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!
It makes me wonder why people are obese. I am obese myself. I do not over eat, in fact, I HATE food. I have hypothyroidism, a collapsed left artery where I am on my third for it, I have had heart surgery, epilepsy, asthma, and I can go without eating for a whole week and I did this, and still gained a pound! I hate being fat, I NEVER was this big like this and get this, when I am pregnant, I gain 25 lbs per baby. I didnt gain nothing w/my first son till 3rd trimester, and 50 with the twins, then 25 w/my second set of twins w/one surviving twin outside utero. I drink sugar free drinks and about to go nuts. I am dx gluten intolerant, gastritis, I swell, and more. Yeah, I wrote a lot of stuff that is wrong with me, and I am blessed because there are others who are less fortunate, but I HATE being fat...to me, obese people are disgusting no matter what problem they have, and I am speaking about my self as well.
PS, does anyone have any knowledge of any books outside of nursing that will help with ped dosage calc?
There is a big difference between telling the truth without sugar coating things, while being respectful, and being downright disrespectful and mean. I too am chunky, after I lost about 200 pounds of fat, I gained back 50 pounds of muscle, and have the "old lady bulge around my middle." Growing up, as a child I was skinny, my Grandmother was embarrassed about that, since in that time era, being slim and trim was assiated with being poor, being fat, or chunky, was a sign of wealth, so she'd push high calorie foods down me, much to the shagrin of my mother. Fast forward to adult life, when all those calories caught up with me, and I ballooned out like Porky Pigs sister. By this time, society reflects things in the oposite manner, and being over wieght is not acceptable, now we've swung the pendulum the other direction, where being 5ft2in tall, supposed to wieght about 90 pounds.
Lets find a happy, and healthy medium. We can be respectful and get the message across, in most cases. I'd also like to point out a former neighbor from my apartment house. This young lady rented the apartment upstairs from me, she was somewhere around 35 years old, had hypertension, CHF, type II diabeties, and arthritis primarily in her hip, knee and ankle joints. Her wt, was 800 pounds. And she was proud of it, because that made her qualify for wealfare SSI disability. Now, remember, I said: "...most cases..." this is a case that needs point blank here it is in your face, "if you don't do this you'll die" approach. This young lady was just plain lazy! Didn't want to work, so found out that by being fat, she could get disability, then along came the other problems as a result of her obesity. A typical meal for her was a package of hot dogs (12) with buns and trimmings, about six hambergers with buns and trimmings, a bowl of macaroni salad, enough servings for six people, a family size bag of potato chips, and three cans of regular soda pop. Now, who's the blame for her obesity? Herself? Her family? Her Dr.? Society? Yes, society, for making clothes that fit a 75 inch waist line. How about the Social worker who "ok'd" her benefits? The little girl next door, age 12, who bluntly told her "You are fat, you need to get off your duff and loose some wieght!" And then this young lady, cried because her feelings got hurt, so she spent an entire day sitting in her oversized recliner, eating cookies and chips and crying about this all day. And her lesbian partner babied her, and let her just sit there! Telling her she loved her no matter what her size is. When this young lady came crying to me the next day, all I told her is: "Ok, you have two choices, you can sit there and feel sorry for yourself, and continue to eat yourself to an early death, or you can get up off your duff, like the little girl said, and loose some wieght." I also pointed out that her diabeties could be reversed if she got healthy. And I offered to work with her on her diet, and an exercise plan, with her Dr's care. The response was that I was not a nice person, and they avoided me for the remainder of their time at this apartment house, a couple months later were evicted for not paying their rent.
It's time we become less tolerant of size, when health matters are concerned. If an obese person takes a trip on a plane, and is over a certian size, they are required to pay double fare, is that being polite when the ticket agent has to ask for the extra from that passenger? How about the steward who has to get the seat belt extender so that passenger can be buckled in appropriately? How about the EMT who has to call for extra manpower so they can lift the stretcher into the ambulance? Even the power stretchers are rated for only 700pounds, and recommended that if a pt is between 500 and 700 pounds that the stretcher remain in low position, so extra manpower has to be called anyway. Unless you live in an area wealthy enough to have another ambulance in the fleet that is designed as a bariatric rig. Meaning it has a special stretcher that fits onto tracks with a wench to pull it into the ambulance, and lowers it out of the ambulance, then the pt has to be able to stand to get from the ambulance stretcher to the hospital stretcher. This only touches the very tip of the iceburg, in order to accomodate people of obese sizes that much, it's a chain reaction of what's needed, oversized wc's, beds, most diagnostic tables aren't made to accomodate such sizes. And all because we have to be politicaly correct, and polite toward those who are that obese. We need to, as health care proffessionals, need to tell it like it is, we can be tactful, we don't need to be hurtful, but being honest, and not babying obese people will be better in the long run. The SS department needs to be involved to, c'mon! being fat a disability so they don't have to go to work! And they just sit at home and eat themselves into oblivion! It's going to take everyone working together, all departments of health care.
