Nursing makes me hate fat people

[LifeCrisis]

Ok, first off let me say I know this topic will probably generate a lot of strong opinions. I will also state that I am not a perfect person and don't take care of my health 100% so please don't think I am trying to be an elitist or something in posting this.

Disclaimer aside, I want to know if other nurses sympathize with me.

I am going to try and be as brief as possible in my story. First of all we have 2 resident patients on my floor that have been there over a year. They are obese and have suffered strokes. They require total care. These particular patients are about 250lbs and 1 has hemiparesis and the other has use of 1 arm (not sure what to call that).

The patient that really has me over the edge is one that is over 300lbs, vent dependent, unstageable sacral (of course, no one wants to turn this patient which is a whole other issue), lower extremities contracted with knee replacements, on dialysis, PEG feeding, restrained because she pulls any tube in sight, and contact isolation for c diff and acenotibacter. This patient has been on the floor for 3 months so far because no LTC facility will take her (understandably).

Not to mention all the cellulitis patients and other comorbities we deal with on admissions.

I am a 25 year old male and starting to feel back pains. This really has me over the edge as a combination of lazy/uneducated coworkers and heavy (literally) care.

Please share how you deal with these kinds of patients and what I can do to reverse my growing animosity towards these patients.

[K+MgSO4, BSN]

What's a Hoyer?

This is the alarming thing I have noticed here, many US hospitals are still manually moving pets themselves instead of with the masses of equipment that is available hoists slide sheets hover mats etc. People go to your OH&S reps and insist on equipment call your unions. In this day and age people should not be 'lifting' or 'boosting' pts.

[LaRN]

I can deal with overweight patients, smelly patients, even rude patients. what I have a hard time dealing with are patients who are never satisfied, always looking for problems.....because they like to make everyone dance like puppets.

after a day of many demands and questions about pts care for which pt and family are never satisfied with the answers... patient and family summons nurse to room for a problem that they want resolved TODAY: a recurring (minor) rash to patients upper arms that has been treated by multiple md's over the course of approx 5 years. when i ask them what has worked in the past...they inform me that they don't just want a medication that will make it go away for now, they want it cured. Yes, they want a biopsy today.

[LadyFree28, BSN, LPN, RN]

This is the alarming thing I have noticed here many US hospitals are still manually moving pets themselves instead of with the masses of equipment that is available hoists slide sheets hover mats etc. People go to your OH&S reps and insist on equipment call your unions. In this day and age people should not be 'lifting' or 'boosting' pts.[/quote']

Agree...THIS.

[Dragan]

I can deal with overweight patients, smelly patients, even rude patients. what I have a hard time dealing with are patients who are never satisfied, always looking for problems.....because they like to make everyone dance like puppets.

after a day of many demands and questions about pts care for which pt and family are never satisfied with the answers... patient and family summons nurse to room for a problem that they want resolved TODAY: a recurring (minor) rash to patients upper arms that has been treated by multiple md's over the course of approx 5 years. when i ask them what has worked in the past...they inform me that they don't just want a medication that will make it go away for now, they want it cured. Yes, they want a biopsy today.

Eternally unsatisfied patients, families...don't get me started ha ha. I have sympathy for patients to a greater or lesser degree, but families who threaten, abuse and attempt to bully staff, possibly my biggest obstacle in providing the best care that I can.

[jaad]

I have been a nurse since 1995.

I hope you allow me to share my story?

I was a mildly obese nurse, according to my doctor... when I asked for my chart 13 years ago.

I saw that dreaded sentence" pleasant female, mildly obese"... I weighed nearly 200lbs.

Surprisingly I was malnourished yet overweight.

I had liver problems, heart palps, pitting edema, bad knees, thyroid problems, high cholesterol, high triglycerides, hypothyroid, depression, anemia, GI distress...you name it.

My body was failing at a young age. My doctor said "you are too young for this".

