Why not question pts about their eating habits?

Long Term Care Columnist / Guide · Dec 18, 2006

I can tell you right off what the problem is with "assessing" overweight patients' nutritional status (besides the obvious fact that many people will lie, deny, under-report, or simply refuse to talk about their eating habits): the average health insurance plan does NOT cover diagnosis and treatment of obesity. They often won't even pay for a nutritional consult, let alone medications, exercise programs, or surgery. What's the point of putting a patient through a potentially humiliating process when there is zero support to help him/her make the necessary changes?

Please don't tell me that all one has to do is "take responsibility", e.g. eat less and exercise more. If it were that simple, there would be no fat people, because NO one would choose to be overweight in a country where the picture of physical perfection is one of genteel emaciation, yet fatty and sugary foods are found in gross abundance on every street corner and heavily advertised.

I've been on every diet in the universe and a few of my own invention, exercised to exhaustion, and yet my weight still hovers around 300 pounds no matter what I do. I know what I'm supposed to eat, and in what amounts I'm supposed to eat it. I can eyeball a portion of any food and know exactly how many calories, carbs, and fat grams are in it. I can recite food facts until I'm blue in the face. What I CAN'T do is stay on a 1200-calorie diet for longer than a few months at a time........eventually, I get tired of starving and feeling deprived, and I lose control. Yet my insurance will not even consider paying for the surgery I desperately need to shrink my stomach so I can't hold as much food, even though I have comorbid conditions such as HTN and arthritis that are shortening my life and affecting its quality.

Sure, in theory, it's a great idea to "assess" patients' eating habits. In practice, however, it's pretty pointless without backup from the medical community, not to mention changes in the insurance racket (excuse me, industry) that acknowledge the role of obesity in disease and death. :madface:

rninme · Dec 18, 2006

Yeah I hadn't heard that either

Pt's with COPD should avoid raw veggies, carbonated drinks .... anything that has the potential to cause 'gas'....which can interfere with diaphragmatic excursion. 'Bloating' pushes up on the diaphragm and makes it more difficult for the COPD patient to breathe, which exacerbates dyspnea. This is the same reason you should offer pt's with COPD 3 small meals and 3 snacks a day instead of three large meals.

Jabramac · Dec 18, 2006

There is one inherent problem with comparing weight issues to smoking or drinking. No every weight problem is related to poor diet or exercise.
For years, I was (and still am) obese. Because of my age, I was always told to eat better and exercise more. I have an aversion to most vegetables so therefore I know that my diet isn't what it should be. However, I did improve it with eating more fruits and more of the vegetables that I will eat. I also got out and exerciesed more. Results, I could only lose about 25 pounds.
I kept food diaries, I cut my caloric intake to 1200 a day, I watch my carbs, I stopped sweets. I walked everyday, I went to the gym, I did yoga. Nothing would help my lose anymore.
It wasn't until a routine pre-op blood test that I found out I had hypothyroidism. I'm talking my TSH was triple what it should have been.
Since starting on the levothyroxine, I have lost close to 30 pounds with NO OTHER change. I can't lose any now that I'm pregnant, but I have kept my gain to under 5 pounds.
My point in this rambling is that with smokers you know what the problem is..it's their addiction to the cigarettes. With weight, you can't be certain it's always their fault.
So, tread lightly in asking these questions...You may accidentally offended someone who is already at wit's end to lose weight.
tvccrn

