Obesity in the United States
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In the United States, nearly two-thirds of adults are obese according to the guidelines set by the national Institutes of Health (NIH) (Pavlovich-Davis, 2003). The NIH uses body mass index (BMI) to determine whether or not a person is obese, and categorizes overweight people into three grades. Grade 1 represents moderately overweight people with a BMI of 25 kg/sq.m to 29.9 kg/sq.m; grade 2 obesity covers people with a BMI of between 30 kg/sq.m and 39.9 kg/sq.m; and grade 3 obesity constitutes people who are massively or morbidly obese, and have a BMI greater than 40 kg/sq.m. Obesity-related conditions and avoidable healthcare expenses such as knee replacements from wear, medications for Type 2 diabetes, and other complications rarely seen in non-obese people cost Americans more than $122.9 billion every year. Clinically, morbid obesity is a disease of excess energy stores in the form of fat, and is an independent risk factor for Type 2 diabetes, coronary heart disease, and hypertension (Pavlovich-Davis, 2003). The NIH suggests that morbidly obese people with BMIs greater than 40 kg/sq.m have surgical weight loss procedures, and also those with BMIs over 35 kg/sq.m in whom other treatments have failed and who have clinical conditions such as cardiovascular problems, obstructive sleep apnea, cardiomyopathy, hyperlipidemia, degenerative joint disease, and diabetes. Weight loss surgery (WLS), now known as bariatric surgery, has been recognized as a specialty by the NIH
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kin dry and reduce skin irritation and fungal rashes. Powder should be avoided because it cakes under skin folds. Morbidly obese patients need to be evaluated for pressure-relieving surface needs to prevent pressure ulcers. Pressure-reduction beds are available for bariatric patients. Wound healing is delayed in bariatric patients because adipose tissue is poorly vascularized. Tension is increased in wound edges from increased body fat, and wound support in areas of stress is needed. This is where the expertise of a WOCN is needed.
Limited mobility poses problems for morbidly obese patients and their nurses (Hahler, 2003, 251). Staff need to plan for help to ambulate the patient, and finding suitable chairs and wheelchairs to accommodate bariatric patients is necessary: ordinary chairs are too small and not strong enough for bariatric patients. Pharmacologically, bariatric patients react differently to medications than do non-obese patients because of their high adipose tissue content and low water content (Davidson, Kruse, Cox and Duncan, 2003, 111; Hahler, 2003, 251). Drugs such as carbamazepine, diazepam, pronofol, and opiate analgesics are highly soluble in fat and distribute mostly in the adipose tissue, so dosage
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Approximate Word count = 2384
Approximate Pages = 10 (250 words per page)
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