My GI doc found flat villi and told me to avoid gluten and go on a low glycemic index diet.

I knew at that point it was either listen to my doctor or possibly shorten my life and die younger than expected!

As I began a major life change...I started planning every meal, avoiding white sugar, salt, white flour, white potatoes, white rice, and gluten. I walked 5-7 times/week.

Within 6 months I lost 65lbs. At this point my knee pain went away, heart palps gone, thyroid began improving, got off of cholesterol meds, liver enzymes improved, hair began thickening, felt happy and like life had begun all over again. Looked forward to starting everyday...Marriage improved...seriously felt like I had been given a second chance!

13 years later I am a complete health nut! I still avoid those 5 whites most all of the time. I eat plenty of raw and steamed greens, fruits, beans, nuts, pea/hemp protein spinach smoothies, salads and low sodium soups.

When I crave sweets I use some defatted peanut powder, cocoa and agave nectar with an apple...and the craving is satisfied.

I wear a size 4-6 pants (from size 16)

I don't weigh myself because I don't want to get hung up on my weight. My focus is health!

People I work with now, at first thought my diet was extreme... and yet they all say they wish they looked like me.

I tell them "when your life was almost taken from you, it may cause you to make extreme changes"!

As a nurse, I have inspired many patients. I will give 100% of my time to anyone and everyone who will listen.

What makes me sad is when people don't acknowledge they have a problem.

I once had a patient on Medicaid who was nearly 400lbs. He used to come to our wound clinic bragging about how is diabetic foot ulcer was the government's "million dollar foot". Instead of discussing his diet, he changed the subject to tell our staff about his expensive coin collection.

Our doctor ended up discharging him from our wound services. We got paid very little for 4 layer compression, weekly wound visits, and little to no participation from the patient.

Unfortunately, obesity has become an epidemic. Young people who are obese and think they are healthy, are just fooling themselves. Our bodies were not meant to be obese. Over time, it will take a toll on them.

While I have patients that are not interested in participating in their health...several of them have been inspired by my story and will contact me months later to tell me their progress and how much better they feel.

When I was heavy, I was too ashamed to discuss healthy eating because I felt like I had no business if I couldn't take my own advice.

I used to have doctor visits non stop. Today, I haven't needed to be seen for several years.

It makes me feel good to know that for now, I am not being a burden to the system while I have my health! Anything catastrophic could happen...I realize this...but I believe my "health care plan" starts with me!

I can so relate to the OP. The obesity we have today will selfishly affect most all of us in one way or another.

[CamillusRN, BSN]

250 lbs? Ha ha! I have had patients more than twice that size. 250 lbs is nothing when one comes across their first 500+ pound patient (and yes, this patient coded and had a multitude of other problems). That being said, NEVER try lifting a patient by yourself. I know too many nurses and aides who have literally broken their backs because they tried to do it on their own. Also, pull some other nurses and aides to help out, as there are strength in numbers. I imagine with a 250-pounder, you only need one or two more people to help out. Five hundred pounds...that is another story.

I'm still recovering from the very traumatic experience of cathing a 600lb female. The operation took 6 staff members and 45 minutes. And the smell . . .

[Libby1987]

I haven't read any responses so we'll see if I sound like a jerk or just an idiot but..

if a patient is still obese after a year of a clinically controlled diet, one would conclude there's more to this cal in/cal out deal, or at least give them credit for the 104 lbs they surely have lost by that theory.

[CamillusRN, BSN]

I haven't read any responses so we'll see if I sound like a jerk or just an idiot but..

if a patient is still obese after a year of a clinically controlled diet, one would conclude there's more to this cal in/cal out deal, or at least give them credit for the 104 lbs they surely have lost by that theory.

So, I think I understand what you're saying, and it's not jerk-ish in the least.

