Week 12: Caring for Adults Who Are Overweight/Obese and Gastrointestinal Disorders

Underweight BMI measurement:

<18.5

Normal range BMI measurement:

18.5-24.9

Overweight range BMI measurement:

25.0-29.9

Obese range BMI measurement:

greater than 30.0

Obese classes 1-3:

Class 1: 30.0-34.9

Class 2: 35.0-39.9

Class 3: greater than 40 extreme obesity

Nursing considerations for measuring waist circumference:

-ask the person to stand

-the tape measure should fit snugly around the waist without compressing the skin

-measure at the end of a normal respiratory cycle

Waist circumference for men vs women:

Men: <40 inch

Women: <35 inch

Waist to height ratio (WHtR):

-0.6 or higher (high adipose)

-0.5 to 0.59 is increased adiposity

-0.4 to 0.49 healthy

Prevalence of overweight and obesity:

-ages 40 to 59 are the biggest

-NOW both genders have more severe obesity

-overall obesity rates have risen

-73.1% of adults in US are overweight or obese

Which ethnicity has the least/most obesity rate?

-African Americans have highest rate

-Asian have the lowest rate

Why has obesity increased in recent years?

-toxic food environment (going out to eat)

-increased availability and affordability of energy dense and ultra processed food

-environmental barriers to activity (sedentary jobs, reduced walking)

-more poor sleep quality

Health risks associated w/obesity:

-depression/low self esteem

-type 2 diabetes

-sleep apnea

-osteoarthritis

-hyperlipidemia

-gastroesophageal reflux disease (GERD)

-chronic kidney disease

-all types of cancer

Orexigenic factors:

factors that increase appetite

Anorexigenic factors:

factors that reduce appetite

Nursing considerations for overweight patients:

-maintain privacy regarding the patient's weight

-anticipate the need for bariatric equipment/supplies

-use respectful nonbiased communication

How to encourage healthy behaviors:

-build a rapport

-ask patients if they wish to discuss their weight or health

-avoid the term obesity

-discuss the benefits of modest weight loss (5%-10%)

-encourage physical activity

-promote self acceptance

What is sarcopenia?

loss of muscle mass if protein intake is not high

Physical activity guidelines:

-maintaining and improving health: 150 mins per week

-prevention of weight gain: 150-250 mins per week

-prevent weight gain after weight loss: 200-300 mins per week

BMI and pharmacological therapy:

-BMI greater than 30

OR

-BMI greater than 27 w/at least one weight-related condition

Orlistat (Xenical)

-over the counter

-4 to 5% weight loss

-contraindicated in gall bladder disease, hx of kidney stones, chronic malabsorption

MOA of Orlistat (Xenical)

-impairs absorption of dietary fat in the intestines

S/s of Orlistat:

-intestinal discomfort and diarhhea

-steatorrhea

-reduces absorption of fat soluble vitamins

MOA for Phentermine:

sympathetic nervous system stimulant that suppresses appetite and increases metabolism

Phentermine

-moderate weight loss but temporary use

-contraindicated in cardiovascular disease (HTN,CAD,HF) and anxiety disorders, hyperthyroidism

S/s of Phentermine

-dizziness

-insomnia

-dry mouth

-tachycardia

-hypertension

Bupropion/Naltrexone (Contrave)

-moderate weight loss

-contraindicated with use of opioids, seizure disorders, uncontrolled HTN

MOA of Bupropion/Naltrexone (Contrave)

appetite regulatory centers and reward pathways in the brain, decreasing food cravings in some indiviuals

S/s of Bupropion/Naltrexone (Contrave):

-dizziness

-nausea

-constipation

-hypertension

-metallic taste

Endoscopic sleeve gastroplasty (ESG):

an endoscopy procedure in which the stomach is folded on itself and sutured to make it smaller and shorter

-contraindicated in pts with hernia, peptic ulcer disease

-less s/s but less long term durability

Intragastric balloon:

restricts gastric capacity and delays gastric emptying

-must be removed via endoscopy after 6 or 12 months

Bariatric Surgery (gastectomy): (sleeve *most common 20%, rux-en-y 30-35%, biliopancreatic diversion 30-45%)

reduces the size of the stomach, restricts the amount of calories the body can absorb, and interferes with the brain's regulation of appetite

Nursing considerations for bariatric surgery:

-monitor for staple line leak

-monitor resp rate, high rate of sleep apnea

-monitor for DVT, PE, pneumonia

-monitor for dumping syndrome

-monitor skin integrity, low airflow bed, trapeze bar

Dumping syndrome:

occurs when stomach contents rapidly dump into small intestines

-occurs 10 to 15 mins after eating sugary or starchy foods

-avoid sugary foods after surgery

GLP-1 receptor agonist

Liraglutide- moderate weight loss 6-10% at 1 year

Subq daily

semaglutide- significant weight loss 12-15% at 68 weeks

subq once weekly

tirzepatide

dual GLP-1 and GIP receptor agonist

significant weight loss- 20% from baseline over 72 weeks

approved for adults for weight loss and sleep apnea

may decrease serum concentration of hormonal contreceptives- switch to non oral

Subq once weekly

indications for bariatric surgery

BMI over 40

BMI over 35 with 1 or more obesity comorbitity

BMI over 30 with diabetes or metabolic syndrome

complications of bariatric surgery

anastomosis (staple line leak)

DVT, PE pneumonia

dumping syndrome (more common in rux-en-y and biliopancreatic)

late: nutritional deficiencies

cholelitheasis- rapid weight loss- formation of gal stones

GERD

Bowel obstruciton

osteoporosis

diet after bariatric surgery

post op stomach capacity= 30 mL

sugar free clear liquids first 24hrs

HIGH PROTIEN

smaller meals

dont drink liquids with meals