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!
"I believe that guilt can be a very powerful motivator in these cases."
I've seen guilt successfully make people (including myself) feel like crap. I've not seen anyone motivated by guilt. Guilty people motivated, yes, but not by the guilt.
I think it's an ego trip for the one applying the guilt.
I'm not entirely sure I understand your complaint - how much less ethnic diversity do you want? White non-hispanic is relatively specific, unless you want white of so-and-so origin. I have other issues with the study, including like you said the reference range they use. If you dismiss every study that isn't perfect though you won't get anywhere. It does not stand alone, that is true. That's why reviews of several studies together are regarded as a higher level of evidence.
Here's another couple interesting studies finding a link:
It's an interesting review addressing whether we would do better to move away from any weight-based target or measure instead focusing on things like intuitive eating (ie, increasing awareness of when your body is actually hungry and full etc), body acceptance, and active embodiment (inc activity vs. exercise as such), it's called HAES. This is my first exposure to it, but they make a reasonable case.
It's all interesting. This field is pretty new, there's a lot that's come out in the last 20 years or so trying to flesh out the exact relationship between different measures of obesity and body fat or mortality or even if weight and body fat is even what we should be looking at in the first place. It's very complex and evolving, but while we're waiting for the true answers (if indeed they even exist), we ought to work with what we have and the best understanding that's out there and keep going from there.
Take a deep breath.
I meant to say "if there were any ethnic diversity to speak of." Early morning posting is not my friend.
In order for a multi-study examination to be meaningful, the researchers would either have to match some existing uniform method/parameters or draw raw data only from multiple studies. If they use a different set of parameters from a similar study for say, baseline, they need to explain why and account for any variance either theoretically or in their analysis and conclusions. I'll have to look over that first study you posted in more detail.
And if this doesn't make a shred of sense, it's because I've been up since 5 am, had two exams and half a clinical day. I am W - I - P - E - D.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
Imagine that your best friend is obese. How would you want him or her treated when in the hospital. How about if it were a first degree relative, perhaps your child...what would you expect the attitude of the nurses providing care to be?
I know my answer...compassionate, kind, and with unconditional regard.
Imagine that your best friend is obese. How would you want him or her treated when in the hospital. How about if it were a first degree relative, perhaps your child...what would you expect the attitude of the nurses providing care to be?
I know my answer...compassionate, kind, and with unconditional regard.
No- I know the answer-
If it were their child- the antifat folks would put their kids on a diet, withhold sweets and fatty foods, and make sure they exercise.
If it were a family member- they'll expect the health care team to be direct and harsh- if need be.
If it were a best friend- well, with the prejudices and disgust these people have for obese people, I doubt many would see past the fat to become friends with an obese person... making this an unlikely scenario.
When I was in my early 20s I had a good friend who was obese (I was very thin).. She was absolutely one of the most beautiful people I've ever known inside and out. She really was a shining star. She moved out of state and to this day I regret not keeping in touch with her. If I had such a prejudice for obesity at the time, I'd never have known this woman and that would have been a shame. So many people here seem to have such a hatred for obese people... you really are limiting yourself from knowing some wonderful people.. people much better then yourself.
SO......it's OK to force fed the anorexic to keep them alive while their bodies are in renal failure, cardiac failure, and cardiomyopathy from lack of nutrition because they are easier to reposition in bed. That the thousands of dollars spent on their meds, dialysis, psycharitrists, TPN (which by the way costs thousands of dollars) physical/psychological therapy for their disease and multiple hospital admissions from one opportunistic infection or another is OK because of their size and they are easier to position in bed????? I am not sure if a cost compairison has ever been done but you assume the obese person would cost more because they are so fat......right?
Does anyone else find this disturbing? To "fire" a patient because they won't lose weight. YOu tell them they have to stay off the limb but they have to excercise and lose weight or they don't have a doctor anymore....they can't excercise and don't lose weight....now they don't have medical care. What's next Euthanasia? What about the cancer patient with a poor prognosis and will probably die anyway....why waste the moneyon treatment when they probably won't survive anyways??? Besides they probably were a smoker.....right??? What is going on?????
I thought the first rule of medicine was.....DO NO HARM.........
I think you misunderstood my post. My point is that a person will usually survive much longer as an obese person. 20-30-40 years even costing millions over time. Someone who stops eating won't make it nearly that long therefore costing less money overall. I was responding to an earlier post.
I think you misunderstood my post. My point is that a person will usually survive much longer as an obese person. 20-30-40 years even costing millions over time. Someone who stops eating won't make it nearly that long therefore costing less money overall. I was responding to an earlier post.
It's also important to note the false equivalence. Anorexia nervosa is primarily a cognitive disorder with a deadly physical component. When we talk about obesity, I am not referring to it as a secondary effect of a recognized primary pathology, but as a result of poor choices and habits--which admittedly might be the wrong way to look at it. Should we treat obese patients as having a cognitive disorder?
