Nursing makes me hate fat people

Nurses Relations

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Ok, first off let me say I know this topic will probably generate a lot of strong opinions. I will also state that I am not a perfect person and don't take care of my health 100% so please don't think I am trying to be an elitist or something in posting this.

Disclaimer aside, I want to know if other nurses sympathize with me.

I am going to try and be as brief as possible in my story. First of all we have 2 resident patients on my floor that have been there over a year. They are obese and have suffered strokes. They require total care. These particular patients are about 250lbs and 1 has hemiparesis and the other has use of 1 arm (not sure what to call that).

The patient that really has me over the edge is one that is over 300lbs, vent dependent, unstageable sacral (of course, no one wants to turn this patient which is a whole other issue), lower extremities contracted with knee replacements, on dialysis, PEG feeding, restrained because she pulls any tube in sight, and contact isolation for c diff and acenotibacter. This patient has been on the floor for 3 months so far because no LTC facility will take her (understandably).

Not to mention all the cellulitis patients and other comorbities we deal with on admissions.

I am a 25 year old male and starting to feel back pains. This really has me over the edge as a combination of lazy/uneducated coworkers and heavy (literally) care.

Please share how you deal with these kinds of patients and what I can do to reverse my growing animosity towards these patients.

DCrux, you could at least try to make an reasonable analogy. You're comparing brown hair to obesity? Seriously? Weight CAN be lost in the vast majority of the population. What do you think the genetics affect? Metabolism? Medical conditions like hypothyroidism, Cushing's, etc, sure - but those are the minority and I stated before that they are not the population of people I am referring to.

Do you think it's any coincidence how the obesity epidemic has spiked in the last 50 years? It's laughable to see this type of obesity myth supported by a healthcare professional. We live in a society where too many people bend over and ask others to do for them what they won't bother to do for themselves. A society where too many people rely on other people's money (welfare) for the wrong reasons. As nurses, as I said, we have to treat our patients with respect and we owe them our service, but to ignore this greater reality is to live in a fantasy land.

Allow me to clarify on my last statement. By "people who can't help themselves" I meant "people who won't help themselves." I admit that statement should have been clearer. You cannot tell me that you haven't seen plenty of patients who are there because they just didn't take care of themselves.

To someone else who asked - as I said, I treat my patients with respect almost universally. That said, I have much more patience for the overweight woman who insults our staff because in reality she's very anxious about her upcoming (very painful) wound care treatment than I do for the drug seeker who curses us out and threatens us with harm the second we delay his morphine for "chest pain."

I think the place where most of the disagreement is at in this thread is the crux between treating patients on your floor and treating patients for their obesity.

I do have private thoughts about the fact that the majority of Americans are carrying unhealthy fat on their bodies and as a direct consequence of this, we spend a massive amount of money to treat conditions these people wouldn't even have if they could lose weight and keep it off.

HOWEVER, you can never tell which ones have weight because they're lazy and which ones have weight because they're on meds or have a messed up hormonal system or whatever other plethora of uncontrollable things. Usually it's a pretty good mix of both. In my hospital, I work ortho. It would be so easy to judge the patients in there for spine and knee replacements, because those are usually directly related to carrying that weight. But that is not my job. I don't have time to go back through their records and see what their history is, whether they are "at fault" for their weight or not. If they go see a doctor, it'll be her job to look at the facts and determine how much the patient need to take responsibility for and how much she as a medical professional needs to find a medical solution for. MY job is to provide unbiased care and get them back on their feet.

So, in short, yes, weight is a problem for many Americans, and it doesn't need to be swept under the rug. The last thing people carrying extra weight need is the healthcare profession making excuses for them instead of treating their obesity-related problems. But it's not my job to treat that specific problem when I see them. I have neither the resources nor the knowledge to accurately judge them for that. It's my job to help nurse them back to health after a major surgery/injury, and that's what I do.

To deal with your animosity you need to be less judgemental. The day will come that you will be in a bed dependent on the care of someone else (unless you are one of the lucky ones). Would you want them to look at you through the eyes that you use to see your patients?

So you're comparing for example cancer or elderly patients, situations that are out of the patients control, with obesity, a situation where the patient can, or at least could have, done something? Big difference.

Specializes in PCCN.

^^^

What about those who are on chronic steroids- they CAN"T help it.This was explained earlier.

I know this certainly is a small percentage, but it is there.

Mgmt needs to recognise the fact that it is what it is , and we need more staff to care for pts like this, irregardless of how they got there.

If we take this mentality, wait til we get more pts to treat that have destroyed themselves with krokodil. I'll take the obese person, thank you.

Specializes in Oncology; medical specialty website.
Esme, I have a general understanding of your position and I feel for your situation, but you are not an example of the patient I am talking about. I stated that obesity is a "general" sign of laziness and I still stand by that statement; ie, it does not automatically apply to everyone who is obese. I am very sorry to hear your story, but your situation is simply not what I am referring to. The vast majority of overweight people in this country have much more control over their situations than you do; and unfortunately, they are clogging up the healthcare system.

