A Weighty Issue

 I checked out a new blog today and saw a blog post after my own heart. My fellow Recovery Room nurse put into words a conversation I have had with several patients. At http://recoveryroomriley.blogspot.com/2012/01/worn-out-joints.html this nurse talks about how an obese patient cannot for the life of her figure out why all of her weight bearing joints are deteriorating and need to be replaced.
I have noticed this same thing with many of my patients. They do not understand why they need to get their knees and/or hips replaced, why they are hypertensive, why they have lower back pain. Many do not even realize that they are obese. Are their physicians not discussing this with them? Now keep in mind that I am not talking about the pleasantly plump individual or the person who has "a little more to love". The patients to whom I am referring are truly in the category of obese, sometimes morbidly so. And it is not just the patient's health that is affected. Every time they pull a 400 lb patient up in their bed or transfer a 350 lb person from a stretcher to a bed, health care workers sigh in relief when their backs emerge unscathed.
  How do we  get the collective American waistline to shrink a bit? This gentleman at CNN compares the response needed for this issue to the war on smoking and even more so to the campaign to reduce highway fatalities  cnn.com.        
  Now my muffin top has grown from barely noticeable to semi-in-your-face over the holiday season, so I am  certainly not immune to the pleasures of pumpkin pie, fudge, and cookies. However, seeing the debilitating health issues that my obese patients face absolutely does help motivate me to not let my weight get too out of control, kind of like old ladies with broken hips inspire me to take my calcium. It is hard in a world where processed, sugary and fatty food is less expensive than fresher, more nourishing choices to always do the healthy thing. However, if we can just get ourselves to the the healthy thing a little more often, I think we could make some giant gains...or giant losses in this case.

Europe and the USA

Apparently this photo is from 2004, long before I entered the blogosphere. So, bear with me if you have seen it before. I admit that I do eat fast food sometimes. Working 12 hour shifts and shuttling kids to activities sometimes makes the drive thru  inevitable, but I can definitely appreciate the humor.

Bariatric Sensitivity Training

   Our hospital, in an effort to become a Bariatric Center of Excellence or some such nonsense, is requiring all staff, including physicians, to attend a bariatric sensitvity course. Now I will be the first to say that I could lose a few pounds. I have a "healthy" BMI, but am at the top end of normal, so three or four more pounds and I would be officially in overweight territory. So I am not some skinny girl hating on anyone heavier than me. I could definitely use more exercise and less sugar, no doubt about it. And of course everyone from Michelle Obama to Elmo is talking about America's obesity issue on television. However, I have to say that this class was by far not the most productive hour of my week.
   We spent the first half of the course covering points that hopefully those of us who are not complete a#%holes already knew. Obviously we should provide a larger bed for a larger patient, so they don't fall out.  Another example: when weighing an obese patient, we should not rudely holler out their weight so loudly that the entire unit can hear it. We also should not yell out "Hey Joe, we need to get the Big Boy wheelchair for this one", an actual example from the power point presentation.  We were also instructed to always provide an extra large gown for our bigger patients, which of course we would do anyway.
   Some of the other points, however, confused and disturbed me a little bit. We were instructed, in an effort to be sensitive, to not weigh a patient if they are uncomfortable about being weighed. Really? Many meds are weight based. An accurate weight is pretty helpful. A CHF patient often needs daily weights to determine if they are retaining fluids or not. This is a more complicated issue than it would seem.
   Another idea that seemed a little out of hand was to only discuss the patient's weight if the patient brought the subject up and wanted to talk about it. Apparently there have been a rash of patient complaints lately in which the patient was offended that a doctor or nurse had the temerity to advise that some weight loss might be a good idea if the patient wanted to live a few more years free of strokes, heart attacks and other not so pleasant things. This just flies in the face of common sense. Isn't prevention of health problems what we are going for (ideally) ? Are we not going to tell the chronic alcoholic with the cirrhotic liver that they should quit drinking? Do we not tell the diabetic who neglects their insulin that if they don't start taking care of themselves that little foot wound could result in an amputated leg? There are patients in our ICU right now who would not be there if not for their morbid obesity. That is a fact.
   We have extra large OR tables. We supposedly have "lift teams".  We have a special private preop area for bariatric surgery patients. We generally speaking are not jerks. We don't typically go around  making fun of anyone's weight. Sure, I know the patient probably aleady realizes they need to lose weight. Yes, I know many people would simply choose to ignore our advice. But damn...if we can't even talk about it in a sensitive manner, even raise the subject of possibly trying to lose some weight, how does that help anyone?

A Weighty Matter

No offense meant to anyone, but as long as obesity, especially morbid obesity, is common, I will always have a job. I am the first to admit that my body is not perfect. I could stand to lose 5 to 10 pounds. I often eat too much sugar and processed foods and get too little exercise. However, it is the population that is 100 or more pounds overweight to whom I am referring. We have had to acquire special hospital beds for the morbidly obese, special wheelchairs, special operating room tables. We have one orthopedic surgeon who has literally made a fortune providing knee replacements to obese patients. We take care of so many people having toes feet, legs amputated because of obesity related diabetes. I am fortunate to have only gotten a few aches and strains from lifting/maneuvering obese patients. I have had coworkers develop severe and chronic back, neck, shoulder, and elbow problems from assisting super heavy patients. Many of these patients are on Medicaid, so everyone else is collectively footing the bill for their numerous medical procedures and quite extensive care. These patients are getting younger and younger. The other day I had a 24 year old female patient who literally could not wipe her own butt. When I asked her what she did about it at home, she replied that her husband did it for her. I have seen ICU patients with trachs for an inability to maintain their own airway and breathe solely due to their morbid obesity. My uber conservative husband makes statements like "Oh, just cut off their food stamps". Somehow I don't think that would get the job done. I don’t know what the solution is. Do you?