Prejudice Against Overweight Patients: An Issue To Ponder - page 11
Weight discrimination is the treatment of someone in an unfair manner due to the person's size. Even though extremely thin individuals are occasionally treated poorly due to their size, overweight... Read More
Jun 24, '12Here's an example from work today that fits this issue perfectly:
The patient was a seven year old female with a diagnosis unrelated to weight. She weighed 70 kgs (155 pounds). As a reference, the 98th percentile for a 7 year old girl is 70 pounds. The patient refused to do simple things for herself- such as help reposition herself in bed, feed herself, and wipe herself after she had a bowel movement. If I told her she had to help or had to do something for herself, she would whine and complain that she "can't do it" or she "didn't know how."
Instead, her mother would do these things for her. Her mother also brought her extra snacks and juices (mom reported the child drinks up to 64 ounces of juice per day). When the child refused to eat the meals that dietary had prescribed for her, the mother would bring her bacon and sausage, grits covered in butter, McDonald's cheeseburgers and french fries, cookies, etc. I don't think she ate a vegetable all day.
It was extremely frustrating for me to take care of the patient when the child was acting so helpless and the mother was enabling her laziness and poor eating habits. I'll freely admit that I had more than a few judgmental thoughts about the family. But what really irritated me was not that the child was morbidly obese, but the attitude that accompanied it. The weight wasn't the issue- it was the fact that the patient (in this case, the patient's mother) refused to acknowledge there was a problem or invoke change, despite education from our nutritionists.
I realize that this situation is not the child's fault. Seven year olds cannot go out and buy McDonalds themselves. They can't drink a gallon of juice per day unless someone is bringing it home for them. They don't get away with doing nothing for themselves unless someone is willing to do everything for them. So my bigger issue was with the mother, not with the child. While the child wasn't admitted for a condition directly related to her weight (but she did have a history of hypertension and obstructive sleep apnea) a good diet is very important in the management of her condition. And even though she wasn't in the hospital for a weight issue, there was no doubt that her weight was directly affecting her medical care and her recovery.
I suppose my point in all of this was that, for many people in the healthcare field, it's not the patient's weight that causes them to have prejudice or be judemental- it's the attitude of the person who is overweight. Or, it's the health care worker's repeated exposure to the attitudes that I described above that cause them to have negative associations.
Finally, even if you don't have a medical problem that's caused by being overweight, the weight can still be a factor in the management of that condition and the overall health and recovery time. A hysterectomy may not be related to weight, but a morbidly obese patient who can't get up and walk after surgery is at much greater risk for complications and much more likely to end up staying in the hospital longer or going to a SNF. So if it wrong of the gynecologist to bring up weight, even though it isn't directly related to the issue at hand?
Jun 25, '12Quote from anotheroneAh, but here's the catch....People who are addicted to drugs and alcohol when deciding to quit, can conceivably then wipe it out of their lives. (for some not easily, but they can). People can't wipe food out of their lives. People have to eat. That is the balancing act that is difficult.I sometimes think, many obese people are addicted to food. addicted like an alcoholic or crack addicts. etc. I think because of that and the feelings of loss of self control that come with an addiction some people get defensive/angry when it is mentioned. just like in that CAGE acronym. how else can we explain the eating a whole bag of chips that don't taste that great, eating a whole pizza, etc. Not every obese/overweight person is addicted to food, i am not saying that, but I think some are. just like one can be addicted to anything.
Jun 25, '12I do find it frustrating overall that as a nurse you might hear a patient say "I had the worst day ever, I am gonna go have a few drinks" and that is an acceptable statement to a number of people. "I smoke pot to relax and 'zone out' sometimes" (or for chronic pain, or for sleep....)," I smoke cigarettes to relax" or "I need some ativan".....there's all sorts of things that patients do,(and a number of family,friends, co-workers) that we need to educate on. (educate the patients--the family, friends and co-workers get a bit testy when one tries to "educate" them...) These, unless a chronic condition, (or a keen sense of smell) are not always a visual. Patients need to share that with you in order for the nurse to be aware and educate accordingly. For people who have issues with their weight, it is an immediate visual, and often patients would not have to share a thing with a nurse, and there are sweeping generalizations. There are a number of reasons that a person can be overweight. It doesn't always mean that they are eating incorrectly, have disordered eating or don't exercise enough. Of course, it could be, but not always. With a visual, it seemingly goes right to a character assault. As nurses, I think that we need to seperate the patient's character from the issues at hand that need educating. Otherwise, we are doing a dis-service to patients.