Not much on the telly tonight, so I ended up watching "My 600 lb. Life" --- the show where folks go to Houston for bariatric surgery… some successful, some not so much.
After watching a couple episodes, I'm left with some mixed feelings.
Is super morbid obesity:
1) a disease along the same lines as alcoholism and drug addiction?
2) a lifestyle issue (poor food choices, lack of exercise, laziness)?
3) a mental health issue (poor self esteem, depression, etc.)?
What have you seen in your practice re: number of super morbidly obese admissions, bariatric surgeries, disease processes related to super morbid obesity, difficulty caring for super morbidly obese patients.
There are also people who are marginally overweight and just don't care. They enjoy the food more than they enjoy being thin.
This is me.. I LOVE my food. Sure I should lose about 20-30 pounds and talk of it. Do I think it will happen anytime soon... n-o-p-e. I like my food and right now my schedule is beyond crazy. I am getting pulled in 1,000 different directions between work and school. Exercise and diet just aren't my priorities.
It takes more than a few bad days to reach 600+ lbs. Those people have many factors that lead up to that weight. Many of them psych related. I cannot imagine being that weight. Just trying to move is an extreme work out. Many judge those people harshly and see nothing but fat slobs. I see someone that needs a lot of help.
It's not all bad though, sometimes obese patients are the most funny, and sadly they can even make fun of themselves.
It is very common for those with low self esteem (low self esteem being a major contributor to overeating) to develop a habit of using humor as a defense mechanism. Be the funny person and people will like you. That in itself becomes dangerous because as the insecure person "puts on a show" and people enjoy it, the less they feel about themselves because (in their mind) it is the show that they are putting on that people like and without the show, no one would like them, further eroding their self esteem. Think Robin Williams, Chris Farley, Jim Belushi.
I'm working part-time as a school nurse and the research I've been studying shows that we are "fatter" nowadays. I'm headed to work so don't have time to link to studies but I think people can agree (maybe?) that there just weren't that many 600 pound people around 100 years ago. Or 400, or 300, or maybe even 250.
I see kids come to school with microwave pizza, Hot Cheetos, cola, Cup O'Soup, etc. School lunches for the most part are not that healthy and even when they are, most of it goes in the trash.
Some teachers have large container of cheese puffs to give out as "treats" for kids who do well on some subject in class.
I have a photo of a mom pushing a stroller with a pretty large 18 month old who was asleep with his hand in a Cheetos bag and the other hand was covered in yellow Cheetos "cheese". Another mom came to see me with a toddler who was drinking orange soda out of a baby bottle.
Many kids have a mouthful of cavities - and then come in with metal crowns.
Serving sizes have increased in restaurants and we feel cheated if the size is smaller.
Etc.
To the original point, obesity can be attributed to some genetics (diabetes or thyroid issues) but those can be treated in a way that keeps you from getting obese.
Obesity can be attributed to mental issues either that you are born with or that are situational - so many broken homes nowadays and kids sit in front of video games instead of interact with family and go outside to play in the yard.
I'm not in complete agreement that this is related to true "addiction" though. I think it is lifestyle choices that lead into illnesses (diabetes) or mental issues (depression).
This is me.. I LOVE my food. Sure I should lose about 20-30 pounds and talk of it. Do I think it will happen anytime soon... n-o-p-e. I like my food and right now my schedule is beyond crazy. I am getting pulled in 1,000 different directions between work and school. Exercise and diet just aren't my priorities.
I read a study recently that suggested we have a finite amount of willpower, and that when one area of our lives demands a lot of willpower, we tend not to exercise it in a different area. It sounds like that's what you're describing. I found the study very interesting, because people always talk about willpower and discipline as if they are bottomless resources.
(Not saying this accounts for every individual who is overweight, just that it seems to apply in some cases.)
I read a study recently that suggested we have a finite amount of willpower, and that when one area of our lives demands a lot of willpower, we tend not to exercise it in a different area. It sounds like that's what you're describing. I found the study very interesting, because people always talk about willpower and discipline as if they are bottomless resources.
(Not saying this accounts for every individual who is overweight, just that it seems to apply in some cases.)
This is an insightful idea. When the fried chicken places are everywhere, pumping out delicious smell, it does overwhelm willpower, doesn't it. Similarly, the Framingham study (a large longitudinal study over 40 years IIRC) showed that when one's friends and family gain weight, it is much easier to gain weight right along with them. We tend to follow the path of least resistance, perhaps because we can only resist so much.
Specializes in Palliative, Onc, Med-Surg, Home Hospice.
Without a doubt, it is a lifestyle issue more than anything else, but yes all three factors play into their disease. Obese people will say that they are at a genetic disadvantage 9 times out of 10 as they polish off their third helping of lasagna and bread sticks. Name the genetic disorder that makes adipose tissue and calories spontaneously appear. Sure, people have different metabolism rates and family history of obesity...well then, prepare to be at a disadvantage and choose foods carefully, exercise daily and you can beat the odds.
