Caring for Obese Patients

Delicate Flower · Jun 12, 2014

For the record, I am not a fervent supporter of being way of the BMI. I am a fervent supporter of treating people fairly, regardless of BMI. Furthermore, I do not promote weight gain (or weight loss) as a regimen of a healthy lifestlye. I promote healthy behaviors as a regimen of a healthy lifestyle, should one be interested in pursuing it.

Delicate Flower · Jun 12, 2014

Nutrition Journal | Full text | Weight Science:Evaluating the Evidence for a Paradigm Shift

tarotale · Jun 12, 2014

Obesity research confirms long-term weight loss almost impossible - Health - CBC News

I have to give you credit for providing an article for your point, but I should say, I still don't buy this. The reason being, if one changes a life style and sticks with it, then until death bed, he/she will not be obese. Also I don't think this article clearly reports the method by which the subjects were tried. If you want to prove your argument, then there has to be a scientific proof that even though the subjects were obligated, monitored and enforced to exercise x amount of minutes/day and given calculated amount of calories less than what was required of each individual's BMR, AND still gained weight, then yes that would back your argument that no matter how much one works out or eats less than required BMR, still human beings are bound to weight gain and can't do much about it, but it does not clearly say anything remotely close to that. It seems like it says "we followed them around 2 yrs, gave them advices on exercises and nutrition, and they were still obese." I don't see the record of how much subjects ate or how much calories they burned during each workout session and what their individual BMRs were and if they devotedly stuck to the program.

I will bet my dollars that given any person, if we can make that person dedicate to exercise regularly, eat less than their BMR and do that consistently everyday and stick with it, they will lose weight and not gain it back.

Why do you think 2.1 billion people are fatter than the past like the article says? Because the lifestyle has changed, because the eating habits changed for the worse turn. US alone increased in obesity from 1950s by about 214%. Doesn't that tell us something? Japan has 3.6% obesity rate whereas US has 32%. If the article suggests that humans are evolved to be fat and stay fat, why are there so much discrepancies between countries? Well for one thing, we can find that answer in lifestyle. I have an article link to this if you want. Again, if someone starts a different lifestyle and sticks with it, I surely believe they will lose weight and stay that way. I have seen way to many cases for it to be only 5%.

jadelpn, LPN, EMT-B · Jun 12, 2014

The best thing that the OP can do for the nurses that are being taught is that we are 2 people. A nurse, and a person outside of being a nurse.

In nursing practice, it is always best to have a content of character--and to smarten up. It doesn't matter one bit if you find obese people repulsive, or any number of other health conditions that require the assistance of a health care TEAM. One can go home and tear any patient to shreds on their own time.

However, moving forward, if one has an obese patient, who is bedbound/can't move well whatever the case may be, then as nurses we need to advocate and speak up for the patient--PT/OT (as how in the world are they going to go home and be able to do a thing for themselves) dietary to talk about eating (as obese people can't just stop eating calories--there's a whole science behind it that a dietician can speak with them about) and equipment needed at home (discharge planning--OT).

In general, nurses should learn that no patient at no time should be embarrassed to seek health care. And to push judgements on any patient for any condition (ie: lazy, dumb, undisciplined....and DON'T even get me started on the molester reference) is not good practice. Period.

We take care of people who have a loss of function. Our goal is to get patients to their highest functional level. Regardless of one's personal beliefs on the condition of the patient.

Esme12, ASN, BSN, RN · Jun 12, 2014

I can speak to this personally...I have always watched my weight. I have always gained weight easily. I have exercised and watched every morsel that entered my mouth. I have maintained a healthy weight. I have always been respectful of ALL patients. But I have heard these comments

Delicate Flower ‼ 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.

Now I am disabled from a rare auto-immune disease that attacks my muscles and have" Cushingoid Syndrome" from long term high dose steroid use.

I hear the comments, the snide remarks, the rolled eyes, the giggles, and disrespect of a patients dignity. I had heard people say.."remind me not to eat lunch" and "if she got out of the chair maybe she'd lose some weight". My husband is very tall and thin I have actually heard the nursery rhyme "Jack Sprat could eat no fat his wife could eat no lean" I have also heard "What did he ever see in HER" from HOSPITAL STAFF.

I hear the staff talking when they read my chart that I have been a flight nurse and hear them comment..."Yeah well I'm Santa Clause" laughing as they walk away. I am sick to death of the disrespectful demeanor as if I am deaf and blind or that I somehow lack the intelligence to comprehend what is being said or that somehow my fat ass diminishes my ability to comprehend and think intelligently.

There are physicians that will not even treat obese patients Mass. Doctor Won’t Accept New Patients Who Are Obese | CommonHealth. I think that the obese person is at a higher risk from obesity for they cannot secure appropriate care. They are marginalized and ignored. I have been treated very differently since I look this way than I did when I was thin. It's disgraceful. The general public is worse.

