Transcript Obesity & Eating Disorders

 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