 72%
40% 6% WhiteMale 68% 28% 3% Female 58% 31% 5% College Some College
High School No High School 16. Obesity Virtually Guarantees Bad
Health Diseases Tied to Obesity School
17. To Address Obesity, Target the Molecule,Cell, and
Population; Not the Individual In the human body, as in the world,
if you control fuel resources, you influence a lot of other things
as well. Molecular/Chemical Level Population
- indoor entertainment:sedentary behavior
- marketing of poor food: poorer nutrition
Fat Cell
- Not a by-product of individual greed and guilt
- An active organ in its own right
Dr. Gkhan Hotamisligil,Harvard School of Public Health 18. 1996
2003 Obesity Trends* Among U.S. Adults BRFSS, 1991, 1996, 2003
(*BMI 30, or about 30 lbs overweight for 54 person) No Data 350 500
1000 150-199 Approximate Initial Energy Deficit (kcal/d) Suggested
Energy Intake (kcal/d) Body Weight(lb) 47. Drugs Are Not the
Answer?
- Weight loss occurring with single drug therapy is typically 10
percent or less.
- Patients are often disappointed with the small change in
weight.
- Most desire much greater weight loss than is achieved by drugs
alone.
48. The Alternative
- Patients have the option of surgical procedure to help them
lose weight.
-
- Must have a BMI of 40 or above.
-
- Produces results that exceed drug therapy.
49. Patient Selection Criteriafor Bariatric Surgery
- Surgery indicated in patients with:
-
- BMI of 35 or higher with significant co-morbidity
-
- Long-standing history of obesity
-
- Multiple unsuccessful attempts to lose weight using nonsurgical
methods
-
- Ability to comply with dietary and behavioral changes as
recommended by the weight management team
50. Who Is a Surgical Candidate?
- No endocrine cause of obesity
- Acceptable operative risk
- Understands surgery and risks
- Absence of drug or alcohol problem
- No uncontrolled psychological conditions
- Consensus after multidisciplinary team evaluation:
-
- Primary care clinician, bariatrician, surgeon, psychologist,
dietitian, exercise physiologist
- Well-informed, motivated, and dedicated to life-style change
and long-term follow-up
51. % Medical Co-Morbidities Resolved after Bariatric Surgery
Wittgrove AC, Clark GW. Laparoscopic Gastric Bypass roux-n-y-500
patients. Obes Surg 2000.And others. 52. Types of Surgery
- The most common procedures are:
-
- Adjustable Gastric Banding (AGB)
-
- Vertical Banded Gastroplasty (VBG)
-
- Gastric Bypass or Roux-en-y (RNY)
-
- Biliopancreatic Diversion (BPD)
53. Adjustable Gastric Binding
- A band is applied around the top of the stomach.
- The inner lining of the band is a longitudinal balloon.
54. Vertical Banded Gastroplasty
- Restricts stomachs capacity by creating a small pouch.
- Vomiting occurs if patient eats too fast, or too large of
particles.
- Long term weight loss is not great.
55. Gastric Bypass or Roux-en-y
- Stomach is sectioned off, creating a small pouch.
- The pouch usually holds only about one ounce of food.
56. Gastric Bypass cont.
- The pouch empties into the small intestine through a dime-size
stoma.
- The small hole allows slow emptying to increase satiety.
- Food must be well chewed for passage.
57. Cont.
- The part of the small intestine that receives food from the
stomach can not metabolize sugars in beverages and sweets.
- Patients often feel ill after eating sugar.
- The inability to tolerate sugars adds to weight loss.
58. After Gastric Bypass
- It is common that patients lose 50 percent of their starting
weight within the first year.
- Excess skin can be a problem, often patients undergo plastic
surgery as a result.
59. Side Effects of Gastric Bypass
- About 70 percent develop dumping syndrome.
- Decreased absorption of iron, calcium, and vitamin B.
- Mechanisms of action of gastric bypass may include hormonal
changes leading to alterations in eating habits and energy
expenditure.
60. Mortality Risk
- Over time the rate averages 4.5% for those obese patients who
did not have the surgery and about 1% for those undergoing gastric
bypass.
- Gastric bypass is becoming a successful current treatment
method of obesity.
61. Short-term Obesity Therapy Does Not Result in Long-term
Weight Loss Change in Weight (kg) Wadden et al.Int J Obes1989;13
(Suppl 2):39. 5-year Follow-up 1-year Follow-up End of Treatment
Baseline Diet alone Behavior therapy Combined therapy 62. Long-term
Weight Loss is Improved with Long-term Maintenance Therapy Weight
Loss (%) Perri et al.J Consult Clin Psychol1988;56:529. P