As far as what have I seen in taking care of obese patients? I've seen many terrible things: unable to do effective chest compressions because of the layers upon layers of fat over the sternum, they usually take a whole bucket of pills in the morning to control their multiple co-morbidiities, lower extremity ulcers/wounds that eventually lead to gangrene and amputations because their diabetes left them with neuropathy and a huge gut so that they couldn't even see their legs unless a friend takes a picture for them, bedside commodes/beds/chairs/CT scanners/MRI machines/doorways/cots/etc that are too small for the morbidly obese patient, staff injured trying to help the obese patient transfer or simply turn in bed, really everything is worse when you have an obese patient to care for because they are so taxing of your time and resources. They put me in a sour mood and I have to force myself to smile when I take care of them, but I do have compassion for all of my patients. It's nice to be able to be honest with my private thoughts, universal to nurses, on this forum. All of the nurses that I have ever worked with have negative things to say about the amount of work it takes to care for an obese patient, unless the nurse is also obese. In that case, we don't discuss the hypocrisy. If they want to become like the obese patients that are slowly killing themselves, then I can't stop them. At least they are in a career that warns them of the cost.
Sadly, the obese population is costing this world a BUNCH of money in new equipment needs. It is ridiculous and their hospital bills should reflect the extra manpower and equipment needed to care for them. I know one nurse who had her wrist SNAPPED when the obese patient was too much for her to handle as she tried to turn him in bed. He flopped back over basically on top of her. She was on short term disability for months after her surgery. An obese patient could suffocate a nurse, so precautions should always be used, like putting on a nasal cannula with high-flow oxygen before lifting skin folds to assess for yeast, especially beneath the behemoth pannus, in case it comes crashing down and knocks out the nurse, suffocating her as a cloud of yeast spores fill the air.
It's not all bad though, sometimes obese patients are the most funny, and sadly they can even make fun of themselves.
From Urban Dictionary: Pannus- A large roll of abdominal fat which can extend anywhere from the genitals to, in some cases, all the way past the knees.That woman is so fat, she has her pannus tucked into her pants!
And you know this how? You have proven that you have a prejudice against people who are obese. You assume they are lazy, eat wrong, etc. So, how do you know all this? Have you researched it? Or have you spoken with everyone? Or do you just want to live in your own little ivory tower and judge?
Specializes in Palliative, Onc, Med-Surg, Home Hospice.
The cheapest "food" products are often the very things which promote weight gain and obesity.
I did research on food deserts and the costs of healthy foods and you are quite right. Healthy foods are not low cost. Produce, lean meats, etc tend to be harder to access for low income people and if you live in a food desert, double so. So, you buy what you can. Some communities are trying to combat that with mobile farmers markets, and inexpensive produce. It helps but it is not enough.
Specializes in Critical/Acute Care, Burns, Wound Care.
@CelticGoddess
Because calories and adipose don't appear out of thin air. OBVIOUS!! Several others have said similar to me on this very thread because we know that poor dietary choices are the principal cause of obesity.
Specializes in Palliative, Onc, Med-Surg, Home Hospice.
Let me explain a few facts to you: I am obese. I used to weigh in at 105, at 5'5". I have asthma. I was put on dexamethasone, prednisone, and solumedrol off and on through out my adulthood. I gained weight. I have a thyroid problem. I could eat a salad and gain weight. I exercise and I gain weight. I have slowly lost weight but this winter have again been on the steroids, so my weight loss has stalled. I DO NOT EAT POORLY. have you got it yet? It is NOT a lifestyle choice. It is a combination of factors.
I would be very careful about throwing stones while living in a glass house. And you do know that they say about people who assume.
Specializes in NICU, PICU, Transport, L&D, Hospice.
@CelticGoddess
Because calories and adipose don't appear out of thin air. OBVIOUS!! Several others have said similar to me on this very thread because we know that poor dietary choices are the principal cause of obesity.
Keep it real.
You KNOW that, eh?
Perhaps you could post links to the credible research and data which informs that OPINION.
If those 3 conditions of addiction, lifestyle and mental health are the mostly likely underlying contributing factors, where is the line of entry drawn? As in how many lbs overweight until it goes from defensible thyroid/medication/major illness/s to addiction and mental health problems?
xoemmylouox, ASN, RN
3,150 Posts
This is me.. I LOVE my food. Sure I should lose about 20-30 pounds and talk of it. Do I think it will happen anytime soon... n-o-p-e. I like my food and right now my schedule is beyond crazy. I am getting pulled in 1,000 different directions between work and school. Exercise and diet just aren't my priorities.
It takes more than a few bad days to reach 600+ lbs. Those people have many factors that lead up to that weight. Many of them psych related. I cannot imagine being that weight. Just trying to move is an extreme work out. Many judge those people harshly and see nothing but fat slobs. I see someone that needs a lot of help.