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Guest Editorial: What is Bariatrics?
As the specialty of caring for larger, heavier individuals evolves, it becomes increasingly important to recognize the need for an appropriate corresponding lexicon. The challenge to healthcare clinicians is to develop a vocabulary that accurately, functionally, and sensitively describes individuals with weight issues.
The word obesity originates from the Latin language and refers to the state of becoming “fattened by eating.”1 Bariatrics is derived from the Greek word baros and refers to issues pertaining to weight.2 In some circles, bariatrics is thought to address weight loss surgery. However, the word comprises a much broader meaning; currently, it refers to the practice of healthcare that relates to the treatment of weight and weight-related conditions. This includes weight-loss surgery as well as reconstruction after massive weight loss, medical weight management, and more.
Issues related to weight are of interest to the public for several reasons. Health and health-related concerns are at the forefront, along with the need for additional and specialized health services and overall access to healthcare.3 Bariatrics as a specialty is becoming increasingly important in pace with the growing number of obese and overweight Americans.
Obesity comes with a substantial economic burden: the total economic costs associated with the disease are estimated to account for 5.5% to 7.8% of all US healthcare expenditures.4,5 Obesity has been found to be associated with a 36% increase in inpatient and outpatient spending and a 28% increase in medications for obese smokers.6 Obesity-related issues cost Americans nearly $150 billion annually – $117 billion are spent on health and health-related issues and $33 billion are spent on the largely unsuccessful weight-loss industry.
Recent estimates suggest that more than 67% of adults in the US are overweight. Of all Americans between the ages of 26 and 75, 130 million are overweight, 10% to 25% are obese, and more than nine million are morbidly obese. From 1976 to 2000, the incidence of obesity increased from 14.4% to 30.9%. This increase has occurred regardless of age, gender, ethnicity, socioeconomic status, or race.7 Overweight and obesity are not limited to the US. Worldwide, nearly 2 billion individuals are overweight, equaling the number of individuals suffering from starvation.8 To fully understand the meaning of these statistics it is important to know how overweight and obesity are defined and measured.
Overweight versus obese. Overweight refers to an excess of body weight compared to set standards. The excess weight may come from muscle, bone, fat, and/or water. Obesity refers specifically to the abnormal proportion of body fat. Many people who are overweight are also obese.
Body mass index. Obesity and overweight are quantitatively defined using body mass index (BMI),9 the most common and widely accepted method of assessing overweight and obesity. Body mass index is a mathematical formula that describes relative height and weight; it is significantly correlated with total body fat content and assigns a certain number to an individual’s relative risk for morbidity and mortality. However, caution must be exercised when interpreting BMI in a child or patient with edema or ascites, in pregnant women, or in persons who are highly muscular because an elevated BMI will not accurately reflect excess adiposity in these instances. Normal BMI falls in the range of 18.5 to 24.9. A person with a BMI >25 is considered overweight; a person with a BMI >30 is considered obese. Within the obese classification are grades I, II, and III, equaling BMI >30, BMI >35, and BMI >40, respectively.10
Calculating BMI is relatively simple and inexpensive. This assessment tool is not gender-specific. It is the measurement of choice for many obesity researchers, health professionals, the popular press, and recently the fashion industry. Many health organizations, including policy makers, use BMI to measure and define obesity and to establish criteria for certain procedures.4 However, BMI as an assessment tool carries certain limitations: muscular people may fall into the category of overweight when, in fact, they are physically fit and people who have lost large amounts of muscle mass may appear to be healthy when they actually have diminished nutritional reserves. Therefore, BMI has been most useful in tracking trends in the general population but must be used with other assessment criteria to determine the health status of an individual patient.
In 1995, the World Health Organization (WHO) recommended using BMI to establish three grades or levels of overweight with the cutoff points of 25, 30, and 40. Two organizations within the National Institutes of Health (NIH) – the National Heart, Lung, and Blood Institute and the National Institutes of Diabetes, Digestive, and Kidney Diseases – concurred with this system, with the caveat that cutoff points are only a guide for definition and useful for comparative purposes across populations over time. For example, an overweight individual with a BMI of 29 does not instantly acquire all of the health consequences of obesity after crossing the threshold of BMI 30. However, researchers agree that health risks increase gradually as BMI increases.
Additional assessment methods. Other assessment tools establish certain risk factors for comorbidities, such as the waist-to-hip ratio.11 A correlation study by Rexrode et al12 suggests that individuals with a high waist-to-hip ratio are at risk for certain cardiac and metabolic disorders; the presence of central obesity exacts greater tolls on this segment of the population.12,13 Additional tools are based on mathematical calculations of the relationship between height and weight, while others are based on measurements of body fat.
Providing care. When considering patient care, preplanning is imperative regardless of practice setting. The physical therapist in a wound care center, a nurse in critical care, or a physician in a primary care office can assist the obese patient with related issues including ostomies, wounds, and more. Preplanning should be based on a set of criteria that not only addresses health concerns, but also decreases the risks of caregiver injury and provides for patient safety.
In summation, standardizing measurements and definitions is an important part of the care plan. It ensures all stakeholders are speaking the same language. Reimbursement, guidelines, and protocols may be defined by these standardized assessment tools. Understanding vocabulary and standardizing measurements and definitions help clinicians determine which patients may develop the common, predictable, and preventable complications related to weight issues and further anticipate what tools (equipment) and resources (clinical experts) can best prevent or manage these events. A functional understanding of bariatrics serves clinicians and patients in this goal.
This article was not subject to the Ostomy Wound Management peer-review process.
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13. Define obesity and overweight. Available at: www.dshs.state.tx.us/phn/define.shtm Accessed June 21, 2007.
