Compassion or reality for obese patients?

CharmedJ7 · Feb 16, 2011

In the article it suggested a nurse say something like, "Let's focus on the aspect of your weight issue that's within your control."

I think the genetics issue is overstated (I'm assuming that "within your control" is implying that a large portion of a given person's weight problem is genetic) in the case of obesity. Predisposition, yes, but I think the number of people with a genetic problem so bad that even moderate exercise and solid diet wouldn't touch it is extremely low - when the whole leptin thing was uncovered so many people were like, this explains everything! But then it turned out that a leptin deficiency was extremely extremely rare. Obesity 'runs' in families, but so does poor diet, sedentary lifestyle, etc.

It's a complicated issue. I do believe that psychosocial issues involved in obesity take predominance, including overeating, over-reliance on extrinsic controls of hunger (see: the never-ending soup bowl experiment, see: large vs. small plate experiments, see: messing with the clock and how much people eat experiments), etc. Decoding the true pathology of psychosocial dysfunctions is notoriously difficult - if it's 'just' a matter of changing attitude, then ultimately it's in your control and thus fixable. At the same time, some would argue that such change is so incredibly difficult to render it just about out of your control. And then there's the socioeconomic issues....

ALL THAT SAID - like many health issues, change comes down to motivation, so I think it will always depend on individual interactions and strategy assessment. Some people need a hug, some a kick in the pants, it's just the way it is.

carluvscats · Feb 16, 2011

Overeating is just another way people self-medicate; I don't think it's any different than using alcohol or drugs or sex, etc. If people could get to the "why" of what is driving them to abuse their bodies (death by fork), perhaps change could occur. Unfortunately, it takes a health crisis for most folks to come out of denial and face reality. And even then, the habit has taken hold of them to the point where change is next to impossible.

So perhaps I'm jaded, but "education", the kind done on a med-surg floor at least, where we might get a few sentences in about the dangers of obesity, probably goes in one ear and out the other. People have heard it all before. I think regular counseling or a support group like Overeaters Anonymous, might make a difference.

spreadlove · Feb 16, 2011

I'm obese at 5'6" and I weigh 220lbs. The few times I've gone to the doctor's office, the nursing staff was just down right rude and disrespectful to me and made me feel less than a human being. Is this what nursing is about? Yes I'm obese and have been on diet with little success but to kick a person when they're down is the worst treatment a person can receive. This type of behavior is not a matter of concern for my health and well-being but a person acting superior to you just because they're thinner than you. Would it be ok for someone to say well maybe if you just didn't sleep around, you wouldn't have contracted HIV or AIDS? This is the reason why I don't go to the doctor. I have a few friends that are obese and they don't go to the doctor for this very reason. And to say that obese people are taxing to the healthcare system is ********. The government provides programs like detox, rehab, meds, counseling services for people addicted to drugs and alcohol. How much money is spent on these programs? They're just revolving doors and all it does it keep people employed in these centers. Right now I'm trying to get my health on tract and I appreciate the resources online that are available. There were no resources available for me from my doctor. Nothing not even a pamphlet or list of nutritionist or dietitians that could help me. I had to keep asking for something as simple as my vital signs and blood test results. I'm a human being and want to be treated as such. But then I realize that most nurses are women and the catty, teenage like behavior is something that is the norm now. Sad but true. IMO, a nurse is nothing but a bully in scrubs.

dudette10, MSN, RN · Feb 16, 2011

I believe that guilt can be a very powerful motivator in these cases.

I disagree 100% Putting someone on a guilt trip may cause a person to shut down completely and pretty much dismiss everything you say after that. It's the antithesis of therapeutic communication.

I suggest that you read some theories about motivating factors associated with health promotion. None of them can be operationalized to a nurse guilt-tripping someone to achieve successful change. You also have to realize that you, the nurse, are not the sole influence for change.

Influencing change is something that happens over time. Family needs to be involved, assistance and support needs to be provided over time every time a patient comes in contact with a healthcare provider, and progress needs to be celebrated. In addition, the patient needs to be able to see how any suggestions can be incorporated into their lives. There are a lot of different options to weight loss, and how amenable a patient is to those options needs to be explored.

