Obesity is one of the most important health and medical, social, and financial problems currently troubling the United States. Over 5 years ago, the World Health Organization described obesity as an "escalating epidemic" and "one of the greatest neglected public health problems of our time with an impact on health that may prove to be as great as smoking." Numerous studies have demonstrated that individuals with obesity are at higher risk of developing one or more serious medical conditions, which can cause poor health and premature death. Data from the American Obesity Association (AOA) indicated that obesity is a contributing cause in at least 300 000 deaths per year and health care costs of American adults with obesity amount to approximately $100 billion. Health care workers are challenged with providing optimum nursing care for the hospitalized obese patient. Not only is medical care more complicated, but basic nursing activities demand careful planning in order to prevent accidents and injuries to either staff members or the patient. Providing a safe and comfortable environment for ordinary components of nursing care (ie, bathing, lifting, moving and transporting, skin care) require the use of special equipment and supplemental manpower. Many health care facilities are not adequately prepared to accommodate the unique needs of the morbidly obese patient.

While the negative impact of obesity is well noted, it is also clear that effective treatments for obesity do exist. Obesity is a complex chronic disease that involves environmental, genetic, physiological, metabolic, and behavioral and psychological components, and therefore determining the most effective and appropriate forms of treatment can be daunting. Dietary therapy, physical activity, behavior therapy, pharmacotherapy, and bariatric surgery are the most noted treatment interventions for weight loss and weight management.

Although medical and behavioral approaches have demonstrated their utility in the treatment of obesity, surgical intervention appears to be more effective in facilitating and maintaining weight loss in patients with clinically severe obesity. The overall benefits of obesity surgery appear to outweigh the risks. Several studies have demonstrated the significance of even minimal weight loss in improving the health and quality of life of clinically severely obese patients. In 1992, the NIH (National Institutes of Health) Consensus Conference 1 reported that after surgery, bariatric patients experienced improvements in the following obesity-related medical conditions: diabetes, glucose intolerance, hypertension, high cholesterol/triglycerides, and sleep apnea. Patients reported an enhanced quality of life, improved mobility and stamina, better mood, positive self-esteem and interpersonal effectiveness, and greater optimism.

This special issue of Critical Care Nursing Quarterly has been designed to address the complex subject of bariatric patient care. Leaders in the American Society for Bariatric Surgery and others, including patients, have contributed articles and commentary on the subject.

Spence-Jones, a Health Psychologist who specializes in counseling bariatric patients wrote the introductory article Overview of Obesity, which provides a framework for appreciating the epidemiological issues associated with the disease. Owens, nurse director of a surgical weight control center, presents her ideas and convictions in Morbid Obesity: The Disease and Co-Mobidities. She strives to help health care professionals become more compassionate with this group of patients by viewing obesity as pathology, not as an individual's personality defect or lack of control. Woodward's Bariatric Surgical Options presents the array of bariatric operative procedures, and outlines risks and benefits of the various approaches for modifying the gastrointestinal system anatomy in order to achieve the desired outcomes. Garza, a nurse manager in a bariatric specialty clinic and surgical unit, has contributed Bariatric Weight Loss Surgery: Education, Prepartion, and Follow-Up. Her clearly outlined strategies stress the key points in perioperative nursing care. The article Critical Care of the Morbidly Obese by Davidson, Kruse, Cox, and Duncan focuses on the care of the postoperative obesity surgery patient in the intensive care unit. Details of nursing care complicated by obesity are discussed, and a case study amplifies the content. Wilson and Clark tackle the complex problem of skin care for this special patient population in their article Obesity: Impediment to Wound Healing. They offer a patient study to chronicle the daunting tasks associated with this patient population postsurgery. Elliot, a registered dietitian who has worked with bariatric patients for over 15 years, shares her experiences on teaching, counseling, and consulting with physicians. Nutritional Considerations after Bariatric Surgery is a vital contribution to this issue and is a "must read" for nurses who care for these patients. The author explains the nuances of dietary advancements after surgery and stresses the judicious use of TPN for this population. Reto's thought-provoking article Psychological Aspects of Delivering Nursing Care to the Bariatric Patient discusses the potential biases that complicate nurse-patient dynamics, and offers strategies for coping with negative attitudes and emotional blocks experienced by caregivers. Finally, 2 patients, Richard Sorensen and Christa Reed, discuss the impact of bariatric surgery in their own lives. From their personal accounts, health care providers will be afforded a unique perspective of the life-long physical and emotional perils that constitute the motivating forces for patients to choose a surgical option to manage their obesity. The postsurgical quality of life improvements experienced by these 2 individuals clearly illustrate that even long-term, morbid obesity can have a positive outcome.

This issue of Critical Care Nursing Quarterly is long-awaited. Nurses as well as patients have their personal struggles with nutrition and weight control, and in some cases, have even faced severe or morbid obesity with its many perils. Hopefully the articles in this work will increase the reader's understanding of this major health problem, and will provide an incentive for new attitudes and behaviors in caring for themselves and this patient population.

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