Super Obese

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in my unit we have had many super obese (500lbs+) pts. Most have been complete care. We only use lifts to get pts oob. it is very difficult to care for such pts because of the logistics and staffing requirements involved. Turning can involve up to 5-6 people. On night shift that might be all/most of the staff. If someone has to be cleaned up that could mean no other nurses or aides on the floor for other pts. And you have to wait for every employee to be available. Hope no other nurse is getting admissions or post ops. Actually lifting skin folds to clean is very exhausting. Depending on the staff working ,5-6 of us can weigh less than the pts. Yes ,I lift weights and the more I get into it , the more it helps but only to an extent. . It is a huge challenge to keep these pts clean and dry and staffing is not increased for it. I have never worked with any lift aside from the hoyer so I don't see how they can help with things like lifting up legs or arms for dressing changes. think a local hospital is rebuilding an area to add bari rooms to accomadate pts but the issue for me is the staffing required to care for such pts. I really hesitated on posting this because I can see it not being well received but I think this part of the "obesity epidemic" and its impact on health care discussed often enough.

lifting a 50lb box or weights is different than lifting a 125 porifice with a completely awkward angle unless i were on the bed too. same with trying to roll such pts and keep them on their sides while the other coworkers race to clean them. and not everyone is the same height although it helps that most of the staff is between 5'1 and 5'7

Some hospitals, like the one I am precepting in, are implementing a special 'lift team' that are the primary lifters. There are 2-3 of them that go around unit to unit every 2 hours turning patients. If they require further assistance they grab the nurses and aids, which is much better because you are not using the entire unit to lift/clean one patient. I think this puts less stress on the unit, and I cant wait till more articles are published to support the better outcomes.

Specializes in Pediatric Pulmonology and Allergy.
When it comes to long term care for such patients, I think there clearly needs to be some sort of special facility set up for such people. Throwing them into the traditional nursing home mix is murder on the staff. We have 1 LPN and 2 CNAs on nights for 49 residents. Four of our residents are in the 500lb range and total care. Our super obese residents take almost as much time to care for per shift as all the others put together. Unfair to the other residents.

I'm sorry, this may sound unkind, but maybe morbidly obese people who work should have to pay a larger percentage of their income to social security. They'll end up using far more as (if) they age. And unlike cancer or genetic disorders, obesity is usually controllable.

Viva right above you explained quite well some of the factors that may have caused them to "get like that." If we recognize alcholism as a disease and drug abuse as a disease it's about time we realized that people do not willingly choose to become that obese. Although there usually is a codependent somewhere in the picture who is providing them with food.

As far as making them pay a larger percentage of their income to SS -- I guess that should apply to anyone whose illness was due to lifestyle choices. And since we will never be able to fully break down how much an individual's health issues are due to lifestyle choices versus factors out of their control, I don't think this is a system we could ever implement. Many health plans do offer incentives for things like gym membership or healthy eating habits, and there are also interventions on a community level like bike paths and public recreation areas. Bloomie's soda tax backfired on him but there are other interventions that can make an impact -- like replacing vending machines in schools with healthier options, etc. Obesity is a multi-faceted problem and just pointing fingers at the obese for bringing it upon themselves is not the solution.

Specializes in Orthopedics.
Some hospitals, like the one I am precepting in, are implementing a special 'lift team' that are the primary lifters. There are 2-3 of them that go around unit to unit every 2 hours turning patients. If they require further assistance they grab the nurses and aids, which is much better because you are not using the entire unit to lift/clean one patient. I think this puts less stress on the unit, and I cant wait till more articles are published to support the better outcomes.

What a great idea! Obese patients are difficult to take care of and as nurses we need to think about possible solutions. I also like the post from someone else mentioning LTC facilities to meet the special needs of the obese patient. Any other hospitals implementing anything to help in the care of the obese patient? I'm interested in hearing.

Specializes in Acute Care Cardiac, Education, Prof Practice.

Viva right above you explained quite well some of the factors that may have caused them to "get like that." If we recognize alcholism as a disease and drug abuse as a disease it's about time we realized that people do not willingly choose to become that obese. Although there usually is a codependent somewhere in the picture who is providing them with food.

