There is an article in this months American Journal for Nursing about nurses showing more encouragement & compassion for obese/smoking patients instead of making the patients feel judged or guilty. I am a pre-nursing student and attempting to formulate a response to this article.
My first instinct when I read this was that it was really sweet, it certainly gave me the warm-and-fuzzies, but it is simply not practical. The United States' obesity epidemic is becoming worse and worse. Researchers now even believe that the avg life expectancy is on the decline for this very reason. I just don't understand why medical professionals are expected to sugar coat their medical advice. Sure, I wouldn't expect a nurse to say, "Holy cow, you're so FAT! Lose some weight!" but I don't see why it would be offensive for a nurse to say, "You need to lose 100 lbs or your diabetes will cost you your legs." 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." Does this statement really reflect the severity of the situation? 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!
There is an article in this months American Journal for Nursing about nurses showing more encouragement & compassion for obese/smoking patients instead of making the patients feel judged or guilty. I am a pre-nursing student and attempting to formulate a response to this article.
My first instinct when I read this was that it was really sweet, it certainly gave me the warm-and-fuzzies, but it is simply not practical. The United States' obesity epidemic is becoming worse and worse. Researchers now even believe that the avg life expectancy is on the decline for this very reason. I just don't understand why medical professionals are expected to sugar coat their medical advice. Sure, I wouldn't expect a nurse to say, "Holy cow, you're so FAT! Lose some weight!" but I don't see why it would be offensive for a nurse to say, "You need to lose 100 lbs or your diabetes will cost you your legs." 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." Does this statement really reflect the severity of the situation? 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!
For starters saying to someone that they'll lose their legs is completely unprofessional. There is a way to convey a message to someone without resorting to negative scare tactics like that. Try and be positive rather than negative. i.e 'you know research shows that by exercising more and eating healthier foods you can live longer and you're mental and physical health health will improve drastically'. The implication that their lifestyle habit is contributing to poor health and earlier morbidity is still there but you're giving someone something to work towards.
I agree that obesity is a growing problem not just in the US but in other countries as well. I also agree that SOME people almost try and hide it from the patient that there lifestyle habits are affecting their health because they don't want to hurt their feelings. I believe that we need to be honest with people who are obese but without being judgemental. I completely agree with the poster who said that it's best to start small with a big impact rather than giving too much information at once and overwhelming people.
I too get very frustrated with some people like one of my friends who constantly complains she's obese but will constantly eat junk food everyday. I have gently told her that she needs to start looking at ways to reduce her calorie intake and that I'm available to help her but it's almost as though she's afraid of change or something? I don't think you can help someone unless they are willing to make this commitment.
She stated plainly she knows about the problems of obesity... You don't need to educate with your 20 year old wisdom. I'll tell you what, come back in 15 years when you have lower metabolism, kids, a house to keep, a full time job and no energy and preach... I was a perfect size 4 with all the answers at 20 too...
"I take 8 classes, work a full time job, and still have plenty of time to workout." I live alone and manage my own home.
Age =/= wisdom. I'm a vegan and I workout two times a day, six days a week. I was able to learn about how to stay healthy years ago. Older age only means you had x many years to learn about nutrition and have not managed to grasp the subject.
Obesity is a major problem for people of all ages young and old. Excuses like the ones you are making are only furthering the epidemic.
"I take 8 classes, work a full time job, and still have plenty of time to workout." I live alone and manage my own home.
Age =/= wisdom. I'm a vegan and I workout two times a day, six days a week. I was able to learn about how to stay healthy years ago. Older age only means you had x many years to learn about nutrition and have not managed to grasp the subject.
Obesity is a major problem for people of all ages young and old. Excuses like the ones you are making are only furthering the epidemic.
With age comes maturity and wisdom which is something you have many more years before you can even pretend to know half the truth.
Other than having your own place and paying it's bills do you have any other responsibility like family, kids, friends, girlfriends, etc. etc. If not- I sure would have some time to exercise too if I were in your shoes!
