Bariatric Space, Technology, and Design: A Round Table.

BACKGROUND: Planning and executing healthcare for the patient or resident living with obesity can be a challenging task that has implications to the occupational health professional. METHODS: Leading global experts in the areas of occupational health, ergonomics, bariatrics, technology, and patient care were identified and invited to participate in a round table discussion. Questions posed to experts were based on literature that addressed patient handling and mobility, architectural design recommendations, clinical care of the person with obesity, and ergonomic guidelines. FINDINGS: Experts agreed that special considerations must be in place to care for the person who is obese. These special considerations should address not only clinical care of the patient, but ways to protect workers from occupational injury associated with clinical care. Experts suggested that, in some situations, a bariatric training suit may be helpful in better understanding space and design challenges, as well as a better understanding of the physical limitations associated with a larger body habitus (although simulated). Further, experts agreed that insensitivities often stem from failure to have proper space, technology and design accommodations in place. Conclusions/Application to Practice: The occupational health professional is a key resource to teams charged with planning and executing healthcare for the patient or resident living with obesity. Interprofessional understanding and communication can lead to a more comprehensive approach to space, design and technology that not only addresses the patient, but the worker providing direct care.

Retirada difícil del balón intragástrico con colonización fúngica grave: ¿cómo lo hago? Respuesta-comentario del Grupo Español de Endoscopia Bariátrica / Difficult explant of intragastric balloon with severe fungal colonization: How do I do it? Response-commentary of the Spanish Bariatric Endoscopy Group

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Devices and Endoscopic Bariatric Therapies for Obesity.

PURPOSE OF REVIEW: In this review, we describe the FDA-approved and investigational devices and endoscopic bariatric therapies for the treatment of obesity. We focus on literature published in the past few years and present mechanisms of action as well as efficacy and safety data. RECENT FINDINGS: Devices and endoscopic procedures are emerging options to fill the significant treatment gap in the management of obesity. Not only are these devices and procedures minimally invasive and reversible, but they are potentially more effective than antiobesity medications, often safer for poor surgical candidates and possibly less expensive than bariatric surgery. As many patients require a variety of management strategies (medications, devices, procedures, and/or surgery) in addition to lifestyle modifications to achieve clinically significant weight loss, the future of obesity treatment involves a multidisciplinary approach. Combinations of advanced treatment strategies can lead to additive or synergistic weight loss. This is an area that requires further investigation.

Clinician challenges in providing health care for a morbidly obese family member: a bariatric case study.

Morbid obesity is a chronic disease affecting millions of Americans. The disorder is likely to increase in prevalence because currently one third of the American population is obese. Many factors are associated with morbid obesity, including psychological (eg, depression), physiological (eg, hypothyroidism) mechanisms, sleep disorders (eg, sleep apnea), drug therapy (antidepressants, antidiabetic agents, steroids), and genetics. Increasing numbers of morbidly obese patients are requiring critical care, presenting major challenges to professional staff across the disciplines. This manuscript presents a case study describing the experiences of a morbidly obese woman in the final years of her life from the perspective of her health professional relative. The patient typifies many of the major risk factors for morbid obesity; her story reveals many of the issues faced as she revolved in and out of the critical care and acute care system. Her substantive health problems affected multiple body systems and included hypothyroidism, congestive heart failure, hyperlipidemia, and subclinical Cushing's Syndrome, likely related to previous medical therapy (cortisone) for rheumatic fever in childhood. The case description addresses many integumentary system issues the patient experienced; skin injuries and infections that can pose serious life-threatening situations for the morbidly obese patient must be prevented or treated efficiently. Health professionals can learn a great deal and improve the care they provide by listening to morbidly obese patients.

Weight loss and improved quality of life with a nonsurgical endoscopic treatment for obesity: clinical results from a 3- and 6-month study.

BACKGROUND: The TransPyloric Shuttle™ (TPS) is a nonsurgical device that is endoscopically delivered to and removed from the stomach to treat obesity. The device consists of a large spherical bulb connected to a smaller cylindrical bulb by a flexible tether. The larger bulb prevents migration from the stomach, while the smaller bulb passes freely into the duodenum to position the TPS across the pylorus. Transpyloric positioning may delay gastric emptying, reducing caloric intake and enabling weight loss. The purpose of this feasibility study was to evaluate the safety and efficacy of the clinical procedure and device. METHODS: Twenty patients with a mean body mass index (BMI) of 36.0 kg/m(2) were assigned to 2 groups of 10 patients scheduled to have the device for 3 or 6 months. Primary outcomes included % excess weight loss (%EWL), % excess BMI loss (%EBMIL), % weight loss (%WL), and adverse events. RESULTS: Devices were deployed and retrieved in all patients with no complications. Three-month patients had mean %EWL of 25.1%, mean %EBMIL of 33.1%, and mean %WL of 8.9%. Six-month patients had mean %EWL of 41.0%, mean %EBMIL of 50.0%, and mean %WL of 14.5%. Early device removal occurred in 2 patients due to symptomatic gastric ulcerations, which resolved after device removal. CONCLUSIONS: The TPS is a promising technology that provides a, nonsurgical, ambulatory method for weight loss.

Equipping your facility for bariatric patients.

As the number of extremely obese people increases worldwide, all healthcare facilities-not just those with bariatric surgical programs-are treating patients who have special equipment and space requirements. Is your facility ready? This article will help you analyze your current capabilities and identify the steps you still need to take to accommodate this segment of the population.