Obesity case study

Obesity Case Study
Patient Profile and Background Information
SL is a 40-year-old white male who presented to a Weight Loss Center for evaluation in
preparation for gastric bypass surgery. He has been obese for many years and tried
unsuccessfully to lose weight through diet, exercise, and medical therapy with appetite
SL’s health risk factors include a strong family history of coronary artery disease,
diabetes type II, and obesity. His job as a salesman requires long trips away from home and his
meals are frequently in the form of high caloric carbohydrate and fat fast foods.
Physical exam reveals a very pleasant gentleman in no acute distress. Blood pressure is
152/92, pulse 98 and regular, respiratory rate 22, and oxygen saturation 94% on room air. SL’s
height and weight are 5’8”, and 302 pounds, respectively. He has expiratory wheezing in
bilateral lung fields, and a generalized redness of the face. The abdomen is large and soft on
palpation with no discernible hepatosplenomegaly or masses. His waist circumference is 50
inches. Serum fasting glucose (FBS) was 118 mg/dl this morning.
History revealed hypertension for the past 5 years that is treated with HCTZ; hip and
knee pain (osteoarthritis) for which he takes Advil PRN; and asthma, diagnosed around 12
years of age, that is treated with Proventil. The patient also complained of shortness of breath
on exertion and a generalized malaise during waking hours. Further discussion led to the
revelation by SL’s wife that her husband snored voraciously while sleeping and had frequent
periods of apnea, lasting 1 to 1? minutes at a time.
Question 1: What is Body Mass Index (BMI) and how is it calculated? Utilizing the
patient’s information, what is his body mass index (BMI) and BMI classification? Include
all weight ranges with classifications in your answer. (2 points)
Physiology of Obesity
There are many theories that attempt to explain the pathophysiology of obesity. These
relate to the classification as either exogenous or endogenous. Exogenous obesity is that which
results from the excessive intake of calories and lifestyle choices; and endogenous obesity
results from genetic mutations and metabolic dysfunction inherent to the individual.
Question 2: What are two major risk factors that may have influenced the development of
obesity in this client? Provide a rationale for each factor. (2 points)
Question 3: What are six major neuroendocrine hormones and/or peptides that regulate
energy balance and food intake? Discuss the function of each. (6 points) Obesity may simply be due to the excessive number and size of the individual
adipocytes, anthropometric measurements attempt to determine the presence of hyperplastic
and hypertrophic adipocytes. Hypertrophy occurs in the obese individual when a positive energy
balance exists. Cellular size increases as fat accumulates within the cellular components.
Hyperplasia results from an increased rate of adipocyte cellular division.
In order to measure SL’s actual body fat composition, a triceps skin-fold thickness test
was done. This test is “a more reliable indicator of body fat than is weight”. While in a sitting
position, triceps skin-fold measurements were made using a skin fold caliper. Adipose tissue is
measured in millimeters squared (mm?) and was determined to be 42 mm?. According to the
American Society for Clinical Nutrition, this measurement placed SL considerably over the 95th
percentile for skin fold thickness, supporting the diagnosis of obesity.
Question 4: Discuss two other anthropometric measures used to assess body fat and
muscle composition? (2 points)
Diagnostic Studies
Embracing the theory that there may be a genetic component to SL’s obesity, diagnostic
tests were ordered prior to surgery. A routine complete blood count (CBC) and thyroid panel
was within normal range for SL and is not relevant to this case study. S.L.’s chest x-ray and
EKG were also normal. His other lab results are found in Table 1.
Table 1
S.L’s Lab Results
Lab Test Result Lab Test Result
Albumin 4.16 g/dl Blood Gases:
Fasting Blood
118 mg/dl PaO2 88 mmHg
Insulin 86 pmol/L PaCO2 50 mmHg
Leptin 100-260% of baseline pH 7.32
Cholesterol 320 mg/dL HCO3 30
HDLs 20 mg/dL O2 sat. 94%
LDLs 195 mg/dL
Triglycerides 220 mg/dL Question 5: Based on SL’s history, PE and lab results, discuss the above lab results that
support the diagnosis of metabolic syndrome. (3 points)
Question 6: What is your interpretation of the above lab results related to his diagnosis
of obesity and other health problems? Discuss only those lab results not addressed in
question 5. (4 points)

S.L. had spirometry tests that revealed a vital capacity (VC) of 4000 mL, total lung
capacity (TLC) of 5000 mL and expiratory reserve volume (ERV) of 1000 mL.
Question 7: Discuss the purpose and normal ranges for each of the spirometry tests and
interpret the results. (2 points)

Question 8: What is the physiological impact of asthma, obesity and sleep apnea on
pulmonary function? (3 points)
Medical Management and Surgical Intervention
As all medical management protocols for obesity had been exhausted for SL, it was
determined that the best method of treatment was gastric bypass or Roux-en-Y surgical
Question 9: What are the physiological effects of gastric bypass surgery (Roux-en-Y)?
What are the criteria for gastric bypass surgery and why is it indicated for SL? (2 points)
Nursing Management
Nursing care of the clinically obese patient can be challenging. Frequently patients who
are overweight resist seeking treatment until their comorbidities are severe. SL was primarily
concerned about the changes that he would be forced to make in his diet and lifestyle after
surgery. An unanticipated response to the prospect of surgery for SL was the perception of loss
that he felt in saying “goodbye” to his former self and the eating habits that had provided
comfort to him over the years.
Question 10: What are two pertinent nursing diagnoses with related interventions and
rationale that should be discussed with S.L. prior to gastric bypass surgery? (4 points) Summary
Caring for the severely obese patient requires a solid understanding of the theoretical and
actual physiology of obesity. SL presented with the understanding that all other measures taken
to control his weight had been exhausted. Genetic predisposition, family history, and lifestyle
issues contributed to his fulfilling, what was considered to be, his ‘genetic potential’ or destiny.
Through the study of the body’s ability to thwart starvation, surgical intervention has come to be
a popular means to the end of obesity.
SL underwent a Roux-en-Y and responded extremely well to surgical intervention. He is 6
months post-op and has lost 98 pounds. He no longer suffers from sleep apnea and is awaiting
the results of post-op blood work to determine insulin levels. He is no longer short of breath, but
continues to suffer from asthma, although the effects are less severe. PLEASE NOTE: The answers to the questions should be complete and include professional
literature to support each answer. You should include at least 3 current references (< 5
years old) of which 2 must be journal articles. References should include current
nursing journals and other professional health related literature. The paper should be typed using APA format. APA format requires that you use
correct grammar and spelling and double-space your entire paper. Use the questions
as your headers. Do not write out the questions in your paper but use the question to make a level 1 heading and then write a paragraph with the answer. You always need a title on the first page of text.

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