Compassion or reality for obese patients?

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Hello,

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!

Specializes in WOC, Hospice, Home Health.

After reading the first 20 posts or so-

Guilt is not an effective motivator. However, I find that sometimes a good dose of fear (aka a reality check) is not necessarily a bad thing. For example- the noncompliant diabetic that just had a toe amp-I've not no problem pointing out that once the doc runs out of toes, he's going to start working his way up the foot to the leg. Of course this is coupled with lots of disease process teaching and positive reinforcement for good health behaviors.

I've had some discussions about weight with obese patients. I'm honest about repercussions- and then we talk about ways to manage their weight. But I don't try to guilt them into anything. You can't guilt change.

For the record, I'm a size 10-12, so I'm no skinny chickie either.

Why do I have to choose to be compassionate or realistic? Who says I can't be both?

Totally agree-those terms are NOT mutually exclusive.;)

Specializes in Critical Care.

Regardless of whether you use guilt, shame or baby steps, there is one thing that must be present for anyone to lose weight and that is MOTIVATION. If a nurse does not motivate a patient they can talk until they are blue in the face and nothing will change. And what motivates one person will not necessarily motivate another. Just because guilt got you up to walk your dog doesn't mean it will work for me. I don't like dogs and don't have one therefore I have no guilt over that.

As a nurse, you need to spend the time (and we all know how much of that we have to spare :D) to try and find out what could be the patient's motivation. Not what the nurse think should be the motivation.

I thank the gods (and that is gods with a small "g" thanks) that I don't have the health problems associated with my weight as yet. I do know one thing, it goes a long way toward my motivation to lose wieght just by reading the attitudes of some on this thread.

I genuinely appreciate those of you who took the time to share your opinions in a respectful manner. Many of you made great points that have definitely given me something to think about.

Specializes in Critical Care.
Most people with eating disorders have "MUCH" self-hatred" to quote you.Both extremes- one seeks to chow more,while the other seeks to lose more weight. How is it more acceptable to talk about anorexia or bulimia(because they are skinny?) than to talk about obesity.

Obviously there is an underlying sense of ,"Look I'm doing this to myself." kind of guilt,which is why the subject is so touchy.

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."

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."

also notable, is that society does not treat skinniness with the contempt that it treats obesity.

rather, 85 lbs is the ideal to many....the thinner, the better.

thus, why so many teen girls struggle with anorexia/bulimia.

it's ironic that while 'we' dislike obesity, 'we' also are part of a culture that encourages fast, fatty, convenient foods.

it's not only the (obese) person that is responsible.

our govt is also remarkably culpable as well.

leslie

Specializes in ICU.

I'll go back and read the responses, but I'd like to mention one thing....

You don't seem likely to use this angle in your paper, but if you take a moment to think about the following question and how you might defend your answer to it, it will either strengthen your argument or (hopefully) cause you to rethink your position:

What do you care what method is used to encourage healthy lifestyle behaviors so long as the end result is healthy lifestyle choices?

That is, unless you've got something against fat people.

What do you care what method is used to encourage healthy lifestyle behaviors so long as the end result is healthy lifestyle choices?

But the question is, is being more empathetic than honest truly the best way to acheive the desired end result?

Specializes in ICU.
But the question is, is being more empathetic than honest truly the best way to acheive the desired end result?

What makes you so certain it isn't?

I am not certain. I was only stating my opinion and asking for others. If I thought my opinion was the "right" one then I wouldn't be asking anyone else :) I'm humble enough to know my views may be distorted or maybe I am not looking at the bigger picture. I wasn't trying to argue my point in this forum as much as I was trying to gain perspective.

Specializes in ICU.
I am not certain. I was only stating my opinion and asking for others. If I thought my opinion was the "right" one then I wouldn't be asking anyone else :) I'm humble enough to know my views may be distorted or maybe I am not looking at the bigger picture. I wasn't trying to argue my point in this forum as much as I was trying to gain perspective.

I am attempting to help you to gain perspective...

If you can defend the question, "What makes you so certain that support and positive regard will not result in positive lifestyle changes?" either academically or logically then you might have a theoretical leg to stand on.

If you cannot, then you're going to come off like you've got something against fat people.

What I mean to say is, you need to dig a little deeper.

Specializes in LTC.
I disagree. I've been thin and fit most of my life and have not experienced what you describe. I have, however, found it very helpful to avoid pointing out the obvious (they're obese) and focusing instead on some small steps they can take to begin improving their health. For an obese person, saying they need to lose 100 lbs or simply "eat right and exercise" is just too nonspecific. I have gotten results with the following:

"Your diabetes is really a threat to your health. Did you know that even losing just 10% of your body weight can reduce your blood sugar significantly?" Also, "you do not have to spend 3 hours a day at the gym to decrease your medications or get off them completely. Did you know that brisk walking 30 minutes to an hour a day can reduce your risk of heart attack just as much as jogging?" Giving a patient small, obtainable goals will go a whole lot further than lectures of how their obesity is killing them. When an obese patient hears that there are some small things they can do which will pack a big punch, you get their attention. And they become more open to other small things they can do, instead of being overwhelmed with some huge goal which will take a year or two to obtain. And small successes often lead to more successes. One week of just getting rid of creamy sauces or greasy fat sounds more doable than completely overhauling their diet overnight.

Show them respect and compassion, give them honest answers to questions, avoid judgments, provide simple, obtainable steps which will lead them down the path to better health, and provide them with resources, and you'll affect some of these people. Some of it will go in one ear and out the other, no doubt. But at least you can go home knowing you provided valuable information without breaking someone's spirit-I think the success rate will absolutely be higher than any short term results you get from "guilting" someone into losing weight.

Finally, I always make it clear that you can absolutely be healthy without being skinny. It's the behaviors, not the number on the scale, which most impact health, and maintaining a reasonable weight, which is much more attainable for most, will keep them just as healthy as the skinny person (if not healthier). Fitness level, not weight, is a better predictor of health and longevity.

Your post made me weepy. :redbeathe:redbeathe:redbeathe If every co-worker I dealt with was like you, I would have quit way fewer jobs.

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