The Next Chapter

It has been five years since the first issue of Bariatric Nursing and Surgical Patient Care was published. In her initial editorial column, then Editor-in-Chief, Dr. Lisa Rowen, discussed the importance of communication among the healthcare team and the critical role it plays in the provision of safe care to bariatric patients and the achievement of optimal health outcomes. As a result of this conversation and subsequent ones in ensuing years, Dr. Rowen and her editorial team can be proud of the communication they inspired and fostered among this Journal's readership. In the short five years that Bariatric Nursing and Surgical Patient Care has been in existence, it has published over 80 original peer-reviewed papers, hosted 15 roundtable discussions with a variety of clinical and national experts, and interviewed leaders in the fields of policy, practice, economics, psychology, and education. Most impressively, the Journal is now widely available around the world, with readers in 148 countries, including 108 countries identified by the World Health Organization as developing nations.

This is no time to rest on what has been accomplished, however. In 2006, the inaugural year of Bariatric Nursing and Surgical Patient Care, the Centers for Disease Control and Prevention (CDC) estimated that the prevalence of obesity was greater than 25% in 22 states; today, that number has increased to 33 states. In the same time period, the number of states with obesity rates >30% has more than quadrupled, from two states to nine states. ¹ Given these grim statistics, it may seem hopeful that during these same five years, the rates of childhood and adolescent obesity remained fairly constant. That “fairly constant” number, however, represents a pediatric obesity prevalence rate of about 17%. ¹ Even though the overall rate appears to have stabilized over the past few years, there is some evidence to suggest that in some populations, the prevalence of pediatric obesity in the top percentile ranks might be increasing; ² in other words, the heavy are becoming heavier. In short, the problem of obesity in the United States is worse now than it was five years ago.

As the obesity epidemic continues to increase and the rate of pediatric obesity threatens the well-being of future generations, we have the obligation to continue to improve the healthcare outcomes for the obese population. Surgical outcomes have continued to improve despite higher severity case mix, and more research into the psychosocial outcomes of surgery, including quality of life, body image, and social well-being, is being conducted and is informing the holistic care of bariatric surgical patients. The first reports of weight loss and psychological outcomes associated with adolescent surgery are now being reported, and will be crucial to providing guidance and direction for the care of this vulnerable population. In fact, this issue's roundtable discussion, “Use of the laproscopic adjustable gastric band system in adolescents: a discussion with the experts,” is about just that: the experiences and outcomes of two programs that are participating in the FDA investigational device exemption study evaluating the use of the LAP-BAND^® in adolescents.

As a healthcare community, we also need to address the fact that patients with obesity, who are not undergoing bariatric surgery, are increasingly located throughout the healthcare system. As providers, we of course strive to provide the same high quality care to patients with obesity as we do for all patients, but in the patient with extreme obesity this can be more challenging. Evidence-based guidelines exist and can guide best practices for optimizing nurse-sensitive quality outcomes and avoiding preventable harms, such as pressure ulcers, patient falls, venous thromboembolism, and healthcare acquired infections, but these guidelines may or may not apply to or be effective for the patient with obesity. As a profession, we have a responsibility to evaluate these practices and guidelines as they apply to the patient with obesity. This is exactly what Dr. Swanson and colleagues demonstrated in their original paper, “Braden subscales and their relationship to the prevalence of pressure ulcers in hospitalized obese patients.” In this study, the authors suggest that there are differences in the Braden subscale scores and their relationship to pressure ulcer prevalence in obese and non-obese patients. This is the type of work we need to continue to conduct and communicate.

In the inaugural issue of Bariatric Nursing and Surgical Patient Care, a guest editorial by Dr. Michael Sarr and Ms. Jane Mai asked the question “Do we need a Journal of Bariatric Nursing?” In that editorial, the authors posited that even though there are several journals dedicated to obesity surgery and research, there was a need for the growing group of bariatric nurses and allied health professionals to have their own journal. In their own words, “time should prove [them] right”. ³ Given the growing prevalence of obesity, the concerning trends in different populations, the changing environment of the acute care setting, and the success of the Journal to date, I think that time has definitely proved them right.

The new editorial team looks forward to continuing the original mission of fostering communication among healthcare team members in order to achieve quality outcomes for all bariatric patients. The Journal will continue to publish original papers, case studies, roundtable discussions, clinical resources, and communication from the National Association of Bariatric Nurses. We look forward to supporting you, the healthcare providers, educators, and researchers, as you continue to teach, inquire, discover, and care for patients and their family members who are affected by obesity.