Certified Bariatric Nurse Review Course Session 1
Session 1 Review of CBN certification Introduction to Morbid Obesity History of weight loss surgery
Objectives The purpose of this program is to inform nurses about bariatric obesity. At the end of this session the nurse will be able to Define obesity Discuss common obesity co-morbidities Review co-morbid conditions that may influence criteria for bariatric surgery Gain knowledge to the history of bariatric surgery procedures
CBN Certification
History of Obesity Obesity Epidemic Definition of Morbid Obesity Causes of Obesity Surgical therapy Criteria for eligibility Contraindication to Surgery
Obesity Epidemic CDC conducts an annual national telephone survey through the Behavioral Risk Factor Surveillance System (BRFSS).
Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%
Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%
Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19%
Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20%
Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%
Obesity Trends* Among U.S. Adults BRFSS, 2010 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%
Childhood Obesity Approximately 17% (or 12.5 million) of children and adolescents aged 2 19 years are obese. 1 of 7 low-income, preschool-aged children is obese Since 1980, obesity prevalence among children and adolescents has almost tripled.
Childhood Obesity Childhood obesity is the result of eating too many calories and not getting enough physical activity. Sugar drinks and less healthy foods on school campuses. Lack of daily, quality physical activity in all schools No safe and appealing place, in many communities, to play or be active. Limited access to healthy affordable foods Increasing portion sizes Television and media.
Obese children are likely to be obese adults
Morbid Obesity The term originated when physicians had to communicate with insurance companies the disease aspect of treating obese patients (clinically severe obesity). Patients who weigh 100% over ideal weight. Patients with a BMI > 35 Patients who develop disease states as a result of obesity.
BMI- Body Mass Index BMI- Body Mass Index is an index of weight adjusted for the height of an individual
Causes of Obesity Energy Imbalance Overeating Inability to feel full Genetic factors Cultural factors Environmental Factors
300+ Human Genes Contribute to Obesity Gene that determines appetite Gene that determines metabolism Gene that determines body fat People accept that height is genetically determined, but they are less willing to accept that a person s weight depends on genetic makeup. --Allen Spiegel, MD National Institutes of Health. Allen M. Spiegel, MD, director, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md.
Food Expenditures From 1980-2000 3.8% average increase in inflation rate 140 120 100 80 60 40 Food prices rose 20 less (3.4%) 0 % Increase in Costs from 1985-2000 % Increase in Costs from 1985-2000
Why Treat Morbid Obesity? 12 X more likely to die suddenly 6 X more likely to develop heart disease 10 X more likely to develop diabetes Increased risk for Cancer, Respiratory Problems, Gallbladder Disease, Sleep Apnea and Acid Reflux.
Cost of Obesity Obesity contributes to at least 100,000 deaths per year and costs the country more than 136 Billion dollars. Mean medical expense: Obese >55 years = $7235.00 Normal weight >55 = $5390.00 Currently only less than 1% of its budget is spent on obesity research.
Medical Complications of Obesity
Co-Morbidity
Working Obesity Odds of injury are 48% higher in obese person Obesity is associated with 39 million lost work days; 239 million restricted-activity days; 90 million bed days; 63 million physician visits. At Union Pacific, 54 percent of the 48,000 employees were overweight (Oct. 2003). Reviewing injury claims and illness records, the company estimated that reducing the percentage by one point would save $1.7 million; by 5 points, $8.5 million, and by 10 percent, $16.9 million.
The history of weight loss surgery 1950 s- Morbidly obese patients were refractory to diets and available drugs. Patients with short gut syndrome lost dramatic amounts of weight All early operations simulated short gut syndrome by bypassing the intestine to cause varying degrees of mal-absorption.
1950 s 14 X 4 end to end Jejunoileostomy performed Operation remained the standard for the next 20 years Procedure offered significant weight loss Bacterial overgrowth and reflux common Bypasses non-functioning bowel became atrophic and thin Electrolyte imbalance, diarrhea, gallstones and kidney stones were common. Liver failure Autoimmune mechanisms causing arthlagias. Fevers, skin eruptions Death occurred in 5% within first year
1960 s 1966- First Gastric Bypass surgery Combination of food restriction and malabsorption Associated with dumping May cause vitamin deficiencies (B12 and iron) Within 10 years, became the dominant bariatric operation in the US
1980/90 s Gastric Banding created. Balloon lined Band connected to an access port Initially a curiosity Use exploded in lap surgeries Evolved into the current adjustable bands
Sleeve Gastrectomy Tubular Stomach 2/3 of stomach is removed Capacity= 100ml
Summary Bariatric surgery has undergone remarkable evolution, since its origin as an attempt to reproduce short-gut syndrome. The popularity of WLS is due to the obesity epidemic, technical progress, and successful weight loss and safety outcomes (COE standards). The field is rich in future prospects in technological advances, and increased understanding of metabolic processes.
References www.nih.gov Handbook of Obesity Surgery: Current Concepts and Therapy of Morbid Obesity and Related Disease, 2010 Flegal KM, C. M. (2010). Prevalence and trends in obesity among US adults. JAMA, 235--4
Session 2 Tuesday February 28 th 3:30pm-4:30pm