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Avoid foodsHigh in fat, high in simple sugars, processed foodsFad diets - quick results, typically reboundoPsychosocial/ behavioralMotivationAssociated with both short-term and long-term weight loss successChanging nutritional environmentSetting realistic goalsPreventing discouragementBehavioral modificationSelf-monitoringStimulus control of unhealthy behaviors RewardsoShould not be food related!Support groups have been proven to help sustainability of weight loss oExercise30-60 min dailyassess daily routineassess preferencesplan activities the patient will enjoy and stick with but also has access to oMedicationsAppetite suppressantsPrescription vs OTCNot a long term solutionInterprofessional CareObesityDiagnostic Assessment• History and physical examination• Family history• BMI, waist circumference, waist-to-hip ratio• Assessment of health risks and co-morbiditiesManagement• Management of co-morbidities• Lifestyle interventions• Participation in weight loss program• Behavior modification• Nutritional therapy• Exercise• Behavior modification• Support groups• Drug therapy (Table 40-9)• Surgical therapy (Table 40-10)Nutritional Therapy1200-Calorie–Restricted Weight-Reduction Diet*General Principles1. Eat regularly. Do not skip meals.2. Measure foods to determine the correct portion size.3. Avoid concentrated sweets, such as sugar, candy, honey, pies, cakes, cookies, and regular sodas.
4. Reduce fat intake by baking, broiling, or steaming foods.5. Maintain a regular exercise program for successful weight loss.Bariatric surgeriesRestrictiveoReduced sizeoReduced amount of food allowed to enter stomachMalabsorptiveoSmall intestine reduced to prevent more absorptionCombinationoBothoSmaller portion of stomach connected to small intestine further downCosmetic surgeriesoNot for weight loss, just for removal of fatty tissue in a specific area oLipectomyRemoving skin flaps after weight lossoLiposection Nursing careoPre-opTotal Health assessmentPsychosocial assessmentPlanning for weights, scalePlan in place prior to coming or specialized unitsEducation for what to expectoPot-opPrevention of complicationsMonitoring for re-sedationTurning and ambulationIncreased risk of respiratory complicationsTurn, cough, deep breathe, incentive spirometer Increased risk for DVTAssess skin for complications oSpecific to bariatric surgerySignificant painMonitor woundsEnsure no re-opening NG tube managementPatent and in right positionIf vomiting occurs, notify physician immediately Complications with tube may be indicative of internal incision, so inform physician immediately Focus on liquid intake and dietary prescriptionProgresses from water to high protein liquid diet to high protein foodsAvoid foods and fluids high in carbsDon’t ingest fluids with mealsTo prevent dumping syndrome Psychological changes