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OPINION

Anthony Leeds: 'Have you stepped up to the obesity challenge?'

  • 23 Comments

Nurses are in an ideal position to tackle the growing rate of obesity, says Anthony Leeds

A recent report from the Royal College of Physicians, Action on Obesity: Comprehensive Care for All, called on the government to “step up” to the obesity challenge and do more to ensure that the NHS provides better management for patients who are obese.

Obesity in the UK is among the highest in the world, exceeded only by the US and some countries in the Middle East. Early projections suggest that most people in Britain will be obese by 2050.

The report argues, however, that primary, acute care and specialist services remain underdeveloped or unavailable to meet the challenge, and there needs to be a much more joined-up approach between hospitals and community services.

Diet, lifestyle, drug and surgical interventions must all be evidence based and understood by health professionals, and the RCP report sets out the needs for education and the setting up of services in the UK.

“The report also highlights the importance of nurses in the overall provision of obesity care for all patients, and the need for education in this specialist field”

The report also highlights the importance of nurses in the overall provision of obesity care for all patients, and the need for education in this specialist field.

It suggests that the Royal College of Nursing should set up a specialist group of bariatric nurses. There are already many specialist bariatric nurses working in surgical units but many more are needed to spend time on non-surgical management.

Nurses as a group probably get more education on and have more experience of diet and lifestyle-related issues, and spend more of their time talking to patients about these issues than doctors. However, most would acknowledge that there is still a need for more focused nurse education reflecting increasing specialisation.

Most people who are overweight or obese will need to be helped in primary care so the role of the practice nurse is critical. Few patients - although as time progresses, the number will increase - will go forward for acute and tertiary care. Patients treated with bariatric surgery will be managed in primary care from two years after surgery so all practice nurses will need to run the annual screening for such patients and be aware of the features of complications and side-effects of surgery that sometimes occur.

The UK and, indeed, the world as a whole is in a strange place with respect to obesity. The condition is a global pandemic. Obesity is an underlying factor, among others, in several major conditions including diabetes, hypertension, heart disease, arthritis and some cancers, all of which cause serious morbidity, lower the quality of life and incur huge medical costs. Obesity is also responsible for huge public spending outside healthcare budgets, for example for absenteeism from work directly related to obesity.

Nurses are in a central position to: assess patients for obesity; raise the topic with patients; explain the hazards; motivate the patients into action; help with individual solutions; and break down the barriers to change.

Anthony Leeds is physician with a special interest in obesity at the Central Middlesex and Whittington Hospitals, London; visiting professor at the University of Copenhagen, Denmark; and medical director of Cambridge Weight Plan.

Take our Nursing Times Learning Unit on managing obesity: www.nursingtimes.net/obesity

 

  • 23 Comments

Readers' comments (23)

  • Dr. Leeds clearly has limited powers of observation !

    I is not difficult to spot the many super-sized nurses in our hospitals !

    To argue that these large "professionals" could provide any credible advice to the obese and overweight is perverse.

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  • I was too polite to comment. Nurses are human too. The RCP report discusses the needs of health service employees, noting that an estimated 700,000 NHS employees are obese but only 15% have been assessed. This is a national scandal. The RCP report recommends that Occupational Health departments should refer employees for appropriate help. Employers should encourage healthy eating (check the canteen menus?), encourage physical activity (where are the hospital staff gyms?) and encourage healthy behaviour change. Anthony Leeds 31st January 2013

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  • Dr Leeds

    Many thanks for responding to "anonymous" !

    I am aware of the vast unmet need for many NHS employees to be assisted toward a more healthy life -style.

    Regretfuly staff welfare and well being does not feature within NHS Trust priorites.

    Most Occupational Health Departments are under resourced and marginalised

    Many staff are exhaused by punishing work loads which results in poor care for patients and "burn out " or worse for staff. The continuing top down, target oriented, bullying nature of NHS "management needs urgent reform.

    I hope Mr Francis QC will provide the required ammunition !

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  • Anthony Leeds | 31-Jan-2013 1:12 pm

    from another anon.

    I believe that this is personal choice. some obese nurses and other employers may not perceive their obesity as a problem and may not welcome being singled out for special "treatment". From my observations some overweight individuals seem perfectly 'normal' and healthy and content as they are. I have also seen individuals on well known weight loss programmes where this loss has done them more harm than good possibly psychologically as well as physically and some, after time, revert back to their previous weight and eating and/or smoking or drinking habits with which they feel most comfortable. I don't think we should treat everybody who do not fit in with certain patterns as a problem but let them decide whether they wish to seek help for change or not.

    Obviously nurses who are obese will not be the most suitable to educate patients suffering from obesity related health problems but there are plenty of others available to take on this role.

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  • Nurses reflect the society they come from. Some of us are fat, some not. Just like joe public, we come in all shapes and sizes, colours and orientations. As for giving credible advice, a patient will only accept help if they actually want help. Someone who is a longtime chronically obese diabetic; will have had plenty of advice. We can't stop them shoving rubbish down their cake holes. We've tried!

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  • Anonymous | 31-Jan-2013 7:02 pm

    So you believe its OK for nurses to be obese?

    Just like all the obese policemen/women, obese firefighters/ Soldiers/Air men/women/sailors ?

    The overweight pilots who fly civil airliners ?
    And its ok to have obese air hotesses/stewards ?

    I loved this post !

    "Obviously nurses who are obese will not be the most suitable to educate patients suffering from obesity related health problems but there are plenty of others available to take on this role. "

    I might ask what else do these overweight nurses expect their slimmer colleagues do do whilst they are busy eating chocolate and crisps !

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  • Jenny Jones | 1-Feb-2013 10:57 am

    your comment is discriminatory!

    we had absolutely no issue with my overweight colleague and it was never a subject of discussion among us. her morphology is her own affair. she was an excellent and highly experienced nurse and her output was higher than many of the less experienced. she worked in A&E and was also on the helicopter rescue team which isn't for the faint hearted.

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  • michael stone

    'Anthony Leeds | 31-Jan-2013 1:12 pm

    I was too polite to comment.'

    Interesting, Dr Leeds.

    I am involved in an ongoing discussion about End-of-Life 'beliefs and behaviours', and I have noticed that it is very difficult to get most clinicians to just say 'You can't be right about that, because ...'.

    They all tend to be much more 'round the houses' - this makes it very time-consuming, and quite difficult, to actually work out what clinicians believe 'to be true'.

    I have often wondered, if the perceived/reported (on these pages, for example) 'relative powerlessness' of nurses, in connection with affecting their working enviroment, is influenced by this 'non-confrontational attitude' - presumably it tends to become ingrained in all clinicians, because clinicians are interacting with patients ?

    For anyone else - yes, I know that was off-topic, but I'm interested in this 'courteousness' and its consequences !

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  • Well the current strategy appears to be cater to the obese and patronise them. After all they have no idea at all how they got that way do they???????

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  • "we had absolutely no issue with my overweight colleague and it was never a subject of discussion among us. her morphology is her own affair. she was an excellent and highly experienced nurse and her output was higher than many of the less experienced. she worked in A&E and was also on the helicopter rescue team which isn't for the faint hearted."

    And the helecopter actually could take off ?

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