Super Obese

[anotherone]

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.

[joanna73, BSN, RN]

Our culture is a major contributor to obesity. Yes, people are responsible for themselves, but everywhere you look...advertisements for buffets, fast food, junk food. Portion sizes are enormous now. Last week, I was in a restaurant and we commented that there was enough food served on my plate to feed four people.

Also, have you noticed how expensive fruits and veggies are compared to a box of pasta? What are people to do on fixed incomes? In more ways than one, people are encouraged to fail.

[Amnesty]

An underactive thyroid can be treated.

Sure, if you have access to the proper channels. The unfortunate fact is that thyroid problems are very complex. That's why there are about 10 different commonly accepted factors that must be checked in blood tests before they can completely make a decision. Most basic thyroid panels only check for 3-5 of those. Sometimes blood tests don't show the problem, but all the symptoms of it are still there. Most general doctors aren't nearly experienced enough in this area to know all the complexities, and good luck finding a specialist.

That's assuming you even have healthcare coverage that'll spring for it. As a student, I have to buy medical insurance. However, preventative stuff like that isn't covered at all. I've had no insurance whatsoever for 6 years now, leading up to having to buy this policy so I can be in nursing school. I can't afford preventative care, but I can certainly afford a Hershey bar.

I'm 5'2", and I spent my entire teenage years being fat. It was really hard because I was never a fat kid, and it was only after my thyroid kicked in (or failed to!) that I became fat. It was a self-feeding problem -- I was fat so I didn't feel like going out, I didn't feel like my exercise efforts mattered, so I became inactive and used food for comfort.

All of this sounds like a big excuse, and I agreed with that. 2 years ago, I got my sh!@ together and decided I wasn't letting it hold me back. 335 lbs is not an attractive weight at 5'2". It's taken me two years, but I've lost 125 lbs. It's been really hard. I've had to be much more strict with what I eat and I've had to push through my hypothyroid-induced lethargy to be a lot more active, too. Whoever said that about losing weight long-term and being patted and told you still have so far to go is ABSOLUTELY correct. I'm still 210 lbs. I'm still obese. It's such a long road.

Point being, I look at the terminally overweight and I understand exactly how somebody could get that way. Nobody should be so quick to judge a situation they do not know. Getting additional staffing to deal with their needs should be the primary concern here.

[anotherone, BSN, RN]

I didn't want this to turn to one of those posts on being obese is an addiction or lack of self control (both imo) or because someone had an awful childhood or evil corporations are to blame or goverment subsidies to corn etc.... It was more along the lines that sadly we will probably all see a lot more of this yet little is done to acknowledge it. A 500lb complete care is different than a 200lb complete care. More staffing is needed for such pts period!. It really is a team effort 1nurse and aide aren't going to be turning them or straight cathing them. Not to mention that older hospitals aren't set up for these pts. bp cuffs , bed pans or bedside commodes, chairs etc.

[FranEMTnurse, CNA, LPN, EMT-I]

You are so right.

[Baubo516, RN]

@BrandonLPN - I just heard a program on NPR recently that talked about employers asking overweight, out of shape employees to pay more for their health insurance, or something like that. Those kinds of policies may be coming.

@VivaLasViejas - thank you for adding an empathetic voice to this conversation. I am not morbidly obese, but at 5'4" I weight 165 lbs, which places me near the top of the overweight category of the BMI, or maybe at the bottom of the obese category. (It's been a while since I checked.) I am ~40 y/o and don't have any thyroid problems that I know of, and obesity does not run in my family. BUT - I am an emotional eater. I firmly believe I have reached this weight because 1) I don't exercise regularly and 2) I self-medicate with food, as well. Food is yummy and in a moment when I am stressed or sad, eating something delicious makes me feel better.

At least I am aware of my problem and I am working on correcting it. I guess this wasn't the issue brought up on this thread, but I just wanted to add another voice of empathy for these patients.

They certainly are difficult to care for, and I get tired of the work, as well - but they are human beings and sometimes controlling our self-destructive behaviors is just not that easy.

[ThePrincessBride, MSN, RN, NP]

I am rather conflicted about this topic but here it goes:

I am an aide who has had MANY experiences with the super obese and let me tell you, NO ONE wanted the obese patient. Not because we didn't like the person, but we loved our backs even more. The problem is that many of these back-related/other injuries that nurses/healthcare workers get are FROM caring for the obese. My former clinical instructor tore her rotator cuff trying to lift a heavy patient by herself, and I know some other staff members who have had multiple back injuries due to caring for heavy patients by themselves (staff to patient ratio was pitiful). Having to care for these morbidly obese patients with such few staff members isn't fair to anyone, ESPECIALLY to the caregivers who are risking their bodies to perform necessary job duties.

