Bariatric Surgical Practice and Patient Care

Childhood obesity has reached epidemic proportions, and the problem is disproportionately represented in low-income, minority settings. In an attempt to intervene, an elementary school-based prevention program designed to educate children and their caregivers in healthy and active lifestyles was developed by a community-based coalition. The coalition was anchored by faculty, staff, and students of a medical school. The design, launch, and operations of this program serves as a model that may be useful to other communities.

Childhood obesity continues to be a public health concern in today's society. A variety of issues contribute to the development of childhood obesity, including culture and family lifestyle, maternal feeding habits, increased consumption of high-fat foods, and a decreased amount of physical activity. Early recognition of obesity in children is a key factor in the prevention of childhood obesity. Primary care providers play a vital role in the detection of childhood obesity. Using a multidisciplinary care approach and including families in the plan of care for these children will help to decrease the childhood obesity epidemic. Primary care providers can work together with families to ensure children become healthy and fit in order to prolong lives and decrease instances of co-morbidities.

Obesity is a major concern for many adults, but more importantly, it is thought to be the leading health problem facing U.S. children today. In healthcare settings, children of size may become immobile simply because of their body weight, postural instability, and weight maldistribution. Patient safety and caregiver injury are fast becoming serious considerations in managing the clinical care of children who are obese. This article explores and identifies some of the challenges in mobilizing larger children, with an eye to preventing caregiver injury. Safety, risk, and ethical concerns are discussed within this context.

Adolescent bariatric surgery is one way clinicians are attempting to solve the problem of childhood obesity. In 2004, the Food and Drug Administration (FDA) granted investigational device exemption of the adjustable gastric band to determine the safety and efficacy of gastric banding in morbidly obese adolescents. The role of the dietitian in the multidisciplinary adolescent bariatric team is challenging. It is the responsibility of the dietitian to improve the adolescent's diet quality prior to surgery, teach the adolescent and the family the new eating guidelines after surgery, and to assess the nutritional adequacy of the diet post operatively. This article reviews the preoperative nutrition management, the nutrition guidelines followed for adolescents undergoing gastric banding surgery at Alfred I. duPont Hospital for Children, and reviews the unique challenges that working with adolescents presents to dietitians.

Childhood obesity rates continue to rise across the United States. With the increased availability of snack foods and greater portion sizes, children have increased caloric intake, snack more often, and eat more high-fat foods. Decreased physical activity and increased sedentary behavior result in less active children. Children can suffer from comorbidities such as hyperlipidemia, hypertension, type 2 diabetes mellitus, and sleep disorders (e.g., sleep apnea, insomnia). Obesity may be a result of unhealthy lifestyle choices. The clinical nurse leader (CNL) can play a key role in educating children and families. The CNL is a nurse with high-level critical thinking skills, leadership and case management abilities, who is well qualified to work on the complex issues that affect children with overweight or obesity and their families. CNLs can help to identify children and adolescents who are overweight or obese, coordinate their care, and assist their families to promote optimal health.

The incidence of pediatric obesity is on the rise. Because pediatric overweight and obese patients are presenting for elective surgery in the day surgery setting, there are concerns regarding perioperative complications in this population. Although there is a paucity of studies specific to the pediatric population, respiratory symptoms, airway management concerns, prolonged postanesthesia care unit (PACU) stays, and increased emesis are significantly more common in pediatric patients with an elevated body mass index (BMI). ¹ This resource guide will provide assistance to nurses and other healthcare providers to increase their awareness of the perioperative complications of pediatric patients with an elevated BMI in the day surgery setting.

Childhood obesity has tripled to a prevalence rate of 17% since 1980. Numerous stakeholders influence the policy process impacting childhood obesity. Professional associations, advocacy groups, clinicians, researchers, and insurers inform the policy process. As a result, nurses must understand interdisciplinary policies impacting childhood obesity prevention and management. Knowledge of available policy resources is vital to advocating for the prevention and management of childhood obesity. The purpose of this brief article is to identify some useful sources of information for the development, support, and implementation of policies impacting childhood obesity. Consumer and professional advocacy centers for childhood obesity, research and funding opportunities for policy research, and insurance policy information specific to childhood obesity are discussed. Focused childhood obesity policy resources are compiled for future policy reference.