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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