Page 85 Complete Your CE Test Online - Click Here When evaluating clients for weight loss surgery, the following issues are considered[46] : ● ● Nutrition and weight history: The healthcare team reviews trends, diet efforts, eating habits, exercise regimen, stress level, time constraints, and motivation. ● ● Current medical condition: General health status is evaluated. Some conditions such as heart disease increase surgical risks. Smoking and alcohol histories are obtained. ● ● Mental health status: Some mental health conditions may make it more difficult for clients to make necessary lifelong lifestyle changes. These include binge-eating disorder, substance abuse, depression, and anxiety disorders. ● ● Motivation: Willingness and ability to adhere to lifestyle changes are assessed. ● ● Age: Risks increase with age, and weight loss surgery is controversial in persons under the age of 18. It is important that clients understand both the benefits and risks of weight loss surgery. The benefits include[49] : ● ● Weight loss that usually occurs rapidly and continues for about 18 to 24 months after the surgery. Most clients do start to regain some of the lost weight, but few clients regain all of it. ● ● Conditions related to obesity, such as diabetes or hypertension, generally improve. Nursing consideration: Clients who have had weight loss surgery require life-long diet and exercise modifications as well as vitamin and mineral supplements. This generally means that long-term follow-up is necessary[46,49,50] . There are risks associated with the surgical procedure itself. These include[44] : ● ● Infection. ● ● Hemorrhage. ● ● Blood clots. ● ● Respiratory distress. ● ● Reactions to anesthesia. ● ● Death (rarely). Long-term risks following weight loss surgery include[49,51] : ● ● Dumping syndrome: Dumping syndrome is caused by malabsorptive surgery and occurs when stomach contents move too swiftly through the small intestine. After eating, the client experiences nausea, sweating, weakness, faintness, and, at times, diarrhea. The client is unable to eat sweets without becoming terribly weak. ● ● Vomiting: Vomiting is a common risk after restrictive surgery. This happens when the stomach is over-stretched by food that has not been thoroughly chewed. ● ● Nutrition deficiencies: Clients may develop anemia, osteoporosis, and metabolic bone disease. In order to avoid these complications, clients must be careful to have the proper intake of vitamins and minerals. Clients may be advised by their healthcare providers to take vitamin and mineral supplements. ● ● Gallstones: Gallstones are a common side effect of weight loss surgery. In fact, more than 33% of clients develop gallstones after undergoing weight loss surgery. This complication may be prevented by having clients take bile salts for the first six months after surgery. ● ● General side effects: These include nausea, vomiting, bloating, diarrhea, diaphoresis, flatulence, and dizziness. Nursing consideration: Women of childbearing age should avoid pregnancy until rapid weight loss has stopped, weight becomes stable, and nutritional deficiencies are corrected[46] . Types of weight loss include the following procedures[48,49,50,51] : ● ● Roux-en-Y gastric bypass: A small pouch is created at the top of the stomach. This pouch is the only part of the stomach that receives food, so the amount of food and drink that can be consumed at one time is quite limited. An incision is made in the small intestine a short distich below the main stomach and connected to the new pouch. Food goes directly from the pouch into this part of the intestine, and fewer nutrients and calories are absorbed. ● ● Laparoscopic adjustable gastric banding (LAGB): With LAGB, an inflatable band containing a balloon is placed around the upper part of the stomach. When the balloon is inflated, the stomach is compressed. A small stomach pouch is created above the band with a very narrow opening to the rest of the stomach. A port is then inserted under the skin of the abdomen. A tube connects the port to the band. The balloon is inflated or deflated by injecting or removing fluid via the port. This procedure limits the amount of food that the stomach can hold but does not reduce absorption of calories and nutrients. ● ● Sleeve gastrectomy: Also called a vertical sleeve gastrectomy, a sleeve gastrectomy is a newer type of weight-loss surgery. Part of the stomach is surgically removed, and the remaining section of the stomach is formed into a structure that resembles a tube. This procedure limits the amount of food that the stomach can hold but does not affect calorie or nutrient absorption in the intestines. ● ● Biliopancreatic diversion with duodenal switch: This is a complex, multi-part surgical procedure. A large part of the stomach is removed. The pyloric valve (the valve that releases food to the small intestine from the stomach) remains, as well as a small portion of the small intestine (duodenum) that normally connects to the stomach. The surgery bypasses the majority of the intestine by connecting the end portion of the intestine to the duodenum near the stomach (duodenal switch and biliopancreatic diversion). This type of surgery limits the amount of food that can be eaten and also decreases the absorption of nutrients. Nursing intervention considerations Nurses play a key role in client education regarding weight management. They also play a key role in the post-surgical care of clients who have undergone weight-loss surgery. But one of the ways that nurses can, and should, change practice efforts, is the attitudes with which the overweight and obese are treated. Clients who are overweight or obese are often looked upon with less than normal compassion. They may be treated with contempt or be the focus of ridicule. Staff nurses should take the lead in educating clients, families, colleagues, and the community at large about the need for objective, compassionate care. Just as important, if not more so, is the need for more effective communication regarding prevention of overweight and obesity[9,38,45] . Nurses should also advocate for the provision of continuing education for nurses as it relates to the prevention and treatment of overweight and obesity. Unless nurses and other healthcare professionals receive the appropriate continuing education that will help them to provide better nursing care, the obesity epidemic will continue to grow. Such education will also help to dispel much of the negativity and harassment that surrounds persons who are overweight or obese. SUMMARY AND CONCLUSIONS Eating disorders and obesity affect a significant number of Americans as well as persons throughout the world. Prevention of these problems as well as early recognition and treatment are imperative. Much of prevention depends on changing the way society views the size and shape of the human body. Unrealistic portrayals of extremely thin women in film and in the printed media may set up corresponding unrealistic expectations of what one’s own body should look like. Just as important is the need to change the way Americans view what is, and what is not, a proper diet. Portion size, the amount of fruits and vegetables, as well as the amounts of fat and calories, are all issues that require education. A healthy diet, the proper amount of exercise, and a healthy sense of self all contribute to body image, appropriate weight, and maximal health. Genetic factors, culture, family dynamics and physical and mental health all contribute to an individual’s state of health. These issues also contribute to the risk for eating disorders, overweight, and obesity.