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