As the prevalence of obesity sky rockets worldwide, the search for successful weight- management strategies follows. For select individuals, surgical intervention is the most appropriate weight-management intervention for sustained weight loss. Surgical procedures, such as the Roux-en-Y gastric bypass, sleeve gastrectomy, and laparoscopic adjustable gastric banding, bring about both dramatic weight loss and the ability to provide the patient with marked improvement in obesity-related conditions such as diabetes, arthritis, hypertension, and obstructive sleep apnea. In this article the authors will address the incidence of obesity and the criteria for weight-loss (bariatric) surgery; describe the preoperative evaluation and selection of the appropriate surgical procedure; discuss postoperative complications and required nursing care; and give readers a preview of future options for surgical weight loss.
Citation: Kaser, N., Kukla, A., (January 31, 2009) "Weight-Loss Surgery" OJIN: The Online Journal of Issues in NursingVol. 14, No. 1, Manuscript 4. Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol142009/No1Jan09/Weight-Loss-Surgery.aspx
Key words: bariatric surgery, bariatric-surgery nursing care, laproscopic adjustable banding, nursing role in bariatric surgery, obesity, Roux-en-Y gastric bypass, sleeve gastrectomy, surgical intervention for obesity
The increasing girth of people in the United States (US) is evident at every turn. Recall your last trip to the store, out to dinner, to the park, or at work, and ask yourself how many overweight people you observed on these occasions. While the statistics related to overweight and obese children and adults are no longer shocking, they do continue to be quite worrisome. It is unfortunate that what we truly know about obesity is sparse in comparison to the rate at which it is spreading. While energy balance is certainly an important factor in weight management, only recently have we come to appreciate that obesity is really a very complex disease that involves a wide variety of factors, including metabolic, environmental, social, behavioral, and psychological factors (Hensrud & Klein, 2006).
The association of obesity with chronic diseases, such as heart disease, hypertension, sleep apnea, degenerative joint disease, gastroesophageal reflux disease, asthma, and depression, is well documented and reinforces the benefit of achieving and maintaining a "normal" weight (Harrington, 2006; Hughes & Dennison, 2008; Sheipe, 2006). Bariatric surgery provides dramatic improvement in these chronic conditions (See Figure 1. Chronic Conditions Improved After Bariatric Surgery [pdf], which is used by permission of the Cleveland Clinic Foundation.) Traditional diet, exercise, and behavior modification programs produce short-term results, but have limited long-term (greater than 5 years) success for obese persons (Wadden, Butryn, & Byrne, 2004). Bariatric or weight-loss surgery is the appropriate option for some of these obese persons. In this article the authors will address the incidence of obesity and the criteria for weight-loss (bariatric) surgery; describe the preoperative evaluation and selection of the appropriate surgical procedure; discuss postoperative complications and required nursing care; and give readers a preview of future options for surgical weight loss.
The Incidence of Obesity
The National Health and Nutrition Examination Survey (NHANES) revealed that in 2005-2006, 33.3% of men and 35.3% of women were obese (Ogden, Carroll, McDowell, & Flegal, 2007). These numbers do not include the many persons who are merely overweight (Ogden et al.). Equally alarming is the percentage of obese children, estimated by the Centers for Disease Control and Prevention (CDC) (CDC National Center for Health Statistics, 2006) to be 17%. Obese and overweight persons are those whose weight is greater than what is deemed healthy for their given height. …