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.

[ThePrincessBride, MSN, RN, NP]

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

Very true, but this shouldn't come as a surprise as eating habits are learned from someone (usually from the parent). In my nutrition class, a child with 2 obese parents has a 75% chance of becoming obese themselves.

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.

I see what you are saying, but then there comes a time where someone has to become responsible for what their own decisions (i.e. what they are putting into their systems). The government can only do so much, and at any rate, it is a lose-lose situation for the government. If the gov tries to interfere, they are accused of being communists trying to encroach upon the freedom of its people. If they don't get involved, then they are seen as facilitators of this epidemic when really, obesity begins at the home and, more often than not, with the parents. We can't expect the government to get involved if the parents won't even take the time to steer their kids in the right direction.

[PRICHARILLAisMISSED]

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.

Ms. Jeanette,

I know that you are well meaning, I believe that. Unfortunately, it is your kind of thinking that enables things like obesity, drug abuse and alcohol abuse. I don't mean to offend you, and I'd like to point out that you are not alone in this way of thinking and I realize that. That being said, I'd like to comment on some of your post in order of the bolded portions:

"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."

As far as this goes, while I understand that the medical profession does recognize alcohol and drug abuse as a disese, I find that ridiculous. I don't think that even proponents of calling these..."ailments" a disease will argue against the opinion that they are the result of choices! It is the same with obesity. I'm sorry, but that's just the way it is. I hope that obesity is never(!) recognized as a disease. If it is, then the obese will cannibalize some of the (finite) resources that should be going towards people with real diseases-like the drug addicts and alcoholics have been shamelessly doing since being granted "disease" status. Remember the various cancers that are still kicking medicine's ***? Those are actual diseases, among many others.

"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."

I've often said this, actually. And while you are correct in saying (Paraphrasing here) that we will never be able to nail down completely how an individual lives his/her life, we can at least get inside the ballpark-mandatory physicals once a year through the insurance (that the ACA is mandating come 2014. And before anyone says that "They" can't force us to take physicals, I ask how is that any more wrong than forcing, yes, forcing a buisness with more than x amt of people to provide insurance for their employees to begin with? Anyway, the results of these physicals will tell us where everyone is at physically). From there we can increase their rates (even decrease them for some who practice a healthy lifestyle! Yes, it should work both ways) accordingly... Is that really so evil?

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.

Ms. Jeanette, it broke my heart when that was ruled unconstitutional-although it technically is. Another "theory" of mine is that it is in fact soda that really jump started us to become such an obese nation. I really don't feel like researching right now and getting an exact date lol, but think back to when the biggest "personal" soft drink available was a 16 oz bottle from the corner store (or if you lived in Brooklyn, you can get a 20 oz soda...Tropical Fantasy was the name of it). We as a nation was far slimmer back then. Then, Pepsi came out with the "BIG SLAM." They took a whole Litre bottle (and if you remember, back then a litre of soda went straight into the fridge as a family drink! It was unheard of for a single person to drink that much soda at once at that time) and widened lip so it was large enough to put your mouth on and drink from it (the lip used to be about just over a half inch wide before this-impractical to drink out of so it was poured into an obscure object called a "cup," or another called a "glass..."). THEN, they got Shaquille O'neil to endorse it, and from there America just blew the **** up. Everyone was walking around with a 1 liter BIG SLAM, and usually drank more than 1 per day. Of course the other soda companies followed suit, then McDonalds "Super Sized" it and here we are now. Shame.

I really wish that it was mandatory to have a fruit vending machine next to a normal one, but it wouldn't make business sense-I have no doubt that half the fruit would go bad before being sold, as we as a nation developed a "sweet tooth."

And sure, obesity is a multi-faceted problem. I don't argue against that. But I would point out that this multi-faceted problem starts with a poor choice on the "victims" part. When all is said and done, that is undisputable. BTW It is NOT the fault of the obese person with a bad Thyroid. I only refer to those who had a choice and were otherwise healthy.

[anotherone, BSN, RN]

fruits and vegetables are very expensive in many areas. I have gone to many fast food places and ordered a plain hamburger. That isn't too healthy but not even that many calories. Frankly, I think obesity is so big here because all food in general is cheaper and more accessible than in many other countries. But that is neither here or there when I have to waste tons of time hunting down 5 people who are coincidentally able to help for maybe 20minutes to turn one person..........

[LydiaNN]

There are 2 different aspects of obesity being discussed here. The first is the one made by the OP, that super obesity is adding yet another challenge for nurses striving to deliver quality care. The second is the endless debate about the roots of obesity and why it continues to rise in this country more so than in most others. Shouting in the form of caps makes a point no more valid. Whether obesity is or is not a choice, in the end it makes no difference to the ethical nurse charged with that patient's care.

[5 meals]

How do the 500lb+ patients get that way? I'm not trying to be mean, I'm seriously confused by what life circumstances cause them to get themselves into these situations!

Obesity can be a trap. Some sports encourage heavy eating, and that can be okay while actively involved in the sport. It's pretty each to keep eating like a big active person even after the activity has subsided. The weight gain starts, and before you know it, you're unable to do the exercises you used to do. You can't jog because it's torture on your knees, and can't walk long distances because there are issues with chafing that skinny people really don't want to know about. The extra girth makes it hard to go some places, and the social stigma makes you want to stay at home. You know what's at home? Food. When there's little else to do but eat, and when getting food isn't a problem, not getting obese can be very challenging.

