How do you talk to patients with weight issues? - page 2

by CrystalSSA

I do not work on a psychiatric unit, but last week alone I had one patient that weighed over 650 lbs and one that weighed under 70 lbs. Both were in total and complete denial. When you have these patients do you talk to... Read More


  1. 0
    This is such a sensitive topic that it's not one that is fruitful to discuss until the patient is ready and brings it up. So what I usually do is start talking in a general way about constructing a self-care plan and ask the patient what they are working on or know they need to work on. If they don't bring it up, then I assume that they are either not ready for change or not ready to discuss it right now. It's not something I bring up unless they bring it up. Because that is a rapport and trust breaker rather than builder, and then change is even less likely.

    If you're really interested in how to help people make change in their lives, then google "Stages of Change" or "Transtheoretical Model of Behavior Change" (Prochaska and DiClementi) and then "Motivational Interviewing" (Miller and Rollnick) for an introduction to this approach. Better still, read the books "Changing for Good" and "Motivational Interviewing: Preparing People to Change". Hope this helps.
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    You say that you don't work in a psych unit, so I'm guessing you're either a floor or ICU nurse. My experience is these jobs do not allow enough time, nor are we properly trained to "counsel" psych patients. My approach has always been to try my best to establish a good relationship with the patients, get them talking and comfortable with me. I don't directly address the issue unless I need to ask them a specific question about it. When I only have 12 hours with them, and a ton of other things to do, I figure the best I can do is make them feel safe and comfortable until they can be transferred to a psych unit.
    anotherone likes this.
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    I have never met one single obese person who didn't know their weight was affecting their health. Not a single one. Myself included.
    To preach to these people, myself included, would simply be insulting.
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    I talk to them the same way I talk to every other patient. Why would their weight come into that? First I address the reason they are in the hospital and why I am caring for them. If they need support or education related to their weight I am happy to talk with them. I believe in positive education and encouragement. You are never going to shame someone into doing what you think they should do, they need to do it and want to do it themselves. As far as being in a psych hospital, well, psych issues and depression can cause weight gain or weight loss. Being overweight can lead to depression and depression can lead to weight gain. It is a chicken or the egg conundrum. Until you walk a mile in someones shoes, we need to refrain from judging and try to help in a positive way. As someone who has lost a great deal of weight on weight watchers, I know how hard it is when people start lecturing you on your weight when you are already feeling bad about it.
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    As a sufferer of an eating disorder, (recovered) nobody could have just addressed my weight with me. They just couldn't. A nurse did change my life, but she didn't address the weight. She only ever said "how can I help you to fix this?" And she told me "hey I know you aren't crazy, we can make this get better, even if we just make it a little better". I grew to trust that she cared about me, and didn't want me to die, she was the CDE in my endocrinology office.
    There is a lot of judgement when you suffer from an ED. It helps to have someone who looks past those judgements and sees you as a real person.
    BTW I'm not a nurse, I'm a student.
    KelRN215, poppycat, and DizzyLizzyNurse like this.
  6. 4
    Address the problem they're in the hospital with. If it's closely related to the weight, then you can relate it to the weight in teaching about the condition. But as a general thing? We don't have the time or the resources to solve all of their problems before discharge. We sure don't have the time or resources to fix THIS.
    KelRN215, anotherone, joanna73, and 1 other like this.
  7. 0
    Quote from missladyrn
    I talk to them the same way I talk to every other patient. Why would their weight come into that? First I address the reason they are in the hospital and why I am caring for them. If they need support or education related to their weight I am happy to talk with them. I believe in positive education and encouragement. You are never going to shame someone into doing what you think they should do, they need to do it and want to do it themselves. As far as being in a psych hospital, well, psych issues and depression can cause weight gain or weight loss. Being overweight can lead to depression and depression can lead to weight gain. It is a chicken or the egg conundrum. Until you walk a mile in someones shoes, we need to refrain from judging and try to help in a positive way. As someone who has lost a great deal of weight on weight watchers, I know how hard it is when people start lecturing you on your weight when you are already feeling bad about it.
    Exactly.

    A lot of times people (thinking they are being concerned and caring) have said things that have hurt me so badly that I turn around and give up and binge. Support is key. And you know what? The sad truth is that you are probably not going to have much of a effect on someone in the few hours you spend with them in the few days they are in the hospital.
  8. 2
    When a pt is hospitalized and is acutely ill, IMHO this is a very difficult time to approach them about their weight. Believe me, it won't come as a shock to them that they are fat.

    I think this falls back to their primary care provider who can approach them in a more relaxed environment and who, hopefully, has an already-established rapport with them.
  9. 1
    Quote from traumaRUs
    When a pt is hospitalized and is acutely ill, IMHO this is a very difficult time to approach them about their weight. Believe me, it won't come as a shock to them that they are fat.

    I think this falls back to their primary care provider who can approach them in a more relaxed environment and who, hopefully, has an already-established rapport with them.
    Agreed.
    DizzyLizzyNurse likes this.
  10. 0
    Quote from CrystalSSA
    I do not work on a psychiatric unit, but last week alone I had one patient that weighed over 650 lbs and one that weighed under 70 lbs. Both were in total and complete denial.

    When you have these patients do you talk to them about their weight? Does it make any difference? I tried being honest and actually said the same thing to both, "your weight is an issue and could kill you". Both gave me excuses. Both could have coded on me due to issues....and neither seemed to care.

    Am I wasting my breath talking to them about their weight? How do you approach them?
    What environment are you taking care of them in? Med-Surg? ICU?

    I'm going to assume the patient who weighed under 70 lbs has anorexia nervosa so will approach my answer from that angle. If a patient with anorexia is hospitalized in the ICU or in Med-Surg it is because she is not yet medically stable enough to be on an eating disorders unit/psych units and/or needs electrolytes monitored very closely because of the risk of re-feeding syndrome. One of the most high risk times for someone with anorexia is when they start to re-feed- congestive heart failure can develop rapidly and the patient can die. The MD/Nutritionist should come up with a feeding plan and usually these are very strict/very concrete. She must eat everything she is prescribed or she will be given supplemental nutrition. If she refuses to eat or to drink the nutritional supplements (Ensure, Boost, whatever it may be), she gets an NG tube or, in extreme cases, gets put on TPN. Telling an anorexic "you are killing yourself" is not going to do her one lick of good. She may very well hate herself and want to die. As an inpatient nurse, the priority would be to get her stable enough to be transferred to a longer term eating disorders/psych unit where they can actually address her issues and help her recover from this disorder. The "denial" you speak of is a symptom of a very serious illness. It's one of the characteristics of anorexia nervosa that people cannot see how emaciated they are.

    Someone who weighs 650 lbs knows they are overweight- I can pretty much guarantee that. They also probably know that their weight could kill them and I don't think telling them so is constructive at all. Someone with that type of morbid obesity needs a lot more than someone to tell them "your weight is an issue and you could die" and it's too big a problem to fix in one hospitalization.


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