GCU Week 5 Health Risks Associated with Obesity Case Discussion. The case scenario provided will be used to answer the discussion questions that follow.
Case Scenario
Mr. C., a 32-year-old single man, is seeking information at the outpatient center regarding possible bariatric surgery for his obesity. He reports that he has always been heavy, even as a small child, but he has gained about 100 pounds in the last 2–3 years. Previous medical Assessments have not indicated any metabolic diseases, but he says he has sleep apnea and high blood pressure, which he tries to control with sodium restriction. He current works at a catalog telephone center.
Objective Data
Height: 68 inches; Weight 134.5 kg
BP: 172/96, HR 88, RR 26
Fasting Blood Glucose: 146/mg/dL
Total Cholesterol: 250mg/dL
Triglycerides: 312 mg/dL
HDL: 30 mg/dL
Critical Thinking Questions
What health risks associated with obesity does Mr. C. have? Is bariatric surgery an appropriate intervention? Why or why not?
Mr. C. has been diagnosed with peptic ulcer disease and the following medications have been ordered:
Magnesium hydroxide/aluminum hydroxide (Mylanta) 15 mL PO 1 hour before bedtime and 3 hours after mealtime and at bedtime.
Ranitidine (Zantac) 300 mg PO at bedtime.
Sucralfate/Carafate 1 g or 10ml suspension (500mg / 5mL) 1 hour before meals and at bedtime.
The patient reports eating meals at 7 a.m., noon, and 6 p.m., and a bedtime snack at 10 p.m. Plan an administration schedule that will be most therapeutic and acceptable to the patient.
Assess each of Mr. C.’s functional health patterns using the information given. (Hint: Functional health patterns include health-perception – health management, nutritional – metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception – self-concept, role-relationship, sexuality – reproductive, coping – stress tolerance.)
What actual or potential problems can you identify? Describe at least five problems and provide the rationale for each.
Obesity and Associated Health Risks
Obesity is a serious medical condition that significantly increases an individual’s risk of various chronic diseases and health problems (CDC, 2021). According to the Centers for Disease Control and Prevention (CDC), obesity is defined as having a body mass index (BMI) of 30 or higher. BMI is a measure of body fat calculated from a person’s weight and height. For adults, a BMI between 25 and 30 is considered overweight, while a BMI of 30 or higher is obese (CDC, 2021).
Mr. C., the 32-year-old man seeking information about bariatric surgery, has a BMI of 48.2 kg/m2 based on his reported height of 68 inches (5’8″) and weight of 134.5 kg (296 lbs). This clearly places him well within the obese class 3 (sometimes called severely or morbidly obese) category, which is defined as having a BMI of 40 or higher (CDC, 2021). Individuals with a BMI in this range face serious weight-related health issues and associated risks if significant weight loss is not achieved.
Some of the key health risks Mr. C. faces due to his severe obesity include high blood pressure, sleep apnea, elevated blood lipids, and increased risk for type 2 diabetes (CDC, 2021). Let us examine each of these risks in more detail:
High Blood Pressure
Mr. C. reports that he has been diagnosed with high blood pressure, which he tries to control through sodium restriction. Obesity is a major risk factor for the development of high blood pressure, or hypertension (Mayo Clinic, 2022a). Extra weight and excess fat tissue puts added strain on the heart, which then works harder to pump blood to the body. Over time, this can damage blood vessels and lead to high blood pressure. Losing even 5-10% of total body weight through diet and exercise changes can help reduce blood pressure in obese individuals (Mayo Clinic, 2022a).
Sleep Apnea
Mr. C. also has sleep apnea, a potentially serious sleep disorder where breathing repeatedly stops and starts during sleep. Obesity is the strongest risk factor for obstructive sleep apnea (Mayo Clinic, 2022b). Extra fat tissue in the neck area can narrow or close the airway when lying down, resulting in paused breathing. Losing weight often significantly improves or resolves sleep apnea symptoms. Untreated sleep apnea increases the risk of heart disease, stroke, diabetes, and traffic accidents due to daytime drowsiness (Mayo Clinic, 2022b).
