Two thirds of Americans, or an estimated 97 million people, are now overweight or obese, so healthcare providers frequently interact with patients who are struggling to lose weight. Indeed, obesity is an important clinical problem that cannot be ignored, and high quality healthcare is critical in efforts to improve health in this population. Additionally, with the increase in the number of bariatric surgeries performed, care must be taken to properly treat and monitor these surgical patients.
Medical providers may be a barrier to proper medical care for obese patients
Research demonstrates that obese patients frequently feel stigmatized in healthcare settings. Overweight or obese patients are more likely to avoid routine preventive care, and when they do seek health services, they may receive compromised care. When obese patients feel stigmatized, they are vulnerable to depression, low self-esteem, anxiety, and suicide. They are less likely to feel motivated to adopt lifestyle changes and may engage in unhealthy eating patterns and avoid physical activity, which can exacerbate weight gain. [1]
Providers may unintentionally communicate overt or subtle forms of bias that can negatively affect patients' care and their future utilization of healthcare services. The problem of weight stigma is serious and pervasive, and providers should be aware of this issue in their clinical practice.
In January, 2015, the Endocrine Society released new guidelines on the treatment of obesity to include some of the following:
- Diet, exercise, and behavioral modification to reduce food intake and increase physical activity should be included in all obesity management.
- Possible use of weight loss medication under the guidance of a physician after weighing the risks.
- Angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and calcium channel blockers, rather than beta-adrenergic blockers, should be considered as first-line therapy for hypertension in patients with type 2 diabetes mellitus who are obese. [2]
Bariatric Surgery
In patients with morbid obesity and associated diseases, bariatric surgery may be the only available therapeutic method associated with significant and relatively sustained weight loss. Well-performed bariatric surgery, in carefully selected patients and with a good medical support team, can counteract the diseases associated with severe obesity.
If, however, the anesthetic care and operative care are not managed properly, bariatric surgery can have terrible consequences for the patient. Doctors and those caring for bariatric surgery patients must:
- Properly position the patient and strap the patient during turning or maneuvering during and after surgery
- Should give care to protecting pressure points and preventing pressure sores
- Avoid brachial plexus and nerve damage from stretch injuries when moving patients
- Properly monitor oxygen and carbon monoxide levels during intubation
- Properly manage blood pressure with equipment proper for the patient’s size
- Plan and prepare for difficult intubation
- Have an anesthetic plan in place that accounts for the patient’s weight
- Closely monitor pulmonary function post-operatively
Failure to adhere to an operative and post-operative plan tailored to the needs of a bariatric surgery patient can result in severe brain injuries and even death.
If you or a loved one has been injured as a result of poor bariatric surgical care, Chelsie King Garza is here to help. With a medical malpractice background and experience in this area, Chelsie Garza is equipped and trained to take your case.
