Tactful education; Obesity

[BlueLightRN]

How can I discuss obesity with a patient in a non-offensive way? The patient's health problems are all directly related to/caused by the patient's morbid obesity (500+ pounds) but the patient wants medication fixes to their problems, medical supplies and equipment to help accommodate the problems, but is not making any effort to lose weight at all, which would basically solve all of the problems in time. Any advice? I tried to discuss normal meals/serving sizes/portions with the patient but all I get in response is "Well, if I only ate that much I'd be starving" and the exercise debate is a non-point because at this point the patient can't even really walk. Not a candidate for surgery or treatments like that due to out of control htn/dm, etc because of the weight. Thanks in advance for any tricks/tips for helping with this. :)

[mmaibaue]

I wish I could convince all my obese patients how much better they would feel if they maintained a healthy body weight. I'm not talking picture perfect but at least under a BMI of 30 for most people. I have seen so many people who say that they are off the blood pressure medication or no longer have their diabetic pills because they lost weight. But do they also realize that their knees and back wont hurt as much and they no longer have to take anti inflammatory medication which carry other risk such as HTN and GI complications. No more Lipitor maybe. No Flexeril for the back. Maybe no Prozac for depression. The list is endless. Living well makes you feel well inside and out and is cheaper than a doctors visit or a prescription. The difficult part is, like you said, trying to convince people that the success rate of weight loss in controlling some diseases is higher than the pharmaceuticals they are taking. I wonder what the actual success rate would be compare with drugs, does anyone know? Has such a study been done? I know there are a lot of variables. But, maybe, if we had solid data showing people the success of healthy weight and healthy living compared with that of medications would people listen. And healthy living has no bad side effects.

[brownbook]

I have read posts about patients refusing some ADL'S as in "I don't want to take a shower," or "I don't want the bedside rails up," etc., Most nurses reply that these patients have the "right" to not do these activities and the nurse has no right to force them to. Which I don't always agree with.

I get the same (or opposite) feeling here. What right do we have tell a patient what food to put into their mouth?.

I think the obese patient has a better idea that their decisions are killing them than the patient who insists they don't need a bath or don't need the side rails up!

Sure talk about good nutrition, diabetes, arthritic pain, etc. make suggestions, but then accept their right to make the decision and let it go!

[imintrouble, BSN, RN]

As the above poster stated, most obese people know their weight is killing them. I liken it to the smoker who smokes 2 packs a day. Or the diabetic who's BG is routinely over 300.

I only talk to a pt about self destructive behavior, if they bring the subject up first.

That includes weight.

[BrandonLPN, LPN]

Ignoring the elephant in the room does no one any favors.

I hope you don't use this exact metaphor in these discussions with your obese patients. :)

[ashnew11]

Situations like these are always difficult. 1. you don't want to hurt feelings. 2. you don't want to upset the patient. The main thing to remember is we are here for the patients and honesty is the best policy. Respectful word choice is the first thing that comes to my mind.

Another major problem is this patient is barely able to walk, who is his/her support system at home? Maybe a conference with the family could help the patient with meal planning and some in bed exercises. If the patient does not have a support system maybe a rehab center would be a good choice for this patient. It sounds like this patient needs physical therapy anyway.

Also with patients like this it is best to start these conversations on admission so you can arrange the appropriate programs. If waiting till discharge to educate and try to help overweight patients they may not get the care they needed. Starting at the beginning of admission lets the patient ask questions through out their stay.

It is important to let the patient know that we still care about their health even after discharge. We are not trying to lecture, we are just concerned. And we are here for support and guidance.

I hope this helps!

[pro-student]

This is always a touchy issue but I like to keep the focus on the risk/negative effects on health. People already know their fat/obese/overweight so it's not a shock to them. They are often surprised when you can give specific examples of how their weight negatively impacts their health. While most people have a general sense that being fat is unhealthy, they're often shocked the myriad ways it damages their health.

Also, focusing on modest goals is a good start. It seems less daunting to swap out a soda a day or go for a walk than to achieve an ideal BMI. Then little victories provide positive reinforcement to continue making progress. Pts often feel being fat and unhealthy are all or nothing. Research shows, however, even slight improvements like 10% weight reduction over a few months can make immense improvements in health.

[Sam J.]

Obese people know they are obese. More commonly then not they are also well aware of the risks. If they want your opinion or advice, they'll ask for it if and when they decide to alter course. I wouldn't advise bring up that subject, until they do. If nothing else you may alienate them.

[4give&4getoften]

If a pt is seriously obese it is more than likely is about portion control they are hurting mentally or emotionally. They need a HCP that truly cares in helping them get to the root of their weight problem. Now going about that in a way that the pt really knows and understands you want to help is what we need to figure out here.

[Retired APRN, MSN, RN, APRN]

I have a really good friend who is over 60 yo, morbidly obese, and has failed bariatric surgery. She hates her weight, hates herself. She has been "fired" by dietitians and therapists because she has a terrible time complying with treatment plans.

Now she is making progress for the first time. She has found a dietitian who is realistic, creative and supportive and who takes a constructive approach to change when my friend is non-compliant. The elements I see in the dietitian's approach that work are unconditional acceptance of the person qua person, trying plans and techniques that fit the person's individual lifestyle, learning style and psychological makeup; realistic optimism, and recognition of failure with emphasis on success, even in small increments.

[Emergent, RN]

I do talk to patients about healthier eating habits. I try to get them to think about making small changes towards better health, not emphasizing weight loss, per se, but gradually trying to cultivate better health habits.

The first favor most Americans, obese or not, can do for themselves is give up pop. It's chemical laden and health sapping. There is evidence that diet pop actually contributes to weight gain, and the chemicals and sugar in these drinks have got to be detrimental. I also encourage them to avoid fast food.

Some obese people are soooo inactive. I encourage them to do small things to increase their activity. Just walk around the block. Park at the end of the parking lot instead of finding the closest space. Just getting the blood circulating faster will give an increased feeling of well being and maybe lead to other things.

They have to stop thinking "I need to lose 200 lbs" and start thinking "I want to feel better". Just taking small steps toward that goal will be a positive.