Caring for Obese Patients

classicdame, MSN, EdD · Jun 11, 2014

I think everyone has some type of bias against some type of patient (alcoholics, obses, psych, etc.). I would include how to work around prejudices. Do nurses consider them ugly or lazy or stupid or what type of negative connotation could there be for obese patients? Then find clinical reasons why those images are false and help them deal with the person inside.

amoLucia · Jun 11, 2014

You know, being a 'big girl' myself, I'll offer my perspective.

If losing weight were so easy, does anyone in the world think we would voluntarily want to remain overweight?!?!? Hell no! We'd all be skinny! We all experience the negative fallout - the 'too tight' fitting chairs, the limited fashionable wardrobe, squeezed turnstyles, non-locking amusement park rides bars, seatbelt extenders for car and airplane, the huffy-puffies upon exertion, aches & pains, all the time ... And we do know the predisposition to serious life-threatening medical comorbidties. They are scarey!

So back to my statement - if losing weight were so easy, does anyone think we would want to remain overweight? I want to be as inconspicuous as possible and I don't want to impose on anyone in any way to bring negative attention to myself. If I must depend on some outside help, I'll try to do as much as I can until I can't do anymore. Then I'll ask someone and I am very appreciative. Example - if I need something on a tippy-top shelf in the grocery, I just can't step on the lower shelf to reach up. NO! Too heavy. So I'll wait for some normo-weight person or a tall person to come by and reach up. And I very sincerely "thank you' them. You learn to compensate.

Dieting is not the simple answer. One only needs to read the literature re recidivism rates for regained weight loss. Kind of like junkies, alcoholics and smokers who 'fall off the wagon'. We all try & fail numerous times. We still need to eat to live. Me? I make terrible choices. I would prefer Pepperidge Farm Bordeaux cookies, Doritos Nacho cheese chips and a diet pepsi for breakfast rather than something healthy. Hunger is not my problem, I like TASTE. And exercising is difficult because you're overweight; you're overweight because you can't exercise. What a Catch-22!.

Now to what you're asking - I have been a pt at times. I will do as much as I can before I can't anymore, and then I need your help. I wish I didn't. But I need your help in a special way. Just give me a chance TO DO IT MY WAY! (Frank Sinatra is rolling over!). I may be slow to scoot over on a stretcher but I can do most of it. And a wide wheelchair may have navigational issues, so let me standup & take a few steps (but I'll have to hang on to a cane/walker/furniture). Just let me tell you how. I may be slow but I can do it.

I'm surprised when staff complain derogatorily about obese pts in my presence. Uh, like hello... And staff bias is so widespread even among usually tolerant staff. I will be honest - there are obese people who do not assist in their care. They are soooo frustrating. And when staff indifference and/or bias is detected, pts will become less motivated to assist. I want to be careful about speaking for other obese pts. But I believe that many of us will help as best as we can. JUST WORK WITH US (OUR WAY).

I watch the A&E (Learning Channel?) TV show for bariatric surgeries. I rejoice for those who succeed; and I want to smack those who fail by setting themselves up for failure (like the one lady who would stop at a fast-food joint driving home just after her doctor appt). Ooh, I want just smack her! I once lost mega weight in a supervised clinic diet group. I mean LOTS of weight. (I never completed the program's transition & maintenance phases due to my big car accident, so all the weight slowly came back over time - all the bad habits returned.) I got skinny for the first time in my life. I had clavicles! Sitting long times was difficult because I could feel my coccyx! You could put your fingers on the side of my chest and they would move with the expansion and contraction of my intercostal muscles. For the first time in my life, I could cross my legs!!!! And I could pass thru my college's library's turnstyles (I actually would go in & out like a 5 year old playing around!!!). But it didn't last.

I could write a book on my dieting.

1 - Like I said, nobody would want to stay overweight if given the option of being skinny.

2 - It's not easy to lose the weight.

3 - Many of us want to do as much as we can for ourselves. Just give us a chance, albeit slow and our way.

