Adult+Obesity

Overview of Adult Obesity

• Adult obesity is defined by a Body Mass Index (BMI) of 30 or greater.

• Morbid obesity is characterized by a BMI of 40 or greater.

• Two types of obesity: Central (apple shape) and Peripheral (pear shape).

Types of Obesity

Central Obesity

• More prevalent in men until menopause.

• Complications include:

  • Hypertension

  • High blood lipid levels (cholesterol)

  • Heart disease

  • Stroke

  • Elevated insulin levels

Peripheral Obesity

• Commonly seen in women, with weight carried in hips and legs.

• Lower risk of heart disease compared to central obesity, but harder to treat.

• Complications may include abnormal lipids.

Medical Complications Associated with Obesity

• Increased risk for:

  • Stroke

  • Heart disease

  • Diabetes

  • Hypertension

  • Fatty liver disease

  • Obstructive sleep apnea

  • Osteoarthritis

  • Certain cancers (e.g., breast, colon, kidney, prostate)

Hypoventilation Syndrome (Pickwickian Syndrome)

• A group of symptoms affecting obesity patients, including:

  • Excessive daytime sleepiness

  • Hypertension

  • Increased red blood cell count

  • Liver enlargement

Metabolic Syndrome

• Characterized by insulin resistance and three or more of the following:

  • Increased waist circumference

  • Hypertension

  • Elevated blood triglycerides

  • Elevated fasting blood glucose

  • Low HDL (good cholesterol)

• 60% of obese patients present with metabolic syndrome.

Assessment and Care for Obese Clients

• Evaluate personal feelings on obesity and use appropriate terminology (avoid 'fat', 'large', 'big').

• Utilize staff and equipment for patient movement to ensure safety.

• Specific assessment considerations:

  • Heart and lung sounds may require patient repositioning to access.

  • Bowel sounds could be tympanic due to adipose tissue.

  • Assess for edema and skin breakdown, especially in skin folds (under arms, breasts, and pannus).

Moving and Lifting Bariatric Patients

• Use appropriate equipment, such as:

  • Bed sheets with handles for boosting

  • Hoyer lifts or ceiling lifts for safe movement

• Bariatric-specific equipment should be utilized to ensure safety and comfort.

Nutritional Considerations

• Medications for obesity should complement diet and exercise.

• Recommended caloric intake:

  • Women: 1200-1500 kcal/day

  • Men: 1500-1800 kcal/day

• Aim for weight loss of 1-2 pounds per week and include a balanced diet rich in nutrients.

• Behavior modification, including food records and support groups, is vital for long-term success.

Treatment Options for Obesity

Bariatric Surgery

• Criteria for surgery:

  • BMI > 40, or BMI > 35 with comorbidities (diabetes, hypertension)

  • Psychological assessment required

Types of Bariatric Surgeries

1. Lap Band

   • Restricts food intake.

   • Adjustable silicone band placed around the stomach.

   • Common side effect: vomiting.

2. Sleeve Gastrectomy

   • Permanent reduction of stomach size (banana-shaped).

   • Reduces ghrelin (hunger hormone).

   • Post-operative care includes clear liquids and monitoring for leaks.

3. Roux-en-Y Gastric Bypass

   • Restrictive and malabsorptive procedure.

   • Limits food intake and nutrient absorption.

   • Higher risk of nutritional deficiencies, requires lifelong supplements.

4. Biliopancreatic Diversion

   • Most complicated with higher risk for nutritional deficits.

   • Significant weight loss, which could lead to gallstones.

Postoperative Nursing Interventions

• Patients post-surgery must progress through diet stages, starting with clear liquids.

• Monitor for complications such as dumping syndrome, which causes nausea and rapid gastric emptying.

• Encourage early ambulation to prevent DVT and promote recovery.

• Long-term patient management includes psychological support and weight maintenance strategies.

Additional Considerations

• Nurses are at risk for obesity due to long shifts and irregular eating patterns.

• Importance of personal health in capacity to care for patients.