My issue with this is mostly practical. I treat my patients with respect as long as they are generally respectful back, and I even give them the benefit of the doubt much, much more often than not. I provide them with the best care that I can regardless. But there is no way to police someone's feelings about people who can't take care of themselves.

You should be treating all of your patients with respect, even the ones who don't give you respect in turn. I've had plenty of patients who were flat-out nasty to me, and I still was respectful to them.

​I would be willing to bet you've had plenty of patients in Esme's situation, but until you get to know their story, they're just, "That fat chick in room 547."

Specializes in Pediatrics, Emergency, Trauma.
So you're comparing for example cancer or elderly patients situations that are out of the patients control, with obesity, a situation where the patient can, or at least could have, done something? Big difference.[/quote']

Not always.

Certain cancers, including lymphoma, breast CA, removal of lymph nodes, chemo and radiation treatments can cause side effects of weight gain or obesity. Elderly pts who have arthritis and have co morbidities such as medication use for anti epileptics, hypothyroidism, and mental health issues that cause weight gain; perhaps push to the point of obesity.

We all throw around "a small percentage"; however, it the grand scheme of things, it's a significant amount of the population; not 5-6 people; add a couple of zeros behind that; and it's enough in a given area or across the nation.

This discussion has made me look further into the ACTUAL illnesses and diseases that cause obesity; we have genetic issues such as insulin resistance; that NOT an excuse :no: ; the human genome project gave rise to the many causes of this epidemic; it's not just "stuffing" one's face; these are REASONs not excuses.

Also, if there is more access to unhealthy foods because they are cheaper; then there's a income gap and issue; a HUGE part of the Healthy People 2020; and for anyone who THINKS the SNAP (aka food stamp program) is a free ride; THINK AGAIN; the money BARELY gives you enough to get nutritious food; many people are FORCED to get foods that are higher in simple sugars and salts to help preserve food longer because the monetary amount isn't enough. There have been income gaps for generations and it will get worse with the economic collapse; there are people who had incomes that were able to maintain a healthy weight; and many have given up certain food choices to afford medications; that's not a "small percentage" either :no:

Compare the prices at local stores/high end and low end supermarkets and see the quality of food that is available; or go into communities that have not had a supermarket in a GENERATION-I'm talking about 40 years; I live near communities that have JUST got a new supermarket and haven't had one in their community in that amount of time; that's NOT and excuse. :no:

Add that to having epilepsy, major depressive disorder, cancer, insulin resistance gene; and there you go; you have a high risk area who will be predisposed to obesity.

Here are few reasons where people who have diseases and illnesses that have a high risk of having obesity:

http://www.medicinenet.com/script/main/art.asp

?articlekey=56872

I'm sure there are more resources that can help us anticipate where are pt's stand; however; we still have an ethical duty to provide quality care; even if that mean getting risk management involved in order to provide the solutions that we need for our patients.

Food for thought....

Not always.

Certain cancers, including lymphoma, breast CA, removal of lymph nodes, chemo and radiation treatments can cause side effects of weight gain or obesity. Elderly pts who have arthritis and have co morbidities such as medication use for anti epileptics, hypothyroidism, and mental health issues that cause weight gain; perhaps push to the point of obesity.

We all throw around "a small percentage"; however, it the grand scheme of things, it's a significant amount of the population; not 5-6 people; add a couple of zeros behind that; and it's enough in a given area or across the nation.

This discussion has made me look further into the ACTUAL illnesses and diseases that cause obesity; we have genetic issues such as insulin resistance; that NOT an excuse :no: ; the human genome project gave rise to the many causes of this epidemic; it's not just "stuffing" one's face; these are REASONs not excuses.

Also, if there is more access to unhealthy foods because they are cheaper; then there's a income gap and issue; a HUGE part of the Healthy People 2020; and for anyone who THINKS the SNAP (aka food stamp program) is a free ride; THINK AGAIN; the money BARELY gives you enough to get nutritious food; many people are FORCED to get foods that are higher in simple sugars and salts to help preserve food longer because the monetary amount isn't enough. There have been income gaps for generations and it will get worse with the economic collapse; there are people who had incomes that were able to maintain a healthy weight; and many have given up certain food choices to afford medications; that's not a "small percentage" either :no:

Compare the prices at local stores/high end and low end supermarkets and see the quality of food that is available; or go into communities that have not had a supermarket in a GENERATION-I'm talking about 40 years; I live near communities that have JUST got a new supermarket and haven't had one in their community in that amount of time; that's NOT and excuse. :no:

Add that to having epilepsy, major depressive disorder, cancer, insulin resistance gene; and there you go; you have a high risk area who will be predisposed to obesity.

Here are few reasons where people who have diseases and illnesses that have a high risk of having obesity:

http://www.medicinenet.com/script/main/art.asp

?articlekey=56872

I'm sure there are more resources that can help us anticipate where are pt's stand; however; we still have an ethical duty to provide quality care; even if that mean getting risk management involved in order to provide the solutions that we need for our patients.