I have watched many shows about morbid obesity, and my favorite is The Biggest Loser. The vast majority of people who suffer from this epidemic have mental illnesses, #1 being depression. The majority aren't lazy, but I have had MANY morbidly obese patients refused to get out of bed, refused to turn and would rather sit in their own urine/feces than be "forced" to move. I had one patient in particular who refused a bath everyday for nearly all the weeks he was in the hospital, and he stunk to high Heaven. All because he didn't want to lift a muscle. *Sighs*

I can see how someone can get to 250, MAYBE 300 (if it is a very tall man), but 500, 600, 900 (!) pounds? The heaviest person in the world was a guy from Mexico weighing almost 1200 pounds! From a logical and mathematical standpoint, someone would literally have to stay laying in bed and shoving their faces to get to that extraordinary weight. Moving around or even walking a couple miles a day could easily keep the weight at a much more reasonable level, so to a certain extend, a person HAS to be somewhat physically lazy in order to reach that point. A simple thyroid problem would NOT, in most cases, make a person balloon to the size of a baby whale.

As for insurance debates, I am perfectly fine with forcing smokers and severely obese people to pay higher rates because they are oftentimes the ones using up most of the resources. It isn't fair to those of us who have chosen to take care of our bodies to be forced to pay for someone who continually abused theirs for years, and on top of that, I think having high rates would encourage people to quit smoking or lose weight which would create a positive cycle of change that America NEEDS.

[hodgieRN]

I think there should be a lot more psych consults for these situations.

[leslie :-D]

i do agree that morbid obesity is a complex, multifactorial epidemic.

and the burden should NOT be on the obese person alone.

these people need support...from family and friends.

i am not talking about "atta girl" type of encouragement, but actually walking the walk with them.

i've noticed that obesity tends to be present throughout the family.

not all are morbidly obese, but there are clearly unhealthy patterns that result in apathyand/or depression, denial, enabling and often ignorance (no, ignorance is not a bad word, before anyone gets offended).

and, as a pp suggested, we live in a nation of fast and convenient foods.

the govt, while it all too readily shows stats of obesity and its resultant comorbids, the govt remains incredibly culpable in contributing to the unhealthy habits that are so pervasive in america.

so yes, u.s. culture and the way we live, needs to be challenged and modified to benefit each and every one of its citizens.

still, nurses have legit complaints about caring for the morbidly obese.

once again, ceos continue dumping on us with unrealistic expectations, less the devices we need in executing our duties.

why SHOULDN'T we complain about caring for a 500 lb person?

the problem is, i believe our frustration is misdirected and we tend to judge the pt...

when we should be demanding equipment made for bariatric pts.

and so, the **** hits the fan because we know hospitals are only concerned about the bottom ($$) line, and we are expected to perform miracles...

even at the cost of our failing, tired, overburdened bodies.

they don't care.

we are just supposed to get it done.

so yeah, the problem is very real and i do wish mo people wouldn't become so defensive.

it is not just about them; it is a problem that affects everyone...including our other pts who need us as well;

yet we often spend a lot of time with the obese pt, merely because their care is time-consuming.

i don't know what the answer is.

because to date, there are (too) many of us who know what we 'should' do, but we're all talk.

perhaps one day, they will create wings for morbidly obese only...

with jcaho demanding these units to have the applicable equipment.

until then, i suppose we keep on keeping on...

and let the chips fall where they may.

leslie

[LydiaNN]

It seems to me like every time a thread starts about the challenges of caring for obese patients- a perfectly legitimate nursing related topic- deteriorates into a sidebar debate about character flaws and moral weaknesses. We are all just huge tossed salads, made up of our genetics, experiences, traumas and influences. If conquering obesity were an easy fix, it would be... fixed.

[VivaLasViejas, ASN, RN]

That is because people start in right away with inflammatory statements like "they should pay more out of their social security (than normal-sized folks) for their care" and "how do people let themselves get to be 500 lbs.?" Caring for super-obese patients IS a logistic nightmare and extremely difficult for nurses, no one disputes that.......but until we take the judgment out of the issue, a sensible problem-solving discussion cannot take place.

[TheCommuter, BSN, RN]

Another thought. . .has anyone noticed that a typical salad at a fast food joint always costs in the $5.00 to $6.00 range, whereas a double cheeseburger can be obtained off most value menus or dollar menus for $1.00? What is a lower income person to do?

Many supermarkets in my area charge staggering prices for fresh veggies and fruits because most things are grown in other states. However, the rice, pasta, potatoes, ramen noodles, white bread, bulk cereal, and other starchy foodstuffs are dirt cheap. Again, what is a lower income person to do?

I wish our government subsidized other fresh produce items to the same extent that they provide price supports for wheat, corn, and other fattening starches.

[ThePrincessBride, MSN, RN, NP]

Another thought. . .has anyone noticed that a typical salad at a fast food joint always costs in the $5.00 to $6.00 range, whereas a double cheeseburger can be obtained off most value menus or dollar menus for $1.00? What is a lower income person to do?

Good point. Sadly, it is less expensive to make these junk food products than to grow and gather healthy crops. Artificial sweeteners and other garbage is a lot easier to replicate than the healthier options.

But here is what gets me: People complain about higher prices for healthier foods, but won't hesitate in spending 150 dollars for a pair of new Jordans or getting a gas-guzzler Hummer that costs more in gas than a mortgage payment on a nice-size home. Clearly, some people have their priorities out of whack.