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Exclusive: Nursing needs to confront its weight problem, says researcher


People are less likely to believe or act on healthy lifestyle advice from an overweight nursing professional, according to research by a former nurse who says it is time to be more honest about this taboo topic.

In fact, healthy living advice may have more impact if it is delivered anonymously online and not face-to-face by someone who clearly has their own health problems, argues psychology graduate and former mental health nurse Helen McDowall.

“There is an incongruity here and something fundamental needs to change”

Helen McDowall

As part of her new study – titled Perceptions of health and source credibility in relation to weight differentials in health professionals – participants were asked to rate the credibility of health advice given by an imaginary nurse shown to have lost or gained weight.

She said the findings demonstrated that participants were less likely to believe statements about healthy eating made by an overweight health professional and more likely to believe someone who was not overweight.

This was also true when it came to non-weight-related advice on quitting smoking, she noted.

Ms McDowall worked as a registered mental health nurse for 19 years and then moved into other caring roles before embarking on a psychology degree at the University of Chichester.

“We are supposed to be non-judgemental and avoid embarrassing our patients”

Helen McDowall

She undertook the study for her final year dissertation and said she was inspired to explore the controversial topic by her own recent experiences of observing healthcare professionals at work.

“It all came about because my husband has got cancer and I spent a long time last summer sitting around in hospital waiting rooms,” she said.

“There were vending machines in every waiting room at my local hospital,” she said. “I saw nurses drinking full sugar Fanta and tucking into chocolates and it seemed incongruous and hypocritical to me.

“I wondered whether other members of the public were thinking critically like that or whether they just accepted it,” she told Nursing Times.

In all, 98 people aged 18 to 85 took part in the online exercise and were divided into two groups.

All were first shown anonymous health information and then introduced to an imaginary female nurse called Charlie described as a “highly respected nurse practitioner” with more than 10 years’ experience and expertise in both healthy eating and quitting smoking.

“Lots of my colleagues at university said I was mad bringing this subject up”

Helen McDowall

As well as being told a bit about Charlie’s background, participants were also shown a silhouette image depicting her as a healthy weight or clearly obese, and told to rate the credibility of her tips on healthy eating and smoking cessation.

They were then asked to “jump forward in time three years” and look at another picture of Charlie that showed she had either lost or gained “a lot of weight” and rate her advice again.

Ratings for believability, authoritiativeness and Charlie’s character increased among those who observed her weight loss while ratings dropped for those who saw the nurse become obese.

“The results make intuitive sense, but nobody’s actually talking about it,” said Ms McDowall, who highlighted that a disproportionate number of NHS staff were classed overweight compared to the general public.

University of Chichester

Nursing needs to confront its weight problem, says academic

Source: Helen McDowall

Silhouette images of nurse

She said her findings suggested that people might be more likely to follow healthy lifestyle advice if it was anonymous.

“It may mean giving advice on the internet, without the involvement of a relationship, might be more effective because it is neutral and avoids the automatic judgements people make that are hard-wired into our minds,” she said.

Some trusts are establishing virtual nursing services, where people can get advice on issues like breastfeeding from a qualified nurse they never see through social media and messaging services.

Ms McDowall told Nursing Times she understood all the issues that may make it harder for nurses to lead a healthy lifestyle, including feeling too tired to exercise, not being able to take proper breaks, the fact they often grabbed the nearest high energy snack just to get through a shift.

“I have been there, I have done the 36-hour shifts and 78-hour weeks and don’t want to do it anymore,” she said.

“I am not sitting here in judgement, but what I am saying is that there is an incongruity here and something fundamental needs to change,” she told Nursing Times.

She said she believed part of the problem was that nurses themselves felt constrained when it came to having frank conversations about sensitive topics like weight with their patients.

University of Chichester

Nursing needs to confront its weight problem, says academic

Helen McDowall

“We are supposed to be non-judgemental and avoid embarrassing our patients,” she said. “We’re not supposed to identify the obvious – we’re not supposed to say ‘you’re fat because you eat too much and don’t exercise enough’.”

Ms McDowall said: “I think this creates an environment which is safe for people who have weight issues – or any health-related issues – to be and to work and not be judged.

