Part 1: Analysis of the Morbid Obesity Process in General
Introduction: Definition of Morbid Obesity
Morbid obesity is a condition associated with individuals who register a body mass index (BMI) of more than 40, which constitutes more than 50% or 100% above what their ideal body weight should be (Sturm & Hattori, 2013). The BMI is a test used in the estimation of body fat content and helps in the determination of an individual’s health based on a correlation between size, height, and weight (Sturm & Hattori, 2013). Despite the fact that BMI does not provide perfect measurements, it does however provide a general estimation of an individual’s ideal range weight for their height.
Pathophysiology and Epidemiology/Prevalence/Risk Factors
According to the Centers for Disease Control and Prevention (CDC), in the United States, more than 50% of the adult population are either overweight or obese, which translates to approximately 120 million adults (Brethauer, Kashyap, & Schauer, 2013). Out of this group those who suffer severe obesity constitute about 20 million adults (Brethauer, Kashyap, & Schauer, 2013). Adults living with morbid obesity in the United States amount to at least 24 million. This problem of obesity is becoming a health epidemic with more people around the world being diagnosed with this condition. In the United States, between the year 1980 and 2010, the prevalence of obesity has increased from 15% to 36% with the prevalence of extreme obesity in women being at 8.2% while that of men at 4.4% (Brethauer, Kashyap, & Schauer, 2013). That said, research has shown that compared to white males, women and minorities are affected the most by obesity and morbid obesity. With 17% of adolescents and children suffering from obesity, the situation appears to be worse especially because the prevalence of obesity in this age group has tripled from 1980 (Brethauer, Kashyap, & Schauer, 2013).
The understanding of what causes morbid obesity is based on the logic that when energy usage is exceeded by caloric intake then one’s total body fat increases (Zhang, et al., 2014). When one eats, the body uses the calories from the food to run body functions and when the calories are not fully utilized, the body converts them and stores them as fat. Morbid obesity is thus a result of too much fat being stored in the body. That said, behavioral factors play a major role in the development of morbid obesity, for instance, there is a strong correlation between people’s eating habits, exercising habits or physical output and the development of morbid obesity (Zhang, et al., 2014). Be that as it may, how an individual’s body stores energy or fat can be affected by genetic factors, which makes certain individuals more susceptible to developing morbid obesity compared to others (Zhang, et al., 2014).
Morbid obesity is associated with over 30 comorbid conditions. 15% to 25% of obese patients present with diabetes mellitus and insulin resistance (Brethauer, Kashyap, & Schauer, 2013). Debilitating joint disease is also common in patients with morbid obesity because of the stressing effect that excess weight has on the back and joints. In morbidly obese patients, conditions such as abdominal hernia, venous stasis disease, stress urinary incontinence, and gastro esophageal reflux are contributed to by intra-abdominal pressure, which is as a result of increased abdominal fat (Brethauer, Kashyap, & Schauer, 2013). Liver failure due to fatty deposits in the liver is also a common presentation especially after the liver progresses to nonalcoholic steatohepatitis (NASH). Type 2 diabetes, blood lipid abnormalities, heart disease, gallstones, reproductive problems, metabolic syndrome, certain cancers, obesity hypoventilation syndrome, stroke, sleep apnea, and osteoarthritis are some of the serious and complicated health problems associated with morbid obesity (Zhang, et al., 2014). According to (Pour, Norouzzadeh, & Heidari, 2015), risk factors such as obesity, smoking and hypertension affected the symptoms of Acute Coronary Syndrome with both younger and older patients exhibiting a lesser chance of experiencing typical symptoms.
Natural history of Morbid Obesity
Primarily, adipose tissue is stored in the abdominal cavity and subcutaneously, with males more likely to deposit fat in the abdominal compartment while females being more likely to deposit fat in the peripheral tissues. Peripheral fat is less metabolically activity compared to central or visceral fat, which is often associated with increased risk of cardiovascular atherosclerotic disease, high blood pressure, type 2 diabetes, dyslipidemia (Brethauer, Kashyap, & Schauer, 2013). It has been observed fairly accurately that in the development of obesity, the number of fat cells are continually on the increase and as they grow higher amounts of cytokines are released and consequently lower amounts of adiponectin are released (Brethauer, Kashyap, & Schauer, 2013). Consequently, lipid metabolism and glucose are affected negatively resulting in the proinflammatory state associated with obesity. This state of low-grade inflammation has been implicated in the development of the hypercoagulable state, and coronary and vascular artery disease seen in patients with morbid obesity (Brethauer, Kashyap, & Schauer, 2013).
In the determination of morbid obesity, a patient’s BMI is one of the most significant indicators together with any noteworthy comorbid conditions such as cancer, heart disease, or arthritis, which are often chronic. To uncover previously undiagnosed comorbidities thorough physical and history examination would need to be carried out. A thorough history examination should also reveal obstructive sleep apnea, which often goes unrecognized in patients with morbid obesity. A baseline electrocardiogram (ECG) should be carried out on patients being evaluated for morbid obesity because obese patients are at greater risk for cardiovascular disease.
Medical Management/Treatment Plan including goals of treatment, pharmacological and non-pharmacological treatment including rationales from evidence-based studies
There are two main options in the treatment of morbid obesity: Non-surgical treatment and surgical treatment. Under the non-surgical option of treating morbid obesity there are conventional methods recommended for weight loss such as medication, exercise, and dieting. While these options may work in the short-term, for people who present with morbid obesity, these options may not solve the problem permanently, resulting instead in the ‘yo-yo syndrome’ where weight lost is continually gained back and lost again often with serious health and psychological consequences. Since the development of obesity may involve central pathophysiological mechanisms such as neuroendocrine hormone dysfunction and impaired brain circuit regulation, anti-obesity drugs may be prescribed in addition to other management therapies to reduce fat absorption and appetite (Zhang, et al., 2014).
Under the surgical option of treating morbid obesity there are certain procedures such as Laparoscopic Adjustable Gastric Banding and the Gastric Sleeve that have helped patients improve their health and enhance their quality of life by maintaining significant weight loss (Alexandrou, et al., 2015). In the effort to lessen nutrient absorption and stomach volume, and to induce faster satiety, Bariatric surgeries performed on morbidly obese individuals have been successful.
Morbidly Obese Patients and Family
Morbidly obese children and adults alike face numerous challenges in their lives and often become withdrawn from society through experiencing instances of stereotyping, stigma, and rejection, which takes a toll on their health and psychological wellbeing. This often results in anxiety, body image concerns, avoidance of physical activity, suicide, self-harm, depression, low self-esteem, and binge eating (Flint, 2015). This further strains their relationships with their families who have to care for them, assist them with mobility, contribute financially to cater for their medical expenses and non-standard lifestyle that requires modifications in nearly all areas, transportation, dietary needs, specialized equipment, and modified structures at home. To help morbidly obese patients and their families to co-existing positively and supportively, the preservation of patients’ dignity remains at the core where the family ought to receive caregiver training and education that uses supportive language, and respectful communication (American Diabetes Association, 2016).
Morbid obesity is an ultimately fatal disease with those living with the disease living in a difficult state. To make the management and care of morbid obesity more effective and streamlined, the needs and perspectives of patients, care providers and the family members of the patients must be understood. To optimize opportunities and to avoid substandard approaches in the provision of the best care for morbidly obese patients, lessons should be continually learned from the current and past experiences of caring for the morbidly obese patients.
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