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!
How is a discussion about BMI and the general medical establishment's parameters for what is considered a healthy weight, in spite of evidence to the contrary, not relevant to the topic?
Evidence to the contrary which you repeatedly state and even as I write have failed to produce a shred of proof supporting your stand.
The second link is quite a lengthy criticism that does a thorough job of covering the subject. However, the first link should give you a general idea of what's really happening in the world around you.
This is the study that shows overweight persons can expect a life expectancy equal to or greater than persons of "normal" or "healthy" weight. Look specifically at tables 2 and 3 under "All men" and "All women" along the rows entitled "multivariate relative risk". The higher the number, the greater the risk.
This is the study that shows overweight persons can expect a life expectancy equal to or greater than persons of "normal" or "healthy" weight. Look specifically at tables 2 and 3 under "All men" and "All women" along the rows entitled "multivariate relative risk". The higher the number, the greater the risk.
This was very informative reading, and appears to be a quality study too with a large cohort of subjects. Thanks.
If we are not too busy insulting one another, is there any possibility of reintroducing and thoughtfully discussing a point I tried to bring up in an earlier post - that there should be a signficant difference in approach to patients who are obese but living active, productive lives ... and the smaller but alarmingly growing subgroup of the obese whose ADLs are significantly impacted, who make up a disproportionate number of LTAC, nursing home and acute care patients?
If we are not too busy insulting one another, is there any possibility of reintroducing and thoughtfully discussing a point I tried to bring up in an earlier post - that there should be a signficant difference in approach to patients who are obese but living active, productive lives ... and the smaller but alarmingly growing subgroup of the obese whose ADLs are significantly impacted, who make up a disproportionate number of LTAC, nursing home and acute care patients?
In all honesty I don't think there should be. It's like asking if we should treat smokers with emphysema differently than those who don't have it YET ? My point is that someone who is obese may be fine now but they will not remain that way over time. Both patients need to lose weight to avoid health complications. Some have them now, some will have them later. Some will chose to focus on the 300lb person who has an ideal BP and A1C and delude themselves that this is the norm. In addition, I have noticed over the years that the second pt you described started off as the first one. You don't get to 500 lbs overnight.
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.
I do not understand how you can genuinely post that:confused:. I would go into comparative advantages and disadvantages but that wouldsimply take too long.
Disregarding other things- "feelings" alone should play a huge role.How do you feel?
Read the book The Obesity Myth by Paul Campos. Quite thought provoking and full of very surprising scientific references. I was stunned by some of the data he presents, although still, my mind has trouble accepting all of it. It's very worth reading.
In all honesty I don't think there should be. It's like asking if we should treat smokers with emphysema differently than those who don't have it YET ? My point is that someone who is obese may be fine now but they will not remain that way over time. Both patients need to lose weight to avoid health complications. Some have them now, some will have them later. Some will chose to focus on the 300lb person who has an ideal BP and A1C and delude themselves that this is the norm. In addition, I have noticed over the years that the second pt you described started off as the first one. You don't get to 500 lbs overnight.
No, one surely doesn't get to 500lb. overnight. Yet, in my experience, the history of the 500 lb. patient points to dysfunction even when his/her weight was 250 lb. or less -- there is often a psych hx, multiple surgeries, disability of some kind, etc. etc.
But you can lump everyone with a BMI > than whatever number you want to chose together -- it's a free country.
It takes a significant span of a lifetime's worth of poor health decisions. An individual who is consistently making good health choices isn't likely to ever reach the point where their weight will be their demise. If that last sentence I just wrote weren't true, then the interventions often recommended to reverse weight gain or promote health maintenance are absolutely useless and should be reexamined (logically speaking).
Compassion: sympathetic consciousness of others' distress together with a desire to alleviate it.
There are no harsh words you could say to someone who is fat that they have not berated themself with, over and over again. What you can do is coach, encourage, and help them to envision a future that is better. This is the thing they cannot see or believe. They have given up, become hopeless, and that is the worst affliction of man...more damaging than obesity. Perhaps you can be honest with yourself for a moment and explore what you would feel like if the things you most hate about yourself were as visible on you as 100 extra pounds. Would you want someone to chastise you, hold a mirror up to you and show you how unworthy you are, or would you want someone to compassionately help you to see beyond the reality of the moment? Medical advice is available anywhere and everywhere. Compassion on the other hand, is becoming more and more rare.
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.
I think this is a horrible statement coming from a future nurse. Making a patient feel guilty is not therapeutic in any way. It is not your place to make a patient feel guilty about anything. I think you have to reevaluate the way you plan to communicate and treat your future patients.
I work for a nursing college. I am obese. I have been my entire life. Genetics plays a large role in this as I have a connective tissue disorder that determines what physical activity I may safely partake in, if at all. I'm horrified by the lack of compassion and empathy shown in some of these comments by nurses. The very people we (obese) as patients put our trust and care into are in fact victimizing us. Unless you have struggled with weight issues, you have no idea how difficult, demoralizing and humiliating it can be. When in a hospital, patients are at their most vulnerable and to be treated with disrespect and rudeness because of physical appearence is unthinkable. Yes, we as obese are cognizant of our health dangers, how could we not be? We are living, breathing, sentient beings. That however does not give anyone - even nurses - the right to treat us as less than worthy of empathetic care. Do you treat a lung cancer patient with contempt because he/she smoked their entire life? Or, do you provide compassionate care for them in the healthcare setting - reserving judgment - and doing what is required by your very profession? I may look different from you, but believe me I experience the same emotions you do and I contribute to the world through my community service and professional achievements. I am worthy of your best care by virtue of the fact that I am a human being on this planet. If you are unable to provide compassionate and empathetic care to ALL of your patients, then perhaps nursing is not the right profession for you. Please reserve judgment until you have walked a mile in my shoes.
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.
There is a difference between society telling a person something, and a nurse trying to make a patient feel guilty about something. It would not be acceptable for a nurse to say any of the above to a patient. There are tactful and respectful ways to speak to your patients. Causing guilt is not one of them
Katie5
1,459 Posts
Evidence to the contrary which you repeatedly state and even as I write have failed to produce a shred of proof supporting your stand.