Criteria-Based Protocols and the Obese Patient: Pre-planning Care for a High-Risk Population

Susan Gallagher, RN, CWOCN, PhD; Jill Arzouman, MS, APRN,BC, CN; Jane Lacovara, RN-BC, MSN, CNS; Ann Blackett, MS, CPHQ, CWCN, COCN, RN; Patricia K. McDonald, RN, MS, CWOCN, GNP, CS; Gayle Traver, RN, MSN; Fran Bartholomeaux, RN, MS, CCRN

O besity is best described as the excessive accumulation of body fat. This chronic condition often manifests as a slow, steady, progressive increase in body weight. In one sense, the cause of obesity is straightforward - the state of expending less energy than the amount consumed. But in another sense, obesity is more intangible, involving the complex individual regulation of body weight, specifically body fat. This individual regulation is the unknown factor in weight management cases.1 Research suggests that the reason many patients are unclear about the cause of their excessive weight is because the etiology of obesity is complex and multifactoral. Several causes have been suggested, including genetic alterations, neurologic disorders, endocrine disease, or drugs.2 In addition, the presence of this condition has social, economic, emotional, and clinical consequences. Despite these consequences, the prevalence of obesity in the US has increased by 30% in the past decade, from 25% to 33%. Six million Americans are morbidly obese.3

In earlier literature, obesity was defined as a body weight greater than 30% of what is described as ideal body weight. More recently, body mass index (BMI), thought to be a more meaningful measurement tool,4 offers a mathematical formula (weight[kg]/height[m2]) that assigns relative risk for mortality and morbidity based on a numeric value. For example, a person with a BMI of 20 to 26 is considered healthy, while someone with a BMI greater than 40 is considered obese. From a clinical perspective, obese patients who are hospitalized reportedly are at a higher risk for certain common and predictable complications because of their body weight and size. For example, patients who weigh 100 lb or more above their ideal body weight have exponential increases in mortality and serious morbidity as compared with their non-obese counterparts.5 Additionally, due to emotional and physical causes, some obese people resist pursuing healthcare and frequently defer hospitalization until the last possible moment; therefore, obese patients are often sicker by the time they access care.6 In many cases, caring for obese patients can be more complicated and, from a practical perspective, more difficult.

Healthcare is fast becoming one of the most dangerous jobs in the US; five of the highest risk groups are healthcare professionals.7 In acute care facilities, turning, lifting, and repositioning very heavy patients can predispose caregivers to physical injury.8 Caregivers report the fear of personal injury when caring for larger, heavier patients, yet pre-planning activities to reduce risk are generally not forthcoming.


1. Gallagher S. Taking the weight off with bariatric surgery. Nursing 2004; 34(4):58-64. 2. Gallagher S, Gates JL. Obesity, panniculitis, panniculectomy, and wound care: understanding the challenges. JWOCN. 2003;30(6):334-341. 3. Mitka M. Surgery for obesity. JAMA. 2003;289:1761-1762. 4. Gallagher S. Panniculectomy, documentation, reimbursement and the WOC nurse. JWOCN. 2003(30(2):72-77. 5. Kral J. Morbid obesity and related health risks. Ann Int Med. 1985;103 (6, part 2):1043-1047. 6. Gallagher SM. Meeting the needs of the obese patient. AJN. 1996;96(8suppl):1S-12S. 7. Charney W. An epidemic of health care worker injury. In: Charney W, Fragala G (eds). An Epidemic of Health Care Worker Injury: An Epidemiology. New York, NY: CRC Press;1998. 8. Gallagher S. Obesity: considering mobility, patient safety and caregiver injury. In: Charney W. Hudson MA. Back Injury Among Healthcare Workers: Causes, Solutions, and Impact. New York, NY: Lewis Press; 2004. 9. Gallagher S. Caring for the overweight patient in the acute care setting: addressing caregiver injury. Journal of Healthcare, Safety, Compliance, and Infection Control. 2000:4(8):379-382. 10. Gallagher S. Barriers to protocol development. Poster presentation. Wound, Ostomy Continence National Conference, Las Vegas, Nev. June 12-16, 2002. 11. Gallagher SM. Outcomes in clinical practice: pressure ulcers prevalence and incidence studies. Ostomy/Wound Management. 1997;43(1):28-40. 12. Gallagher Morbid obesity: a chronic disease with an impact on wounds and related problems. Ostomy/Wound Management. 1997;45(5):18-27. 13. Gallagher SM. Restructuring the therapeutic environment to promote care and safety for the obese patient. JWOCN. 1999;26:292-297. 14. Gallagher SM. Basic nursing competencies in caring for the obese patient. Poster Presentation. Symposium Advanced Wound Care. Las Vegas, Nev. April 10-14, 2003. 15. Gallagher S. Meeting the needs of the obese patient. AJN. 1996;96(8) supp:1S- 12S. 16. Gallagher S. Caring for obese patients. Nursing 98. 1998;28(3): 32hn1-32hn5. 17. Yanovski JA, Yanovski SZ. Recent advances in basic obesity research. JAMA. 1999;282(16):1504-1506. 18. Wolf AM, Coditz GA. Social and economic effects of body weight in the United States. Am J Clin Nur. 1996;53:1595S-1603S.

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