As far as making them pay a larger percentage of their income to SS -- I guess that should apply to anyone whose illness was due to lifestyle choices. And since we will never be able to fully break down how much an individual's health issues are due to lifestyle choices versus factors out of their control, I don't think this is a system we could ever implement. Many health plans do offer incentives for things like gym membership or healthy eating habits, and there are also interventions on a community level like bike paths and public recreation areas. Bloomie's soda tax backfired on him but there are other interventions that can make an impact -- like replacing vending machines in schools with healthier options, etc. Obesity is a multi-faceted problem and just pointing fingers at the obese for bringing it upon themselves is not the solution.

Ty for this. Pretty much summed up what I was thinking. I remember watching a Lifetime special on morbid obesity. One of the moms of an obese son brought him food everyday. She was so damaged from the infant death of her first child that she felt obsessed to do anything and everything for the second, including enabling the habits she had created. It's easy to point a finger and blame, but another task entirely to try and see where the problems might truly arise and appreciate that we all struggle with something.

Specializes in LTC, assisted living, med-surg, psych.
Although there usually is a codependent somewhere in the picture who is providing them with food.

Obesity is a multi-faceted problem and just pointing fingers at the obese for bringing it upon themselves is not the solution.

DINGDINGDING!!! We have a winner!!! :D

Co-dependency is a HUGE (sorry) problem with the super-obese. You know darn well they can't get up out of bed themselves..........somebody's got to be bringing them the food. And it's not a burger and an order of fries, either---it's more like 4 burgers and orders of fries, and a half-gallon of soda to wash it all down with. Might as well hand an alcoholic a bottle of Jack Daniels, or give a suicidal person a .38 Special.

But like other types of addicts, many food addicts can be sneaky and manipulative, and they use guilt to force their family members to bring them the foods they crave. It's an unbelievably tough situation. I've seen a few hospitalized super-obese patients berate their caregivers for bringing them "only" one bag of Hershey's Kisses, or for failing to stop at the store to fetch their nightly Big Gulp. But again, this is a symptom of addiction, not a moral failing or character defect. :no:

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I'm not obese, but I come from a line of morbidly obese relatives on my mother's side of the family.

My maternal grandmother weighed more than 400 pounds when she died 10+ years ago at age 77. At the time of her burial, she required an oversized casket and two plots of land due to her hefty size.

My mother is 55 years old, inching toward the 300 pound range, and continues to eat compulsively despite her type 2 diabetes, stage 3 chronic kidney disease, HTN, and other issues. Eating has been my mother's way of dealing with emotional issues since she was in her mid-twenties. Food and television are two of the few pleasurable activities in her life right now.

While I am disturbed by morbid obesity, I am cognizant that food is highly addictive for some people to the point that they'll eat well beyond the point of physical discomfort. As always, no simple solutions can be applied to complex problems.

Some newish research has suggested that the brains of morbidly obese people react to food similarly to addicts react to their drug of choice (and explicitly diffrently than how 'healthy weight' peoples brains react to food. )

No one grows up wanting to be a meth addict or morbidly obese. This is a hugely complicated problem and not only does saying its as simple as a matter of will power sound as naive as telling a suicidal patient to cheer up, it's also not productive.

If you want to advocate for better staffing and equipment--and you should--start tracking staff injuries and expenses due to injury related to caring for patients beyond your capacity. I believe with some counting and organization you can convince your facility that it's cheaper to not understaff and have people get hurt. If you get a work related injury does your workplace have a policy of puttin you on light duty till you recover? What if you started advocating for yourselves and a bunch of you went on light duty because of the very real aches in your bodies? It's cheaper for the facility for you not to get hurt.

(who's naive now ;)? )

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I can tell you how people allow themselves to balloon up to 500, 600, 700 lbs. and so on.

It's called "self-medication". Not too long ago, I was well over 300 lbs. myself and headed for 400, so I can empathize very easily with the super obese. Yes, mental disorders can cause compulsive overeating; once I was treated for mine, the drive to stuff myself until I was miserable went away, and I've lost over 40 lbs without much effort. But many people NEVER discover what, literally, is eating them, and since food is the one addiction that can never be completely overcome due to the necessity of eating to live, they go on until it kills them.