I've never been 500 pounds, but I used to be 260 pounds. At that weight it already hurts to sit on a bicycle, it hurts to run, and sprinting is out of the question. I can already feel the trap of obesity. At that weight, my physical activity is largely limited to lifting weights and spending short periods on a recumbent bicycle. If I allowed myself to gain even more fat, I'd become even more limited.

So based on my limited experience, I'm sympathetic to very obese people. I understand their reality, or perception of it, can severely limit their ability to lose weight until they lose weight. It's a chicken and egg kind of deal. Getting to a point where exercise can be fun and pain-free can take those folks years of agony, especially if they don't have an incredible support system at home.

[dirtyhippiegirl, BSN, RN]

As far as this goes, while I understand that the medical profession does recognize alcohol and drug abuse as a disese, I find that ridiculous. I don't think that even proponents of calling these..."ailments" a disease will argue against the opinion that they are the result of choices! It is the same with obesity. I'm sorry, but that's just the way it is. I hope that obesity is never(!) recognized as a disease. If it is, then the obese will cannibalize some of the (finite) resources that should be going towards people with real diseases-like the drug addicts and alcoholics have been shamelessly doing since being granted "disease" status. Remember the various cancers that are still kicking medicine's ***? Those are actual diseases, among many others.

But plenty of diseases are the result of choices. Should we divert less money to studying lung cancer or COPD because the majority of sufferers CHOSE to smoke?

[Wrench Party]

Grumble. I can empathize with the mental disorders that cause obesity, and how much it must suck to be that obese. However, my empathy starts to go out the window when it's my back and knees that end up hurting at the end of a shift because I have to help lift these people, or they don't give a crap about my teaching because they're too busy stuffing food down their throats that their family members have brought. I'm not ruining my health to take care of patients.

[Susie2310]

As far as this goes, while I understand that the medical profession does recognize alcohol and drug abuse as a disese, I find that ridiculous. I don't think that even proponents of calling these..."ailments" a disease will argue against the opinion that they are the result of choices! It is the same with obesity."

Although people usually have the choice to begin the habit of drinking alcohol socially, some people, for a variety of reasons, become addicted to alcohol. The people I have known who were/are alcoholics, unless they became sober through AA, could not choose not to drink. Drinking alcohol was a compulsion that took over their lives, that they could not control through willpower, even though it destroyed them, their lives, and their families. As the illness progressed, some of the people drank regularly to try to avoid withdrawal symptoms, and eventually to try to avoid DT's. The ability to choose, for them, existed when they were in the early stages of social drinking, but after some time and/or after certain events in their lives, they were no longer in control of their drinking and no longer in control of their lives, unless they were able to get and stay sober.

I do not think people who become alcoholics (or indeed any kind of addicts) should be absolved of responsibility for their addiction. On the contrary, I believe they need to get to work with earnest (where their health and strength permit) to arrest their addiction i.e. in the case of alcoholics, get in to AA, to take back their lives and be able to fulfill their responsibilities towards themselves, their families, and to society. I believe in supporting people who try in earnest to become sober, but not to the point of making it possible for them to avoid the consequences of their actions.

Some people on this thread have mentioned the process of becoming addicted to eating. If a person's addiction to eating large quantities of food results in them becoming morbidly obese, to the point where their health is jeopardized or destroyed, and where their personal/family life suffers, to me this is someone who may need the support of an organization like OA, just as the alcoholic and drug addict does with the 12 step program.

[Kandy83]

Grumble. I can empathize with the mental disorders that cause obesity, and how much it must suck to be that obese. However, my empathy starts to go out the window when it's my back and knees that end up hurting at the end of a shift because I have to help lift these people, or they don't give a crap about my teaching because they're too busy stuffing food down their throats that their family members have brought. I'm not ruining my health to take care of patients.

thank you:)

[applewhitern, BSN, RN]

I put on weight when I had my thyroid removed. I was a size 5/6 at age 43. Then developed Grave's. My doctor kept my replacement dosage so small, I was gaining a whole size every few weeks! He started me at 12.5 mcg, and it took several years before my endocrinologist finally got me up to 150 mcg. I still haven't lost the weight I gained during this. Plus I had to take steroids because of the goiter; that caused weight gain, too. I don't know why my doctor kept insisting on tiny incremental increases, while other patients would get a much larger dose immediately. My brother's doc started him at 100 mcg just because he was hypo.

[jadelpn, LPN, EMT-B]

I have often wondered the same thing. At what point in their lives did food become more important than anything else? Freedom, independence, family, health.......all thrown away for food.

I well remember a 750# RN I cared for. It's been 25 years ago, and I am still haunted by the memory of her.

Much like when drugs, alcohol, gambling, sex and any and all other addictions that take over someone's life. Food is drug of choice.

[jadelpn, LPN, EMT-B]

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.

How does one allow themselves to be addicted to anything? And as a pp pointed out, with drugs and alcohol, one can choose to partake or not. No one can completely give up food. Much like any other addiction, one doesn't wake up one day and decide to eat themselves to the 500+ pound mark.