"if you weren't so obese, you probably wouldn't have 1/2 the illnesses you do"

[SNB1014]

i'm not sure if this is a vent or just an effort to regain my sense of nursing compassion, but WHAT HAPPENED to honest patient teaching? some of the RNs on my floor seem scared to address the obvious- being an obese smoker who seems allergic to any type of a healthy lifestyle is the main reason a majority of our patients are here, on our med/surg floor.

The main illnesses I see? uncontrolled Hypertension, uncontrolled type 2 diabetes, CHF etc. How can I be more compassionate yet still addressing the truth?

At least in the children, the odds of them being "at fault" for their illness are very, very slim- I'm considering a transfer to Peds.

How can I keep "the hunger" I started with when I see so many chronic diseases that are intrinsicly linked to poor lifestyle choices?

Please help. i dont want to become a RN who is there to clock in and clock out while secretly wanting to smack some common sense into them, lol

Thank you all, in advance.

[sistasoul]

I like to sit down with my patients who need a lot of health teaching and find out about their lives, where they are from, childhood, work, family etc... And ask them if they have questions about their lifestyle. Such as things that are static that cannot be changed, and things that can. I ask patients what they have tried in the past for their specific problem, be it smoking, obesity, drug addiction etc...I find out how motivated they are to make a change, and see if there is a consult that I can try to set up. Such as physio, psych, pharmacy, or a dietitian. This way the patient has the right to choose, and you have done your job as a health care provider to health teach and show that there are options. You can recommend help-lines or websites that are credible. As most things now a days are so revolved around technology. This can be time consuming and sometimes physically and emotionally draining. But you have to do your best. When I feel how you do, I try to go back to my roots of what nursing is all about...

Good Luck,

Sabrina

Hi Sabrina,

You sound like a very caring person. Kudos to you. I work on a medsurge unit and there is barely enough time to do assessments, meds, charting, discharges, admits, dealing with all radiolgy, pt, pharmacy, mds, families, etc.,etc...and get out in 8 hrs. Never mind get a real lunch. I wish I had more time to help my patients in the ways you describe. This is what nursing is all about- you are absolutely correct.

[CuriousMe]

The only thing that upsets me about obese people is that they don't care who breaks their back tryting to hold them up. I am not saying all obese people are like this but a lot of them are. When I was an aide I had one obese lady tell me that her legs would not hold her up. As I was trying to help her I told her that she would have to try to because I certainly could not hold her up. If your legs cannot hold you up you would think that would be an incentive to lose some weight. I think with most obese people that a psych isssue plays into the reason for why they overeat. Maybe low self esteem, anxiety , depression, etc. Why else would you allow yourself to become so large? I know some people do have medical reasons for being obese but I think the majority do not. Maybe if their thought processes were healthier they would not overeat. Just my humble opinion.

So, it's not possible the patient (as they felt they were going to fall) wasn't rationally thinking through the physics of the situation....but was instead voicing their fear of falling?

I was a lifeguard as a teenager. One of the first things you're taught for a water rescue, is that the victim will try and push you under in order to hold themselves above water. This is not because "they don't care" about the folks risking their lives to save them. It's because they're in the midst of fight or flight and are not thinking...they are reacting.

I'd be shocked if, when a patient was feeling like they might fall, they logically thought it through and decided they "didn't care about who breaks their back holding them up."

[Music in My Heart]

I've observed that nurses seem to be more tolerant of obese people than they are of abusers of other substances. Being a food junkie is no better - and no worse - than being a meth junkie or a boozer.

[GHGoonette, BSN, RN]

Most studies of obesity state categorically that bad eating habits start in childhood; in other words, an obese child will become an obese adult.

I frequently see fat toddlers that my colleagues coo over and I just have to shake my head and walk away. I don't know how many times I have drummed it into their heads that fat children are not healthy children, and hopefully they carry that message over when raising their own children, and in some cases their grandchildren.

Wrong reward systems (if you're good, I'll take you to Macdonalds, buy you a chocolate, buy you an ice cream) just reinforce the growing trend of fat children-and it's so sad. Some have even referred to it as a form of abuse...

What I'm trying to say is, catch them when they're young! Stress the importance of healthy eating to young parents! Get school nurses involved! Make sure your own kids take up sport, and never buy them computer games for Christmas!

I would say ban hamburgers, but that would probably cause a revolution....

But don't feel bad about the numbers of obese Americans; Google South Africa's first ladies (there are 3 of them ) and compare them to your first lady....

[whodatnurse]

I mean this quite sincerely when I say that it may be helpful to keep in mind when you meet such individuals that they're not perfect...and neither are YOU. EVERYONE has 'flaws' of some sort, it's just that some are more immediately visible to the world than others. You know what they say about 'until you've walked a mile in another person's shoes...'.

[TDCHIM]

I always wondered, patients that suffer from anorexia are giving opportunity to regain their health through continuous therapy involving multiple health care providers but why shouldn't obese patients have access to therapy and the same type of treatment? Food is an addiction for some of these patients and I believe it should be treated as such rather than expecting patients to just be discharged home and hope they somehow lose weight. Instead these patients return a few weeks or months down the road with additional weight gain. For that reason, it would be important to incorporate as much teaching regarding eating habits and exercise regimens.

If we all just ignore it then the issue will persist.

Marleyna, that is an excellent point. Why shouldn't obese people be given intensive, sustained assistance to overcome the problem? I mean, if the biggest argument against those who are obese is that they end up raising everyone's insurance rates because of all the illnesses that obesity causes or contributes to, wouldn't we come out ahead overall by providing intensive therapy to help obese patients with the desire to change alter their ways? We know that it often requires significant amounts of support or therapy for people to overcome other negative or detrimental behaviors - why should this be any different?

