Obesity & Metabolic Syndrome | Chapter 45 - Lewis’s Medical-Surgical Nursing (12th Edition)

Chapter 45 of Lewis’s Medical-Surgical Nursing (12th Edition) explores obesity as a chronic, multifactorial disease that impacts health, function, and psychosocial well-being. Obesity is linked to type 2 diabetes, cardiovascular disease, sleep apnea, musculoskeletal disorders, certain cancers, and reduced quality of life, making it a global epidemic requiring comprehensive nursing management.

✨ Epidemiology & etiology – Over 43% of U.S. adults are obese, with higher rates among Black and Hispanic populations, and in the South and Midwest. Obesity results from excess caloric intake compared to energy expenditure, influenced by genetics (FTO gene, leptin resistance, ghrelin imbalance), environment (high-calorie diets, sedentary lifestyles, food deserts), and psychosocial factors (stress, depression, food as comfort/reward).
✨ Health risks – Android (abdominal) obesity increases risk of cardiovascular disease, stroke, dyslipidemia, hypertension, type 2 diabetes, GERD, gallstones, nonalcoholic steatohepatitis (NASH), sleep apnea, osteoarthritis, gout, infertility, kidney disease, and cancers (breast, colorectal, endometrial, esophagus, gallbladder, kidney). Obesity is also associated with depression, stigma, discrimination, and social isolation.
✨ Assessment & classification – Nurses assess BMI, waist circumference, waist-to-hip ratio (WHR), and body shape (apple/android vs pear/gynoid). BMI ≥30 = obesity; ≥40 = extreme obesity. Android distribution poses greater metabolic risks. Subjective data include weight history, comorbidities, exercise patterns, eating habits, and psychosocial concerns. Objective data include BP, respiratory function, labs (lipids, glucose, LFTs), and comorbid disease evidence.
✨ Management – A holistic, interprofessional approach includes nutrition therapy (balanced caloric restriction, DASH/MyPlate, high protein/fiber), exercise (150 min/week moderate activity), behavior modification (self-monitoring, stimulus control, non-food rewards), support groups (TOPS, Weight Watchers), drug therapy (orlistat, bupropion/naltrexone, liraglutide, semaglutide, phentermine/topiramate), and bariatric surgery.
✨ Bariatric surgery – Options include restrictive (gastric banding, sleeve gastrectomy, gastric plication, intragastric balloon), malabsorptive (biliopancreatic diversion, duodenal switch), and combined (Roux-en-Y gastric bypass). Complications include leaks, dumping syndrome, anemia, vitamin deficiencies, and hernias. Nurses manage perioperative care, promote ambulation, monitor for anastomosis leaks, support nutrition changes, and provide psychosocial support for body image adjustment. Cosmetic options (lipectomy, liposuction) may address excess skin.
✨ Metabolic syndrome – Defined by ≥3 of 5 risk factors: abdominal obesity, high triglycerides, low HDL, hypertension, and impaired fasting glucose. Insulin resistance underlies the condition, increasing risk for CAD, stroke, and diabetes. Management focuses on weight loss, exercise, diet, and treatment of individual risk factors.

Gerontologic considerations emphasize obesity’s role in worsening frailty, disability, sleep apnea, incontinence, and joint disease in older adults, while modest weight loss can improve function and longevity.



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