I can tell you right off what the problem is with "assessing" overweight patients' nutritional status (besides the obvious fact that many people will lie, deny, under-report, or simply refuse to talk about their eating habits): the average health insurance plan does NOT cover diagnosis and treatment of obesity. They often won't even pay for a nutritional consult, let alone medications, exercise programs, or surgery. What's the point of putting a patient through a potentially humiliating process when there is zero support to help him/her make the necessary changes?
Please don't tell me that all one has to do is "take responsibility", e.g. eat less and exercise more. If it were that simple, there would be no fat people, because NO one would choose to be overweight in a country where the picture of physical perfection is one of genteel emaciation, yet fatty and sugary foods are found in gross abundance on every street corner and heavily advertised.
I've been on every diet in the universe and a few of my own invention, exercised to exhaustion, and yet my weight still hovers around 300 pounds no matter what I do. I know what I'm supposed to eat, and in what amounts I'm supposed to eat it. I can eyeball a portion of any food and know exactly how many calories, carbs, and fat grams are in it. I can recite food facts until I'm blue in the face. What I CAN'T do is stay on a 1200-calorie diet for longer than a few months at a time........eventually, I get tired of starving and feeling deprived, and I lose control. Yet my insurance will not even consider paying for the surgery I desperately need to shrink my stomach so I can't hold as much food, even though I have comorbid conditions such as HTN and arthritis that are shortening my life and affecting its quality.
Sure, in theory, it's a great idea to "assess" patients' eating habits. In practice, however, it's pretty pointless without backup from the medical community, not to mention changes in the insurance racket (excuse me, industry) that acknowledge the role of obesity in disease and death.

It seems to me tht these are all reasons WHY we should be placing more importance on this. I obviously see that a nursing assessment is not enough, it needs to be followed up on and other medical professionals need to be proactively involved, especially physicians.

There absolutely are other reasons that cause obesity, as others have pointed out. That fact only brings out more the importance of investigating to see if there are other cuases of it.

Insurance payments are a major barrier. But insurance covrerages will never change if the medical profession does not demonstrate that we feel it is an important issue. But, if the medical field can show that it is important, over time things may change with that. In addition, although I know many over weight people know they are over weight and may not want to hear about it, there are still many who want help, but don't know what/who to ask. As someone was saying there is such an over abundance of weight loss information on TV, but all this information IMHO adds more confusion. Especially when so many different "diets" contradict each other. Not to mention there are certain diets that should not be undertaken with out consulting a physician first. We should be there to help sort out this information.

I am proud to have lost 40 lbs, but I feel like I did it on my own, and did not start the process nearly as soon as I should have. I would have loved if 6 years ago when I had a physical and I asked the doctor what those new strange marks were on my body and he explained to me that "those are stretch marks. You must have gained a lot of weight," that he would have followed that up with "lets investigate more, see my friend, the nutritionist, and check back with me." With the possibility that some may not follow through there should be reinforcement that we are a resource to help. "If you decide not to act on this at this time, please remember that we are always here to help when you do need more assistance with your weight."

gentle · Dec 19, 2006

Can you elaborate on this? I didn't know raw vegetables could aggravate dyspnea.

I have seen dietary send "newly admitted exacerbation copd patients" a nice thin slice of roast beef with green beans and a salad. the patients are already working at breathing. They haven't had enough steroids yet to get them back to baseline, hence the hospitalization.

IMHO, it is during this moment that it would be better for these patients to temporarily try a full liquid diet. Then as previously stated return to smaller frequent meals. Our dieticians are wonderful. They do try to send our patients appropriate meals; however, nothing is perfect.

I perform my teaching regarding the salads, vegetables later during the hospitalization. The goal is to help them understand how to cope with dyspnea at home during times of a cold or during allergy season. Maybe spooning a carnation instant breakfast shake isn't perfect, but, I hope it will decrease the frustration and anxiety associated with breathing during this time. (After all, they don't always return to the hospital because of a cold. Sometime they manage to stay at home with help from the doctor's office. Well, at least, this is what I believe. I could be wrong though.)

Thank you rninme.

I must confess that I didn't know all the information you shared. I just noticed that my patients became more dyspneic if the vegetables weren't well cooked and if the food was too difficult to consume. The aforementioned has just been my way of trying to help.

Ruby Vee, BSN · Dec 19, 2006

probably because we don't want people to feel bad....it's like kids in school that get ribbons on field day because we don't want them to feel bad because they didn't win...just a thought.
anywhoo, my point is, we have gotten to where we are politically correct to a fault. no one is responsible for thier own consumption anymore.................
linda

actually, it seems that weight is the last bastion of discrimination left! it's not politically correct to discriminate based on race, religion, gender or sexual preference. but even on this board, no one thinks twice about calling another nurse "unhealthy" or a "poor example" if he or she is overweight. there are rabid threads about how overweight nurses shouldn't be taking care of patients because they're setting such a bad example. our society may be overyly politically correct, but not about weight. at least, not yet.