Hope this makes sense to you and might help for your presentation.

tarotale · Jun 12, 2014

Good afternoon. I am interested in your presentation of this topic since American is very obese country and we very often get obese patients (TX). To be frank, obese patients have very bad notion with the nurses that I worked with or encountered. If they are not my patients, who cares? But I am the one to risk chronic injury assisting them or pulling them up, and this is where people get irritated and mark them as lazy, irresponsible, and undisciplined; not alone mentioning that obesity is serious risk to health and we all start rolling our eyes when we find out that our patient for hyperglycemia or cp is 200lbs overweight, non-compliant and just freely brewing his/her own demise. There are many compassionate nurses out there, but as soon as we get to the patient that is obese, whether I am giving report or receiving it, we start with "this lady is very obese" and we roll our eyes and make comments about it.

Personally I was a chub, and I lost all the weight and am physically fit, lean and healthy through strict diet and exercise. I don't see why anyone cannot do it. Science is science; amount of excess calorie goes in, then that turns into excess weight. The solution? Eat less, start working out. It's THAT simple really and people don't do it. We know it's hard, who doesn't know that? But good healthy, fit body doesn't fall out of sky.

I see that my opinion can't really help you in your presentation of infusing compassion for obese patients, but I do think that most of the "obesity-bashing" especially in nursing come from "making my job harder", "your laziness is killing you, so your own fault", and of course our precious backs that will dwindle and crush as years pass by thanks to all the obese people. I do wonder if my ideology is accurate for nurses that dislike obesity in patients. By the way, I think nurse practitioners are awesome and know I will be one one day. Thank you for paving our roads!

Heliantus · Jun 12, 2014

You know, being a 'big girl' myself, I'll offer my perspective.
If losing weight were so easy, does anyone in the world think we would voluntarily want to remain overweight?!?!? Hell no! We'd all be skinny! We all experience the negative fallout - the 'too tight' fitting chairs, the limited fashionable wardrobe, squeezed turnstyles, non-locking amusement park rides bars, seatbelt extenders for car and airplane, the huffy-puffies upon exertion, aches & pains, all the time ... And we do know the predisposition to serious life-threatening medical comorbidties. They are scarey!
So back to my statement - if losing weight were so easy, does anyone think we would want to remain overweight? I want to be as inconspicuous as possible and I don't want to impose on anyone in any way to bring negative attention to myself. If I must depend on some outside help, I'll try to do as much as I can until I can't do anymore. Then I'll ask someone and I am very appreciative. Example - if I need something on a tippy-top shelf in the grocery, I just can't step on the lower shelf to reach up. NO! Too heavy. So I'll wait for some normo-weight person or a tall person to come by and reach up. And I very sincerely "thank you' them. You learn to compensate.
Dieting is not the simple answer. One only needs to read the literature re recidivism rates for regained weight loss. Kind of like junkies, alcoholics and smokers who 'fall off the wagon'. We all try & fail numerous times. We still need to eat to live. Me? I make terrible choices. I would prefer Pepperidge Farm Bordeaux cookies, Doritos Nacho cheese chips and a diet pepsi for breakfast rather than something healthy. Hunger is not my problem, I like TASTE. And exercising is difficult because you're overweight; you're overweight because you can't exercise. What a Catch-22!.
Now to what you're asking - I have been a pt at times. I will do as much as I can before I can't anymore, and then I need your help. I wish I didn't. But I need your help in a special way. Just give me a chance TO DO IT MY WAY! (Frank Sinatra is rolling over!). I may be slow to scoot over on a stretcher but I can do most of it. And a wide wheelchair may have navigational issues, so let me standup & take a few steps (but I'll have to hang on to a cane/walker/furniture). Just let me tell you how. I may be slow but I can do it.
I'm surprised when staff complain derogatorily about obese pts in my presence. Uh, like hello... And staff bias is so widespread even among usually tolerant staff. I will be honest - there are obese people who do not assist in their care. They are soooo frustrating. And when staff indifference and/or bias is detected, pts will become less motivated to assist. I want to be careful about speaking for other obese pts. But I believe that many of us will help as best as we can. JUST WORK WITH US (OUR WAY).
I watch the A&E (Learning Channel?) TV show for bariatric surgeries. I rejoice for those who succeed; and I want to smack those who fail by setting themselves up for failure (like the one lady who would stop at a fast-food joint driving home just after her doctor appt). Ooh, I want just smack her! I once lost mega weight in a supervised clinic diet group. I mean LOTS of weight. (I never completed the program's transition & maintenance phases due to my big car accident, so all the weight slowly came back over time - all the bad habits returned.) I got skinny for the first time in my life. I had clavicles! Sitting long times was difficult because I could feel my coccyx! You could put your fingers on the side of my chest and they would move with the expansion and contraction of my intercostal muscles. For the first time in my life, I could cross my legs!!!! And I could pass thru my college's library's turnstyles (I actually would go in & out like a 5 year old playing around!!!). But it didn't last.
I could write a book on my dieting.
1 - Like I said, nobody would want to stay overweight if given the option of being skinny.
2 - It's not easy to lose the weight.
3 - Many of us want to do as much as we can for ourselves. Just give us a chance, albeit slow and our way.
Hope this makes sense to you and might help for your presentation.