From my past experience of working as a physiologist, I can absolutely agree that there is SO MUCH more to the management of obesity than simply a caloric imbalance. The number of factors (genetics, hormones, cancer, environment, progression of illness, etcetera ad infinitum) that play a part in obesity risk could easily fill a good-sized textbook. For example, even the slightest change in hormonal secretion (and it doesn't even matter which hormone) can affect cellular metabolism. The body typically is able to counter these changes naturally, but for any host of reasons this can go wrong. The pituitary overreacts, the adrenals overreact, the thyroid overreacts, and so on and so forth. Unless the root cause is corrected (and in some cases, it simply can't be), the metabolic changes will continue to create havoc on the body until (A) the condition stops naturally (B) a synthetic cure is applied, or © the body simply gives up.

And now a short rant about the ignorance surrounding the problem of obesity:

The idea of "diet and exercise are the cure to obesity" is simply archaic in light of the discoveries being made regarding obesity as an epidemic. There are certainly those who would benefit from a little less Mickey-D's and a little more walking, but that's just not the case for a great number of people struggling with obesity. This study, along with a great number of others easily accessed from the National Institutes of Health (US National Library of Medicine), has demonstrated that.

The 600lb female I mentioned previously (which, after having a chance to read the entire thread, I regret posting) was obese d/t her body being taken over by an aggressive cancer, hypothyroidism, serotonin imbalances, SIADH, CHF, Type I Diabetes (the one you can't prevent), and genetic predisposition to obesity AEB the entire family being > 300lb. Her diet and level of activity had very little, if anything, to do with her size. There was no thought of "why would someone do this to themselves" every time the entire unit had to come to her room to provide personal care - her health history and many setbacks were well known to all the nursing staff caring for her.

I hate to come across as harsh, but the people who label obese individuals as "lazy" or "gluttonous" are as obtuse as people who still describe mentally handicapped children as "retards." In my not-so-humble opinion.

[NOADLS]

Prior to getting into nursing, I used to despise fat people. However, I received the best nursing advice from a "fat person." Do as little as possible and get paid as much as possible. Now every time I see a fat person, I am not quick to pass judgment.

[Libby1987]

So, I think I understand what you're saying, and it's not jerk-ish in the least.

From my past experience of working as a physiologist, I can absolutely agree that there is SO MUCH more to the management of obesity than simply a caloric imbalance. The number of factors (genetics, hormones, cancer, environment, progression of illness, etcetera ad infinitum) that play a part in obesity risk could easily fill a good-sized textbook. For example, even the slightest change in hormonal secretion (and it doesn't even matter which hormone) can affect cellular metabolism. The body typically is able to counter these changes naturally, but for any host of reasons this can go wrong. The pituitary overreacts, the adrenals overreact, the thyroid overreacts, and so on and so forth. Unless the root cause is corrected (and in some cases, it simply can't be), the metabolic changes will continue to create havoc on the body until (A) the condition stops naturally (B) a synthetic cure is applied, or © the body simply gives up.

And now a short rant about the ignorance surrounding the problem of obesity:

The idea of "diet and exercise are the cure to obesity" is simply archaic in light of the discoveries being made regarding obesity as an epidemic. There are certainly those who would benefit from a little less Mickey-D's and a little more walking, but that's just not the case for a great number of people struggling with obesity. This study, along with a great number of others easily accessed from the National Institutes of Health (US National Library of Medicine), has demonstrated that.

The 600lb female I mentioned previously (which, after having a chance to read the entire thread, I regret posting) was obese d/t her body being taken over by an aggressive cancer, hypothyroidism, serotonin imbalances, SIADH, CHF, Type I Diabetes (the one you can't prevent), and genetic predisposition to obesity AEB the entire family being > 300lb. Her diet and level of activity had very little, if anything, to do with her size. There was no thought of "why would someone do this to themselves" every time the entire unit had to come to her room to provide personal care - her health history and many setbacks were well known to all the nursing staff caring for her.

