Obesity and Gastrointestinal Disorders

Question: Discuss about the Obesity and Gastrointestinal Disorders. Answer: Introduction Obesity is a chronic disease gaining attention as a major health concern in different countries across the globe. Its association with gastrointestinal health has been under research in the contemporary era since it has major implications for health care and nursing practice (Ng et al., 2014). Several reports have indicated an increased prevalence of gastrointestinal diseases in obese individuals in studies conducted in different communities. Gastroenterologists and nurses have an important role in recognising the increased rate of obesity and the causal relationship it holds with multiple gastrointestinal conditions for adequately managing obesity-related gastrointestinal complications. An awareness of all associations and complications of obesity in relation to gastrointestinal conditions is crucial for providing comprehensive care by the nursing profession (Johnson,2010). The present paper highlights the relation between obesity and gastrointestinal health with a focus on nursing implications for the condition. The paper discusses the factors surrounding gastrointestinal health that are to be considered in the nursing assessment for obesity, and gastrointestinal and dietary considerations that the nurse addresses in providing education to a patient with obesity. It also critically analyses the manner in which gastrointestinal anatomy and physiology is affected by obesity and throws light on the most significant diagnostics and pharmacological treatment for obesity and the role of the nurse in providing these. Factors surrounding gastrointestinal health that will need to be considered in the nursing assessment for obesity Obesity is a multifactoral, complex condition in which individuals are put at an increased risk of health complications due to excess amount of body fat. Excess fat may be due to an imbalance of energy expenditure and energy intake. For proper treatment and management of obesity, it is essential that an efficient assessment of the individual is carried out for indicating obesity. Apart from the nutritional assessment of the patient encompassing biochemical assessment and clinical examinations, one must consider an assessment of gastrointestinal health for assessment for obesity. A nurse is to carry out a complete examination of past and current gastrointestinal (GI) information through health history and physical assessment. Questions are to be asked regarding symptoms like indigestion, gas, pain, vomiting, nausea, constipation and diarrhoea. In addition, the patient also needs to be asked about bowel habits, previous GI diseases and occurrence of jaundice. Physical assessment needs to include auscultation, inspection, palpation and percussion of the abdomen. The abdomen is to be inspected for nodules, bruises and wounds along with lesions, scarring, inflammation and discoloration. Distention and bulging are to be noted (Hurt et al., 2010). A thorough gastrointestinal health assessment is crucial for assessing patients for obesity. An abdominal pain assessment needs to be carried out, and patients are to be asked specific questions regarding pain occurring before or after meals or at the time of eating. Questions also are to involve heartburn and issues like sore mouth, throat or tongue. Changes in appetite, the presence of nausea and food intolerance are to be noted effectively. The patients are also to be questioned regarding their use of antacids and laxatives. In addition, amount, frequency and colour of stool are also to be noted. The previous history of GI diseases like inflammatory bowel disease and cholecystitis are to be assessed (Ashburn Reed, 2010). According to Huseini et al., (2014) evaluation of the GI tract for assessment of obesity yields valuable information that has major implications for planned treatment. Assessment is to include upper endoscopy, testing for H pylori and evaluation of the gall bladder and liver disorders. A nurse specialised in gastroenterological assessment would contribute to the proper evaluation of the patient. Testing for H pylori is necessary as infection from the bacteria has been reported in almost 40% cases of obesity. Noninvasive urease test with positive result indicates abnormal endoscopy. Liver histology when done in obese patients usually reveals major abnormalities such as non-alcoholic fatty liver disease. Liver diseases are therefore to be assessed in patients with the help of imaging tests like ultrasonography and blood tests. Obesity is highly associated with gallstones that ultrasonography. It is vital to make sure that suitable indications exist regarding performing endoscopy in pat ients suffering from obesity. Obese individuals have increased chances of having upper gastrointestinal symptoms as well as gastritis and hiatal hernias. It has also been established that obese patients are at more risk of underlying gasterointestinal pathology. Thus, there can be changes in the threshold for carrying out endoscopy in patients though there may be increased risk related with the procedure. Dietary and gastrointestinal considerations the nurse need to address in providing education to the individual with obesity Nursing interventions for patients with obesity include patient education is an important element. Patient education for obesity needs to include components of a healthy diet, principles of proper weight management and the negative impacts of binging, purging and fasting. Nurses are to provide nutritional recommendations to the patients so that they are able to achieve positive