I'm so sorry about your car accident. Also, I'm sorry that you are struggling with your weight, and the way people perceive and treat you because of it! I know how hard it is! While I'm not over weight, my mother is, and no matter how hard she tries, she's always back where she started.

In contrast, I am a skinny person. I weigh 112lbs 5'5", so quiet thin. I am always being commented on, (bones are for dogs etc). No matter how hard I've tried to gain weight, it never sticks. I gained almost 50lbs when I was pregnant, but it was all gone by the first year after birth. I don't eat like a bird too, so calories is not the problem here.

My point is that people will critics others no matter their size. We're too fat, too skinny, too tall, too short, you name it. You can't please everyone.

Just try to be the best that you can be, not what someone wants you to be.

mmc51264, BSN, MSN, RN · Jun 12, 2014

In my experience, I have heard nurses and aides vent about the physicality of care, but I have not seem anyone disparage a pt personally. It is harder to care for an obese pt, but that doesn't mean we forget they are people.

I am a "fluffy" girl, too, so I can empathize. And like amoLucia said, we don't choose to be larger, it is a daily struggle.

ceccia · Jun 12, 2014

I have heard nurses and aides vent about the physicality of care

that's my problem. i'm not judging people or thinking they're 'less than' for being overweight/obese, but i just physically cannot handle moving larger people past a certain point. I'm tired of getting hurt attempting to lift/turn/transfer people who are 3 times my size. that's not a value judgment or character assessment, it's physics. it just doesn't work. so yes, i get frustrated when i get another obese patient - i feel the same way about max assist pts of any size - it's too much. it has nothing to do with them as people; i do not want to sprain my back for a third time. i've heard of these magical facilities that are "no-lift", apparently they provide equipment so people aren't spraining their backs. yeah, i've never worked in such a facility.

Delicate Flower · Jun 12, 2014

To the OP: please refer to everything Tarotale said, and then base your presentation on the OPPOSITE of all that nonsense. The bias, negativity and prejudice that obese patients experience from healthcare providers (and the public at large) stems from these incorrect statements from Tarotale:

1. "Science is science; amount of excess calorie goes in, then that turns into excess weight. The solution? Eat less, start working out."

2. "But I am the one to risk chronic injury assisting them or pulling them up"

3. "obesity is serious risk to health" and "your laziness is killing you, so your own fault"

Point one is simply false. Weight depends on many factors and is not a simple calories in/calories out equation. Eating less and working out may help MOST people lose weight in the short term, but the body is able to adjust metabolically and the vast majority will gain it back, and then some. The diet industry and media would have you believe that when the weight comes back, it is the fat person's fault because clearly they are not following the plan. But there are many examples of people who eat less, work out, and they are still fat. Fit, yes, but fat.

Point two is a misnomer. It is not the patient's fault if you are risking your back to help move them around. It is your fault for not getting enough help or for not using proper ergonomics or lift equipment. Or it is the facilities fault for not providing adequate staff, equipment, and training. It is not the patient's fault if your facility does not have a bed, chair, stretcher, or blood pressure cuff to accomodate them. Would you blame a paraplegic patient if you hurt your back helping them?

Point three comes from the "studies" (many funded by the weight loss industry) that have correlated health risks with obesity. Please, please, please reinforce to your audience that 1) Weight is not the same thing as health, and 2) Healthy behaviors, not weight loss, is correlated with improved health outcomes.

