Tactful education; Obesity

LadyFree28, BSN, LPN, RN · Jan 2, 2014

I would return to the diet portions by suggestion of smoothies, specific snacks based in calorie, complex carbs and proteins. Do meal planning to adhere to what the pt's preferences are. find out what economic budget they are on, and go from there. HTH!!

SoldierNurse22, BSN, RN · Jan 2, 2014

I'd be very professional but very honest: tell the patient that at this point, you can provide them with supplies to help make his life easier, but that is not going to be a long-term solution. The only way to make him better is for him to lose weight. Reassure him that you'll be there to help him. Talk out reasonable plans to step-down his diet and increase his physical activity. Even if he just walks across the living room a few times a day, that's a step in the right direction.

In the long run, however, you cannot make this patient change his behavior. That's the grim reality of our profession, and it sucks to see people throw their lives away when they could make all their problems disappear with a little effort, but we as nurses can only encourage. Your patient needs to find the desire within himself. Until then, all you can do is support, educate and encourage.

llg, PhD, RN · Jan 2, 2014

I agree with the "head on" approach recommended by SoldierNurse. It's useless to discuss specific weight loss strategies if the patient is not ready/wanting to lose weight. Ask him head on about his long-term goals. Does he want to improve his condition? Or does he simply want to be helped to be more comfortable while he lives whatever time he has left? How does he envision his future? What are his hopes? etc. Start there. He needs to be a partner in whatever treatment he receives -- so don't "push him away" by hounding on a approach that is not compatible with his goals and wants.

By working WITH him and emphasizing HIS goals, you will begin to establish a relationship that may allow you to begin addressing weigh loss. And he needs far more weight loss intervention than portion control, etc. He needs attention by professionals who specialize in the care of morbidly obese patients. Establish a positive relationship ... and then use that relationship to help him access the very specialized expertise he needs.

BlueDevil,DNP, DNP, RN · Jan 3, 2014

Sometimes "nice" doesn't work and you just have to stop enabling them, be frank and tell them they either change or die. I guarantee you they will take offense, but that's too bad. I sometimes remind people that I am their health care provider, not their friend. It isn't my job to cheer them up, it is my job to apprise them of their risk factors and help them mitigate them as much as possible. That doesn't mean I'm insulting of course, but I don't mince words either. I can't help them if they won't help themselves, and I say as much.

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

LadyFree28, BSN, LPN, RN · Jan 3, 2014

Sometimes "nice" doesn't work and you just have to stop enabling them, be frank and tell them they either change or die. I guarantee you they will take offense, but that's too bad. I sometimes remind people that I am their health care provider, not their friend. It isn't my job to cheer them up, it is my job to apprise them of their risk factors and help them mitigate them as much as possible. That doesn't mean I'm insulting of course, but I don't mince words either. I can't help them if they won't help themselves, and I say as much. Ignoring the elephant in the room does no one any favors.

Agree. :yes:

That's what I meant by my original post; you MUST work with the patient in getting them to modify their diet, and go from there; my point is be proactive, and at least get them to understand that the first step is changing their diet; no form of meds and accommodations is going to work if they can actually see that starting with what they eat and how they eat if affecting them...discussing the diet will find out through assessment what is concerning them; it may be psychological.

Either way start at a point and work on the root causes; find a way to get the pt involved to have some form of empowerment in their health decisions.

BlueLightRN · Jan 4, 2014

Well I spoke with the patient. I asked the patient about the problems and then when the patient was talking about the problems, asked what would help those problems? What is causing the problem? When did the problem start? And they all tied back to one thing. I think the patient got that after a little bit. Essentially our goal is this: Keep a food diary and see how much you are eating. Also, write down what physical activity you do. Maybe you walked to the mailbox. Walked in the store. Maybe you exercised your arms while you were watching tv. I'll see where it goes. Patient still thinks medicine and equipment is the answer but at least now recognizes the real problem... which isn't the lazy b-word nurse who won't spend an hour on the phone to get paperwork for medical supplies medicaid won't cover anyways and who won't force the doctor to give the patient more and more percocets....

edmia, BSN, RN · Jan 4, 2014

This is always such a hard situation... I would be honest as SoldierNurse suggests, although I'm sure this patient has heard the warnings before and has not changed their behavior.

If you come across this often in your practice, there's a good book that helps health care providers address health promotion with patients. I don't recall the author, but the title is Motivational Interviewing in Health Care. I had to read it for a class a couple of years ago and was pleasantly surprised with the content. I reference it often.

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spencernic · Jan 5, 2014

Well said SoldierNurse22

Not_A_Hat_Person, RN · Jan 6, 2014

People will start where they are. I think medication and bariatric equipment have a place for a 500 lb. patient. They didn't reach 500 lbs. overnight, and they aren't going to reach their goal weight overnight. A person who can barely walk and can't wash themselves after a workout isn't going to be very motivated to start a walking program (which can be very strenuous for someone who can barely walk). If a bariatric shower chair, a butt wiper (don't know the technical term) and other equipment make it possible for the person to keep clean independently, they may be more interested in walking.

Plus, at 500 lbs, the patient's weight problems go beyond portion control and exercise. Obesity is more complex than calories in- calories out. They may need a bariatric specialist. They may need a counselor. Since they have DM and hypertension, a consult with an RD or endocrinologist may help.

wingding · Jan 7, 2014

Good advice - start small, basic & get used to small changes. Pt. needs positive reinforcement to keep on that roll. Obese person has eyes - they can see themselves. No on wants to be fat - there is more than food going on - be it MH problems, eating disorders, or health problems (thyroid) or side effects of medications being taken.

Cobweb · Jan 9, 2014

I just wanted to add a couple of things, as a pretty chunky gal myself (thank you, steroids).

A person doesn't have to starve and doesn't have to cut how much they eat as much as what they eat. For instance, changing from potatoes and bread to celery and red peppers is a pretty good tradeoff, and you can eat just about as much of that kind of thing as you want.

My second suggestion, if it is possible, is to get them into a swimming pool. The pool where I go has a bariatric lift to get people in the water. On a bad day, I can hardly walk 10 feet on land, but my first day in the pool I did 10 laps of water walking. That is 3/10 of a mile! Two weeks in the pool has helped me more than a whole year of lifting weights and biking.