Obesity

 

1) How we define obesity (by BMI)

• Underweight: <18.5
• Normal: 18.5–24.9
• Overweight: 25–29.9
• Class I obesity: 30–34.9
• Class II obesity: 35–39.9
• Class III (severe) obesity: ≥40 → often needs specialty care

2) Health risks to remember

• High blood pressure
• High risk of stroke
• Fatty liver / metabolic disease
• Type 2 diabetes

3) Common causes / contributors

• Genetics
• Medications (e.g., steroids)
• Social & economic factors (food access, stress)
• Age / hormone imbalance
• Stress & lack of sleep
• Gut health (diet, possible role of probiotics)

GLP-1: not a cause—this is a treatment class (e.g., semaglutide). It lowers appetite, slows stomach emptying, and helps with weight loss.

4) Stigma & access

• Weight stigma is common.
• Many patients have limited resources (healthy food, time, support).
• Be supportive and non-judgmental.

5) Bariatric surgery types (simple)

A) Restrictive only

• Laparoscopic Vertical Sleeve Gastrectomy (VSG)
  
• Makes a small stomach “sleeve” (~4 oz).
• Limits how much a patient can eat.
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B) Restrictive + some malabsorption

• Roux-en-Y Gastric Bypass (RYGB)
  
• Small pouch + rerouted intestine → less absorption of calories/sugar.
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6) Immediate post-op nursing care (first 24 hrs)

1. Airway & breathing: continuous pulse oximeter to watch for respiratory depression (anesthesia, opioids, OSA risk).
2. Positioning: head of bed up / sit in chair early.
3. Early ambulation: start within ~2–4 hours after arrival to unit; then frequent walking → prevents DVT/PE, promotes bowel function.
4. Oral intake: usually 1 oz (30 mL) every ~15 minutes if surgeon allows → prevents nausea and overfilling.
5. Pain & anti-nausea meds as ordered.
6. Incision & drain checks, vitals, I&O.

7) Diet progression (typical path—follow the surgeon’s orders)

1. Clear liquids (sips)
2. Full liquids (often ~2 weeks)
3. Pureed/soft foods
4. Regular protein-focused small meals

8) What to avoid & WHY

• No straws → swallow air → pain/gas in small pouch.
• No soda / carbonation → gas expands the pouch, discomfort.
• No caffeine (early) → increases acid and irritation, worsens reflux, can dehydrate.
• Avoid high sugar (especially after bypass) → dumping syndrome
  
• s/s: cramping, diarrhea, flushing, palpitations, dizziness.
• (It doesn’t “cause a heart attack,” but it can feel scary—teach patients the symptoms.)
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9) Teaching & psychosocial support

• Use the RESPECT model with patients:
  
• Rapport – warm, respectful connection
• Empathy – reflect feelings, validate struggles
• Support – affirm strengths, offer help
• Partnership – set goals together
• Explanations – use clear, simple language
• Cultural competence – honor beliefs & food culture
• Trust – be consistent and non-judgmental
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• Screen for depression and social rejection.
• Encourage family/support persons.
• Use gentle, respectful touch/approach (e.g., shoulder tap) and person-first language.

10) Quick test points (memory triggers)

• VSG = restricts volume; RYGB = restricts + reduces absorption.
• 1 oz q15 min, early ambulation, pulse-ox.
• No straws, soda, early caffeine.
• Dumping = high sugar → GI + vasomotor symptoms.
• GLP-1 = treatment, not a cause.