I'm not making any excuses for anyone. And a lot happens throughout someones life that allows them to actually experience the things that they preached so heavily about when they were young. You know, the whole, "I'll never get fat" or "I'll never let myself go" or whatever! You won't get this for a decade or two but these things, the 'I'll never' WILL come back to haunt you. Never say Never, as they say.
It wouldn't hurt for you to actually respect the people that are older, more experienced, and have some 15+ years of life's wisdom that can not be acquired though any other venue but time. You're not going to learn it during all of your class. It comes with age, plain and simple. So yes, age=wisdom. With wisdom- understanding of things that simply aren't in your range of ability right now.
Good luck. I hope you can find a nicer way to deal with your patients because a woman patient is likely to be highly offended by your attitude if you end up her nurse. I think you guys have an uphill battle already with female patients feeling comfortable around you to begin with. Work on the bedside manner.
Educating and motivating your patients to take control of their weight is important. But making them feel bad or guilty for where they already are is not a good way to movtivate them. Believe me anyone who is obese knows it and already feels bad about it. There are many emotional reasons for someone to be so out of control that they allow themselves to gain so much weight. Trying to be understanding and help them to realize they need to take control of it is a better way to go. There before the grace of god....
With age comes maturity and wisdom which is something you have many more years before you can even pretend to know half the truth.
Other than having your own place and paying it's bills do you have any other responsibility like family, kids, friends, girlfriends, etc. etc. If not- I sure would have some time to exercise too if I were in your shoes!
I'm not making any excuses for anyone. And a lot happens throughout someones life that allows them to actually experience the things that they preached so heavily about when they were young. You know, the whole, "I'll never get fat" or "I'll never let myself go" or whatever! You won't get this for a decade or two but these things, the 'I'll never' WILL come back to haunt you. Never say Never, as they say.
It wouldn't hurt for you to actually respect the people that are older, more experienced, and have some 15+ years of life's wisdom that can not be acquired though any other venue but time. You're not going to learn it during all of your class. It comes with age, plain and simple. So yes, age=wisdom. With wisdom- understanding of things that simply aren't in your range of ability right now.
Good luck. I hope you can find a nicer way to deal with your patients because a woman patient is likely to be highly offended by your attitude if you end up her nurse. I think you guys have an uphill battle already with female patients feeling comfortable around you to begin with. Work on the bedside manner.
Everyone has responsibilities that eat up their time. Some days I'm so swamped that I have to read notes while I'm on the treadmill. You're a nursing student, so I assume you can multitask. There is no excuse not to make an effort.
Experience, not age, results in wisdom. Just because you're nearly twice my age does not mean you have more life experience than I do. Sure, it's a possibility that you do. But you can't just jump on that assumption.
Work on the bedside manner.
You're going to try and insult me. This is not clinicals. This is an internet forum. I have to be blunt to get my message across. I'm not going to dance around the subject and say, "Yeah, so and so is only 400 lbs. Maybe he should go on a diet. I don't want to hurt his feelings though, so I'll wait for someone else to tell him." I respect people enough to tell them the truth. I'm not going to lie to someone's face and tell them they don't have a problem.
Everyone has responsibilities that eat up their time. Some days I'm so swamped that I have to read notes while I'm on the treadmill. You're a nursing student, so I assume you can multitask. There is no excuse not to make an effort.
Experience, not age, results in wisdom. Just because you're nearly twice my age does not mean you have more life experience than I do. Sure, it's a possibility that you do. But you can't just jump on that assumption.
You're going to try and insult me. This is not clinicals. This is an internet forum. I have to be blunt to get my message across. I'm not going to dance around the subject and say, "Yeah, so and so is only 400 lbs. Maybe he should go on a diet. I don't want to hurt his feelings though, so I'll wait for someone else to tell him." I respect people enough to tell them the truth. I'm not going to lie to someone's face and tell them they don't have a problem.
I think this has gone on long enough, good day.
Ditto. People make time for the things that are important to them. Staying fit is like going back to school , gambling, or a football game. If it means enough, it is made a priority but if it isn't you can always find an excuse.
