Why not question pts about their eating habits? - page 2

Why is it that, on our assessment intake, we always question pts about cigarettes and drinking, but there's not section about their eating habits? I ask this because I just watched the movie... Read More

  1. by   Retired R.N.
    Quote from Jabramac
    IMHO the whole health care system does a very poor job of addressing over weight issues. I can say, being over weight my self, I get weighed at the clinic each time I am there and once the physician talked to me about watching my portions.

    Where I work we send people home with brochures and instructions on smoking cessation, ETOH abuse, domestic violence, but nothing about obesity. We have an assessment area for "nutritional status" but the only time I ever see anyone fill it out is when people appear under weight.

    I think it still must be taboo. We want people to be happy and comfortable, and eating is comfortable (at least for me). What I think is there needs to be a better network of services for weight loss that can be triggered and accessed through physcians. Instead of telling people in the office about weight loss, or sending home with a brochure, why not a referal to a nutrisionist, deitician, weight loss clinic, or weight loss program. What about having follow up appointments just for weight issues? "We noticed you are XX lbs over weight today. Here is a referal to a nutritionist and I would like to see you back here in about a month or two to review."

    Here is an interesting question- who has weight loss programs or services at their hospital, and what is it? We host weight watchers, and periodically have some type of physical fitness campagne were we are encouraged to walk, run etc, but very little incentive.

    On a happy note, I am proud to say I did join weight watchers and have lost 40lbs so far.
    While I agree that it would be very nice if we could refer patients to nutritionists for dietary advice, who is going to pay the bill? Is this something that insurance companies, Medicare, and Medicaid are willing to finance? Many people avoid seeing a physician for anything that isn't causing them a great amount of pain because they simply can not afford it while working a minimum wage job that does not have any health insurance.

    The patients I saw who were most overweight were also the poorest ones. If they ate fast food it was because it was available in their neighborhoods, and they didn't own an automobile to make regular trips to a supermarket to buy good food. Does anyone offer good advice on how to prepare nutritional tasty meals on a low-income budget, keeping in mind that people working full time are not going to have unlimited time for cooking?

    In my opinion, the worst example of the food industry's misguided advertising efforts is the "Milk Moustache" ads. While visiting a middle school cafeteria one day, I noticed that none of the girls were drinking milk with their lunches. When I asked if anyone had seen those ads, there was a great amount of snickering, but one girl finally commented to me, "If they can't be bothered to wipe their faces, what do you suppose their @**es look like?" Yes, I took the time to talk with them about calcium building strong bones, but I wonder if I was able to do very much to counteract the effects of that ad.

    It can be a real challenge to talk with patients about dietary habits without coming across as being condescending and insulting. Also, a bit of a challenge when we ourselves often do not make the effort or take the time to eat decently. Nurse, Assess Thyself!
  2. by   gauge14iv
    Most insurance companies DO pay for nutritional consults when there are comorbid conditions present such as obesity, CAD, diabetes etc.

    During physicals, I ALWAYS address diet - no matter is the person if overweight or not. Caloric intake vs caloric burn, healthy food choices vs unhealthy food choices, watching out for food content that the body can't use as fuel but stores as fat - such as "enriched wheat flour" products and high fructose corn syrup. They get a whole packet of printed materials, a list of website links and books and cookbooks.

    If they are obese they also get a nutritional consult and a referral to a physical therapy program to get them exercising again. They also are tested to rule out hormonal abnormalities.

    Obesity is the elephant in the living room. We can't afford to let these patients walk out of the office without discussing their weight for fear of making them "feel bad". Since when is guilt a factor? We certainly aren't afraid of making smokers feel guilty. Discussions about weight and obesity can (and should) be done with sensitivity to feelings however, and in such a way that the individual who is obese has hope again.
  3. by   Jabramac
    Quote from Retired R.N.
    While I agree that it would be very nice if we could refer patients to nutritionists for dietary advice, who is going to pay the bill? Is this something that insurance companies, Medicare, and Medicaid are willing to finance? Many people avoid seeing a physician for anything that isn't causing them a great amount of pain because they simply can not afford it while working a minimum wage job that does not have any health insurance.
    ......
    It can be a real challenge to talk with patients about dietary habits without coming across as being condescending and insulting. Also, a bit of a challenge when we ourselves often do not make the effort or take the time to eat decently. Nurse, Assess Thyself!
    I agree with you that cost is a concern. But cost is a concern with all medical aspects. I'm probably being too idealistic. However, shouldn't the medical profession make the steps to show that we take it seriously? Even if pts are not going to follow through, shouldn't we be helping to give options and make it important?

