References
Understanding bariatric surgery to support patients in primary care
Abstract
The relatively new field of bariatric surgery is increasingly used as an option to address issues linked to obesity. Practice nurses must understand how they can manage patients who have undergone these procedures
Obesity is steadily rising, with 64% of adults in England in 2017 being classified as overweight or obese. Obesity is strongly linked to metabolic diseases such as cardiovascular disease, type 2 diabetes mellitus (T2DM), non-alcoholic fatty liver disease (NAFLD), polycystic ovary syndrome (PCOS), musculoskeletal and respiratory disorders, cancer as well as psychological illness (World Health Organization (WHO), 2018). Therefore every opportunity should be taken to support patients to lose weight and maintain weight loss. Practice nurses are in a unique and pivotal position to guide patients in a variety of options to assist in their weight loss. Bariatric surgery in England is relatively new, with its usage having increased dramatically in the last 10 years. Practice nurses require knowledge of bariatric surgery to undertake their role effectively. This article provides information to assist practice nurses in providing care and support to patients who have had a surgical intervention. This paper also highlights signs and symptoms of physical and psychological complications including pregnancy and excess skin and recommended action and advice including nutritional monitoring and supplementation.
Obesity is defined as a chronic disease associated with abnormal and excessive fat accumulation (World Health Organization (WHO) 2018). Obesity is commonly measured using body mass index (BMI), a calculation that divides an adult's weight in kilograms by their height in metres squared. A BMI above 35 kg/m2 is classified as obese, and morbid obesity as a BMI above 40 kg/m2 (National Institute for Health and Care Excellence (NICE), 2014). However, weight and BMI are not always an accurate measure of obesity, since BMI does not distinguish between muscle, body fat and its distribution (Hanson and Barber, 2019). Waist circumference measures the accumulation of central body fat and is also considered a good measure of obesity (Ashwell and Gibson, 2009). South Asian people are at a higher risk of centralised body fat with lower waist circumference and of developing diabetes (Rush et al, 2004). Waist circumferences vary across different ethnicities and therefore no universal measurement can be applied worldwide (Qiao and Nyamdorj, 2010). Therefore, to correctly identify patients at risk of health problems practice nurses should use both BMI and waist circumference assessment tools (Table 1).
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