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Guest Editorial
What is Bariatrics?
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between the ages of 26 and 75, 130 million are overweight, 10% to 25% are obese, and more than nine million are morbidly obese. From 1976 to 2000, the incidence of obesity increased from 14.4% to 30.9%. This
increase has occurred regardless of age, gender, ethnicity,
socioeconomic status, or race.7 Overweight and obesity
are not limited to the US. Worldwide, nearly 2 billion
individuals are overweight, equaling the number of individuals suffering from starvation.8 To fully understand
the meaning of these statistics it is important to know
how overweight and obesity are defined and measured.
Overweight versus obese. Overweight refers to an
excess of body weight compared to set standards. The
excess weight may come from muscle, bone, fat, and/or
water. Obesity refers specifically to the abnormal proportion of body fat. Many people who are overweight are
also obese.
Body mass index. Obesity and overweight are quantitatively defined using body mass index (BMI),9 the
most common and widely accepted method of assessing
overweight and obesity. Body mass index is a mathematical formula that describes relative height and weight; it
is significantly correlated with total body fat content and
assigns a certain number to an individual’s relative risk
for morbidity and mortality. However, caution must be
exercised when interpreting BMI in a child or patient
with edema or ascites, in pregnant women, or in persons
who are highly muscular because an elevated BMI will
not accurately reflect excess adiposity in these instances.
Normal BMI falls in the range of 18.5 to 24.9. A person
with a BMI >25 is considered overweight; a person with
a BMI >30 is considered obese. Within the obese classification are grades I, II, and III, equaling BMI >30, BMI
>35, and BMI >40, respectively.10
Calculating BMI is relatively simple and inexpensive.
This assessment tool is not gender-specific. It is the measurement of choice for many obesity researchers, health
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s the specialty of caring for larger, heavier individuals evolves, it becomes increasingly important to recognize the need for an appropriate corresponding lexicon. The challenge to healthcare clinicians is to develop a vocabulary that accurately, functionally, and sensitively describes individuals with weight
issues.
The word obesity originates from the Latin language
and refers to the state of becoming “fattened by eating.”1
Bariatrics is derived from the Greek word baros and refers
to issues pertaining to weight.2 In some circles, bariatrics
is thought to address weight loss surgery. However, the
word comprises a much broader meaning; currently, it
refers to the practice of healthcare that relates to the
treatment of weight and weight-related conditions. This
includes weight-loss surgery as well as reconstruction
after massive weight loss, medical weight management,
and more.
Issues related to weight are of interest to the public for
several reasons. Health and health-related concerns are at
the forefront, along with the need for additional and specialized health services and overall access to healthcare.3
Bariatrics as a specialty is becoming increasingly important in pace with the growing number of obese and overweight Americans.
Obesity comes with a substantial economic burden:
the total economic costs associated with the disease are
estimated to account for 5.5% to 7.8% of all US healthcare expenditures.4,5 Obesity has been found to be associated with a 36% increase in inpatient and outpatient
spending and a 28% increase in medications for obese
smokers.6 Obesity-related issues cost Americans nearly
$150 billion annually — $117 billion are spent on health
and health-related issues and $33 billion are spent on the
largely unsuccessful weight-loss industry.
Recent estimates suggest that more than 67% of
adults in the US are overweight. Of all Americans
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Susan Gallagher Camden, RN, CNS, CBN, MSN, MA, PhD
Dr. Camden is the Clinical Advisor, Celebration Institute, Houston, Tex. Please address correspondence to: [email protected]. This article was not subject to the Ostomy Wound Management peer-review process.
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In summation, standardizing measurements and definitions is an important part of the care plan. It ensures
all stakeholders are speaking the same language.
Reimbursement, guidelines, and protocols may be
defined by these standardized assessment tools.
Understanding vocabulary and standardizing measurements and definitions help clinicians determine which
patients may develop the common, predictable, and preventable complications related to weight issues and further anticipate what tools (equipment) and resources
(clinical experts) can best prevent or manage these
events. A functional understanding of bariatrics serves
clinicians and patients in this goal.