The pendulum can swing the other way just as bad too, so rather than put a number on things, why not just get healthy! One can be at ideal wt but not be healthy, yet, be about twenty pounds over and be healthy. Let's loose the number's game, and go by individual health. And stop being polite about things, and tell it like it is point blank.
This is another point where obese people annoy me. They want to be treated the same as everybody else. They want bigger seats in planes, cars, etc. When these planes etc were built, obese people were not the norm.
One of my friends flew overseas and had to sit next to a very obese guy, who's fat was spilling all over her, sweated and smelled the whole way, ate like a pig (her words, not mine), had no detectable hygiene rituals she could see, left crumbs and crap everywhere and it all flew over in her direction. She was cramped, disgusted and dejected. She actually complained to all the staff who could do nothing cos the plane was full, but this guy should have paid for another seat. As my friend said, you can't get to weigh 500 lbs or 200 kg or whatever, then blame everybody else for being discrimimatory. My friend said it wasn't HER fault this guy weighed so much, but she ended up paying for it!
She also said she was never so glad to get off a plane in her life. And when she booked her return ticked she said she needed the booking agent to find out if she would be sitting next to an obese person, cos she was gonna change her seat/time/date or she said they would be giving her her money back.
It's OK to have compassion but when that obese person is practically SITTING IN YOUR LAP, it's a completely different story.
This is another point where obese people annoy me. They want to be treated the same as everybody else. They want bigger seats in planes, cars, etc. When these planes etc were built, obese people were not the norm.
One of my friends flew overseas and had to sit next to a very obese guy, who's fat was spilling all over her, sweated and smelled the whole way, ate like a pig (her words, not mine), had no detectable hygiene rituals she could see, left crumbs and crap everywhere and it all flew over in her direction. She was cramped, disgusted and dejected. She actually complained to all the staff who could do nothing cos the plane was full, but this guy should have paid for another seat. As my friend said, you can't get to weigh 500 lbs or 200 kg or whatever, then blame everybody else for being discrimimatory. My friend said it wasn't HER fault this guy weighed so much, but she ended up paying for it!
She also said she was never so glad to get off a plane in her life. And when she booked her return ticked she said she needed the booking agent to find out if she would be sitting next to an obese person, cos she was gonna change her seat/time/date or she said they would be giving her her money back.
It's OK to have compassion but when that obese person is practically SITTING IN YOUR LAP, it's a completely different story.
And what does this story have to do with being a nurse? .. we arent working as nurses on an airline. Most obese patients I have had have never wanted anything better or bigger and most are humiliated about their size. There have been exceptions but as a rule.. most are fully aware of their weight and dont feel good about it...
Specializes in neuro, ortho, peds, home, home cardiac.
Obese people usually know they're obese, and stating the obvious only serves to make the patient withdraw from contact with the health care system and its providers. This is counterproductive on two counts. First, it doesn't allow us to continue education and counseling efforts. It also makes us helpless to prevent the complications to which these patients are prone. Education regarding the risk of complications and weight loss efforts can be provided without attacking the patient's self-esteem. Many of the commentators here hint that they harbor a belief that they can compel a patient into success by pounding him/her with "the truth". Some of them even write of disciplinary methods which might be appropriate for a recalcitrant toddler without the mental maturity to accept a reasonable justification for following a parental directive. Children comply only when they're susceptible to the parents' control. When the control is removed, they revert to natural behavior, since they lack the reasoning to recognize the consequences of their behavior. Unless you're sending the patient home with around-the-clock security to guard the kitchen door, these methods will fail. In fact, emotional eating, a problem for many of these patients, may increase after a non-therapeutic encounter such as this. Adults who lack a source of external control must be otherwise armed. Education and emotional support are vital during the long process of weight reduction, and the emotional support may be needed for a lifetime. You are all correct in your belief that honesty is always indicated. If you become a nurse, there will be many times when the thing that comes into your head to say is may be the truth, but when you gain the insight that comes with experience you will recognize that there are many truths, not all of them therapeutic. Right doesn't always make right! Feel free to contact me, stephanyjoy!
You said you're a pre-nursing student. You need to reflect on your career choice. A great nurse is not only compassionate and kind, but smart. Attempting to use guilt as a motivator is not kind, compassionate or something that an educated professional would do. And BTW, do you really think that the overweight diabetic patient doesn't know that he needs to lose weight or doesn't already self-loathe?
As a nurse you need to have empathy. You also need to tell the patient what they need to do to make their health better. It is still their decision whether they want to improve their life or not.
? 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!
Frankly, I find it incredible that you would think obese patients need anyone to make them feel guilty. They already do. They are made to feel like second class citizens everywhere they go. I know in NS we are taught to teach our patients but it is NOT our job to degrade them or make them feel guilty for their health problems. Whether we perceive those problems to be things they brought on themselves or not.