“Lots of my colleagues at university said I was mad bringing this subject up, because nobody is interested in talking about it and just want to push it under the carpet,” she said. “But we need to talk about it.

“It’s about being honest and transparent and recognising that healthcare organisations not only have a responsibility to members of the public, but also a responsibility to look after their staff and give them the opportunities, the working patterns, the facilities, the time to be able to live a healthy lifestyle,” she added.


Readers' comments (6)

  • Recently I fell and fractured my wrist and shoulder and had to attend a few clinics, the Nurse in orthopaedics outpatients was overweight and appeared very slow and lethargic, laborousily dawdling from one part of the department to the other, I had to remind myself they may have other issues - chronic conditions etc, but initial perception was they were not a good 'role model'. I agree with most of the article - I wouldn't take any advice on healthy eating from an overweight nurse, nursing assistant, dietician etc - unless she was open and honest and 'admitted' their own struggle with trying to maintain a healthy lifestyle etc. But 'hiding' behind a computer is not ethical, it's like saying all Nurses are "OK" when we are not. For the record I am overweight, no excuses, just need to exercise more and eat less. I also have chronic conditions and have for many years seen many physiotherapists - both private and NHS, yet I've never seen one that was 'overweight'. Maybe we need to look at physios and see if the solution lies in their mindset.

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  • It's overdue for Ms McDowall and Anon to update their knowledge on how we become and remain overweight.

    It is not a simple matter of calories and taking in more than we expend - and never was, despite the dictates of some condescending bullies in the medical profession and the compliant response of their victims.

    Other considerations like IGF factor 1, leptin and grehlin and micro biomes and poverty are very influential.

    I am overweight but if I overeat prior to reducing calorie intake then initially I lose weight but do not proportionately lose weight when I actually reduce calorie intake. However trying to do the 5/2 diet with 12 hours food free overnight meant I lost weight and gained health with surprisingly relatively little effort. But I lost focus on myself because shoddy care for my mother by the NHS took so much of my attention... the ramifications of government policies that work on diminishing the NHS.

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  • Whilst I have to agree that taking advice from someone who practices what they preach is probably much more effective I have to comment on the whole question of obesity. I am of average weight but only because I go hungry on the wards rather than eat the only things that are available when there is no time for a break, namely biscuits, cakes and chocolates. However, no matter what I ate I am sure I could never get morbidly obese, simply because I could not consume that amount of calories. We all know the child who is not allowed so much as a crumb before lunch because they will lose their appetite, and also the child who will eat first at a party and continue to eat while everyone else is playing. What makes them different? I do not believe it is greed because all children are greedy for nice things given the chance. Obesity and certainly morbid obesity is a disease the same as bulimia and anorexia nervosa is. Surely they are all eating disorders, so why are we so sympathetic with one and treat the other with disgust.

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  • I would not take advice from any nurse if they suggested the whole issue was a balance between calories in and calories out. It's an outmoded piece of advice that does not take into consideration the way we metabolise different food groups. Having spent my entire life following the advice of those experts, and gaining weight year on year, I finally took control, did loads of research and discovered that if I only reduced my carb intake and bumped up my fat intake I could lose 6 stone - and more importantly - keep that 6 stone off. It doesn't matter who gives the advice if it's duff advice. What if overweight people over eat BECAUSE they are fat? Could obesity be, as many people are beginning to question, a disorder of fat deposition not simply an imbalance of calories in and calories out?

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  • I agree with above comments. It's a more complex issue than nurses stuffing chocolates and biscuits, as the article suggests. It is true that hospitals provide easy access to vending machines which are stuffed with fizzy drinks, chocolate and crisps, so perhaps the ethos of supplying the to staff and to the public needs to be questioned. As a person who has recently lost a considerable amount of weight, I know the importance of not having access to temptation. Internal rotation doesn't help either; the digestive system is not designed to take on food in the middle of the night when it is accustomed to working during the day. We are forced by our employers to adopt an unhealthy lifestyle; it is up to us to do something about it.

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  • I think people should look at the well now model approach to healthy life styles. Another problem is the way we are treated 30 min for lunch and 30 min for dinner breaks in 12 hour shift. Not natural I worked in South Africa for years, where we had an hour for each. At least we could eat properly and even have time for a walk about much more civilized if you ask me.

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