Caring for Obese Patients

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Hello everyone! I am an NP currently working as full-time faculty in an ADN program, and doing per diem work in an occupational health setting. I have been asked to present at a hospital-based healthcare conference on the topic of "bariatric sensitivity" in nursing, and I am looking for your input. This topic is so important, but it is also so broad! Caring for obese patients is certainly challenging, and sometimes even back-breaking. However, there does seem to be a great deal of "acceptable" prejudice toward obese patients (I have even heard nurses make derogatory comments right in patients' rooms, not to mention the talk that goes on at the nurses' station). I would welcome your thoughts and observations on this topic as I plan this presentation. I want to make it relevant to the nurses and other health care providers who will be listening. Thank you in advance for your input!

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

As a once fat person, I can personally vouch that it IS possible with just little effort everyday. I don't eat ice cream, fatty foods, cheese, fast foods, not too much carbs and eat when I am hungry and still work out to this day. I have seen countless people transform, so please stop encouraging self-defeating behaviors. People either have champion mentality, the fight to make it, and never-give up spirit, or the opposite of. I and many others chose the life of fighter and we won. There is no excuse.

1. It is true that some people have harder time losing weight due to metabolism and genetic issues, but again, I have done it myself, and many others I have seen and helped. If you eat less than what your basal metabolic rate, it is literally impossible to gain weight but lose it.

2. With your logic, it's like saying child molesters are not at fault, but the parents should have been careful to not let them play in the playground. Let's be understanding and say that it's not their fault that the patient is very obese, but saying it's your fault for hurting the back while taking care of obese patient is the quite offensive and insensitive things to say regarding many many nurses who hurt their backs and still struggle. And no one is insane enough to pull 300lb+ patient up the bed by themselves jeez.

3. Obesity IS one of the highest risk of health along changeable risk factors such as smoking and drinking. When I said "your laziness is killing you, so it's your fault", I was simply concocting an example of ideas that nurses feel when they take care of obese patients. Don't make things up to fit in your argument.

I agree with Brandy1017. I mean why do we even do education on nutrition people if we don't think it's a bad habit??? It is a debilitating habit for health and needs to be corrected for their own good. But since the noncompliant will be noncompliant, we should focus on nurse safety techniques as well.

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I agree with previous posters who have noted that lack of adequate staffing and equipment are a problem, and may in part contribute to the negativity on the part of care providers. But I've seen plenty of prejudice and bigotry aimed at very mobile, physically self sufficient fat patients. It's not all about "the fatty hurt my back!" Yes, there is definitely an issue when it comes to lack of proper lift equipment, staff and training. But fat people DO NOT own that problem, and it is certainly not a justification for 1) Negativity, prejudice, and bigotry, or 2) Inadequate care - "I can't be expected to find 5 staff members to turn this 600 lb fat person every 2 hours!" (yes, you can).

Sensitivity, though, is a whole separate thing. How about respecting the person as a person, no matter what their body size?

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But I've seen plenty of prejudice and bigotry aimed at very mobile, physically self sufficient fat patients.

what are you thinking of when you refer to prejudice and bigotry? any specific examples?

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Tarotale,

"As a once fat person, I can personally vouch that it IS possible with just little effort everyday. I don't eat ice cream, fatty foods, cheese, fast foods, not too much carbs and eat when I am hungry and still work out to this day. I have seen countless people transform."

Your experience and those of your friends do not science make. Studies over the last 50 years have shown that 95% of people who attempt intentional weight loss gain it back after 5 years, and many end up heavier than when they started.

How am I encouraging self defeating behaviors? I don't care if losing weight is as easy as snapping your fingers; fat people still have a right to exist in their bodies. The possibility of losing weight and/or the ease of doing so has no bearing on their right to fair treatment.

"People either have champion mentality, the fight to make it, and never-give up spirit, or the opposite of. I and many others chose the life of fighter and we won. There is no excuse."

Not everyone defines success the same way you do. Plenty of fat people are fighters, they never give up, and are champions. How does someone's body size define whether they are a "champion" or the "opposite of?" Give me a break.

"With your logic, it's like saying child molesters are not at fault, but the parents should have been careful to not let them play in the playground."

Stop the logic train, I think we lost a passenger. Come again now? OK, let's review: if a fat person punches you in the face and then kicks you when you're down, your injuries are their fault. If you attempt to pull them without proper assistance or equipement and you get hurt, it is NOT their fault. How in the world would that comment be offensive to you?

"Obesity IS one of the highest risk of health along changeable risk factors such as smoking and drinking"

Studies have not shown that obesity is a changeable risk factor -long term- at all. Comparing it to smoking and drinking is useless since those are behaviors, and obesity is a body size. Studies have shown significant health benefits to go along with healthy behaviors, but no benefit has been shown to accompany weight loss. What was I making up?

"I mean why do we even do education on nutrition people if we don't think it's a bad habit??? It is a debilitating habit for health and needs to be corrected for their own good. But since the noncompliant will be noncompliant"

This smacks of ignorance and paternalism! "For their own good"? Really!?