Nurses in doctors offices, and in my experience they are not even nurses but medical assistants (the people that take your weight, bp, temp), should keep any and all comments to themselves. When I went to the doctor a few months ago, my bp was up. The medical assistant noted that it was up and that was it. After seeing the doctor we decided a good plan of action was to come back weekly for bp checks (even though I can obviously have taken care of that on my own). The first week when I went back my bp was still high. This time I was seen my the RN and she did talk to me about diet, exercise, sodium intake, etc. She did it in a non judgmental way. She used therapeutic communication and related her own experiences with her weight to our conversation. I felt good talking to her. Even though I knew everything she was saying already, I did not mind hearing it again from her. Now think about how I would have reacted if that same nurse had tried using guilt to relate the same info. I would have walked out of there angry and probably rebellious.
Remember, most people will react much more positively to gentle, caring treatment than to condescending, mean spirited treatment. Which in my humble opinion is what making someone feel guilty about their health problems is.
This is another point where obese people annoy me. They want to be treated the same as everybody else. They want bigger seats in planes, cars, etc. When these planes etc were built, obese people were not the norm.
One of my friends flew overseas and had to sit next to a very obese guy, who's fat was spilling all over her, sweated and smelled the whole way, ate like a pig (her words, not mine), had no detectable hygiene rituals she could see, left crumbs and crap everywhere and it all flew over in her direction. She was cramped, disgusted and dejected. She actually complained to all the staff who could do nothing cos the plane was full, but this guy should have paid for another seat. As my friend said, you can't get to weigh 500 lbs or 200 kg or whatever, then blame everybody else for being discrimimatory. My friend said it wasn't HER fault this guy weighed so much, but she ended up paying for it!
She also said she was never so glad to get off a plane in her life. And when she booked her return ticked she said she needed the booking agent to find out if she would be sitting next to an obese person, cos she was gonna change her seat/time/date or she said they would be giving her her money back.
It's OK to have compassion but when that obese person is practically SITTING IN YOUR LAP, it's a completely different story.
First of all, get your facts straight. Airlines have been making the seats smaller and smaller for years. Adding rows of seats so they can maximize their profit. It is very uncomfortable to fly, even normal sized. The last time I flew internationally I had a man sitting in front of me who kept his seat reclined the entire trip. He had horrible dandruff and it actually was shedding all over the seat. It completely grossed me out. If the rows were wider and the seats a little bigger, this would not have affected me. As it was, I couldn't even put my tray down without fear that he was going to flake dandruff onto me.
It is a misconception that obese people have poor hygiene. Sure, some do but as demonstrated by Mr. Flakey, many non obese people also have poor hygiene. There are also many people who wear too much perfume, talk on their phones obnoxiously loud, watch Media on their laptops (where you can obviously see since you are only about 6" from it), babies and small children crying or running up and down the aisles, snoring, etc.. Flying is a pain in the ass for everyone. I feel for that friend that had to sit next to the obese guy. I feel he should have been provided with a seat that had a little more space but I do not think it is fair to require him to purchase a second seat. I am fairly normal sized at 5'8 170 lbs but I find plane seats to be very small and uncomfortable. There is no way a 500lb person could even fit in a regular seat. Also, even if they did purchase a second seat, the arm rests do not go all the way back into the seat so they would be sitting on a lump and have an arm rest in their back. Is that fair?
Specializes in Clinical Research, Outpt Women's Health.
It makes me wonder why people are obese. I am obese myself. I do not over eat, in fact, I HATE food. I have hypothyroidism, a collapsed left artery where I am on my third for it, I have had heart surgery, epilepsy, asthma, and I can go without eating for a whole week and I did this, and still gained a pound! I hate being fat, I NEVER was this big like this and get this, when I am pregnant, I gain 25 lbs per baby. I didnt gain nothing w/my first son till 3rd trimester, and 50 with the twins, then 25 w/my second set of twins w/one surviving twin outside utero. I drink sugar free drinks and about to go nuts. I am dx gluten intolerant, gastritis, I swell, and more. Yeah, I wrote a lot of stuff that is wrong with me, and I am blessed because there are others who are less fortunate, but I HATE being fat...to me, obese people are disgusting no matter what problem they have, and I am speaking about my self as well.
PS, does anyone have any knowledge of any books outside of nursing that will help with ped dosage calc?
I would nix the sugar free drinks, I have heard that the artificial sweetners are actually linked to an increase in body weight! Not the healthy alternative that the soda companies would like you to believe. Don't be so hard on yourself! We all have our battles. I hope you have success losing weight if you chose to do that, because you can do it! Your already on the right track with knowing what conditions you have that may contribute to a weight issue.
This is another point where obese people annoy me. They want to be treated the same as everybody else.
I have no idea what your story has to do with nursing, but in the context of a hospital and nursing care, they should be treated the same as everybody else! Why would it annoy you that obese people want to be treated the same as everyone else?! We have access to larger wheelchairs and beds. Many of their needs can be accommodated without too much effort. There are challenges of course, when it comes to moving incapacitated morbidly obese patients, with respect to scales or certain procedures which have weight restrictions, but we do the best we can and treat them with the same compassion, respect, and empathy as we treat our other patients (hopefully we are treating them with kindness, respect, and empathy, but the more time I spend on this site, the more I question whether even that is happening).
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an2on, BSN, RN
238 Posts
Just tell the patient what an ideal weight is without being direct. Trust me, they will know!