Guest Editorial: Innovative Methods to Better Manage the Clinical, Cost, and Humanistic Aspects of Bariatric Care

  According to the World Health Organization,¹ obesity is a disease and is defined as a condition of excess body fat to the extent that health is impaired.   The National Institutes of Health² state obesity is defined as a body mass index (BMI) ≥30; morbid obesity is defined as BMI >40. The American Society for Metabolic and Bariatric Surgery³ defines obesity as a lifelong, progressive, life-threatening, genetically related, multifactorial disease of excess fat storage with multiple comorbidities. Recent discoveries suggest obesity is more than simply overeating or lack of control and self-discipline; gender, genetics, physiology, biochemistry, and neuroscience and cultural, environmental, and psychosocial factors influence weight and its regulation.⁴

  Obesity has become a worldwide issue as evidenced by the emerging demographics of obesity among all categories of individuals. For example, 71.4% of Americans are overweight or obese, more than one third of all Americans are obese, and 3% to 10% (at least 8 million) people are morbidly obese.⁵ Morbid obesity, once a rare occurrence in America, has essentially quadrupled since the 1980s. Research also shows the most overweight Americans have become more so in the past decade. Studies point to a substantial increase in obesity among all age, ethnic, racial, and socioeconomic groups.⁶ In the early 1960s, only one fourth of Americans were overweight; today, more than two thirds of US adults are overweight, as are 35% percent of US children.⁷

  According to the literature,⁸ patients with a high degree of adiposity are at risk for a number of well-documented concerns at a greater rate than their leaner peers. Adipose tissue acts like an endocrine organ and influences hormone and cytokine production and secretion. Cytokines such as tumor necrosis factor alpha, leptin, and interleukin-6 are cellular messengers that regulate various inflammatory responses. Dysregulation of cytokines, often observed in the obese patient, causes an environment of chronic inflammation. This dysregulation plays a role in the function of every organ of the body, including the intestinal tract, affecting fecal incontinence, the integumentary system (which affects wound healing), and the body’s response to an acute illness.⁹

  Venous disease, as a threat to the already compromised integumentary system of the obese individual, is a significant condition that poses risks to skin health and impacts quality-of-life outcomes, including acute and chronic pain. Gibbons et al¹⁰ describe an innovative approach to successfully improve healing and reduce pain levels among all categories of patients, including those with complex comorbid conditions. Su et al¹¹ conducted a study that addresses quality of life and fecal incontinence; further, the authors present a means to reduce the clinical consequences of fecal incontinence, which include perianal fecal contamination, incontinence-associated dermatitis, lower urinary tract infection, bacteriuria, and leucouria.

  Beitz¹² describes a common situation that has emerged as the prevalence of obesity has risen among all categories of patients in the US. However, what is unique about her case report is that she presents the clinical challenges from the perspective of a family member. She contends skin injuries and infections pose serious and life-threatening situations for the morbidly obese patient and presents prevention and treatment alternatives.

  As the prevalence of obesity continues to rise across all categories of patients, health care providers and researchers continue to seek innovative and proven methods to better manage the clinical, cost, and humanistic concerns of bariatric patient care. This issue of OWM provides insights into the management of the bariatric patient with the understanding that obesity can complicate any health condition.

  This article was not subject to the Ostomy Wound Management peer-review process.