Good nutrition is a great habit and we should educate and encourage our patients. However, good nutrition does not equate to "lose weight." And many fat people are very "compliant" (I hate that word in health care).

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Ceccia- You really need examples?

I have heard many comments referring to obese pt's body odor, certain areas of their body (FUPA), judgemental emphasis on the food that they are eating, comments made about their excrement, competition involving the patient's BMI, judgments made about their family members, assumptions about their socioeconomic status or intelligence level, etc. etc.

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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.

Ceccia,

I'm sorry you have gotten hurt. I would say that if you do not have adequate unicorns, I mean staff, to care for your patients the proper way, and management doesn't care, how about moving up the line? Maybe the Joint would care.

Staff should not be doing things known to put themselves in danger, and mangement shouldn't be looking the other way when it happens.

Maybe fat people in your hospital should be upset about the tiny nurse they are given?

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Ceccia- You really need examples?

"need"? no, not literally. yes I am curious to know what behaviours/attitudes you've seen that you find offensive. Because the only negative comments I hear from my co-workers are re: transfers and lifts being difficult, or people complaining that they've hurt their backs. Which again, isn't a value judgment on the person.

I have heard many comments referring to obese pt's body odor, certain areas of their body (FUPA), judgemental emphasis on the food that they are eating, comments made about their excrement, competition involving the patient's BMI, judgments made about their family members, assumptions about their socioeconomic status or intelligence level, etc. etc.

ok yeah, that's awful. no excuse for any of it.

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Specializes in Critical Care.
Ceccia- You really need examples?

I have heard many comments referring to obese pt's body odor, certain areas of their body (FUPA), judgemental emphasis on the food that they are eating, comments made about their excrement, competition involving the patient's BMI, judgments made about their family members, assumptions about their socioeconomic status or intelligence level, etc. etc.

I don't think you've heard all these things on all nurses? I can't believe that! I've been working for over 20 years and haven't experienced comments like that here or at work or anywhere. I'm sorry if you have experienced this kind of rude behavior. It is terrible and uncalled for.

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Ceccia,

I'm sorry you have gotten hurt. I would say that if you do not have adequate unicorns, I mean staff, to care for your patients the proper way, and management doesn't care, how about moving up the line? Maybe the Joint would care.

good idea. (my rant wasn't intended AT you btw...just general frustration because finding staff to help with transfers and whatnot is about as likely as finding mythical creatures in most of the facilities where i work).

Maybe fat people in your hospital should be upset about the tiny nurse they are given?

sure, why not? it wouldn't be the most ridiculous/petty complaint i've heard. :p

but seriously, it's not a "staff vs. obese pts" thing...or at least it shouldn't be. if facilities would invest in proper lift equipment (and more techs? well, we can dream, right?), then workers wouldn't be complaining about breaking our backs AND larger patients wouldn't be put in a potentially unsafe and undignified position. it's not fair to us OR them that we can't get some ceiling lifts, sliding sheets, etc. that would make everything easier/safer.

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I'm not a nurse, but I was once obese.

I was a normal weight until I turned 40 and several things happened that caused me to gain weight.

I accepted a job that required me to travel from 5am Monday morning until 11pm Friday evening. Traveling meant I was eating at restaurants (mostly in airports). It is hard to find healthy food in airports.

I was used to doing at least an hour of aerobic exercise a day. The travel made that impossible. The exercise had been my stress-reliever / natural antidepressant. When I stopped exercising I became depressed. No exercise meant that I wasn't burning as many calories, and the depression made me crave calorie rich foods.

The travel meant that I wasn't getting adequate sleep thus increasing my cortisol levels.

I knew I needed to see my doctor, but I didn't want to deal with the judgement of healthcare providers. I kept thinking I would lose the weight and then go see my provider, but I instead gained more weight.

I gained 100 lbs before I went to the doctor. Fortunately she was wise enough to not comment on my weight. She instead starting addressing all the health issues and depression. Once she did that I lost some of the weight I had gained. When I felt "safe," I brought up the subject of weight loss. Then we started working together to address my weight. Now in my 50s I'm back to a healthy weight.

Fortunately my provider was wise enough to realize that obesity is a complex problem. It's not just a matter of will power. Will power will work for a finite amount of time, but people aren't able to use will power indefinitely.

Things I'd like healthcare providers to understand:

1. Fat people know they are fat. You don't need to tell them.

2. People know you are judging them even if you don't say anything. The majority of communication is non-verbal. They can read your opinions in your body language.

3. Obese people probably need your care MORE than thin people because of the health issues associated with obesity.

4. Your judgement is keeping people from getting the care that might help them lose the weight in a healthy way. Even if they don't lose the weight you can optimize their health.

5. Anyone who isn't thin HATES being weighed at the physician's office. Why do physicians put their scale in the hall where everyone can see it? This keeps people from seeking healthcare. Why do nurses line up with their patients at the scale. I'm now a normal weight, and I still hate it when another nurse brings a patient up behind me to wait to be weighed. It's bad enough that the nurse and the doctor have to see my weight. Does a stranger really need to see it too?