    As far as "nurse, asses thyself!" You are right that we need to set the example. That's why I would be interested to know what different hospitals are doing to encourage staff to loose weight. Where I work I find it ironic that our hospital cafeteria seems to have some of the least health foods to sell to staff. Nurses are like the rest of the population, some are overweight, some smoke, some are alcoholics, some abuse their spouses. Some nurses could use the help themselves.
  4. by   canoehead
    Quote from gentle
    If I have a COPD patient, I encourage well cooked but not "boiled to death vegetables" so that they can get in their vitamins and nutrients. I also warn them to be aware if salads may or may not aggravate their dyspnea.
    Can you elaborate on this? I didn't know raw vegetables could aggravate dyspnea.

    I think that a nutritional assessment that relied on the patient's report would not be as accurate as a good physical assessment. If they are 400lb, with low albumin, and hematocrit, they are nutritionally deficient. I don't believe just asking a question will improve nursing care. Clearly the patient knows they have a problem, the media tells them that every day. Unless we find specific teaching needs I vote we spend our limited time addressing more change-likely behavior. I treat food issues in the obese the same way I treat smoking COPDer's. The statement "You know, smoking is going to make it harder for you to recover." They usually roll their eyes and say "yeah, I know" and I say "Let me know if you want any help with that." They've all heard the speeches, but for whatever reason have made a less healthy choice.
    Last edit by canoehead on Dec 18, '06
  5. by   gauge14iv
    Quote from canoehead
    Can you elaborate on this? I didn't know raw vegetables could aggravate dyspnea.
    Yeah I hadn't heard that either
  6. by   DizzyLizard
    I agree that a majority of obesity is due to poor dietary and exercise habits but medication side effects as well as med conditions can also cause weight gain. When I was on prednisone I gained 60 pounds in about 6 months. Whenever I went to the doctor for checkups I was counseled on "good" eating habits and scolded for not maintaining my weight and exercising. It didn't do any good to remind him that I am a health freak and extremely physically active. So, there is a fine line with eating junk food resulting in obesity but there are many other reasons that also need to be explored. Don't assume....
  7. by   Tweety
    I had a patient fire a doctor who "had the nerve to tell me I was overweight. Like I don't know that already. Who is he to judge." Seriously.
  8. by   DizzyLizard
    I agree Tweety, if a doc needs to get after a patient about their weight then it should be done. To elaborate on my situation, what angered me was the fact that I gave him the 24 hour food diary he requested and also told him what my 6 day a week exercise workout consisted of. He basically told me I was a liar, that there was no way I could be doing what I was and gaining weight. It's called prednisone. Healthcare providers need to be more open about the many causes of obesity and not stereotype so much. I'm fortunate that I dropped the prednisone weight when it was d/c'd. Health insurance does cover nutritional counseling for those that meet medical criteria but if a person doesn't want to help themself whether it be drinking, smoking, obesity, etc. there's not much we can do.
  9. by   UM Review RN
    IMO, unlike other medical conditions, people simply have too much information on dieting. It's everywhere. You turn on the TV, boot up your computer, read a magazine and every other ad is for a diet plan.

    In fact, I challenge you to read the news, watch TV, turn on your computer without seeing one ad for Jenny Craig or NutiSystem, or Weight Watchers. The fact that I can throw these names out there and not have to explain what their programs are is proof that we're inundated with this stuff on a daily basis.

    In other words, people have plenty of education about this problem.
    I think that people are only obsessed with their weight because of their concern for their appearance, not because they have a desire to be healthy.

    There are also some people who are obsessed about other people's weight problem. In other words, my fatness might bother you a lot more than it bothers me. Being fat is simply unacceptable in our society.