Food for thought....

You have made many good points and I agree with most of what you've said. AS IVE POSTED EARLIER-there is a big difference between overweight, as a lot of people are, particularly what you have pointed out adequately, and morbidly obese to a point where they struggle to ambulate, which is a part of my argument. Most people due to either various conditions which you've pointed out, poor diet, lack of education on the matter, or no time to exercise will carry around a bit of extra weight, the issue is people where it significantly impacts on their life. How many people that you've mentioned above have over 150kg? You mustn't think I'm making an argument of overweight people, that's absurd, its those in the extreme end of the spectrum.

Specializes in Pediatrics, Emergency, Trauma.
You have made many good points and I agree with most of what you've said. AS IVE POSTED EARLIER-there is a big difference between overweight as a lot of people are, particularly what you have pointed out adequately, and morbidly obese to a point where they struggle to ambulate, which is a part of my argument. Most people due to either various conditions which you've pointed out, poor diet, lack of education on the matter, or no time to exercise will carry around a bit of extra weight, the issue is people where it significantly impacts on their life. How many people that you've mentioned above have over 150kg? You mustn't think I'm making an argument of overweight people, that's absurd, its those in the extreme end of the spectrum.[/quote']

In my pt population over the 8 years I have worked as a nurse-65 %...maybe more who were obese were due to a co morbidity. I can only think of TWO pts who were WELL over 150 lbs and they were admitted with hypertensive crisis that were obese without any documented co-morbidities.

The others had a myriad of issues; mainly due to circumstances as I stated above; had genetic predisposition, many had autoimmune disorders, co morbidities of organ failure due to addiction and tried to quit and gained the weight and has the organ failure; lymphomas; epilepsy, mental illness. Hx of cancer, in remission.

One gained weight after a traumatic amputation due to caloric needs during his major medical injury, was on antidepressants and anti-psychotics; in addition, MS, Spinal Shock and Spinal Cord Injury-people we like to call "old quads."

I am in a position where I track my past weight gain an nutritional status more closely than I ever before had to in any position; I work in LTC; the pts who are obese have medications that cause weight gain; one has a major stroke where this pt is severely paralyzed; she was svelte before the stroke; she has suicidal thoughts, and in addition she is on a great amount of meds that cause weight gain; yet keep her out of pain and without debilitating spasms; another has epilepsy; another has DJD; her medication management has meds that cause her weight gain; and she needs a great amount of caloric needs; that combination alone is not helping with their weight; but then again, risk vs benefits...

I get a variance of shapes and sizes; and maybe because of the population that I have worked with and the co morbidities that I encountered in the area that I clinically practice since nursing school made me well aware and equipped when caring for complex pt's what their history was in order to have a clear picture that a lot of obese pts have co morbidities well beyond that "idea"; one of our important pieces of our practice is to look at the pt individually and holistically; I have been in PLENTY of situations where I was scared for my back as I stated before; without the various lifts, mattresses and pt transfer sheets that were available; and a good amount of coordinating care; it wouldn't have been possible. :no:

I feel you. I hate to be ugly but it can be soooo frustrating when you have morbidly obese patients in your facility needing to be waited on hand and foot and yet they still are snacking and drinking soda. It's such a fine line to cross..with reimbursements directly affected to HCAPP scores and patient satisfaction. You don't want to be rude or upset the patient but so many times to I want to say "You shouldn't eat that, that's not part of your diet the Dr. ordered." but people are so sensitive to that subject and it can really rub them the wrong way. All you can do is give the best possible care, without judgment but also protect your body. Turn heavy pt's when you have extra help, don't try it alone.

Specializes in ER, ICU.

I'm just thrilled that I am the one standing next to the bed, rather than the one lying in it. If you can't safely move a patient to provide care, go find help or document why the care couldn't be done. These people are our bread and butter and are not going away. Without them there would be much fewer nursing jobs. Does a plumber get upset when he has to come fix your pipes? I'm not saying you should be happy these people are sick, but you should be happy that you get to take care of them. Happiness at work is largely in your mind.

Specializes in Medical Surgical/Addiction/Mental Health.

The only advice I would give is that you have only one back. If it becomes injured, you will become limited of what you can do. I always have help when turning and lifting heavy patients. Being a guy, I am generally helping other nurses to move patients. However, I have made it clear that I am not there to do all of the heavy lifting. I am happy to help, but the two of us signed the same job description. In other words, the other nurses need to be able to help move a patient up in bed too.

While I understand it is a busy floor, you really should be asking for help. If your facility is short-staffed, think of how short-staffed it will be when you’re out on short-term and long-term disability (proving you followed all proper protocols). I will venture to say that the insurance company may refuse to pay a claim if you did not have help lifting or moving a patient. If it is written in your facility’s policy to have help moving a patient, I would strongly encourage you to do so (even if it wasn’t policy).

Good luck!

I said over 150kg, not 150lbs (I'm 240!), bit of a difference, but you are right, certainly more to it then people think of.

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