article on the Obese Pt/Dr Nurse relationship

roser13, ASN, RN · Jun 17, 2015

Why I Think Doctors Must Better Accommodate Fat Patients - Yahoo News
I found this interesting.

In what way?

Horseshoe, BSN, RN · Jun 17, 2015

I have mixed feelings about this. Body weight and composition is actually more complicated than people realize. It simply is not always about calories in/out. Read the comments to this article and you see the same old "quit being a pig and get off your duff!" comments. I am sure that these sentiments are also held by a fair number of nurses. I probably thought that way myself for many years.

A few months ago, I stepped on the scale and saw a number I'd never seen before. I had always been slender my whole life until a few years ago, when it became more and more difficult to maintain my weight. I did not consume massive amounts of calories; in fact, I know many other women who eat far more calories, don't work out at all, yet remain thin. I got very discouraged that nothing that used to work for me even made a dent.

I will cut to the chase and say I found out that I had high fasting insulin levels and resulting insulin resistance, high blood pressure, high trigycerides, high LDL cholesterol. Not obese, but definitely overweight and uncomfortable. Nothing I tried had worked, not reducing calories, not going on a daily walking program as prescribed, not by eating all those "healthy" fruits, legumes, and whole grains. The problem wasn't eating too many calories, it was eating too many processed foods i.e., simple carbohydrates, sugar, etc.

Because of my insulin resistance, which is a one way street to eventual diabetes, I simply cannot process simple carbohydrates the way I once could. In the presence of high circulating insulin, it is pretty much impossible to lose weight. When the cells quit "listening" to insulin, the only option is for insulin to usher circulating glucose into the fat cells, and those cells will not liberate their contents while circulating insulin remains high. This is called metabolic syndrome, and results in weight gain (particularly around the abdomen), as well as high blood pressure, high trigs, cholesterol, etc.

In a matter of only a few months, I have finally lost the weight and I have NOT reduced my calories.The only thing which worked for me was to reduce my consumption of simple carbohydrates. I eat fish, eggs, poultry, some beef, and LOTS of leafy greens and other non starchy vegetables. No sugar, flour, grains, breads, potatoes, rice, or other starchy vegetables. Rare alcohol. Limited amounts of berries and grapefruit. I exercise not because it's possible to burn off tons of calories in an hour, but because it helps immensely with insulin resistance.

I'm thin again, but only because I did my own research and discovered how to treat metabolic syndrome and insulin resistance. My calorie intake is the same as when I was heavy. Go figure.

I wish more overweight people who are insulin resistant would be identified and given information which actually help them, rather than the old "eat less and exercise" speech that they've likely already tried multiple times. Most doctors don't talk about this or even consider that their overweight patients might have metabolic syndrome vs. stuffing their face constantly. We know that type II diabetes has skyrocketed, and one of the main reasons is the development of metabolic syndrome in response to years of eating simple carbohydrates, processed foods, even too many whole grains and fruits. Thanks alot, old food pyramid.

For a lot of people, it's really not about how much they eat, but WHAT they are eating. Years of eating poor quality food can erode the body's ability to process carbohydrates, making weight gain inevitable. The high carb diet most insulin resistant folks eat can also contribute to feeling hungry more often than a normal person, so it's not totally false that many people overeat. You would too if your cells were screaming for nourishment because they were resistant to the important functions of insulin.

Of course, the author of this article addresses none of this. She correctly bemoans the negative attitudes she encounters which do nothing to help. But she also endorses avoidance behaviors in both the health care workers and the patients as well.

Nagging and shaming don't help patients; in fact, I think they stay away from health care environments because of this, which only exacerbates the negative cycle of obesity and poor health outcomes.

I don't think we are going to solve this problem without a better understanding of what causes obesity (there is more than one cause). Our "experts" cannot agree on what constitutes a healthy diet. The research actually conflicts with much of the prevailing advice that is given to society by doctors and nutritionists. It is a multi faceted problem which will not be solved soon.

Farawyn · Jun 17, 2015

Horseshoe. I'm so glad you found your answer. Clean eating, or cleaner eating, is something I have to take the plunge with, myself.