    Unlike smoking, which is an optional activity that has an immediate and dramatic effect on the environment around the smoker, the overweight person MUST eat to survive. There are no direct, immediate consequences for having that second Big Mac; no one's going to jail for being stuffed to the gills.

    Even when people have compelling medical reasons to follow a diet (Diabetes, CHF) we all know there will be those who will be noncompliant some or all of the time.

    So I think it's not a topic covered much in the hospital because:

    1. Not covered by insurance
    2. People are already saturated with information about obesity.
    Last edit by UM Review RN on Dec 18, '06
  10. by   tvccrn
    There is one inherent problem with comparing weight issues to smoking or drinking. No every weight problem is related to poor diet or exercise.

    For years, I was (and still am) obese. Because of my age, I was always told to eat better and exercise more. I have an aversion to most vegetables so therefore I know that my diet isn't what it should be. However, I did improve it with eating more fruits and more of the vegetables that I will eat. I also got out and exerciesed more. Results, I could only lose about 25 pounds.

    I kept food diaries, I cut my caloric intake to 1200 a day, I watch my carbs, I stopped sweets. I walked everyday, I went to the gym, I did yoga. Nothing would help my lose anymore.

    It wasn't until a routine pre-op blood test that I found out I had hypothyroidism. I'm talking my TSH was triple what it should have been.

    Since starting on the levothyroxine, I have lost close to 30 pounds with NO OTHER change. I can't lose any now that I'm pregnant, but I have kept my gain to under 5 pounds.

    My point in this rambling is that with smokers you know what the problem is..it's their addiction to the cigarettes. With weight, you can't be certain it's always their fault.

    So, tread lightly in asking these questions...You may accidentally offended someone who is already at wit's end to lose weight.

    tvccrn
  11. by   RazorbackRN
    Quote from GardenDove
    This must be the new trend. Glad to hear it!

    I graduated in May and we were taught the same thing for assessments. On our admission forms for the hospital where I work, we obtain a 24hr diet history.
  12. by   VivaLasViejas
    I can tell you right off what the problem is with "assessing" overweight patients' nutritional status (besides the obvious fact that many people will lie, deny, under-report, or simply refuse to talk about their eating habits): the average health insurance plan does NOT cover diagnosis and treatment of obesity. They often won't even pay for a nutritional consult, let alone medications, exercise programs, or surgery. What's the point of putting a patient through a potentially humiliating process when there is zero support to help him/her make the necessary changes?

    Please don't tell me that all one has to do is "take responsibility", e.g. eat less and exercise more. If it were that simple, there would be no fat people, because NO one would choose to be overweight in a country where the picture of physical perfection is one of genteel emaciation, yet fatty and sugary foods are found in gross abundance on every street corner and heavily advertised.

    I've been on every diet in the universe and a few of my own invention, exercised to exhaustion, and yet my weight still hovers around 300 pounds no matter what I do. I know what I'm supposed to eat, and in what amounts I'm supposed to eat it. I can eyeball a portion of any food and know exactly how many calories, carbs, and fat grams are in it. I can recite food facts until I'm blue in the face. What I CAN'T do is stay on a 1200-calorie diet for longer than a few months at a time........eventually, I get tired of starving and feeling deprived, and I lose control. Yet my insurance will not even consider paying for the surgery I desperately need to shrink my stomach so I can't hold as much food, even though I have comorbid conditions such as HTN and arthritis that are shortening my life and affecting its quality.

    Sure, in theory, it's a great idea to "assess" patients' eating habits. In practice, however, it's pretty pointless without backup from the medical community, not to mention changes in the insurance racket (excuse me, industry) that acknowledge the role of obesity in disease and death.
  13. by   rninme
    Quote from gauge14iv
    Yeah I hadn't heard that either
    Pt's with COPD should avoid raw veggies, carbonated drinks .... anything that has the potential to cause 'gas'....which can interfere with diaphragmatic excursion. 'Bloating' pushes up on the diaphragm and makes it more difficult for the COPD patient to breathe, which exacerbates dyspnea. This is the same reason you should offer pt's with COPD 3 small meals and 3 snacks a day instead of three large meals.
    Last edit by rninme on Dec 18, '06

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