Weight Loss Surgery Surgery as a means of treating obesity is becoming more popular. This is especially true for those persons for whom healthy diet, exercise, and other positive lifestyle changes did not help to lose enough weight (Mayo Clinic, 2017). Weight loss surgery, also referred to as bariatric surgery, is not for everyone. Before such surgery, complete physical and mental health examinations are conducted. Weight loss surgery requires permanent lifestyle changes. Such surgery can help reduce the risk of some weight-related problems such as type 2 diabetes, hypertension, and sleep apnea. There are also potential significant risks and complications of weight loss surgery (Mayo Clinic, 2017). Guidelines for weight loss surgery vary, but such surgery is generally considered when the BMI is 40 or higher and a life- threatening or disabling condition coexists that is related to being overweight. Following are general guidelines for clients considering weight loss surgery (Henry Ford Health System, 2019): ● Have a BMI over 40, which means about 100 pounds overweight or 200% of one’s ideal body weight ● Have a BMI between 35 to 40 with at least one obesity- related medical condition: ○ Arthritis ○ Diabetes ○ Hypertension ○ High cholesterol ○ Reflux disease ○ Sleep apnea ● Cannot achieve a long-term weight loss by diet and exercise initiatives alone ● Are committed to lifelong lifestyle changes ● Are committed to long-term follow-up medical care When evaluating candidates for weight loss surgery, the following issues are considered (Mayo Clinic, 2017): ● Nutrition and weight history: The healthcare team reviews trends, diet efforts, eating habits, exercise regimen, stress level, time constraints, and motivation. ● Current medical condition: General health status is evaluated. Some conditions such as heart disease increase surgical risks. Smoking and alcohol histories are obtained. ● Mental health status: Some mental health conditions make it more difficult for clients to make necessary lifelong lifestyle changes: binge-eating disorder, substance abuse, depression, and anxiety disorders. ● Motivation: Willingness and ability to adhere to lifestyle changes are assessed. ● Age: Risks increase with age, and weight loss surgery is controversial in persons under the age of 18. Obesity Medications The use of weight loss medications might be considered if weight-loss levels remain at an unacceptable range or if medical problems are not adequately controlled. FDA has approved the following medications for weight loss (Obesity Action Coalition, 2018): ● Phentermine products (Adipex-P or Lomaira), approved for short-term use ● Orlistat (Xenical or Alli), approved for long-term use ● Lorcaserin HCL (Belviq), approved for long-term use ● Naltrexone HCL and bupropion (CONTRAVE), approved for long-term use ● Phentermine-topiramate ER (Qsymia), approved for long- term use ● Liraglutide injection (Saxenda), approved for long-term use Health At Every Size Health at Every Size (HAES) approach to public health and aims to minimize the emphasis on weight loss as a health goal
It is important that clients understand both the benefits and risks of weight loss surgery. A benefit is that weight loss usually occurs rapidly and continues for about 18 to 24 months after the surgery. Most clients do start to regain some of the lost weight, but few clients regain all of it. Another benefit is that conditions related to obesity such as diabetes or hypertension generally improve (Gersch et al., 2017; WebMD, 2017d). Healthcare consideration : Clients who have had weight loss surgery require lifelong diet and exercise modifications as well as vitamin and mineral supplements. This generally means that long-term follow-up is necessary (Gersch et al., 2017; WebMD, 2017d). Certain risks are associated with the surgical procedure itself (Mayo Clinic, 2019): ● Infection ● Hemorrhage ● Blood clots ● Respiratory distress ● Adverse reactions to anesthesia ● Gastrointestinal perforation ● Death (rarely) These are long-term risks following weight loss surgery (Mayo Clinic, 2016; WebMD, 2017d): ● Dumping syndrome: Dumping syndrome is caused by malabsorptive surgery and occurs when stomach contents move too swiftly through the small intestine. After eating, the client experiences nausea; sweating; weakness; faintness; and, at times, diarrhea. The client is unable to eat sweets without becoming terribly weak. ● Vomiting: Vomiting is a common risk after restrictive surgery. This happens when the stomach is overstretched by food that has not been thoroughly chewed. ● Nutrition deficiencies: Clients may develop anemia, osteoporosis, and metabolic bone disease. To avoid these complications, clients must be careful to have the proper intake of vitamins and minerals. Clients may be advised by their healthcare providers to take vitamin and mineral supplements. ● Gallstones: Gallstones are a common side effect of weight loss surgery. In fact, more than 33% of clients develop gallstones after undergoing weight loss surgery. This complication may be prevented by having clients take bile salts for the first six months after surgery. ● General side effects: These include nausea, vomiting, bloating, diarrhea, diaphoresis, flatulence, and dizziness. Healthcare consideration : Women of childbearing age should avoid pregnancy until rapid weight loss has stopped, weight becomes stable, and nutritional deficiencies are corrected (Mayo Clinic, 2017). and reduce stigma towards overweight or obese individuals. Supporters believe that traditional weight-focused interventions like dieting often don't lead to positive health outcomes. It offers an alternative to the weight-focused methods of treating individuals of all body sizes. It also seeks to foster size acceptance, eliminate weight discrimination and stigma and reduce society’s preoccupation with weight loss and thinness. They argue that health is influenced by lifestyle behaviors that can be pursued regardless of body weight. However, critics contend that weight loss should be a specific healthcare goal in some cases due to the negative health effects linked to obesity
(ASDAH, 2020). HAES Principles WEIGHT INCLUSIVITY
Acknowledge and embrace the natural diversity of body shapes and sizes, avoiding the idealization or pathologization of specific weights.
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