6. It's humiliating to have the nurse show you to the room where a gown is laid out for you and then have her say "Oh, your going to need a larger gown." Then she has to start rooting around for a fat gown.

7. The same is true for the blood pressure cuff.

There are so many things that you as healthcare providers don't think anything about, but are very emotionally painful for the patient. It's embarassing for even a person with a young, beautiful body to be seen naked by a stranger (healthcare provider). It is 1000 times worse for an obese patient.

Most people go into healthcare because they want to help others, but judging others hurts them both physically and psychologically.

Good luck with your presentation. It's an important topic.

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Tarotale,

"As a once fat person, I can personally vouch that it IS possible with just little effort everyday. I don't eat ice cream, fatty foods, cheese, fast foods, not too much carbs and eat when I am hungry and still work out to this day. I have seen countless people transform."

Your experience and those of your friends do not science make. Studies over the last 50 years have shown that 95% of people who attempt intentional weight loss gain it back after 5 years, and many end up heavier than when they started.

How am I encouraging self defeating behaviors? I don't care if losing weight is as easy as snapping your fingers; fat people still have a right to exist in their bodies. The possibility of losing weight and/or the ease of doing so has no bearing on their right to fair treatment.

"People either have champion mentality, the fight to make it, and never-give up spirit, or the opposite of. I and many others chose the life of fighter and we won. There is no excuse."

Not everyone defines success the same way you do. Plenty of fat people are fighters, they never give up, and are champions. How does someone's body size define whether they are a "champion" or the "opposite of?" Give me a break.

"With your logic, it's like saying child molesters are not at fault, but the parents should have been careful to not let them play in the playground."

Stop the logic train, I think we lost a passenger. Come again now? OK, let's review: if a fat person punches you in the face and then kicks you when you're down, your injuries are their fault. If you attempt to pull them without proper assistance or equipement and you get hurt, it is NOT their fault. How in the world would that comment be offensive to you?

"Obesity IS one of the highest risk of health along changeable risk factors such as smoking and drinking"

Studies have not shown that obesity is a changeable risk factor -long term- at all. Comparing it to smoking and drinking is useless since those are behaviors, and obesity is a body size. Studies have shown significant health benefits to go along with healthy behaviors, but no benefit has been shown to accompany weight loss. What was I making up?

"I mean why do we even do education on nutrition people if we don't think it's a bad habit??? It is a debilitating habit for health and needs to be corrected for their own good. But since the noncompliant will be noncompliant"

This smacks of ignorance and paternalism! "For their own good"? Really!?

Good nutrition is a great habit and we should educate and encourage our patients. However, good nutrition does not equate to "lose weight." And many fat people are very "compliant" (I hate that word in health care).

And have you thought WHY they gain it right back? Hm... let's see, ah ha yes, I think in your world, adipose tissues just appear out of magic clouds and attach themselves to one's body while they are asleep, you know without that person ever getting back to their formal sedentary lifestyle with obesity inducing foods... I think I read something like that in my dreams.

and again, when did I ever mention that we need to turn away the obese population from treatment because they don't deserve it, or that in order to prevent staff injuries, we need to give up turning obese immobile pts q2 hrs because it's their fault, when did I say that?? We still do them, and it hurts. So it's totally justifiable for them to continue unhealthy habits of being 300lb+ overweight and clogging up every major arteries with plaques? Yes they have their rights to do what they want, no one denied their rights as human beings. But when their over-indulgence affect the lives of others, and also shorten their lives brewing every formidable diseases, are you telling me we need to just continue encouraging them to eat as much as they want and keep coming back to hospital? Even the most liberal person would at least think first before encouraging harmful behaviors. Is that your philosophy in this field?

Obesity is NOT a changeable risk factor? Are you kidding me? Are you saying obesity is not changeable like age, genetics, gender, race? So if it's not changeable like you say it is, how do we see people losing weight everyday? Are we falling into an abyss of hallucination here? Let me see that study that says weight loss is not a changeable risk factor like gender, age, and race. Also, no benefits come with losing weight... just type weight loss benefits and see what the MDs write about it; but of course, these are just MDs, you know, what the heck they know about health and benefits of weight loss.

If you want to get on a train, at least you need to obtain a ticket, and seeing that obviously you didn't possess the ticket, sorry you were never on it. It's not their fault that we get hurt, but like I said, no one is stupid enough to even attempt to carry a massive patient by themselves, and if they do, that's foolish and disaster waiting to happen. Well, as you the fervent supporter of being way over the BMI, I am very pleased that you will promote weight gain as a regimen of healthy lifestyle. I think all these times I have heard the doctors say that patient needs to lose weight and watch what they eat to prevent aggravation of CHF or diabetes, or arteriosclerosis was all bogus. Now if you will excuse me, I need to go make some brown fudge and distribute them to my non-compliant diabetic patients who come in all the time for hyperglycemia at work tomorrow since you have intellectually enlightened me that healthy dieting and weight loss is just a sack of garbage to their health.

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