I'm just going thru all these threads, and someone on here said we don't make fun of anorexics but we make fun of obese people, and in society it seems in the main to be acceptable.
Anorexics are just as bad in nature as obese people. I have cared for people with all sorts of eating disorders. MOST anorexics are highly manipulative, sneaky, lie re eating/purging and exercising, and - in the end - do not care if they hurt their families/close friends etc. They are also extremely selfish people in the main. They may not start off this way, but the disease makes them become secretive and sneaky; it's like a game to them. I have met some anorexics who are genuinely nice people, and who really try to get help, and follow advice.
But it bothers me GREATLY that we pander to anorexics and obese people.
When we raise children, (I am not a mother BTW but have helped raise nieces etc), we try to teach them right and wrong, and to be accountable for what they say, do, etc. I have seen my niece and mums in the supermarket say to their kids - 'No treats today, you only get those occasionally', or 'No ice-creams, better to have fruit instead for dessert'. We try as adults to raise our kids to be responsible people, and to face reality.
I am often just baffled - and fascinated TBH - when I hear Drs and nurses say: 'Don't discuss with an anorexic that they can die from not eating, or re body issues, or that they will get heart arrythmias', or 'do not say to the obese person they are overweight and this can affect their heart and their out of control diabetes means they could possibly lose a limb'. Why can't we say that?
It is like as medical professionals we are all avoiding the issues UP FRONT, saying it like it is, rather than addrsssing the seriousness of the above illnesses.
I had a patient not long ago, she got Dx with PCOD/PCOS. She had had no-one come and explain this illness properly and re BSLs/diabetes. I sat with her for a few hours (and I was busy that day), and when I explained the seriousness of diabetes and that she couldn't wander round w/out closed shoes on, explained re cuts/infections and how people CAN (not necessarily will) have limbs surgically removed, she was horrified. NOBODY had sat down and explained this to her, they had all beat around the bush it seemed. Anyway, I let her mull it over and gave her some resources, the next time I saw her she was giving up smoking, and wearing enclosed shoes outside. She told me my talk had jolted her into reality, and that she would have to learn to live with her disease, not let it take over her life. I had told her I certainly was not trying to make her disease seem like a death sentence and was trying not to scare her, but I told it like it was in a professional way. She is only in her early 20's and started taking responsibility for her illness, and in one so young, she will have an excellent outcome living with her disease and secondary Dx diabetes.
I am not talking re a Dr Phil approach and just saying 'You're an idiot, why are you doing this, etc?'
One anorexic I cared for, her plan to 'get well' and for re-feeding included instructions from the dietician. The dietician had a standard re-feeding plan on computer, and had added info onto it b4 printing it out. Some of the things were: Do not discuss body image/sizes with client (patient); Do not discuss clothes sizes; Do not discuss cooking methods and amount of fat used; Do not discuss purging etc - you get the picture. And as I was reading this I was thinking WHAT THE...? Are we supposed to, as nurses, just avoid ALL and EVERY issue related to this patient's anorexia, so she doesn't 'get worse' (the logic it seems). I felt like shouting: 'SHE IS IN HOSPITAL BECAUSE SHE WEIGHS SO LITTLE SHE WILL BLOW AWAY ONE DAY, AND YOU WANT US TO AVOID TALKING RE THESE ISSUES?' Unbelievable! Seems many professional medical people want obese/anorexics to live in denial for some reason. I also chatted to this patient's psychiatrist and he was unhappy with what the dietician had added - he WANTED this patient to talk re her most embarrassing oddities to professionals who were non-judgemental, but it was important for her to establish a rapport with the staff and TALK re her illness, otherwise she would become more secretive and introverted, leading to more anorexic behaviour etc.
Why is it any different to not treat adults as ADULTS, and tell them in a professional way the reality of their illness and situation? And I know people live in denial - you can tell them anything and it won't penetrate their psyche.
I believe we need to be more honest and up front re people's illnesses. I'm tired of not saying what I believe to frequent flyers in the hospital, being admitted again and again with the same problems, and not being allowed to state what we should be telling them. The worse people are private patients, their every whim is pandered to, but I believe this does not help people.