Elevated Blood Lipids
Obesity is strongly linked to unhealthy changes in blood lipid levels, such as high total cholesterol, high triglycerides, and low HDL (“good”) cholesterol (CDC, 2021). Mr. C.’s lab results indicate abnormal lipid levels in all three categories. Excess weight contributes to insulin resistance and increased fatty acid levels in the bloodstream, which can raise triglycerides and lower HDL levels. Sustained weight loss through lifestyle changes is an effective strategy for improving blood lipid profiles (CDC, 2021).
Risk of Type 2 Diabetes
The risk of developing type 2 diabetes increases dramatically with degree of overweight and obesity. Mr. C.’s elevated fasting blood glucose of 146 mg/dL places him in the prediabetes range, indicating high risk for future diabetes. Approximately 90% of those with type 2 diabetes are overweight or obese (CDC, 2021). Even modest weight loss through diet and exercise is very effective at reducing diabetes risk over time. For those who are already prediabetic, losing 7% of body weight through lifestyle changes can prevent or delay the onset of type 2 diabetes by 58% on average (Knowler et al., 2009).
Subtitle: Is Bariatric Surgery Appropriate?
Given the severity of Mr. C.’s obesity and associated health risks, bariatric surgery may be an appropriate intervention to facilitate significant, sustained weight loss. The CDC (2021) recommends consideration of bariatric surgery for individuals with a BMI of 40 or higher who have been unable to achieve and maintain adequate, clinically beneficial weight loss through nonsurgical methods.
Several major studies have found bariatric surgery to be highly effective for weight loss and resolution of obesity-related diseases in the long-term (Arterburn et al., 2015; Sjöström et al., 2004). One randomized controlled trial found participants who had gastric bypass lost an average of 109 pounds (49.8 kg) 5 years after surgery compared to 13 pounds (5.9 kg) in the control group receiving conventional medical treatment alone (Sjöström et al., 2004). Rates of complete remission of type 2 diabetes were reported between 66-95% one to two years after bariatric surgery compared to just 13% in the control group (Arterburn et al., 2015).
While bariatric surgery is a serious medical procedure with risks, it may offer Mr. C. the best chance for long-term weight control and health improvement when more conservative measures have failed. Close monitoring by a physician and adherence to postoperative nutritional guidelines are important for achieving optimal outcomes (CDC, 2021). Given his young age, lack of medical contraindications, and high motivation to improve his health, bariatric surgery seems a reasonable option for Mr. C. to consider. However, the final decision should be made by Mr. C. and his doctor based on a thorough Assessment of risks and benefits.
In conclusion, Mr. C.’s severe obesity places him at high risk for numerous chronic health conditions. While lifestyle changes aim to reduce weight and disease risk over time, bariatric surgery may offer him the best opportunity for clinically significant, long-term weight loss given his degree of overweight. With proper medical management and lifestyle adaptations, bariatric surgery could help Mr. C. achieve substantial weight loss and improved quality of life.
References
Arterburn, D. E., Olsen, M. K., Smith, V. A., Livingston, E. H., Scoyoc, L. V., Yancy Jr, W. S., & Eid, G. M. (2015). Association between bariatric surgery and long-term survival. JAMA, 313(1), 62-70. https://doi.org/10.1001/jama.2014.16968
CDC. (2021, November 17). Adult obesity facts. Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/data/adult.html
Knowler, W. C., Barrett-Connor, E., Fowler, S. E., Hamman, R. F., Lachin, J. M., Walker, E. A., & Nathan, D. M. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346(6), 393-403. https://doi.org/10.1056/NEJMoa012512
Mayo Clinic. (2022a, January 18). High blood pressure (hypertension). https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410
Mayo Clinic. (2022b, January 18). Sleep apnea. https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377791
Sjöström, L., Narbro, K., Sjöström, C. D., Karason, K., Larsson, B., Wedel, H., … & Carlsson, B. (2004). Effects of bariatric surgery on mortality in Swedish obese subjects. New England Journal of Medicine, 350(24), 2410-2421. https://doi.org/10.1056/NEJMoa032622
