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.

[jadelpn, LPN, EMT-B]

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.

That is not always the case. I have had 150 pound contracted patients that take more than one or 2 to even turn!

If the focus is on moving difficult patients, then don't limit it by using obese patients as an example. It is inflammatory.

My suggestion would be to do your research, see what is out there as far as equipment to help one move a patient. There are complete no lift hospitals. Research them and see what they use. A lift team is a great idea. There are perhaps grants available to help purchase equipment. Get your physical therapy and occupational therapy involved. Then bring it to administration. If you get a team together to help solve this issue, it improves patient safety. And administration likes that. It improves press gainey scores. And administration likes that. Be innovative, think outside the box, do what you can for you and the rest of the staff's safety.

[JeanettePNP, MSN, RN, NP]

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."

...

I don't have time or energy to debate this, the way I look at it is this: I know I have some unhealthy eating habits. I eat fatty and/or sugary foods every day. I don't exercise nearly enough. Yet my weight is stable at around 150. Still overweight for my height but not ballooning out into obesity. So what is the difference between me and the 500# person? I can't say it's because I make better choices or have more self control. And I'm not denying my own responsibility to change my eating habits before they catch up with me eventually (I have a strong family history for type II diabetes on both sides). If I gorge on cake or ice cream I have nobody to blame but myself. But they're paying the price and I'm not (yet). That's why I think we need to look more into sociocultural, psychologic, economic, and genetic factors that contribute to obesity rather than blame the individual.

[SNB1014, RN]

The patient doesn't even have to weight >500 lbs. A 250-300 pounder wears me out! Especially if they can't/won't help you.

true statement.

i consider myself strong for being thin but fit. 200lbs of dead weight who is confused , contracted and connected to tele monitor, ng/peg, foley and God knows what else is a PROJECT. thank God for tradelenberg, but if they are very sob trendelenberg doesn't always work for them.

plus i just started paying off student loans and this back has got to last me another $20k!

[SNB1014, RN]

i find lower Socio-economic status to be the biggest predictor for obesity and general health issues. (not a blanket statement).

i had a professor who talked about "institutionalized racism" and "top down SES" regarding how a fried chicken and waffles platter is typically cheaper than grilled chicken with baked sweet potatoes and a fruit compote sauce. how most fruit does not grow in the inner city due to regulations and space, so a nyc bodago man can sell mealy apples for a crazy high price.

in 3rd world countries, most people in poverty are skin and bones. in america, those in poverty are indeed malnourished, but instead they are obese.

[FranEMTnurse, CNA, LPN, EMT-I]

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.

So true. In addition, some fast food joints like McDonalds put additives in their foods to get people addicted.

[FranEMTnurse, CNA, LPN, EMT-I]

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.

Not this gal. I get most of my clothing at the Good Will store, or when there is a clearance at Walmart.

[FranEMTnurse, CNA, LPN, EMT-I]

Genetics in some cases predispose a person to substance abuses.

[PRICHARILLAisMISSED]

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?

This is 100% true, dirtyhippiegirl. Many diseases are the result of lifestyle choice. However, the difference between things like Alcoholism, drug addiction and obesity is that in most cases it is entirely within the "victims" reach to fix it. Yes, it will bw difficult, but it is in their hands.

Lung cancer however, well medical intervention is absolutely necessary for this one. Not much the pt can do on their own...

[PRICHARILLAisMISSED]

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.

Everything you say here I agree with. All of it. The bolded is actually what I mean to say, only with a bit more sympathy than I used. But please understand that I'm not vilifying the obese (or alcoholic or drug addict for that matter). I was simply saying that I do not believe that it should be classified as a disease because it is within the "victims" grasp to help themselves. You yourself say that they should not be absolved of responsibility.

I just get so tired of ppl (not necessarily you) who enable others, you know? Even as a teenager, I've felt that we all should take responsibility for our own indiscretions. But these days, nothing is ever an individuals fault. It's always "Societies" fault, or the Governments fault or they have a somewhat different chemistry in their brain (all of our brain chemistry is somewhat different than anyone else's btw) that compels them to do what they do. While that last is valid for many things, I also gotta say that we all have desires and compulsions that we stave away because they are either dangerous and or unacceptable in society.

This has to stop, as we have already become so mentally week. We cannot foster this anymore.

[BuckyBadgerRN, ASN, 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.

Graves Disease with a TT here too. My MD will medicate based on my labs AND Sx---its a Godsend.

Back to the OT--personally I think its CRAZY that nurses and other caregivers are expected to potentially serious injury to their back or more by moving morbidly obese people who, in MANY cases (not ALL) made the choice to get the way they are. One of the health channels last night had a mini-marathon on several obese persons and their journey (ie: path to surgery) to lose weight. Every. Single. One. Of. Them. stated that they made the decision to continue to eat the way they did, even when they knew it was harmful to their health. And they all had "loved ones" who admitted to contributing to the problem by supplying them with whatever they wanted to eat whenever they wanted to eat it.

[tewdles, RN]

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.

I doubt that these folks were "once healthy". I suspect that they had an underlying mental health issue that was inadequately treated even before it expressed itself in the self destructive abuse of food.

[anotherone, BSN, RN]

That is not always the case. I have had 150 pound contracted patients that take more than one or 2 to even turn!

If the focus is on moving difficult patients, then don't limit it by using obese patients as an example. It is inflammatory.

My suggestion would be to do your research, see what is out there as far as equipment to help one move a patient. There are complete no lift hospitals. Research them and see what they use. A lift team is a great idea. There are perhaps grants available to help purchase equipment. Get your physical therapy and occupational therapy involved. Then bring it to administration. If you get a team together to help solve this issue, it improves patient safety. And administration likes that. It improves press gainey scores. And administration likes that. Be innovative, think outside the box, do what you can for you and the rest of the staff's safety.

I have turned my fair share of all types of pts. If they are unable to help the more they weigh the more difficult it is. period. Obviously a 450lb mobile walkie talkie is easier to care for then a 150 contracted pt with a peg tube and foley and wound vac and trach.

Are we seeing more super obese pts or not? has it leveled off or is it increasing? I have only been a nurse for an few years and it seems about the same adult pt wise. But as a kid I rarely saw obese children . 15years later I see a lot more. If it is increasing than hospitals better get with it ( another project to be nursing responsibility @@?).