How do you talk to patients with weight issues?

lmccrn62, MSN, RN · May 5, 2013

I don't think it's not because the don't care but they are unable to help themselves. When the are at extreme weights telling them they are killing them selves isn't helpful. They need very structured programs that include psych and years if help.

Jory, MSN, APRN, CNM · May 5, 2013

Uh, that wouldn't exactly be my first choice of wording. I take it you are relatively new.

The weight of the patients on both ends of the spectrum is their way of getting control over something. That something is food.

You won't get through to them by addressing the weight...I can assure you they don't care. The focus needs to be on WHY one is probably not eating and the other is eating too much.

Find out why they have an unhealthy relationship with food, make the appropriate referral and the problem theoretically should take care of itself.

MizzMo · May 5, 2013

First I'm not a nurse (yet! Got accepted into September program, very excited)

I've always found weight to be a very difficult subject to discuss with people when you're concerned about their health and well being. However from my experience i often find that it's really not the weight that's an issue but more so being over/under weight a symptom of something else.

I know someone who is morbidly obese and has been for probably 15 years. I wasn't surprised when she recently told me she was diagnosed with depression and anxiety. I think it's often a cycle. When she was a child she experienced a traumatic event which started her depression. She turned to food for comfort and gained weight. Weight gain caused more depression. More comfort eating etc.

I've known quite a few people with other eating disorders (anorexia/bulimia) and again it's usually not about weight but more about control, depression, anxiety etc.

I found when i was younger that some of my friends would feel like their lives are out of control so they grasped onto the idea of controlling the number on the scale.

Sometimes eating disorders are a form of self punishment. I suppose in the same way some people may cut themselves and get a rush of endorphins, some people may feel that rush and "high" when they gorge and purge.

Anyway. I was going to say perhaps try talking to your patients about other issues in their lives. I don't know what is/isn't appropriate to ask a patient (again I haven't completed school yet so I'm new to all this). But I would be more likely to approach it as a symptom. Perhaps ask how old they were when they started gaining/loosing weight. Then ask if any significant events took place at that point in their life.

If they give you excuses for their weight, as much as it is excuses, hear them out. Kind of "read between the lines".

OCNRN63, RN · May 5, 2013

This is a really hot, hot topic. I would check the search function; there have been numerous threads about this. (No, I'm not being mean, I'm just saying the OP will find a lot of info right away without having to wait for replies to her thread.)

Caffeine_IV · May 5, 2013

I don't say anything unless they bring it up. I find it is best to meet people where they are with whatever issue they have. Scare tactics don't work if they aren't receptive atall Obese people know they are obese. If they want to talk about weight, I give encouragement and tips if I have any but I don't burden myself beyond that.

twinmommy+2, ADN, BSN, MSN · May 5, 2013

If its someone who is obese (not to the extreme of 650lbs) they normally know they are. You have to find that time when they are asking questions and seem open to a conversation about their disease. I won't come right out and start off with "you know you're killing yourself right?" but will have a conversation leading up to it and then give them options that are available at the facility I work with or give them information to read about if they are interested. They may need some real life examples of people who were where they are now to give them the push they need to start loosing weight.

In regards to the 70lb person, and the 650, they both need mental health help and a long period of rehabilitation before they can function normally.

Not_A_Hat_Person, RN · May 5, 2013

I'm obese. Have been for a long time. I'm very aware of my weight, and I do what I can to control it. If losing weight was easy, no one would be overweight. No one ever lost weight because of concerned lectures, just like no one ever quit smoking because of concered lectures.

If the weight is directly affecting their health, talk to them about it. Otherwise, leave it alone unless the patient brings it up. A lifetime of mental health issues and poor eating and excercise choices are not going to be solved in a 3-day hospital stay.

jadelpn, LPN, EMT-B · May 5, 2013

Yikes! However well meaning "you know you are killing yourself" sends up the biggest wall between you and your patient that you could ever imagine. Most people on each end of the weight spectrum are well aware of their eating issues. Perhaps the goal IS to kill themselves, but never the less, no one is one extreme or the other in a day. This is years and years of disordered eating. Patients need a multi-disciplined approach to relearn how to eat. Eating disorders are so difficult in that we all have to eat, there's no abstinence to this addiction.

If a patient says "I can't lose weight" or "I can't keep weight on" I would really be clear that you are not judging, you would like the patient to function at the highest level possible. Tell them you will speak to the MD about some different disciplines that can come in, talk and try to make a plan.

But don't lecture. It is a very sensitive topic for a number of patients, and the goal is function not judgement.

CrystalSSA · May 5, 2013

Thank you for your answers, and I will search the topic!

greenbeanio · May 6, 2013

This is such a sensitive topic that it's not one that is fruitful to discuss until the patient is ready and brings it up. So what I usually do is start talking in a general way about constructing a self-care plan and ask the patient what they are working on or know they need to work on. If they don't bring it up, then I assume that they are either not ready for change or not ready to discuss it right now. It's not something I bring up unless they bring it up. Because that is a rapport and trust breaker rather than builder, and then change is even less likely.

If you're really interested in how to help people make change in their lives, then google "Stages of Change" or "Transtheoretical Model of Behavior Change" (Prochaska and DiClementi) and then "Motivational Interviewing" (Miller and Rollnick) for an introduction to this approach. Better still, read the books "Changing for Good" and "Motivational Interviewing: Preparing People to Change". Hope this helps.

Annaiya, NP · May 6, 2013

You say that you don't work in a psych unit, so I'm guessing you're either a floor or ICU nurse. My experience is these jobs do not allow enough time, nor are we properly trained to "counsel" psych patients. My approach has always been to try my best to establish a good relationship with the patients, get them talking and comfortable with me. I don't directly address the issue unless I need to ask them a specific question about it. When I only have 12 hours with them, and a ton of other things to do, I figure the best I can do is make them feel safe and comfortable until they can be transferred to a psych unit.