What makes obese people so deserving of discrimination and ridicule? Because it's their fault? An alcoholic gets a standing ovation of 2 weeks of sobriety. An obese person on a diet for 10 months and 25 lbs lost gets....Well...good for you....you gotta long way to go though. It angers and frustrates me.

I think ALL members of society, but especially care givers, need to remember....There but for the grace of God go I.

Thank you I feel better.

AmyRN303, BSN, RN · Jun 12, 2014

As a student, I heard a ton of snide remarks about obese patients, in many different types of facilities. I'm short and petite, and while I understand that obviously, I'm going to need 2-3 more people to turn this patient, I'd have preferred a simple statement to that end, not the obnoxious eye rolls and comments.

In my new facility, we have several bariatric rooms equipped with tracks on the ceiling and other amenities which make it easier on staff to move patients. Yes, it's understandable that we as nurses would like to save our backs, but it isn't necessary to dehumanize others to do so.

Technicolourhobo · Jun 12, 2014

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.

What if I told you that the plural of anecdote is not data?

Anna Flaxis, BSN, RN · Jun 12, 2014

I can speak to this personally...I have always watched my weight. I have always gained weight easily. I have exercised and watched every morsel that entered my mouth. I have maintained a healthy weight. I have always been respectful of ALL patients. But I have heard these commentsNow I am disabled from a rare auto-immune disease that attacks my muscles and have" Cushingoid Syndrome" from long term high dose steroid use.
I hear the comments, the snide remarks, the rolled eyes, the giggles, and disrespect of a patients dignity. I had heard people say.."remind me not to eat lunch" and "if she got out of the chair maybe she'd lose some weight". My husband is very tall and thin I have actually heard the nursery rhyme "Jack Sprat could eat no fat his wife could eat no lean" I have also heard "What did he ever see in HER" from HOSPITAL STAFF.
I hear the staff talking when they read my chart that I have been a flight nurse and hear them comment..."Yeah well I'm Santa Clause" laughing as they walk away. I am sick to death of the disrespectful demeanor as if I am deaf and blind or that I somehow lack the intelligence to comprehend what is being said or that somehow my fat ass diminishes my ability to comprehend and think intelligently.
There are physicians that will not even treat obese patients Mass. Doctor Won’t Accept New Patients Who Are Obese | CommonHealth. I think that the obese person is at a higher risk from obesity for they cannot secure appropriate care. They are marginalized and ignored. I have been treated very differently since I look this way than I did when I was thin. It's disgraceful. The general public is worse.
What makes obese people so deserving of discrimination and ridicule? Because it's their fault? An alcoholic gets a standing ovation of 2 weeks of sobriety. An obese person on a diet for 10 months and 25 lbs lost gets....Well...good for you....you gotta long way to go though. It angers and frustrates me.
I think ALL members of society, but especially care givers, need to remember....There but for the grace of God go I.
Thank you I feel better.

I cannot imagine saying any of those things about a patient. It is behavior that I do not engage in, but I believe you when you say it's happened to you. I cannot imagine how hurtful those comments must be, and I wish I could make it all not have happened to you. I'm so sorry.

I also realize that my frustration about lack of resources to adequately care for this patient population is *not the patient's fault*, and so that frustration should not be taken out on them.

To whoever said, about rounding up five more staff members, "yes, you can", NO, actually I can't. I work in a hospital with less than 50 beds and lean staffing. It takes time for staff to disengage from whatever they are doing at the moment, and many cannot leave their area because there is nobody to cover them.

Installing ceiling lifts in the ER is very low on the priority list. This hospital has struggled financially to the point where they have come close to closing their doors. There are so many things we need to spend money on, and no money to spend on them, that ceiling lifts are not likely within the next decade. So, simply stating that we should have a "lift free policy" is impractical for the setting in which I work. We are a small community hospital with limited resources, not a giant hospital system with money coming out the ears.

As far as bariatric sensitivity goes, I really think "There but for the grace of God go I" sums it up pretty well. We have to be able to put ourselves in the shoes of this person in front of us. We need to see how easily it could be us in that bed, and to behave accordingly.

To the OP, I think putting the human face on the patient with morbid obesity- in other words, telling the stories like Esme12's, might be helpful. Let people see how easily their own fortune could change and maybe it would be easier for them to empathize.

Esme12, ASN, BSN, RN · Jun 12, 2014

I can walk about 2 feet. I dress myself and can get on and off stretchers by myself. I would rather stay home than go anywhere I can't help myself. I am still (Thank heavens) able to do plenty on my own.

I can tell you that these comments were universal across departments and facilities. It also included some of the TOP teaching facilities in the US as well as community hospitals. I have heard them (and reprimanded the staff) as a RN slender and pretty and as a fat patient who is disabled and not so pretty any more.

I think that there is a general failing of social skills in polite society. With the use of anonymous media and an instantaneous ability to TWEET your thoughts with no time to consider anyone's feelings except one's own..... there has been a loss of kindness and social skills.

Manners matter.