Your 3rd paragraph from the bottom of your post is my problem with the article posted. Minimal solutions/suggestions, just complaints about what the other one should do better for them.

Horseshoe, BSN, RN · Jun 17, 2015

Horseshoe. I'm so glad you found your answer. Clean eating, or cleaner eating, is something I have to take the plunge with, myself.
Your 3rd paragraph from the bottom of your post is my problem with the article posted. Minimal solutions/suggestions, just complaints about what the other one should do better for them.

Yeah, she pretty much wants everyone to ignore the whole issue and pretend it's not a problem. She mentions praying that her labs are okay. She hopes against hope that her obesity will not actually result in poor health. Denial, of course, as it's unlikely, at least in the long run, to avoid the negative consequences of obesity forever. There are some heavy people who are also pretty fit, and some of them are actually pretty healthy. But most of them are not obese, merely heavier than the charts recommend.

BTW, I'm not endorsing the idea that everyone who is overweight is insulin resistant. But as the rising diabetes stats reflect, there are probably a whole lot of people who have metabolic syndrome, and who will eventually join the ranks of the type II diabetic population without intervention.

dirtyhippiegirl, BSN, RN · Jun 18, 2015

Well, that was an interesting exercise in the power of denial.

Farawyn · Jun 18, 2015

Well, that was an interesting exercise in the power of denial.

And accountability.

allnurses Guide · Jun 18, 2015

In what way?

I just found it interesting because of the stigma attached to being overweight. I confess I am overweight and am not really sure why as I eat healthy food in right sized portions and get regular exercise - my doctor thinks it has something to do with gentetics and surgeries I had for ulcerative colitis. Still he says my labs and BP are better than his. I am always treated with respect at my physicians office but I see nurses all the time who act dusgusted to have to care for the obese person.

nyc2011 · Jun 18, 2015

This article is true..though I am very skinny my fiancÃ©'s is not and his family is OBESSSED with weightâ€¦.they are all obese not morbidly or anything but they are obsessed with itâ€¦

and then they all look at me like I'm obsessed with being skinny lol but i am just meâ€¦it's in their head

but every time my fiancee aunt comes around she says "your hips are getting bigger" your going to get fat soon (and I'm sure she has a evil cackle in her head)

Libby1987 · Jun 18, 2015

Well I agree with Horseshoe (I think the metabolic portion of the post should be sticky here and everywhere) but I also think the author asked for pretty reasonable accommodations in a health care facility.

A few armless chairs.

Exam table safely secured (everyone benefits here).

Provide privacy when checking weight and any other assessment. Duh.

BP cuffs for all shapes and sizes (I bet they have to search for a pedi cuff for the frail little patients)

Some larger gowns. Okay maybe this one could remotely be considered caving into the obesity epidemic but geeze is this really going to be the hill we die on?

Farawyn · Jun 18, 2015

Well I agree with Horseshoe (I think the metabolic portion of the post should be sticky here and everywhere) but I also think the author asked for pretty reasonable accommodations in a health care facility.
A few armless chairs.
Exam table safely secured (everyone benefits here).
Provide privacy when checking weight and any other assessment. Duh.
BP cuffs for all shapes and sizes (I bet they have to search for a pedi cuff for the frail little patients)
Some larger gowns. Okay maybe this one could remotely be considered caving into the obesity epidemic but geeze is this really going to be the hill we die on?

NO. Not at all the hill I want to die on. I agree with your post. SOME accommodations, of course. And, as in the TG thread, treat all patients with respect.

But there HAS to be some accountability on this writer's part. What is SHE willing to do?

Her labs are all out of whack and all she is doing is complaining about what is not done FOR her.

My doc and I make deals all the time. You come back in 6 months. If your total Chol. under 150 I won't do a rectal exam that visit. Trust me. It works.

Libby1987 · Jun 18, 2015

Rectal exam as a consequence? I'm sure that does work! :wacky:

I read accountability in statements insisting on treating her weight naturally and not with pills.

The rest about increasing education on IR (and dealing with it on the front end before it develops) I'm afraid I agree with.

And is there seriously a survey where NP's thought people who are obese to be less tidy? I'm the thin messy one in my office, the overweight and obese nurses in my office are neat freaks. (That's what messy people call organized tidy people)