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've got to talk to BMI here. CharmedJ7, with all due respect, I do appreciate what you are saying. We do need to have some across the board clinical scales for many purposes. But I also want to make it heard that BMI can be very misleading. My husband has been a professional athlete...full of lean muscle with no fat; yet when his insurance looks at his BMI he is called obese. Rates can go up. We had to fight this once upon a time. This is really a whole new topic now, but my point is that the BMI is really misleading.
I aboslutely see your point. Although I would amend your statement to say BMI can be really misleading. Professional athletes are not the norm, they are the exception. I would agree to say perhaps that BMI is over-valued and/or an oversimplification, so it should never be used to drive something like insurance quotes unless it's used in combo with something else (abd obesity, body fat composition, etc).
BMI can be very, very misleading. Someone with a lot of muscle mass will come up heavier on a BMI when they are quite fit. Also- someone with a healthy BMI may have the unhealthiest lifestyle (smoking, drinking, drugs) and be 100X less healthy than the person with a much higher BMI.
Specializes in Trauma Surgery, Nursing Management.
But the question is, is being more empathetic than honest truly the best way to acheive the desired end result?
AH! The core issue lies in the motives of the teacher (you the nurse) and his/her listening skills of the patient. Bear with me as I try to clumsily explain my rationale:
If you have a pt who is scared and defensive, they will not welcome an "honest lecture" about the harmful effects of being overweight/underweight. This pt population already see the medical world as cold and uncaring. You must first lend an ear to the pt to find the root cause of their weight imbalance. This takes time to do, because the pt must feel that they can trust you. Only then can you determine what motivates the PATIENT to choose an unhealthy lifestyle. When you find this, you can then start to develop a plan of action WITH THE PATIENT. For example, if you have an obese, non-compliant pt who is ambivalent about their health, you must open a dialogue with them about why they are ambivalent, non-compliant. This is no easy task. The topic is very sensitive, and pts will resist a conversation regarding it. Ambivalence is a facade that has developed over time by others either commenting or judging in a negative way. The key here is to LISTEN. When you listen, you are viewed by the pt as an empathetic nurse. Only then will they be more than likely be ready to accept changes, and subsequently be more open to treatment, whether it be counseling, or a measurable and goal-oriented plan to lose/gain weight. It is often a very tricky and very painful road for both you and your pt. Remember that this pt population has been dealing with this issue most of their lives, and they have no doubt had both successes and disappointments along the road.
So the bottom line is that you must first offer EMPATHY before you can expect a pt to accept REALITY.
I once injured my hand and wrist---badly---by punching a refrigerator. Why I did it is a story for another post; but the day after, my hand was swollen, black and blue, and so painful I couldn't even bend my fingers. So I went to the local clinic to get it looked at, and the doctor just said, "This wouldn't have happened if you didn't weigh 240 pounds."
Excuse me??
"Obese people have a tendency to fall, and they always have a harder time recovering from injuries than normal people."
Well, now. Funny, I thought I'd punched the fridge, not fallen on my hand. And I thought I'd punched it because I was mad, not because I was fat. Or maybe the doc thought I was mad BECAUSE I was fat. Either way, he didn't do a darned thing for me except tell me to lose weight and, oh, of course, to come back if the hand got any worse. He didn't even X-ray it.
That's only one of a number of times my complaints have been dismissed, or blamed on my weight alone. So please, don't tell me that prejudice against fat people among medical professionals is "overblown".
So at which part of your visit did the doctor tell you that you were stupid and lazy ? I never said that obesity isn't blamed when it isn't the cause, I said that I have never heard a HCP call someone stupid, fat and lazy. And I don't believe that they have said that to you either. Just my opinion.
BMI can be very, very misleading. Someone with a lot of muscle mass will come up heavier on a BMI when they are quite fit. Also- someone with a healthy BMI may have the unhealthiest lifestyle (smoking, drinking, drugs) and be 100X less healthy than the person with a much higher BMI.
1) Yes, as previously agreed, muscle mass will increase weight and artificially increase BMI. But honestly, that's not the case in most people, and for times when it is, one would expect the clinician to use their judgement and see the whole picture. This is why BMI should not be used independently like in insurance things.