Carrie RN · Jun 12, 2014

I come from a long line of heavy women. I, thankfully, am not. Everyday I work at it. The one thing I have noticed, and you might too if you spent some time with your bariatric patients. They are not stupid. I have never met people that could rattle off the calorie count of something faster than an RD. They are obese for a variety of reasons. The main reason that bariatric are not treated as well, is few hospitals have the proper equipment to assist with their care. Most are malnourished. Yep, all kinds of deficiencies from iron to vitamin D. They have multiple medical problems that make their care complex. There are worse things in life that being fat, for one, being unkind.

fetch, BSN, RN · Jun 12, 2014

I have to give you credit for providing an article for your point, but I should say, I still don't buy this.

Well that says it all - you don't care about actual research done on this topic, you just want to judge everyone who stays fat. Continuing to discuss this with you is just going to be an exercise in beating heads against the wall but I'll give it a try.

I will bet my dollars that given any person, if we can make that person dedicate to exercise regularly, eat less than their BMR and do that consistently everyday and stick with it, they will lose weight and not gain it back.

1. You would lose those dollars.

2. BMR = Basic Metabolic Rate. This is the absolute MINIMUM requirements for your body to exist and do nothing more than breathe, digest, live. If you do ANY exercise beyond lying in bed and breathing, your body requires more calories. Eating below your BMR, especially for an extended period of time, puts you into starvation mode . . . which means your body will hoard fat stores and surprise! You won't lose weight. What's more, encouraging someone to eat so little that they are in starvation mode, regardless of their starting weight, is encouraging disordered behavior. You would never tell a skinny anorexic "wow, you've got so much self-control, to eat so little and lose so much weight!" (At least I hope you wouldn't.) You should never say anything to a fat person that you wouldn't say to a skinny person if they did the same thing.

3. If eating something that tastes good is more important to me than eating what you determine to be "healthy," why do you care? If spending time cuddling my dogs is more important to me than hitting the gym, why do you care? Do you care so much that people are dying their hair more these days than in the past? Because that has about as much true effect on actual health as weight does.

Here's some links for you, both research based and opinion articles.

Health vs Weight Focus

An explanation of why BMI is a poor indicator of health (written in easy to understand language with citations included).

5 health care myths (with 29 references for you to peruse if you want more detailed research).

Publishing bias - AKA why you should ALWAYS follow the money (and the weight loss industry is a multi-billion dollar industry.)

The answer to the obesity crisis.

Health at Every Size - that it is and what it isn't.

"From the perspective of efficacy as well as ethics, body weight is a poor target for public health intervention."

Lots of resources located here - all the links below are taken from that page.

"Conclusion - Individuals with obesity receive numerous instructions about what to do to address their weight, but very few are given appropriate long term guidance or support with which to follow through those instructions. Understanding the positive role of social networks may be particularly important in engaging individuals in physical activity."

"There are serious ethical concerns regarding the continued use of a weight-centered paradigm in current practice in relation to beneficence and nonmaleficence."

"It should also make us pause to consider how propagating the idea of an 'obesity epidemic' furthers the political and economic interests of certain groups, while doing immense damage to those whom it blames and stigmatizes."

"Obese persons experience a high degree of stress, and this stress plausibly explains a portion of the BMI-health association. Thus, the obesity epidemic may, in part, be driven by social constructs surrounding body image norms."

"As physical activity expenditure has not declined over the same period that obesity rates have increased dramatically, and daily energy expenditure of modern man is in line with energy expenditure in wild mammals, it is unlikely that decreased expenditure has fuelled the obesity epidemic."

To the OP: I recommend reading through some of those research articles (here's the link again for the Fat Nutritionist's research page, which is a good starting point). Most of the research these days is showing that encouraging self-acceptance, regardless of size, leads to better health. Helping patients learn to love themselves as they are reduces the stress and anxiety of negative self-esteem, which helps with starting and maintaining healthy habits. If you are less stressed, you are less inclined to stress-eat, for example. If you are sensitive to judgmental stares from others when you put on workout clothing, you are less likely to keep up an exercise regimen of any kind. Focusing on other health goals instead of weight - such as ability to run a mile, or lower cholesterol, or decreased BP, etc - often coincides with reducing weight as well.

I don't have any data on this (only anecdotes, which are not research I know!), but I have heard MANY stories of patients who do not receive appropriate medical care because their physicians blame any health issue on being fat and do not look harder for an underlying cause. Reducing the stigma of being fat can help with that.

JasBSN · Jun 12, 2014

As fat girl myself, I think a very important thing for healthcare providers to remember is not every injury or health issue is because I'm fat. I injured my back several years ago, the first doctor I saw said "well, you need to lose weight, then your back won't hurt." I actually hurt my back bending and twisting wrong to pick something up off the floor. The absolute worst was a hematologist I saw. While going through my health history I told him I was on an antidepressant. He said "if you lose weight you won't need the antidepressant." I informed him that depression is caused by a chemical imbalance in the brain, not my weight, walked out of the office slamming the door as I left. The receptionist asked if I needed to schedule a follow up appointment. By this time I'm in tears, told her the doctor was an uneducated ***** and I would not be back!