Bariatric Care Flashcards
What is the denfition of obesity?
Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health.
A bariatric person is an individual of any age (child to adult) who has limitations in health and social care due to physical size, health, mobility and environmental access.
Obesity is responsible for 3.4 million deaths, has nearly tripled worldwide, contrary to other major global risks (tobacco)
Projected increase of 11 million obese adults in the United Kingdom by 2030.
What does the Scottish health survery say about obesity?
Scottish Health Survey 2018
65% of adults were overweight;
28%who were obese;
68% of men and 63% of women were overweight or obese;
Mental wellbeing was lowest among those within the morbidly obese BMI range;
The annual cost of treating conditions associated ranged from £363 million to £600 million.
What defines an obese person?
The World Health Organisation defines overweight as a BMI≥25kg/m2 and obesity as a BMI≥30kg/m2.
BMI is defined as weight in kilograms divided by the square of the height in meters.
BMI provides the most useful population-level measure as it is inexpensive, easy to use, the same for both sexes and for all ages of adults.
What are the limitations of BMI?
Limitations of BMI:
Does not assess body fat distribution, because it is a measure of excess weight rather than excess body fat.
Does not account for factors such as age, sex, ethnicity, and muscle mass.
What is the fundamental cause of obesity?
The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended.
Obesity is a complex, multifactorial chronic disease that is strongly associated with multiple comorbidities.
It is not uncommon to find undernutrition and obesity co-existing.
Multiple factors influence including genetics, socioeconomic status, environment and individual decisions play a significant role.
What are the contributing factors for obesity?
Underlying health problems e.g. hypothyroidism in Down’s syndrome and eating issues such as Prader-Willi syndrome (excess hunger)
A lack of energy
Difficulty with chewing or swallowing food or its taste or texture
Medications that can contribute to weight gain and changes to appetite e.g. steroid medication
Physical limitations that can reduce a person’s ability to exercise pain on movement (e.g. in cerebral palsy, rheumatoid arthritis
Lifestyle Factors: A lack of healthy food choices; Accessible environments that enable exercise; Resources and appropriate social support systems
What act does NOT classify obesity as a disbility?
The Equality Act 2010.
What “reasonable adjustments” can be made to a dental practice to aid universal access of obese individuals?
Reasonable adjustments can be physical, such as alterations to buildings in the form of wheelchair ramps or tactile signage. Or they may mean changes to attitude, such as through policies, procedures and staff training, to ensure that services are as accessible for all patients.
Be aware of comorbidities or predisposition to dental disease.
Appropriate referral onto Secondary and Tertiary care.
May have to provide emergency care prior to onward referral.
Raise concerns with patient, parents or carers of vulnerable adults and children.
What is alcoholic fatty liver disease?
Non-alcoholic fatty liver disease (NAFLD) is the term for a range of conditions caused by a build-up of fat in the liver. It’s usually seen in people who are overweight or obese. A healthy liver should contain little or no fat.
What do you need to consider before an appointment for a bariatric patient?
Prior to the appointment:
Ensure your venue has appropriate facilities for patient care.
This may involve telephoning the patient/referrer/carer prior to initial visit querying: Patient Weight or BMI, Mobility e.g. do they use a wheelchair? Manual or motorised?
Travel:
Is the patient taking private transport e.g car / taxi? Parking should be available as close to the venue as possible.
Ambulance transport - will only take patients to Hospitals.
What do you need to consider for an obese patient when arriving at the practice and during an appointment.
Accessibility:
Waiting room with suitable high weight bearing armless chair.
Adequate door widths
Toilet facilities accessible
Is the practice accessible via lift or stairs
Emergency Evacuation procedures
Under no circumstances should staff attempt to break the fall of an obese patient
Timing:
May require longer appointment times due to reduced mobility
Extra weight around the face can obstruct the access to the mouth
Safety:
Specialist equipment may mean patients need referral tospecialist clinics or hospitals
Wider cuff blood pressure monitors.(e.g. “thigh cuff”); Longer IM needles are needed.
May be unable to get patient rapidly into supine/recovery position or physically move patient.
Airway management may be more difficult.
Resuscitation – identification of landmarks for chest compressions may be difficult
In the chair:
If the patient does not know their weight and is perceived to exceed 22 stone/140kg an accurate weight must be obtained through weighing the patient.
Unfortunately most standard weighing scales only weigh up to 22 stone.
People who carry weight on their chest and upper body are at risk of hypoxaemia when lying flat.
In extreme circumstances some obese patients may present with obesity hypoventilation syndrome, a result of chronic hypoventilation due to the excess weight preventing full expansion of the lungs.
What is the weight limit for a normal dental chair?
DO NOT exceed 22 stone/140kg.
What is the weight limit for a higher weight dental chair?
32 stone.
What is the weight limit for a bariatric wheel chair?
50 stone.
What are medical complications of obesity?
Hypertension Stroke Sleep apnoea GORD Osteoarthritis Depression Anxiety Liver and gallbladder disease Cellulitis and intertrigo (inflammation with excessive body folds) Coronry heart disease Cancer Severe pancreatitis Pulmonary disease etc.