In terms of prevalence, the obese patient DOES have a higher societal cost. AN occurs in about 0.5% of the population in developed countries whereas obesity occurs at around 25% of the US population.
Do you feel that we should force feed the anorexic patient???? That because they are starving themselves to death and if we educate them that not eating has consequences like death they will suddenly be all better??? That reality is their magical cure for sticking their fingers down their throats refusing to eat more than a cracker and excercising like a lunatic will release them from their nightmare? If you do ...you're deluded. Do you believe That the anorexic is less of a societal and financial burden.... just because they eat less and take up less space and are easy to reposition in bed??? Do you think that becasue they purge, binge, don't eat at all tand excercise like a maniac that they are less cost on medical/hospital/psychiatric care?? or they have less of a lost productivity?? that if you just yelled at them to "JUST EAT SOMETHING YOU ARE KILLING YOURSELF!!!!" Will cause them to pick up a fork?????
Maybe we should just put a peg tube in them all so they can finally put some weight on and get a job!! Of course,that's a modest proposal.......
Sounds harsh???? In my opinion it is.....whether too big or small we need to practice tolerance, compassion to enable us to educate and treat.....just my :twocents:
We DO force feed anorexic patients...in the inpatient setting, they must eat a certain percent of each meal (usually at least 90%). If they fail to meet that, they must drink a meal supplement, if they refuse, they are put on bed rest and have a feeding tube put in.
And because anorexia nervosa is considered a mental illness, many anorectics are committed against their will. This seems to fit every definition of force feeding.
Many do end up with pegs and ostomies (bowels stop working after the laxatives are gone).
Your attempt at dark humor only revealed how little you know about eating disorders and their treatment.
It's also important to note the false equivalence. Anorexia nervosa is primarily a cognitive disorder with a deadly physical component. When we talk about obesity, I am not referring to it as a secondary effect of a recognized primary pathology, but as a result of poor choices and habits--which admittedly might be the wrong way to look at it. Should we treat obese patients as having a cognitive disorder?
In terms of prevalence, the obese patient DOES have a higher societal cost. AN occurs in about 0.5% of the population in developed countries whereas obesity occurs at around 25% of the US population.
AN is wildly underdiagnosed.
Disordered eating is disordered eating. AN is no different than other forms of eating disorders. The mortality rate for people diagnosed with AN is higher than the rest of the population due mainly to suicide, not secondary physical effects.
Disordered eating is disordered eating. AN is no different than other forms of eating disorders. The mortality rate for people diagnosed with AN is higher than the rest of the population due mainly to suicide, not secondary physical effects.
Are you referring to a particular group of studies? I know this has been the aim of quite a few now with mixed results and am interested in hearing anything new, but it seems like we're getting off track unless you're proposing that we DO treat obesity as we treat AN.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
we do force feed anorexic patients...in the inpatient setting, they must eat a certain percent of each meal (usually at least 90%). if they fail to meet that, they must drink a meal supplement, if they refuse, they are put on bed rest and have a feeding tube put in.
and because anorexia nervosa is considered a mental illness, many anorectics are committed against their will. this seems to fit every definition of force feeding. and this costs less????
many do end up with pegs and ostomies (bowels stop working after the laxatives are gone).
your attempt at dark humor only revealed how little you know about eating disorders and their treatment.
this is no atempt at dark humor here. this was an attempt to try to bring to light mistreatment and discrimination by the very medical field i belong to does to the obese and the desparing treatment given to that population........bring to light the fact that everyone else deserves to be treated with compassion and understanding except that fat, lazy, uneducated, slob over there in the corner who doesn't deserve the time of day becasue they are too fat, lazy, and too stupid to be helped!!!!
the arguement that the obese cost society too much money therefore we need to be treated like scum i find offensive. does the anorexic, drug addict or alcoholic cost that much less that the obese should be treated with disrespect, crulety and distain.? that becasue the obese should be ignored or better yet be euthanized because they are too expensive?
my point is that a person will usually survive much longer as an obese person. 20-30-40 years even costing millions over time. someone who stops eating won't make it nearly that long therefore costing less money overall. concoquer+ (quote)
i am talking about the lack of respect, kindness and empathy afforded to other patient populations but not afforded to obese patients. it seems to me that the medical community ignores the fact that obese people do have disordered eating behaviors and most try very hard and fail to control their disordered eating. i also believe that the obese patient has genetic issues beyond eating food. i truly believe that they metabolize calories and store calories different making it more difficult to shed those excess fat cells and stores fat differently leading to easy accumilation of fat. the only reason more money isn't spent on investigating and curing obesity is becasue the private sector multibillion diet rip off miracle cures, pills,teas, and yes certain gym equiptment all promising the desperate miracle cures. the obese person wants to be accepted and treated with respect as much as anybody else if not more so eager to be liked.........and are easy pray for these marketing vultures who do nothing more than fill their pockets.
