Morbid Obesity: Causes and Complications

Study Notes

Morbid obesity is defined as a body mass index (BMI) exceeding 30 kg/m2 or a weight more than 100 pounds greater than the ideal body weight.
Patients with morbid obesity are at higher risk for health complications, such as cardiovascular disease, arthritis, asthma, bronchitis, and diabetes.
They frequently suffer from low self-esteem, impaired body image, and depression.

Conservative management involves placing the person on a weight loss diet in conjunction with behavioral modification and exercise, but diet therapy is usually unsuccessful.
Treatment of depression with bupropion hydrochloride (Wellbutrin) may be helpful.
Acupuncture and hypnosis may be recommended before surgery.

Medications approved for obesity include sibutramine HCl (Meridia) and orlistat (Xenical).
Sibutramine decreases appetite by inhibiting the reuptake of serotonin and norepinephrine.
Orlistat reduces caloric intake by binding to gastric and pancreatic lipase to prevent digestion of fats.
Side effects of sibutramine include dry mouth, insomnia, headache, increased sweating, and increased heart rate.
Side effects of orlistat may include increased bowel movements, gas with oily discharge, decreased food absorption, decreased bile flow, and decreased absorption of some vitamins.

Bariatric surgery is performed only after other nonsurgical attempts at weight control have failed.
Gastric bypass and vertical banded gastroplasty are the current operations of choice.
These procedures may be performed laparoscopically or by an open surgical technique.

Nursing management focuses on care of the patient after surgery.
General postoperative nursing care is similar to that for a patient recovering from a gastric resection, but with attention given to the risks of complications associated with morbid obesity.
Complications that may occur in the immediate postoperative period include peritonitis, stomal obstruction, stomal ulcers, atelectasis and pneumonia, thromboembolism, and metabolic imbalances.
The nurse provides six small feedings consisting of a total of 600 to 800 calories per day and encourages fluid intake to prevent dehydration.