How can I say anything?

Antikigirl, ASN, RN · Oct 17, 2006

Proactivity hon! Make goals on something else other than weight. And most times the benifit of weight loss happens and when it does...the patient is happy!

Focus on the positives of the treatment as it stands..and weight either plus or minus as a side effect...and use my facial features or their own reaction as a sign on how to continue with it....

Remember...you as a lone RN are NOT going to make a 100% change of that persons weight! It will take teamwork and help outside of what you can do in your limited time...your goal should rationally be...hey, this would be a very good thing...let me help you and teach you if you wish how to do it outside of here dependant on situation.

Also remember that people that are very overweight do have changes that happen to their bodies to adapt to being overweight (not necessarily good ones..but must respect they are there), so these changes must be done gradually! You can't be there for all of that...so if the situation presents itself...offer help outside the hospital or someone that does know of those resources...give them to her..and let her choose!

jojotoo, RN · Oct 17, 2006

I got an admission the other day. A 57 yo female, 5'3", 370#, cellulitis in her bil lower ext., Major Depression, COPD, DM (uncontrolled, newly dx'd), HTN, hyperlipidemia, and a lot of other dx to go with.
I want to help this woman but how can I say anything to her about her weight when it is the source of her depression without making her depression worse?
Any suggestions would be helpful. Thank you!

How do you know that her weight is the cause of her depression? And not just a contributory factor? Overeating/ weight gain AND anorexia/ weight loss are both signs of depression. I can assure you that the patient is quite aware of her weight and the problems that it is causing her. She's probably had quite a few people point that out to her - family, other health care professionals. I would suspect that if you bring this problem up, she will tune you out and then also be resistant to any future teaching from you (DM, wound care). But if SHE brings it up, that's a different story.

If you feel that SOMEBODY has to say something, have her MD order a diet consult and a psych consult. I think that it is very important that she see her nurse as a non-judgemental, supportive teacher so that she will be receptive to what you have to offer her.

Tweety, BSN, RN · Oct 17, 2006

It's a shame that we as nurses can't broach this subject without seeming judgemental. However, it's such a delicate subject in our society if we even try to talk about it among ourselves as nurses it's "I'm an overweight nurse and how dare you judge!" So we simply ignore it.

Which is basically my approach. I support the patient, and try to send the message that I'm not there to judge, that I care about the person they are exactly as they are, and if they want to talk I'll talk. Otherwise, I'll do the current medical practice of putting out the fires and leave them to their own choices. Because as was mentioned above, the patient knows she's overweight, no need for me to try to fix that.

RGN1 · Oct 17, 2006

I think you can tell early on if a patient wants to make changes to their lifestyle though & if that's the case then I think it is part of the nursing role to offer help. Doctors are the fix-em-up & send-em out brigade - our role can be much more subtle. We should take opportunities to help if the occasion arises & the patient shows willing.

It's the same with smoking & other such problems as well. If someone really wants help they will at the very least give off clues, if not pretty much ask flat out. Watch for the more subtle signs & if she "lets you in" then go for it.

Equally though you can't help if help isn't wanted so you also have to know when to put up & shut up. That's the lot of the nurse!

all4schwa · Oct 17, 2006

I want to help this woman but how can I say anything to her about her weight when it is the source of her depression

in my case my depression is the cause of my weight. when my depression is better treated, so is my weight.

unfortunately neither one is on the up and up at this point... :rolleyes:

beautifulb · Oct 17, 2006

I know, it is so hard to talk to someone about their weight. If the weight is due to overeating, it is so hard to change their weighs (oops, ways). Seriously though, if I have a pt. who is asking a lot of questions as to why they have diabetes, heart problems I will honestly tell them that part of it may be because of their weight. I don't say it in a demeaning way or a way that would make them feel guilty or uncomfortable, but instead in a way that is in an educational way. I actually have only talked to a handful of pts about this in my past 12 yrs of nursing. The pt's that I have talked to have been pt's that I thought would not be offended and that I had a good rapport with. But I agree, tread lightly.

weirdRN, RN · Oct 18, 2006

I work in a long term care/ SNF/ Rehab facility. Part of this person's reason for bieng in my care is her weight.

Actually, this situation for this patient is a chicken and egg kind of thing. I was doing a health history for the lady. She has been overweight all her life. She says she is miserable. She said her parents were always picking on her to loose weight. The more they picked, the more she ate. She said she lost a beau b/c he said he couldn't be with a fat woman. She said that was when her weight went way up.

I did not directly broach the situation as a societal judgement thing. I broached it through the context of a health history. Onset, precipitating factors ect. I asked directly: Are you happy with your current weight? She began to cry and said she was terribly unhappy. I sat with her for over an hour just listening to what she had to say. After she had poured her heart out, I hugged her and told her I would take more time to talk to her tomorrow, that there was a lot to learn and a lot to do.

I have a lot of education to do with this woman. I have tons of info and lots of moral support to bring her tomorrow. I am looking forward to meeting this challenge and helping her get through this crisis.

ceecel.dee, MSN, RN · Oct 19, 2006

"Why do you think you are having such health issues now?", and go from there.

Obese people KNOW they are obese.