I do know how hard it is to care for such patients. Back when I was a hospital nurse, we had a frequent flyer who weighed ~ 650 lbs. and literally required 10 staff members to get OOB. Bathing him took half a dozen.......three were needed just to hold up the enormous pannus that probably went at least 250 lbs. all by itself. He was one of the nicest patients I've ever cared for; polite, respectful, totally non-demanding, only pushed his call light when he desperately needed something. He passed away at age 48, not surprisingly from CHF. The take-home lesson from taking care of him was simply this: Obese people have ears. They have feelings, too, and they know when we healthcare providers don't like them. Sometimes, they act out because they know they're disliked!

Believe me, your basic 500+ pounder is VERY aware that a) they are dangerously obese, and b) they're not going to live long if they continue eating as much as it takes to maintain such a large body. If you yourself knew you were going to die soon, wouldn't you want to indulge what few pleasures were left to you? I know I would......and since food is often these patients' only source of satisfaction, can anyone out there understand why they may choose to continue stuffing themselves?

Well said again........:) I agree with Viva and Commuter. It is such a multifaceted problem. I don't think charging more or taking from their social security is the answer to this problem. Many people on social security have paid in far more than their fair share and deserve their benefits as much as the next guy. remember that when you are young and make statements that you have no idea what your future has in store for you.

I also think that if obesity such an epidemic the system should spend the same amount of money on research and genetics as it does on cancer and heart disease and make it easier to get medical assistance including drugs and surgery. There is a sad fact that people who are obese get different health care because many feel they put themselves that way and they are not deserving because they refuse to help themselves. That diet pills are dangerous......But you can get drugs to maintain an erection that can cause blindness and inject botulism into your face for vanity.

However, the OP makes a good point that it is difficult to care for this population and while it is an "epidemic" the medical profession does little to accommodate them and provide assistance/staffing to help care for them. From wheelchairs to B/P cuff there is little equiptment available.....maybe just because, as I said, the medical community just believe they just don't deserve help because they don't help themselves.

Someone announces 6 months of sobriety and the get a standing ovation everywhere they go. An obese person says they've lost 30 lbs is still obese and they get......how nice you've got a long way to go.

There but for the grace of God go I.

Specializes in OR, Nursing Professional Development.

How do people gain so much weight? Well, here's how it happened to me:

My childhood came to a screeching halt at the age of 8. That was when the sexual abuse started. Terrified of what would happen if I told someone curtesy of the threats I received, I probably could have been diagnosed with clinical depression. I turned to food for comfort. By age 12, I was 175 lbs. Now, at age 30, I'm battling to stay under 300. Even with counseling, having moved a decent distance away from home, and using a meal service to help keep me away from take out/ fast food/ microwavable dinners, my eating habits still aren't perfect although they've greatly improved. Food is the one addiction that people can never give up. Drugs? Don't need them to live. Alcohol? Don't need it to live. Food? Without it, eventual death. So yes, I made the choice to use food for comfort, but I had help: parents who kept junk food and soda stocked and never said a word about how quickly it vanished, a family who turned a blind eye to what was happening under its own roof, and then disbelief when I finally spoke up, leading to me feeling at fault for the destruction of my family and a further reliance on food for comfort. Don't judge someone until you know the whole story.

I like the lift team idea, very much. I worked at one hospital that had a "Code Assist" that I liked, too. The assist team usually consisted of available men and physical therapists that would come and turn a patient or get them out of bed to the bedside commode and back.

I really don't think it's a good idea to staff without regards to weight/height. I think of it in terms of assigning a little person to turn an average height person. There are obvious physical inabilities that need to be overcome. When I was in nursing school, I was assigned to a patient that was 7' 1" and weighed over 600 pounds. He was also a daily weight. Just the logistics involved in accomplishing that blew my mind.

I don't judge people for their addictions or their weight. I don't throw around melodrama, either, when it's time to care for them. I just try to do my job in the safest manner for me and them. There are safety protocols in place for the suicidal patient, for the violent patient, and for the patient at risk for falls. Why not put protocols in place for the safety of the bariatric patient? Just think how much it hurts them to fall with all that weight pressing on them, or to be turned incorrectly and have a lung squished to the point where they can't breathe.

I think there is a lot of room for improvement in the treatment of our big patients.

Specializes in HH, Peds, Rehab, Clinical.
I agree. I understand if a patient has a true medical problem - underactive thyroid, has lost a limb, etc. But I don't understand how once healthy adults allow themselves to become 500 + lbs.

An underactive thyroid can be treated.

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