[jmtndl]

In Pediatrics, are you going to ask the 14 y/o new mom who is completely overwhelmed why she didn't think her situation thru 9 months ago?

[SlightlyMental_RN]

I've observed that nurses seem to be more tolerant of obese people than they are of abusers of other substances. Being a food junkie is no better - and no worse - than being a meth junkie or a boozer.

Oh for cripes sakes. Please stop...Really, the OP is looking for ideas to regain her compassion. This is neither the time nor place to let this dissolve into a bash the fatties discussion.

[nursemike, ASN, RN]

Just dont complain when you'l become a short of breath..

I won't. I'm 54 years old, and for 40 years or so, my problems have been my problems. If I retain my mental faculties and live that long, I don't imagine I'll be much different in 20 years. If you feel I owe you more than that, you're free to say so, and I'm free to ignore you.

A number of posts have suggested that the OP has been misinterpreted as callous or insensitive when her intent was to find ways to be both compassionate and effective. Re-reading the original post, I can buy that, but in the context of the title, I still think it's a fair argument that the best place to start would be in being less judgemental. Or, going back a little farther in the thought process, one could start by deciding what it is one wants to accomplish. "If you weren't so obese, you probably wouldn't have 1/2 the diseases you have," is a perfectly fine and valid approach, if your main goal is to feel better about yourself for not being fat. It is, to me, a reflection of a puritanical hypocrisy which has become even more epidemic than obesity. Assigning blame has nothing to do with therapy, or at least not with therapy for the patient. Do I think I'm a better person than some of my patients? Have you seen some of my patients? How could I not? But if I can realize that their reason for being there, for being, period, is not merely so I can feel superior to them, then maybe I can do what I'm being paid to do and be their nurse.

So, a different, perhaps kinder goal might be to solve all the patient's problems in one fell swoop during a 5-day (or 5 week) hospitalization. And you know what, if nagging could accomplish that, then by all means, nag away. But however good our intentions, that just isn't realistic. A comment was made about ignoring the obvious. I would argue that the opposite--pointing out the obvious--has a pretty limited utility. If you see a group of your coworkers performing CPR, is there value in informing them that their patient isn't doing well? Fat people know they are fat. They have a general idea how they became fat. They know the ways to become less fat. They--we--are far more interested in not being fat than you are in fixing us, and some may actually succeed in being less fat, but a lot of us will die fat, and many of complications of being fat.

There's a recurring theme on this and similar threads that the nurse has to choose between being blunt and matter-of-fact, telling it how it is and holding patients accountable, or "candy coating" the problem and being politically correct. Others have tried to suggest ways to be therapeutic and offer support to patients who are in a teachable moment. I'm all for that, but some moments are more teachable than others. You know what--if you could recommed to a patient my age and weight that they have a colonoscopy, you might save their life. If you want to add that obesity is one risk factor for colon cancer, go ahead. If they rub their chin and muse that colon cancer might be a way to lose weight, they're messing with you, and probably not in a teachable moment. In any case, if you believe your only options are to say, "You're fat," or to pat them on the shoulder and assure them, "You're just big-boned," I'm humbly suggesting that another, more constructive approach might be just minding your own business and saying nothing. Well, okay, not so humbly, but still...if you look at someone who is 450 lbs with multiple comorbidities who describes their health as "great," maybe it's time to educate them on something that isn't obvious. It isn't like a flu shot would hurt them.

[Music in My Heart]

Oh for cripes sakes. Please stop...Really, the OP is looking for ideas to regain her compassion. This is neither the time nor place to let this dissolve into a bash the fatties discussion.

Oh, you see a difference between food addiction and addictions to other substances?

Recognizing and speaking the truth helps to engender both compassion and resolve, for cripes sake.

(Oh, and having already dropped 25 lb, *I'm* still 35 lb too fat).

[SlightlyMental_RN]

Oh, you see a difference between food addiction and addictions to other substances?

Recognizing and speaking the truth helps to engender both compassion and resolve, for cripes sake.

(Oh, and having already dropped 25 lb, *I'm* still 35 lb too fat).

Yes, as some one that works in chemical dependency detox and psych: There is a difference. Again, let's please keep to the topic on hand, which is helping the OP.

[nursemike, ASN, RN]

Oh, you see a difference between food addiction and addictions to other substances?

Recognizing and speaking the truth helps to engender both compassion and resolve, for cripes sake.

(Oh, and having already dropped 25 lb, *I'm* still 35 lb too fat).

It's entirely possible to live for years without consuming any methamphetamine. You can go your whole life--if you call it a life--without beer. So, yeah, there's a difference. But, certainly, eating can be a compulsive disorder. As for your assertion that the obese are no better, or worse, than meth junkies, that's fair enough, as long as you're prepared to recognize they are no better, or worse, than marathon runners. Hitler and Gandhi were fairly fit. Mussolini and Santa Clause were a bit portly.

Obesity is: a.) an addiction

b.) a disease

c.) a character flaw

d.) all of the above

e.) none of the above

For me, the correct answer is f.) both d and e. I haven't known any meth addicts. I've known some alcoholics. Some were parents, some were married, some played guitar, some were auto mechanics. For many, alcohol was a problem that impacted many areas of their lives. For some, it may have been their defining characteristic. But I've never known one whose only characteristic was being an alcoholic. And it's the same with obesity. Fat people are people. Except for being fat, they're just like regular people. Hell, in the US, they are the regular people.