Nurses throughout the UK will be intrigued by the recent report on obesity but its relevance to everyday nursing practice is perhaps limited.
Tackling Obesities: Future Choices, compiled by Sir David King, the government’s chief scientific adviser, projects a picture of the UK in 2050, in which just 10% of men and 15% of women will be the right weight for their height, while 35% of boys and 20% of girls aged 5–10 will be obese.
Along with this, there will be a rise in the incidence of obesity-related diseases such as type 2 diabetes, heart failure, stroke, coronary heart disease, sleep apnoea, fatty liver disease, brittle bone disease and infertility.
In stark economic terms, the NHS’s bill for treating these disorders may reach £6.5bn a year. If we add to this the cost of lost working days, plus benefit payouts to those incapacitated by obesity, we see that the country’s overall annual bill could top £45bn.
For a nursing student like me, it is hard to grasp obesity problems on this scale. I cannot see their immediate bearing on what I do in ward work or patient visits. And although I read about them with rapt interest, I find little to carry away for practical application. This is no criticism of the authors. No one admires, even reveres, academic excellence more than I do. It merely reflects my belief that academic researchers and hands-on nurses live in different worlds.
For instance, Sir David contends that turning round the national obesity problem will take 20–30 years and will carry huge implications for governments, trusts and planners. Nothing short of a paradigm shift – a radical change in the way we think of things is required. But what is that to me?
I am too busy with the here and now to worry about the world in 30 years. I work to limited objectives. My job satisfaction depends on a one-to-one relationship with each patient. In their pain and suffering, they look to me for sympathy, understanding and help. I feel for them. Occasionally I weep for them. But my emphasis is on the immediate and the practical and I bend over backwards to give them all the help I can. To the extent that this is facilitated by a grasp of their economic, religious and cultural background, I will explore it but always as a nurse, not as an academic.
Let me make this more concrete. Here, say, is a stroke patient, Mr Bland, with a clinical obesity problem. How do I deal with him? Happily, I am past the stage where I would seek to feed him the facts about healthy diet and exercise and leave the rest to his willpower. In this respect, my acquaintance with sociological and epidemiological literature has been very helpful – it has corrected my ignorance. But now I try to empathise with Mr Bland, to see how I would be in his position.
I begin with myself. I am not clinically obese but I know what it is to overeat – especially in the chocolate area – and I have to make an effort to exercise to avoid piling on the pounds. How do I manage to maintain a healthy weight while Mr Bland does not? Chatting with him, I learn he lives on his own, lost his wife in an accident 10 years ago, and has no family or friends. He has not had my advantages.
He came from a deprived background and learnt early that comfort-eating can blot out suffering and loneliness. He used to go to church but the death of his wife caused him to lose his faith. In short, his obesity problem is a multi-dimensional one and calls for the attention of social workers, health visitors and perhaps a sympathetic minister when he is discharged from hospital.
If I can win his trust and inspire him to accept the help on offer, I can feel happy about myself. I have not changed the world, but I have done my job. I have helped one sick, lonely soul, and that is what nurses do best – this is nursing.
All this comes more clearly into focus as I reflect on the King report, and I understand why I will never be one of his kind. What his report offers me is limited. I am a nurse in the making, not an academic. Both are essential to the national healthcare effort but we work with different skills, at opposite ends of the spectrum.
Lesley McHarg is a second-year nursing student in Scotland