UM Review RN, ASN, RN · Dec 19, 2006

actually, it seems that weight is the last bastion of discrimination left! it's not politically correct to discriminate based on race, religion, gender or sexual preference. but even on this board, no one thinks twice about calling another nurse "unhealthy" or a "poor example" if he or she is overweight. there are rabid threads about how overweight nurses shouldn't be taking care of patients because they're setting such a bad example. our society may be overyly politically correct, but not about weight. at least, not yet.

right.

but "weight issues" discrimination is only about people perceived as fat. no one says anything to the anorexic (they have a right to refuse food), the bulemic (that's an insured medical condition).

if i say "weight problem" you think "fat." if i say "eating disorder," you think anorexia or bulemia, no matter how many pounds too thin that person may be.

GardenDove · Dec 19, 2006

Hey, I thought anti-Catholicism was the last acceptable prejudice? At least that's what they say on some internet sites. Or was it anti-Mormonism?

Just kidding, but everyone seems to be the victim these days and claiming people are discriminating against them. I've noticed, though, that discussion of overweight is a bit taboo, I've noticed that from posting on the internet, since I don't really discuss it much in real life since it's a taboo for a thin person to bring up the subject. My overweight friends seem to discuss it all the time. Sort of like the 'N' word and Black folks. I've heard it used within the black community, but I would never use it.

gauge14iv, MSN, APRN, NP · Dec 20, 2006

Pt's with COPD should avoid raw veggies, carbonated drinks .... anything that has the potential to cause 'gas'....which can interfere with diaphragmatic excursion. 'Bloating' pushes up on the diaphragm and makes it more difficult for the COPD patient to breathe, which exacerbates dyspnea. This is the same reason you should offer pt's with COPD 3 small meals and 3 snacks a day instead of three large meals.

Heh - for the limited calories many COPD patients eat - thats probably the last thing Id be worrying about, I'd just be happy if they ate adequate calories to support their increased work of respiration! However, for some - that might be a valid concern. Can't say that it would be high on the list however.

leslie :-D · Dec 20, 2006

Heh - for the limited calories many COPD patients eat - thats probably the last thing Id be worrying about, I'd just be happy if they ate adequate calories to support their increased work of respiration! However, for some - that might be a valid concern. Can't say that it would be high on the list however.

there's something to be said for the increased work of metabolism also.

i personally think an advanced copd'er would notice the difference between digesting 3 large, heavy meals vs 6 lighter, smaller ones.

leslie

gauge14iv, MSN, APRN, NP · Dec 20, 2006

there's something to be said for the increased work of metabolism also.
i personally think an advanced copd'er would notice the difference between digesting 3 large, heavy meals vs 6 lighter, smaller ones.
leslie

I don't doubt that but most of them eat like birds in the advanced stages. Getting them to eat anything remotely healthy is an accomplishment. Ensure just isn't so appetizing :)

Lizzy6 · Dec 20, 2006

Why is it that, on our assessment intake, we always question pts about cigarettes and drinking, but there's not section about their eating habits? I ask this because I just watched the movie Supersize Me, which you probably already know is about the dangers of fast food.
We all know that obesity is a huge public menace. Why don't we start emphasizing it more in our pt education? For instance, why not ask pts how often they eat fast food? According to the movie, our consumption of fastfood is directly related to our weight. The guy in the movie also had dramatic changes to his bloodwork lab values.
I think it's high time for us to start including that in our pt teaching. I also think hospital cafeterias should quit offering junk food themselves. This epidemic is the cause of so many chronic illnesses, it's no joke.

I think it is a very good idea. I saw the Super Size movie and actually thought it was quite interesting.

We already question pt's regarding their diet in regards to their diagnosis. But, as another poster mentioned, some of our pt's who live below poverty and do not have access to a car, let alone live near a market, often eat fast food. Also, the fresh fruits, veggies and lean means are often too expensive for them to purchase on their income. America is supposedly the most obese/over weight country in the world. Go over to Europe and you'll find that food and drink portions are a fraction of the size they are in the U.S., as well as other countries. Also great emphasis is placed on exercise and a healthier lifestyle in other countries as well. Good topic to discuss.