health outcomes. The usefulness of diet and required modifications of any kind are also to be explained to the patient (Mushref Srinivasan, 2012). Johnson (2010) outlines the considerations that nurses need to address while educating an obese patient. Patients are to be educated to include in their diet sufficient amount of vegetables and fruits on a regular basis. An excessive amount of fat and sugar are to be avoided at all costs. Healthy food choices made at home are to be encouraged, and fast food is to be discouraged. It is important for the patient to know about the different types of fat and their role in a healthy diet. Patients must consider consuming mono, and poly-unsaturated fats as these help in lowering the blood cholesterol levels. Cholesterol free and saturated fat-free food options are to be encouraged. Sodium content in food increases blood pressure and are to be consumed in low amount. A balanced diet with rice, wheat, potato and barley products would be beneficial. Other ingredients that are to be consumed would include beans, legumes, fresh lean meat, fish, tofu and egg whites, olive oil, sunflower oil and nuts. Milk and dietary product must also be considered in the diet. Nurses may also motivate patients to eat daily meals together with the family as this has a positive implication for eating habits. Being mindful of the portion size of food choices is also crucial, and the patient is to be educated regarding this. Patients are to be educated regarding the need of physical exercises in this context. Educating patients about the importanceof healthier food choices can be often time-consuming and frustrating for nurses. It is expected that nurses demonstrate patience and sympathy while educating patients on this matter. Since a nurse is on the front line of handling patient problems due to overweight, it is pivotal that nurses educate patients about the tremendously damaging impact of obesity. Educating the patient about the gastrointestinal complications arising due to obesity, like diarrhoea, bloating, nausea and vomiting would help in bringing behavioural changes in the patient. Su fficient information is to be provided to the patients about the secondary health complications that arise due to obesity so that they are aware of the potential complications they can face in due course. Nurses are to face the problem head-on and not turn a blind eye to the challenges faced by the patients. Critical analysis of the manner in which gastrointestinal anatomy and physiology is affected by obesity The effect of obesity on the gastrointestinal physiology and anatomy and the succeeding requirement for gastrointestinal procedures warrants critical consideration. The relationship between obesity and gastrointestinal disorders is predominantly strong to raise the chances that there is a mechanical connection between the two. Examination of how obesity leads to changes in physiology and anatomy of the gastrointestinal (GI) system or vice versa is undertaken the time and again (Rajindrajith et al., 2014). Data has revealed that obesity is linked with diarrhoea and a number of explanations come up to describe the relationship. It has been hypothesised that patients suffering from obesity consume an excessive amount of sugars that are poorly absorbed by the human body that is a main cause of osmotic diarrhoea. Particularly, patients with obesity consume more amounts of fructose that the permissible limit. The findings can explain a section of the link between obesity and changes in the gastrointestinal system. The studies already conducted have not considered control of specific dietary variables, laying provisions for judging whether the established relationship holds chances of being muted or eliminated. It is further possible that proton pump inhibitors (PPIs) confound the relationship between gastrointestinal diseases and obesity. Patients with gastroesophageal reflux disease (GERD) have increased chances of receiving PPI treatment in comparison to patients not having GERD. PPI ther apy promotes the different forms of bacterial overgrowth as a result of the elimination of gastric acid that promotes abdominal pain, constipation, bloating and symptoms related to dyspepsia. Moreover, PPI therapy alters duodenal, gastric, and intestinal bacterial profiles (Phatak et al., 2016). Acosta and Camilleri (2014) highlight that a proposed mechanism that explains the imbalance of gastrointestinal system in association with obesity is binge eating. Binge eating can be witnessed in patients suffering from obesity, and this leads to an alteration in the gastrointestinal system as patients eat to an extent causing abdominal discomfort. Researchers have surveyed obese patients and their eating behaviours and the GI symptoms they have. It has been found that excess eating due to binge eating results in an increased calorie intake, leading to dealy in gastric emptying. Delay in gastric emptying is a significant physiological event, and patients suffer from vomiting and nausea. Alemn et al., (2014) studied the impact of fat gained due to obesity and gastric motility. The researchers found that diet with high-fat content, as marked by obesity, induces changes in the sensitivity to hormones like leptin and ghrelin instead of changes in the rate of secretion. High-fat diet als o changes postprandial levels of Peptide YY (PYY) hormone and secretion rate of Cholecystokinin (CCK) hormone. Donohoe et al., (2014) argue that though a number of studies have documented changes in gastric physiology and anatomy in obese patients, the results have inconsistency between them. The cause of such inconsistency