Guideline Title: Obesity
Effective Date: September 2013
Approved By: Nursing Practice Guidelines Committee; Nursing Practice Council
I. Guideline Overview
Obese patients, including those undergoing bariatric surgery, cared for within the UW Health system.
Nursing Practice Guideline Objectives
To describe best practices surrounding the care of obese patients. Specifically, this guideline addresses
nursing assessment, safe patient handling, bias, and nursing considerations related to bariatric surgery.
Clinical Questions Considered
When caring for obese patients:
How does knowledge of a modified nursing assessment influence the nurses’ ability to optimize
care and proficiency in this specialty population?
How does a safe patient handling program and related equipment influence staff or patient
injuries and patient’s perception of care?
How does awareness of bias affect healthcare interventions and patient perception of care?
What nursing considerations are needed to optimize care for bariatric surgical patients?
For more information, please see the complete guideline
II. Practice Recommendations
For more information about rating scheme used to describe strength of recommendations, see below.
Nurses should modify assessment techniques when caring for obese patients.
Appropriate safe patient handling equipment should be available and education provided for all staff
members who care for obese patients to prevent staff and patient injury during care.
Nurses should identify biases in providing care for obese patients.
Nurses should be knowledgeable about the various approaches to bariatric surgery and resulting
Nurse should be aware of potential post-operative complications of bariatric surgery to guide assessment
Nurses should be aware of the unique pre-and post-operative psychosocial needs of those undergoing
bariatric surgery. Assessment and advocacy for appropriate referrals should be made by the nurse across
the continuum of care.
Nurses should provide patient education to bariatric surgery patients relevant to their unique self-
management needs (such as dietary progression, potential for nutritional deficits, medication regimen,
incisional care, signs and symptoms to report that could indicate complications, importance of physical
activity, and information about support groups).
Likely to Be Effective
University of Wisconsin Hospitals and Clinics
Nursing Practice Guideline At-a-Glance
III. Pertinent Resources
1. Policy 1.19 Scope of Service and Nursing Care
2. Policy 8.02 Assessment and Reassessment of Patient and Documentation in Clinics
3. Policy 8.17 Therapeutic Support Surfaces and Frames (Specialty Beds)
4. Policy 8.76 Pain Management
5. Policy 9.02 Criteria for Bariatric Increment Charge on Adult and Pediatric Inpatient Units
B. Patient Education Resources
1. Health Facts for You #7750: The Roux-en-Y Gastric Bypass Surgery
2. Health Facts for You #6364: Laparoscopic Adjustable Gastric Band Surgery
3. Health Facts for You #327: Eating after Gastric Bypass or Sleeve Surgery
4. Health Facts for You related to Weight Management (#405, #406, #407, #409)
5. Health Facts for You related to Healthy Eating (#203, #364, #392)
C. Clinical Tools
1. Assessment Resource (Phillips, 2013)
2. Safe Movement and Repositioning Techniques (SMART) Resources and Tips (U-Connect)
3. BMI (Body Mass Index) Chart
4. Bed Use Algorithm (Adult)
5. Bed Use Algorithm (Pediatrics)
a. Selection of Therapeutic Pressure Redistribution Support Surfaces for Patients with BMI
< 55 – Pediatrics
b. Selection of Therapeutic Pressure Redistribution Support Surfaces for Patients with BMI
> 55 – Pediatrics
6. Bariatric Resource Grid
7. Wound and Skin Resources (U-Connect)
8. Bariatric Surgery Complications Resource (in development)
See full guideline for list of references.
V. Rating Scheme For The Strength Of The Recommendations
Interventions for which effectiveness has been demonstrated by strong evidence
from rigorously designed studies, meta-analysis, or systematic reviews, and for
which expectation of harm is small compared to the benefits.
Likely to be
Interventions for which effectiveness has been demonstrated from single rigorously
conducted controlled trial, consistent supportive evidence from well-designed
controlled trials using small samples, or guidelines developed from evidence and
supported by expert opinion.
Interventions for which clinicians and patients should weight the beneficial and
harmful effects according to individual circumstances and priorities.
Interventions for which insufficient or conflicting data or data of inadequate quality
currently exist, with no clear indication of harm.
Interventions for which lack of effectiveness has been demonstrated by negative
evidence from a single rigorously conducted controlled trial, consistent negative
evidence from well-designed controlled trials using small samples, or guidelines
developed from evidence and supported by expert opinion.
Interventions for which lack of effectiveness or harmfulness has been demonstrated
by strong evidence from rigorously conducted studies, meta-analyses, or systematic
reviews, or interventions where the costs, burden, or harm associated with the
intervention exceed anticipated benefit.