References
1.
Aronson SM. A physician’s lexicon: the verbiage of obesity.
Medicine and Health Rhode Island. 2003;65(5):154.
Deitel M, Melissas J. The origin of the word “bari”. Obes Surg.
2005;15(7):1005–1008.
Camden SG. Nursing care of the bariatric patient. Bariatr
Nurs Surg Patient Care. 2006;1(1):21–30.
Kortt MA, Langley PC, Cox ER. A review of cost-of-illness
studies on obesity. Clin Ther. 1998;20(4):772–779.
Thompson D, Wolf AM. The medical care cost burden of
obesity. Obesity Review. 2001;2(3):189–197.
Strum R. The effects of obesity, smoking, and drinking on
medical problems and costs. Health Affairs.
2002;21(2):245–253.
Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States 1999-2004. JAMA.
2006;295:1549–1555.
Buchwald H. Is morbid obesity a surgical disease? General
Surgery News. 2007;June:9–15.
National Institutes of Diabetes, Digestive, and Kidney
Diseases. Statistics related to overweight and obesity. Available
at: www.niddk.nih.gov. Accessed June 1, 2007.
Classification of overweight and obesity by BMI, weight circumference and associated disease risks. National Heart,
Lung,
and
Blood
Institute.
Available
at:
www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/bmi
_dis.htm. Accessed December 16, 2007.
Gallagher S, Langlois C, Spacht DW, Blackett A, Henns T.
Preplanning with protocols for skin and wound care in obese
patients. Adv Skin Wound Care. 2004;17(8):436–441.
Rexrode KM, Carey VJ, Hennekens CH, et al. Abdominal adiposity and coronary heart disease in women. JAMA
1998;280(21):1843–1848.
Define obesity and overweight. Available at:
www.dshs.state.tx.us/phn/define.shtm Accessed June 21,
2007.
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professionals, the popular press, and recently the fashion
industry. Many health organizations, including policy
makers, use BMI to measure and define obesity and to
establish criteria for certain procedures.4 However, BMI
as an assessment tool carries certain limitations: muscular people may fall into the category of overweight when,
in fact, they are physically fit and people who have lost
large amounts of muscle mass may appear to be healthy
when they actually have diminished nutritional reserves.
Therefore, BMI has been most useful in tracking trends
in the general population but must be used with other
assessment criteria to determine the health status of an
individual patient.
In 1995, the World Health Organization (WHO) recommended using BMI to establish three grades or levels
of overweight with the cutoff points of 25, 30, and 40.
Two organizations within the National Institutes of
Health (NIH) — the National Heart, Lung, and Blood
Institute and the National Institutes of Diabetes,
Digestive, and Kidney Diseases — concurred with this
system, with the caveat that cutoff points are only a guide
for definition and useful for comparative purposes across
populations over time. For example, an overweight individual with a BMI of 29 does not instantly acquire all of
the health consequences of obesity after crossing the
threshold of BMI 30. However, researchers agree that
health risks increase gradually as BMI increases.
Additional assessment methods. Other assessment
tools establish certain risk factors for comorbidities, such
as the waist-to-hip ratio.11 A correlation study by Rexrode
et al12 suggests that individuals with a high waist-to-hip
ratio are at risk for certain cardiac and metabolic disorders; the presence of central obesity exacts greater tolls on
this segment of the population.12,13 Additional tools are
based on mathematical calculations of the relationship
between height and weight, while others are based on
measurements of body fat.
Providing care. When considering patient care, preplanning is imperative regardless of practice setting. The
physical therapist in a wound care center, a nurse in critical care, or a physician in a primary care office can assist
the obese patient with related issues including ostomies,
wounds, and more. Preplanning should be based on a set
of criteria that not only addresses health concerns, but
also decreases the risks of caregiver injury and provides
for patient safety.
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