may be the variation in tools used for the measurement of the agreed parameters. On an interesting note, many studies have indicated that patients with obesity have increased gastric emptying of solids as compared to those who are not obese. On the contrast, other studies are known to have indicated no major changes in gastric emptying in patients with changing BMI. In summation, studies have generated number of importat questions than significant answers in relation to the link between obesity and changes in the gastrointestinal system. Most significant diagnostics and pharmacological treatments for obesity and the Nurses role within providing these Obesity can be effectively diagnosed through a number of diagnostic tests that reviews the health condition of the patient through physical examinations. The most effective tool for diagnosing obesity is the calculation of Body Mass Index (BMI) for the patient. BMI is calculated by height and waist measurements. It is a method of quantifying the amount of tissue mass in the individual and then categorising the individual as normal weight, underweight or obese. A person with high BMI is referred to as being overweight. The second most effective method for assessing obesity is measuring the waist circumference. Blood tests for diagnosing obesity may include liver function tests, cholesterol tests, fasting tests and thyroid tests amongst others. An overall physical examination would include measurement of vital signs like body temperature, blood pressure and heart rate (Bray Bouchard, 2014). Apart from behaviour modification, exercise and dietary changes, pharmacological interventions are crucial for managing obesity. Drug therapy acts as an adjunct for the treatment of obese patients. Until in recent times, pharmacological treatments for obesity have had limited application as there are concerns related to safety and efficacy. Long term administration of the drugs is required since the patients have a tendency to regain weight after the drugs are stopped being consumed. As such, in case the patient is not successful of losing the modest sum of weight it is advisable to stop the medication. In the present times, pharmacological treatments are being considered as adjunctive therapy in overweight and obese patients (Yanovski Yanovski, 2014). Phentermine is an amphetamine derivative that is approved by the concerned organisation for achieving short-term weight loss. The agents act by stimulating the release of norepinephrine and dopamine, causing the repression of appetite . Despite a growing enthusiasm from patients towards pharmacological treatments for obesity, only a handful of drugs has been approved for administration. These list of drugs include Saxenda, Xenical and Duromine. These drugs are the main options to loose weight that mainly acts by preventing the body from maximum absorption of fat or suppression of appetite. Benefits in blood pressure and glycemic control have also been established. There may be however some side effects of the medications that are to be taken care of, including fluctuations of weight. Best alternatives are to be strongly considered wherever needed (Nathan Gorman, 2015). As opined by Apovian et al., (2015) nurses have a key role in providing obese patients with the best-suited diagnostics and treatment options. Initiating and engaging a conversation with the patient suffering from obesity for considering the diagnostics and treatment may be challenging for nurses as patients are often victims of stigma and discrimination in the society. Patients with obesity find it difficult to engage in an open conversation for discussing the medical needs and the emotional support needed for adhering to the mediation regime. It is the responsibility of the nurses to motivate the patients in a positive direction to achieve better patient outcomes through inspiration and encouragement. The nurses need to minimise the discomfort of the patients in accessing the suitable treatment options for reducing obesity. It is crucial to explain to the patients the importance of adequate treatment of obesity while being highly sensitive to the readiness of the patient to bring a bout the change (George et al., 2015). Conclusion Obesity is one of the most severe conditions of the human body that leads to poor psychological and medical health as well as premature death. Alarmingly, the rate of obese individuals is rising rapidly. The associated diseases of obesity lead to a considerable amount of healthcare costs. In a quest for treating obesity researchers have given emphasis on the relationship between obesity and gastrointestinal health. Obesity has the potential to impact the gastrointestinal anatomy and physiology to a considerable extent. Physicians and nurses are on the front line for the diagnosis and treatment of patients with gastrointestinal disorders presented with obesity. Nurses are positioned uniquely to care for patients suffering from obesity and provide with primary care options and sufficient patient education. A number of diagnostics and pharmacological treatment options have emerged that can clinically manage obese patients. It is the responsibility of the nurses to be acquainted with the most effective treatment options and the potential risks, indications, complications and benefits of the treatment options. The overall goal of nursing care for the patients suffering from obesity would be to bring about healthy changes in daily practice in order to curb the negative impact of obesity on gastrointestinal health. References Acosta, A., Camilleri, M. (2014). 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