1. Hydock, Claudia Marie MS, BSN, RN

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We are all aware that obesity has reached a crisis level in America and throughout other developed countries around the world. Everyday in the news we are bombarded with statistics that the population of obese children and teenagers is also reaching an all-time high. Our populations are becoming more sedentary as a result of improving technologies. Our diets have become filled with processed foods, additives, and excess amounts of salt and sugar. Whole grain breads and pastas have been replaced with refined grain ones. Fruits and vegetables are canned and frozen, causing many of them to lose their original fiber content through processing. Family "dinnertime" seems to be a lost tradition, with many families running off to soccer practice or cheerleading practice or another late day spent at the office; everyone grabs the quick toaster-oven snack and microwave dinner on their way out the door. As a result, children and adults are suffering the consequences of eating foods high in fats and carbohydrates with little protein and fiber. The incidence of obesity and diabetes are on the rise in children as young as 10 to 12 years old. Please read Juanita Warman, CRNP's article, "The Application of Laparoscopic Surgery Treatment of Severe Obesity in Adolescents Using a Multidisciplinary Adolescent Bariatric Program," for her institution's response to the problem.


The adult population is seeing a rise in diabetes, hypertension, and high cholesterol, with concomitant rise in heart disease, respiratory compromise, and peripheral vascular disease. Women who are morbidly obese will also experience hormonal disturbances such as anovulation, dysfunctional uterine bleeding, and decreased fertility as discussed by Rita Raymond, CRNP, in "Hormone Status, Fertility and Pregnancy Before and After Bariatric Surgery."


As a nurse, I have many friends who fit the distinction of "obese" and "morbidly obese," and several of these friends have decided that bariatric surgery was the answer to their weight problem. But my friends have also suffered some of the consequences of bariatric surgery which are not often talked about by the movie star in the magazine article or the LA surgeon who turns ugly ducklings into swans. One friend lived with daily vomiting after vertical banded gastroplasty, constant GERD, and food pieces occluding the outlet from the gastric pouch, thus requiring endoscopic removal. She suffered dehiscence of the gastric staple line with subsequent weight gain. Then, a year later, due to continued vomiting, erosion of her teeth enamel, and basic starvation she had "rescue Roux-en-Y Gastric Bypass" surgery to save her life. I have another friend who developed "dumping syndrome," which became so severe that she had no control of how much weight she lost nor how fast; read "My Story: A Personal Perspective on Bariatric Surgery" in this issue.


Some of these friends have success stories and have returned to normal lives at a much smaller size. Others continue to suffer the consequences of malnutrition. It has been the suffering I have seen in these women that prompted my interest in the complications of bariatric surgery. My investigation into the different bariatric programs throughout the country has allowed me to make several observations: (1) proper screening of patients is necessary to determine compliance with the strict regimen of post-op care, (2) nutrition counseling and proper food choices are imperative to maintain good health, (3) medical follow-up for years by a caring team of physicians and counselors helps the patient stay "on track." Good nutrition, laboratory testing, and emotional support ensure a more successful outcome. Dr Jorge Vasquez and Melanie Schuster, CRNP, have contributed their vast knowledge of this topic to our journal.


As you read the contributions of the various authors, I hope you will understand that the problems and complaints that patients may present to you in your clinical area may be directly related to the bariatric surgical procedure he/she has had last year, or 2 years ago, or 5 years ago. This new area of medicine has very little documented follow-up, but with thousands of patients each year choosing to have bariatric surgery, the medical community needs to prepare for the future and understand that surgically induced malabsorption and malnutrition may have dramatic and devastating effects on an aging society. As you read each article, please ask yourself, "What long-term effects could each of these topics have on the adolescent and young adult? On the middle-aged population? What else should I look for when ordering laboratory studies on this patient? Do I need to inquire more in-depth about a patient's nutritional status when completing an admission history? Does this patient take nutritional supplements? Why?


My sincere thanks goes out to all of "My Fellow Authors" who contributed their time and expertise to this project. Each of them offer compassion and understanding when caring for the bariatric patient because they know the complexity of the physical as well as the emotional burden that each patient lives with.


Thank you, Carmen Warner, for giving me this opportunity to be Issue Editor for Critical Care Nursing Quarterly.


Thank you Susan Leininger-Hogan, RN, APN, for your guidance and support throughout the project.


Thank you to Bonnie Kurpakus, RN, Manager of the Post Anesthesia Care Unit at Allegheny General Hospital, for giving me the time and space to make this issue a success.


Claudia Marie Hydock, MS, BSN, RN


Issue Editor, Post Anesthesia Care Unit, Allegheny General Hospital, Pittsburgh, Pa