As someone said, we are enabling people to become a nation of big, sooky babies - they are not told to be responsible, sensible and we certainly don't want to tell them the truth about anything!
I really despair as health professionals how we are told to handle these overweight/underweight people, instead of confronting their issues head on, and formulating a plan of attack. My point is we are dealing in the main, with ADULTS - and we need to start talking to them frankly, and telling them to be responsible for their health in an adult way.
I see your point. Tell me if I interpreted correctly- for skinny people(irrespective of disease), it's okay because they are skinny as opposed to overweight people because they are well,bigger.
I understand better.
I said nothing abut their being skinny. If you re-read my post:
"It is more acceptable to talk about those disorders because when people do so they do it with compassion and with the attitude that they are diseases and those who struggling with them need our help. They don't feel the need to "give those people what they deserve."
People don't talk about skinny people with contempt, they talk about them with admiration for the way they look.
Our society looks upon skinny people as desirable and healthy. It doesn't take into account the effect being UNDERweight has on a person's body can be just as disasterous as being OVERweight.
I said nothing abut their being skinny. If you re-read my post:
"It is more acceptable to talk about those disorders because when people do so they do it with compassion and with the attitude that they are diseases and those who struggling with them need our help. They don't feel the need to "give those people what they deserve."
People don't talk about skinny people with contempt, they talk about them with admiration for the way they look.
Our society looks upon skinny people as desirable and healthy. It doesn't take into account the effect being UNDERweight has on a person's body can be just as disasterous as being OVERweight.
Good point. I think this is partly because a woman weighing 125lb may/may not be healthy. No way to tell unless she is bald, covered in lanugo, and has ribs showing. A woman weighing 325 is obviously not in a good place healthwise and with the exception of maybe .001% of the population it is due to personal choices. Overeating is seen as a personal weakness that can be helped. Personally I feel the same way about cigarettes/alcohol/drugs. Its a choice. Even if the choice is to not START doing those things. Do I give my best care to a veteran smoker with lung CA and emphysema? Absolutely. Do I feel sorry for them? Not even a little. That included my father whom I loved very much. In the end he chose cigarettes over his life and bit it at 49. His choice.
In fact, from what I understand, studies (even the one from the New England Journal of Medicine that was grossly misinterpreted by the CDC) show that people who are OVERWEIGHT - as in BMI of 25-29.9 have an equal or longer life expectancy on average, than those in the "normal" or "healthy" BMI range.
You're going to try and insult me. This is not clinicals. This is an internet forum. I have to be blunt to get my message across. I'm not going to dance around the subject and say, "Yeah, so and so is only 400 lbs. Maybe he should go on a diet. I don't want to hurt his feelings though, so I'll wait for someone else to tell him." I respect people enough to tell them the truth. I'm not going to lie to someone's face and tell them they don't have a problem. 
Scrubby
1,313 Posts
For starters saying to someone that they'll lose their legs is completely unprofessional. There is a way to convey a message to someone without resorting to negative scare tactics like that. Try and be positive rather than negative. i.e 'you know research shows that by exercising more and eating healthier foods you can live longer and you're mental and physical health health will improve drastically'. The implication that their lifestyle habit is contributing to poor health and earlier morbidity is still there but you're giving someone something to work towards.
I agree that obesity is a growing problem not just in the US but in other countries as well. I also agree that SOME people almost try and hide it from the patient that there lifestyle habits are affecting their health because they don't want to hurt their feelings. I believe that we need to be honest with people who are obese but without being judgemental. I completely agree with the poster who said that it's best to start small with a big impact rather than giving too much information at once and overwhelming people.
I too get very frustrated with some people like one of my friends who constantly complains she's obese but will constantly eat junk food everyday. I have gently told her that she needs to start looking at ways to reduce her calorie intake and that I'm available to help her but it's almost as though she's afraid of change or something? I don't think you can help someone unless they are willing to make this commitment.