i am not referring to it as a secondary effect of a recognized primary pathology, but as a result of poor choices and habits--which admittedly might be the wrong way to look at it. quote neuromoms
i happen to be secondary effect of a primary disorder obese person. i take 80 of prednisone with intermittant doses of high dose (1-2 grams) iv steroid for an inflammatory myositis called dermatomyositis. which means i am wheelchair bound right now, i am fat and i have purple skin and a purple face! i have gained at least 80 lbs in the last year and my beautiful hair has become so thin from methotrexate. trust me when i say this........... most medical personnel believe that obese peole are stupid, lazy, overeaters who are deaf!!! and don't deserve the time of day nor the common courtesies afforded to "normal" sized humans. that if more those fat a** lazy humans got off their fat a**e* the world would be a better place and they would be smaller and take up less space. trust me! if i could get off my fat ass you had better run because i am going to chase you down for an apology for all those nasty rude things you said about me.
i have heard such horrible things spewed my way. giggles and laughter behind badly concealed mouths......trust me when i say this.......patients hear much more than you think, especially at night........we have nothing else better to do other than eavesdrop.........ooooooo! the things i've heard!!!!!! i could probably give the day shift report:rolleyes:.......and then some .
i have actually wanted to say to nurses, lab techs, rad techs, transport personnel....you know i was normal sized once and i was actually pretty! this thread has confirmed my fears. i was hopung that it was just a few bad apples and not a blight on the whole crop.
where and when have we lost our humanity? when did we stop having compassion for others? when did we stop empathizing with our fellow man? when did we start believing that one patient population is more or less deserving that another. it is no less discriminatory than treating someone different because of the color of their skin, hair, or eyes. it makes me very sad...........
Being obese by eating a lot is like using drugs. And people who belittle or downgrade obese people usually aren't all that perfect either. I have an extremely obese patient at work. I feel for her because I know why she overeats, she's depressed and she's given up. She has no motivation whatsoever. The only thing that gets me about her is that when we turn her or lift her up in bed she has the ability to help but doesn't. I hurt my back very very badly after turning her and I was very worried for a while but my chiropractor fixed that for me. From now on I tell her that I will only help to lift her up roll her etc only if she helps. If she says no I wont' help I don't do it I don't want to risk my back like that again.
I go crazy when people (staff) make fun of her because she lays in bed eating all day, and it drives me crazy because hell if I was her size and in a LTC and depressed (yes she's on antidpressants) I'd eat to I mean what the heck. I also despise her doctor because he's very unkind to her because of her "laziness" and obesity, to the point where one time he didn't want to treat her UTI, so I left a note with my DON (she didn't know) and told her, so our house doctor treated her with ABT's instead.
There's too much discrimination against obesity.
Also I am 5 foot 5 and I weigh 200 pounds and I hate it when my doc says I'm obese. Looking at me you'd think I'm 160. I am very muscular and big boned, I swim an awful lot was taught by an olympian swimmer, I do yoga, and I do a lot of walking. Yeah I have about 20 pounds to loose (I've lost 14) then I'll be down to 180. But all my bloodwork is perfect, so much so my doctor was really really surprised.
Excuse me. My original post re: patient care was post #89. May want to refer to my nursing judgement. Again, the most recent posts were directed towards nurses who are at their wits end about their obesity. And within nursing judgement I will add, if you have renal issues, things will be very different re: my weight loss advice. Protein can not be so accentuated. Now, I also stated I've spent much of my life being, yes....OBESE. So don't try that judgement on me. Look to thyself with that! I agree, diet and excercise needs to be tailored. I was giving advice to the bedside 0700-1900 RN. No you can not strap a preschooler to your back. But if you have a husband, an older child, a neighbor, a teen.....all doable. When my son was too old for the backpack, I did yoga at 0300, as I stated. And I learned it from a BOOK, not a class, reading by KEROSENE LAMPS. Yes, it was HARD. It was also hard having the love of my life DIE. It was HARD, living on 40 acres in the outback without electricity or running water! It was HARD, going through college and nursing school with a child this way! What I am saying is that if I could find a way, any nurse can find a way to fix whatever is ailing her!!!! Geez. Sorry if I sound mean, but I have been offended myself here as well. I simply am telling those who have asked what to do....how to work with their metabolism!!! So get off me here! I am venting now! Exxxuuuussse MEEEEE." Shallow "is such an insult! Try watching your beloved husband die in the prime of his life, and try to make a new life alone for your child and yourself! And then if you can make it that far....try to see the rewards...OK? Blessings, already.
Thank you. You have given all of us some really good information. If something is wanted bad enough, it is worth it to give it everything you've got! Congratulations on your weight loss!
What's next Euthanasia? What about the cancer patient with a poor prognosis and will probably die anyway....why waste the moneyon treatment when they probably won't survive anyways??? Besides they probably were a smoker.....right??? What is going on????? 
:twocents:
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newtinmpls, BSN, RN
61 Posts
"I believe that guilt can be a very powerful motivator in these cases."
I've seen guilt successfully make people (including myself) feel like crap. I've not seen anyone motivated by guilt. Guilty people motivated, yes, but not by the guilt.
I think it's an ego trip for the one applying the guilt.