OBSEITY

1. New Modalities Management For obesity
And Overweight
And It Is Complications
May 24 1
UNDER SUPPERVISION
Prfo: Amira Ahmed
Prepare by:
Ahmed Jamal
Wifag Abdulhadi

2. Morbid Obesity
• One in three Americans is 20% or more over his or her ideal body
weight (U.S. Department of Health and Human Services, 2001).
• Morbid obesity is the term applied to people who are more than two
times their ideal body weight or whose body mass index (BMI)
exceeds 30 kg/m2.
• Another definition of morbid obesity is body weight that is more than
100 pounds greater than the ideal body weight (Monteforte &
Turkelson, 2000). Patients with morbid obesity are at higher risk for
health complications, such as cardiovascular disease, arthritis, asthma,
bronchitis, and diabetes. They frequently suffer from low self-esteem,
impaired body image, and depression
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3. Classification :
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4. Medical Management
• Conservative management consists of placing the person on a weight
loss diet in conjunction with behavioral modification and exercise;
however, diet therapy is usually unsuccessful.
• There is a belief that depression may be a contributing factor to weight
gain, and treatment of the depression with bupropion hydrochloride
(Wellbutrin) may be helpful (Wangsness, 2000).
• Some physicians recommend acupuncture and hypnosis before
recommending surgery.
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5. PHARMACOLOGIC MANAGEMENT
Several medications have recently been approved for obesity.
• Sibutramine HCl (Meridia) : By inhibiting the reuptake of serotonin and
norepinephrine, sibutramine decreases appetite
• Orlistat (Xenical):Orlistat reduces caloric intake by binding to gastric
and pancreatic lipase to prevent digestion of fats.
• Both medications require a physician’s prescription.
Contraindications:
• Sibutramine may increase blood pressure
• should not be taken by people with a history of coronary artery disease,
angina pectoris, dysrhythmias, or kidney disease; by those taking
antidepressants or monoamine oxidase inhibitors; or by pregnant or
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6. Side effects Sibutramine
• Dry mouth,
• Insomnia
• Headache
• Increased sweating,
• Increased heart rate.
Side effects of Orlistat
• Increased bowel movements,
• Gas with oily discharge,
• Decreased food absorption,
• Decreased bile flow,
• Decreased absorption of some vitamins.
• A multivitamin is usually recommended for
patients taking orlistat.
• Women who are pregnant or nursing.
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7. SURGICAL MANAGEMENT
• Bariatric surgery is performed only after other nonsurgical attempts at
weight control have failed.
• The first surgical procedure to treat morbid obesity was the jejunoileal
bypass. This procedure, which resulted in significant complications,
has been largely replaced by gastric restriction procedures. Gastric
bypass and vertical banded gastroplasty are the current operations of
choice. These procedures may be performed laparoscopically or by an
open surgical technique.
• In gastric bypass surgery, the proximal segment of the stomach is
transected to form a small pouch with a small gastroenterostomy
stoma. The Roux-en-Y gastric bypass is the recommended procedure
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8. • After weight loss, the patient
may need surgical intervention
for body contouring. This may
include:
• lipoplasty to remove fat deposits
• a panniculectomy to remove
excess abdominal skinfolds.
FIG.1
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9. Nursing Management
• Nursing management focuses on care of the patient after surgery.
• General postoperative nursing care is similar to that for a patient
recovering from a gastric resection, but with attention given to the
risks of complications associated with morbid obesity.
 Complications that may occur in the immediate postoperative period
include:
• Peritonitis,
• Stomal obstruction,
• Stomal ulcers,
• Atelectasis
• Pneumonia,
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10. CON…
• After bowel sounds have returned and oral intake is resumed, the nurse provides six small feedings
consisting of a total of 600 to 800 calories per day and encourages fluid intake to prevent
dehydration. P
• atients are usually discharged in 4 to 5 days with detailed dietary instructions. The nurse instructs
patients to report excessive thirst or concentrated urine, both of which are indications of
dehydration.
• Psychosocial interventions are also essential for these patients.
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11. CON…
• Efforts are directed toward helping them modify their eating behaviors
and cope with changes in body image.
• The nurse explains that noncompliance by eating too much or too fast
or eating high calorie liquid and soft foods results in vomiting and
painful esophageal distention.
• The nurse discusses dietary instructions before discharge and
schedules monthly outpatient visits.
• Long-term side effects may include increased risk of gallstones,
nutritional deficiencies, and potential to regain weight
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12. CON…
Postoperative nursing care for bariatric surgery patients include:
• Monitoring for postoperative complications such as leaks, bleeding,
obstructions, and slipped bands.
• Notifying the surgeon promptly of symptoms like persistent
tachycardia, sudden onset of left shoulder pain, fever, decreased urine
output (indicative of a leak), severe abdominal pain, and nausea with
emesis of bile (suggestive of a bowel obstruction).
• Providing individualized and continuous assistance throughout the pre,
trans, and postoperative periods.
• Offering patient education, counseling, and support to facilitate
recovery and the resumption of daily life.
• Ensuring compliance with physician's orders, follow-up care, and
lifestyle changes.
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