Bariatric Interventions Flashcards
Anatomic and Physiological Changes with Obesity
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Cardiac
cardiomyopathy (HF)
abnormal ventricular remodeling, atrial fibrillation, dysrhythmias
Anatomic and Physiological Changes with Obesity
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Pulmonary
Asthma, obstructive sleep apnea, hypo ventilation syndrome
Anatomic and Physiological Changes with Obesity
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kidneys
Decreased renal perfusion
Anatomic and Physiological Changes with Obesity
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Genitourinary
- Urinary incontinence, infertility
Anatomic and Physiological Changes with Obesity
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Integumentary
- infection, hyperkeratosis, acanthosis nigricans
Anatomic and Physiological Changes with Obesity
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Vascular
- Incr Total blood volume, altered stroke volume and CO, HTN, venous insufficiency, varicosities
Anatomic and Physiological Changes with Obesity
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musculoskeletal
- OA, altered mobility patterns
Anatomic and Physiological Changes with Obesity
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adipose tissue
- Incr production of adipokines
Anatomic and Physiological Changes with Obesity
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Liver
- non-alcoholic fatty liver disease, non-alcoholic steatohepatitis
Anatomic and Physiological Changes with Obesity
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Pancreas
- Insulin resistance, type 2 DM
Medical Management of Bariatric Patients
- Due to the multi-system health risk, MD involvement is imperative for support on many levels
- with MD, pt more likely to have appropriate medical management of co-morbities as well as access to education which may assist in weight loss goals.
- Fot pt who do not elect to attempt weight loss, the MD role typically becomes more focused on the management of health.
Behavioral Therapy for Bariatric Patients
- Typically there is some degree of psychological influence associated with the behaviors that lead to obesity
- identifying and addressing these influences can significantly improve long-term outcomes that could otherwise be limited by underlying issues of motivation and compliance
- May be individualized or in group formats
- Pt hoping to undergo bariatric surgery are typically required to participate in some form of behavioral counseling to surgery
Increased Activity for Bariatric Patients
- Essential for long term weight loss and weight management .
- For obese pt, increased activity in the first 6 mo of weight loss efforts has not been shown to significantly impact weight reduction
- Pt education and support should be offered so as to prevent frustration and diminished motivation in attempts to make long-term modification in activity level
- a general target of 30 min of incr activity daily is recommended and may be spread out into smaller intervals over the course of the day
Dietary Modifications for Bariatric Patients
- in obese populations a 500-1000 kcal/day reduction in dietary intake is usually sufficient to produce a 1-2 lb loss/ week.
- this rate can typically be maintained for 6 mo before slowing.
- pt often have misconception that reducing fat intake alone will produce the desired weight loss result
- while this is a component of dietary modification, reduction of carbohydrates intake and overall calories are equally important
- it is recommended that patients who are obese consult with MD and dietitian to ensure a medically safe and nutritionally sound approach to weight loss
Pharmacology for Bariatric Patients
- FDA has approved a number of pharmacological weight loss agents for short-term adjunct use with diet, activity, and behavioral modifications
- classes of approved medications include appetite suppressants and lipase inhibitors
- appetite suppressants function to either reduce feelings of hunger or incr feelings of fullness
- lipase inhibitors decr the body’s ability to absorb dietary fats, thereby decr overall caloric intake
Community resources available to Bariatric Patients
- a variety of community -based weight loss programs are in existence, each with their own structured approach
- Program commonalities include advocating incr activity and decr caloric intake
- Pt often cite geographical, philosophical or financial concerns as barriers to participating in a formal program
- EX: Weight watchers, JEnny Craig, food addicts anonymous etc
Bariatric Surgery
- for those who are morbidly obese and is often considered the last resort.
- surgical procedures may be classified as restrictive, malabsorptive or a combination.
- most common is Roux-en - Y Gastric Bypass which facilitates weight loss through a combination of restriction and malabsorption.
Pre-operatively to bariatric surgery
- pt must meet a number of requirements in order to be considered a surgical candidate
- this typically includes BMI >40 or >35 with assitional risk fatcors and evidence that other weight loss interventions have been uncessful