I had a single male patient the other day who had had his second CVA in five months, and he was way too young for that to happen to him. I was doing some dietary teaching, and based on what he had told me and what was in his chart, I had a sneaking suspicion that he ate fast food for nearly all his meals. (Single, no kids, doesn't know how to cook.) So, I asked him outright, and my suspicions were confirmed. I emphasized "baby steps" to healthier eating with him. I asked him what he snacked on, and he said chips and stuff. I suggested just foregoing the chip aisle and heading over to the produce section to choose baby carrots, apples, grapes, etc. You know what? He actually seemed to like that idea, and said, "That's something I could do to start with." One of my favorite suggestions (to people who don't have hemiparesis, that is) is to use the stairs instead of elevators and to park your car as far away from store entrances as possible. BABY STEPS!

I'm a student, I had the time in the acute care setting, and I hope I never see him again (because it means he had another stroke). Baby steps...things that patients can actually do without overwhelming them with "100 pound" goals. No guilt-tripping involved because every obese person knows they should lose weight and every smoker knows they should quit.

llg, PhD, RN · Feb 16, 2011

I believe that guilt can be a very powerful motivator in these cases. I don't see guilt being a bad thing when it comes to issues as important as health.
QUOTE]
Where is your research to back up that opinion? If you are trying to write a scientifically sound response, you will need FACTS to back up your opinions -- research studies, etc.. You can have as many personal opinions as you want, but you won't be taken seriously by anyone who knows anything about healthcare and/or working with the public unless you can back up those opinions with scientific fact. Most research supports the idea that you get a better response from patients if you are kind to them than if you are blunt and insensitive. Fear, scare tactics, punishments, etc. sometimes work for a while, but have been shown to be ineffective motivators over the long term.
And finally ... but perhaps even more important ... You don't have to be "un-real" to be compassionate. A good nurse can be BOTH compassionate AND real. We can show our caring and respect for the patient while at the same time giving him/her the correct information. We can be supportive and kind while also being honest.

systoly · Feb 16, 2011

I agree with the above, it's much more complicated. As far as communication style is concerned, I would not limit myself to one size fits all. The goal is to help the patient achieve maximum well being. You choose whatever style the individual patient is most likely to respond to. Some patients may need to feel that they're not alone in this while others may respond better to a (verbal) kick in the beans.

stefanyjoy · Feb 16, 2011

There is an enormous difference between guilt and shame. I did not cite my sources here, but I have researched the differences between the two extensively. I did not intend to imply that nurses should make their patients feel humiliated and ashamed.

CrunchRN, ADN, RN · Feb 16, 2011

Give them the info in a nice manner, but do not belabor the point. Ultimately, once they are educated about the risks/benefits then it is their choice what they want/can do.......

Horseshoe, BSN, RN · Feb 16, 2011

Hello,
I believe that guilt can be a very powerful motivator in these cases. I don't see guilt being a bad thing when it comes to issues as important as health.
If you would like to just provide a general opinion, that would be great. If you don't mind your opinion potentially being used in my paper, please let me know and I'll send you a message to get more info. Thank you!

Okay, my opinion is that I think your assertion that "guilt" is a powerful motivator is nonsense. And just how do you intend to accomplish making an obese patient feel "guilty?" I would be very interested to hear what nursing strategies you would employ in order to accomplish this result.

njsdca · Feb 16, 2011

It's important to partner with the patient, regardless of their appearance, it's imperitive that you find a commongrounds for educating. I find it EXTREMELY easy to get through to patients on a REAL level once you've become their trusted expert advisor.

Talk to these people, get to know them and then present solutions... otherwise it will never stick.

stefanyjoy · Feb 16, 2011

Okay, my opinion is that I think your assertion that "guilt" is a powerful motivator is nonsense. And just how do you intend to accomplish making an obese patient feel "guilty?" I would be very interested to hear what nursing strategies you would employ in order to accomplish this result.

There is no need to be rude. You can respectfully share your opinion without insulting another's opinion. You've never been motivated by guilt? I surely have. As I previously mentioned, there are differences between guilt and shame. Google it and you'll get a vast selection of literature on the guilt vs shame comparisons.

This seems to really hit a nerve with some of you. I find it curious that society in general finds it acceptable to tell smokers they stink, will get cancer, are killing themselves, have bad breath, have trouble attracting mates, etc. but the obesity issue needs to be tiptoed around in order to not hurt someone's feelings. I was reading another post on this site about physicians refusing even to tell their patients they are "obese" or "overweight" -- to just tell them to watch their "excess calorie stores"? My point is, smoking became taboo because society made it taboo. You do not believe this should be the case for all unhealthy, life-threatening behaviors? I am really not saying we should put a scarlet letter F on all overweight patients and ridicule them. I am saying to be honest about your patient's health condition in a tactful manner while addressing major concerns.