I hate to come across as harsh, but the people who label obese individuals as "lazy" or "gluttonous" are as obtuse as people who still describe mentally handicapped children as "retards." In my not-so-humble opinion.

Obtuse is right. The obesity epidemic is where I part ways with most nurses and dietitians. You would think as a group they would have more comprehensive knowledge re cause and solution but they seem to be no more knowledgeable nor insightful than the average lay person. Flame on, I'll die on that hill.

We have laws against minors smoking due to the addictive and disease causing properties. Across the board everyone from the AMA to little kids agree smoking is the of one the worst things for individual and societal health.

Yet we either embrace or show apathy towards our food culture that creates the foundation of heart disease and diabetes in our general population, and then we ***** about the burden they place on us financially and increase our workload. Oh, and how bad they smell.

Our food culture is creating little diabetics everyday.

If iwe had tobacco stores on every corner marketing and selling to kids we would flip out. But good gawd don't take away our Starbucks. Not only must we keep a high fat/high sugar/habit forming drink station on every corner, we will actually pitch a fit if the min wage barista doesn't get our diabetic shake perfect. If that can enrage a skinny person, doncha see how pervasive and habit forming that combo is? Have you seen the music video, "It's just a ******* cup of coffee"? My daughter works at Starbucks, that's what refined processed crap does to some people. It's addictive. Just like the rest of our refined diets.

Anyway, we say that the individual should be able to show self constraint and not over do it.

We never tell kids it's okay to smoke, just have some self control and smoke on holidays.

For some reason, even health science majors are so stuck in the 70's in that they continue to deny both the additive properties of our cultural diets as well as the different tipping points for IR in individuals.

The theory of, "well I can control what I put in my mouth and so should you" is as ignorant as the smoker who escaped lung disease and made it to 89 and claims he didn't have a problem with smoking.

I'm not fat. In fact I was born with the model thin stereotypical body type and maintain it in middle age. People stop me and ask how I do it. Well it's not by the theory thrown around here. I'm lucky that I won the genetic lottery and maintaining my weight is no challenge from a numbers perspective. Menopause seemed to have made me carb sensitive and while I'm able to work with that thanks to everything else that went right in my life, I've had a peek into what carb intolerance feels like.

Obesity is a societal problem much like our other health epidemics. If we approached it from the perspective of societal responsibility we would no more let Starbucks (and all of the other garbage food companies, I just like to single out Starbucks as it was their initial coolness that seemed to have exploded the phenomenon, Baskin Robbins sure didn't become the place to be seen or carry their company logo on recycleable cups) create little diabetics than we'd let the corner liquor store sell booze and cigarettes to minors. We at least make them wait until they were adults and had a good start, AND we would collectively demand that our govt and medical organizations stop pushing 300 gms of non vegetable carbs as the healthy diet for everyone.

Do I want to single handedly muscle obese patients? Of course not. And I don't think staff should just have to absorb the increasing weight of the general patient population without adjustments in equipment, patient ratios and the staffing models. Who's responsible to pay for the extra expense? A societal problem usually has to be paid for by the public ie tax dollars, not your employer who isn't getting additional reimbursement. That's sucks, doesn't it? It's the reality though.

[calivianya, BSN, RN]

I don't think many nurses really hate fat people in their day to day lives outside of the hospital. Another person's weight has nothing to do with my perception of them until their weight becomes my problem, which only happens at work.

[SmilingBluEyes]

I have to struggle with this myself. For example,when we get a 500lb patient, the work that goes into getting them on and off treatment is immense at times.

I try very hard to look the person in the eyes, and talk to them kindly, and really, really work at remembering there is a human being who has feelings, hurts and pains that put them in the place they are.

I had one very large lady who used to ask for me everyday. At first I was annoyed, but I realized she just wanted a hug from me; she needed that human connection and felt it with me somehow. Changed my whole outlook.

I am no angel; I just try very, very hard to keep the human element involved when I get frustrated or exasperated.