If you want the ultimate resource, I would like to point you to Ragen Chastain's blog, DanceswithFat.com. Here is a great entry I think will give you a very good perspective of what it is like to be a fat patient: Fat Chance for Healthcare Access | Dances With Fat

brandy1017, ASN, RN · Jun 12, 2014

Instead of emphasizing bariatric sensitivity you should be advocating for a no lift environment complete with ceiling lifts! Sensitivity is all well and good, but should be part of being a compassionate person! What healthcare workers really need is hospitals stepping up and providing a safe no lift environment so workers do not have to be injured or live in chronic pain because of caring for obese patients!

I know too many coworkers who have been injured, some permanently, others living in chronic pain because of the refusal of hospitals to buy and maintain lift equipment such as ceiling lifts. This problem is also one of the main reasons nurses leave the bedside!

Anna Flaxis, BSN, RN · Jun 12, 2014

I think everyone has some type of bias against some type of patient (alcoholics, obses, psych, etc.). I would include how to work around prejudices. Do nurses consider them ugly or lazy or stupid or what type of negative connotation could there be for obese patients? Then find clinical reasons why those images are false and help them deal with the person inside.

I think this is very helpful. We all have biases, and learning to recognize them is the first step in changing our perspective.

Specifically with patients who have morbid obesity, the difficulty I have as a nurse is that I cannot easily round up another five staff members to help me turn, reposition, or transfer them. Starting a peripheral IV is difficult. Placing a Foley catheter requires several staff members just to hold tissue out of the way. These patients can be physically difficult and time consuming to care for, requiring more resources and time than many nurses have available. This can be really frustrating, triggering negative emotional responses from the caregivers, who are pressed for time caring for a multiple patient assignment. Charge nurses don't necessarily give you a reduced patient load simply because you have a patient who is morbidly obese. In the ER where I work, we simply don't have enough staff available, nor do we have a bariatric lift, to be able to provide very good care to the patient who is morbidly obese, and to attempt to move such a person without adequate resources puts my health and well being and my livelihood at risk.

What really helps me deal with the frustration is to depersonalize it. This is not MY emergency, it is theirs. This is not MY crisis, it is theirs. So, focus on their experience, focus on what they are feeling rather than my experience and my feelings, and when I cannot safely accommodate them, simply explain it as kindly as possible. People generally understand when you explain things in a way that respects their dignity and intelligence. They're not idiots. They *know* they're heavy, and they can see I'm tiny.

ceccia · Jun 12, 2014

Instead of emphasizing bariatric sensitivity you should be advocating for a no lift environment complete with ceiling lifts! Sensitivity is all well and good, but should be part of being a compassionate person! What healthcare workers really need is hospitals stepping up and providing a safe no lift environment so workers do not have to be injured or live in chronic pain because of caring for obese patients!
I know too many coworkers who have been injured, some permanently, others living in chronic pain because of the refusal of hospitals to buy and maintain lift equipment such as ceiling lifts. This problem is also one of the main reasons nurses leave the bedside!

this, exactly.

ceccia · Jun 12, 2014

i get that it's "not the patient's fault"...but i don't care whose fault it is; i just don't want to get hurt again.

it's my fault if i get hurt because i didn't "get enough help"? where is this magical help supposed to come from? An adequately staffed facility where there are enough CNAs/techs to help with every bariatric patient transfer when needed? lol i guess this hypothetical facility has real live unicorns gallivanting in the hallways as well.

It's my fault for not using proper ergonomics and/or equipment? all we get are hoyers, which really aren't helpful. it's somehow my fault that none of the places I've worked in have provided equipment? if i would just "advocate for it", they'd make it happen? lol. if i had a dollar for every time I've said something to management about how/why we need better/more equipment, i'd be rich enough to live in a charming flat in Paris with my magical unicorn and wouldn't be worrying about lifting bariatric patients in the first place.

re: ergonomics, I've taken continuing ed classes on bariatric transfer techniques and have tried them. guess what? they don't work. i'm 5' and

i get that obesity isn't a character flaw or moral failing or judgment-worthy. i get that it's not the patient's fault that i can't turn or lift them. i didn't say i'm frustrated AT the patients themselves, just frustrated in general because i'm tired of being in pain from being expected to do more than i can physically handle re: moving larger patients.