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.

Since 1980,

obesity prevalence

among children

and adolescents

has almost

tripled.

1 of 7 low-income,

preschool-aged

children is obese

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. Al len 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

Food prices rose

less (3.4%)

020406080

100120140

% 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 mal-absorption

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 28th

3:30pm-4:30pm