2) Yes, smoking and drinking and drugs are bad. They are also independent risk factors, like BMI. If I had a pt with BMI of 30 but clean lifestyle, I'd be less worried than my BMI 22 chain smoker who shoots up every once in awhile. That's why they're all risk factors, not the be all end all substitute for clinical judgment.
I just still fail to see why BMI gets blasted so much for not holding all the answers for everyone. It's a tool, not the gold standard diagnostic test for impending mortality and morbidity.
Compassion until manipulation starts. Then like any other pt. I think I'm being very generous considering I just injured my back pushing a lady through the hall for discharge, so heavy she nearly bent the wheels on the chair and was giving me attitude at the same. time. It took 2 nurses to get the chair in motion. I think the chair is broken for good. I try to remember food is like any other addiction. I don't give narcotics willy nilly to " addicts," and I don't give food to over weight people willy nilly. I wish wallmart would get rid of the scooters or keep them for people who are over 80 or in a cast. The not good for you isles should be in the back of the store.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
1)
I just still fail to see why BMI gets blasted so much for not holding all the answers for everyone. It's a tool, not the gold standard diagnostic test for impending mortality and morbidity.
What if health insurance companies consider and use it as the gold standard diagnostic test?
Specializes in Oncology/Hematology, Infusion, clinical.
"So at which part of your visit did the doctor tell you that you were stupid and lazy ? I never said that obesity isn't blamed when it isn't the cause, I said that I have never heard a HCP call someone stupid, fat and lazy. And I don't believe that they have said that to you either. Just my opinion."
I think it is more likely that patients are told things like these, just not in so many words. I'm sure that this, along with the patients' perception that the HCP personally believes the he/she is "stupid, fat, and lazy" is equally as hurtful, resulting in an experience one would likely relate to flat out being told he/she is "stupid, fat, and lazy". There are ways to say things without actually saying them.
Oh yeah, and we have a doc that once told a patient "I'm sorry, there is nothing more we can do for you: you are just too fat". No joke.
I just still fail to see why BMI gets blasted so much for not holding all the answers for everyone. It's a tool, not the gold standard diagnostic test for impending mortality and morbidity.
Because it is used far too frequently to explain far more than it is capable of explaining by people who have no clue just how pathetic a diagnostic tool it really is.
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."
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.
Has anyone ever seen people laugh at the person suffering from anorexia and is laying in a hospital bed 76 lbs and being fed by tubes? You don't hear HCPs laughing in the breaking room saying, "Holy Cow that girl is skinny- hahaha- all she has to do is eat and she'll be fine!" Nope, I've never heard anyone think anorexia/bulimia is a laughing matter. It's actually treated like a disease and with compassion. People understand the pressure women (and men) feel to be perfect and seem to accept that this disease is hurtful and dangerous.
People with eating disorders on the other end of the spectrum are treated like crap, laughed at, told "just eat less/more healthy/stop stuffing your face/you're disgusting, etc. etc." and sent on their way or dismissed completely. There are just as many outside factors related to overeating as their are contributing to anorexia. Food ads designed to get that hamburger in your head, unhealthy foods in the grocery store cheaper than the healthy foods, food being generally part of the American culture.. I could go on and on and on. Fat is one of those things that it's perfectly okay to discriminate against, make fun of, and generally treat like ****.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
no need being pc about it. if you're fat, you're fat and need to quit chowing.losing weight and keeping it off can be a menace as most of us know,but when you see a very obvious obese person chowing down, it's upsetting.
excuse me, but "quit chowing?"
everyone needs to eat, even obese folks. and if you see a fat person eating a donut, you don't know a thing about them except that they're fat and eating a donut. that may be the only fat or sugar they've had in six months and they're treating themselves to one donut after a 50 pound weight loss. or it may be third breakfast. my point is, you don't know, and you're in no position to judge.
CharmedJ7
193 Posts
I aboslutely see your point. Although I would amend your statement to say BMI can be really misleading. Professional athletes are not the norm, they are the exception. I would agree to say perhaps that BMI is over-valued and/or an oversimplification, so it should never be used to drive something like insurance quotes unless it's used in combo with something else (abd obesity, body fat composition, etc).