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Practice Comment

“Ensure people who are obese receive non-judgemental care”


Do you make assumptions about people who are obese? And, if so, how does that impact on the care you give?

We can all be guilty of allowing our prejudices to get in the way of our interactions with others, but by anticipating our reactions, we can ensure that we build good relationships with bariatric patients and give them the best care we can.

We need to think carefully about how we care for patients who are obese, and first impressions count.

When you first see patients who are morbidly obese you may be overwhelmed by their appearance. You have only a few seconds to make an impression and in that time, patients will decide whether you are trustworthy, likeable, a friend, even. It is easy for your gaze to fall on their body, but it is vital to use those seconds wisely by smiling, showing an interest in your patient and focusing on their face.

Patients who are obese may have experienced prejudice from others, and blaming these patients for their size is not uncommon among health professionals. Physical contact is an important aspect of care, yet obese patients report less physical touching by carers than other patients.

It can also take significantly longer to nurse an obese patient than others, and this may subconsciously influence your approach to your work. Your thoughts might not be “how can I effectively carry this activity out”, but “I won’t finish on time, because this patient is going to make me late”. It is therefore important to focus on the positives: ask patients what they are able to do for themselves, rather than assuming they are totally dependent.

While understanding the importance of having appropriate handling equipment and staff training is only part of the answer, it does form the basis of a good working relationship with your patients.

Alongside nursing care, it is vital to have adequate policy arrangements and staffing levels, a suitable environment, and staff who are educated and skilled to manage the needs of this group. For example, privacy is a major concern - particularly if a patient cannot fit into a toilet cubicle and has to use a commode behind a screen. And imagine how it feels having to wear an examination gown that does not fasten.

If you are requesting equipment, find out what you need it to do, as each body type requires a separate solution. For example, some patients might need a wider sleeping platform, and therefore additional bed space if they are being nursed in a multiple-occupancy room. A suitable bariatric chair must also be carefully considered to fit the patient’s body shape, not forgetting the role of building design from door widths to elevators. This all requires careful assessment and planning.

Aim to identify with obese patients’ feelings. Understand the importance of individual identity and self-esteem in emotional and spiritual wellbeing. Above all treat people equally regardless of their size. Their size does not define them.

Anne Murray is moving and handling adviser at NHS Grampian. Ms Murray will be speaking at Naidex Scotland at the Scottish Exhibition Conference Centre, Glasgow, 18-19 September.

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Readers' comments (20)

  • Substitute the word *obese* with *black* or *asian* or *gay* or *handicapped* and re-read the article again!

    The increasing amount offensive nonsense being written about fat people - a group to which I belong - is beyond me!

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  • Anonymous | 9-Sep-2013 5:16 pm

    Stop being offended and do something about a situation (of your own creation: not something that can be said of someone who is black, asian or gay!) which will drastically increase your risks of poor health and premature death.

    This is the next serious health issue and needs to be addressed urgently. It is already costing too many lives, and the treatment of the chronic illnesses caused by obesity (a totally preventable condition) is already unaffordable!!

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  • Anonymous | 9-Sep-2013 5:16 pm

    nonsense! what is offensive about the article?

    is it offensive to advise the smoker with COPD that smoking is exacerbating the condition? is it offensive to advise the alcoholic with ALD that continuing to consume alcohol is going to damage the liver beyond repair? no. neither is it being judgemental.

    moving and handling morbidly obese patients takes longer and requires specialised equipment. those are facts. we are seeing more patients who are obese and that needs to be discussed.

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  • Oh my word, did you two not read the article before you started ripping into your colleague?
    School yard bullies.
    Your responses absolutely sum up the intention behind this article. I hope you are good at hiding your cruel taunts and your put down looks when you actually look after patients. They will know which nurses they can trust and which wouldn't give them the time of day.

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  • Anonymous | 10-Sep-2013 2:09 pm

    And there it is....the accusation of bullying! That didn't take long did it? People like you have no place in healthcare.

    What cruel taunts? What has been said that is not true? Nothing. You just don't like it. That's all. Obesity in this country is reaching epidemic proportions and it is totally preventable. That is evidence-based fact. People like you do nothing except take offence, call everyone a bully and stick your head in the sand. That is what is disgraceful here.
    This problem needs to be dealt with and dealt with now by honest and frank professionals who can affect change, improve health and save lives. Not those who can't even speak about obesity in a mature fashion without resorting to silly, childish name calling.

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  • Obesity in children is now at 30%. It is mainly caused by over eating and too little exercise. This is not rocket science. It is not anyone being judgemental. It is the truth.
    Smoking rates have halved in the last 40 years with a reduction in deaths from smoking related illnesses. I can think of many upsetting TV ads over the years which were quite blunt about the effects of smoking. Health professionals and policy makers have often been attacked by pro-smoking lobbyists and supporters and accused of being guilty of bullying and a variety of "isms".
    Obesity needs to be tackled and people need to start being honest with themselves about the reasons behind them being overweight.
    Put down the pie/cake/biscuit that you really don't need and go for a walk instead. It doesn't need to be a 5 mile hike. Just walk up a flight of stairs, or walk quickly for the few minutes that it would have taken you to eat the pie/cake/biscuit. Small changes will become good habits.
    But mostly, take responsibility for your own health and accept that it is your job to change. Those who are throwing the 'bully' word around are in most need of the self reflection.

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  • Hi, I'm going to tell you my story just in case anyone's up for an inside view. I am morbidly obese. I could tell you about medication I was on, or mental health problems I had in the past, but the fact is I have maintained my weight myself by over eating for years. I am thirty on Sunday, I have put off having children until I've lost more weight, I so desperately want children but I'll get diabetes, harm my baby etc. I work very hard, too hard sometimes just to prove myself, but it's obviously because I'm frightened that people judge me before they know me and how fantastic and kind I am. My feet suffer the most, carrying this weight, they are mangled, but you won't find me complaining. I mean ever. I know maintaining my weight is ridiculous. I am fully aware that my health is suffering and will suffer more. Changing a lifestyle is not straightforward because life is not straightforward is it? But I'm coming along. A pound a week for two years. Its slow and the setbacks are frequent. But i don't want overstretched extra skin do i? Why create that problem. I most definitely don't ever want to put this weight back on which I believe I am more likely to do if I binge diet.

    I would spitefully eat a big bar of galaxy between the sobs if someone told me to get off my fat arse and go for a walk. I'm not stupid, I'm not lazy. The fact does remain that I am fat and it's of my own doing. It makes my own life hard but i think it impacts very little on the lives of others most of the time. I love my job so much and i'll get my baby one day.

    With specific regard to the article, I treat obese patients as I would treat anyone (smokers, swearers, babies, ladies, idiots, offenders) Never on face value, as unassuming as I can (being a bit of a nelly know all), with attention to detail and as much as possible how I would like my own family to be treated.
    Obesity is a problem, I believe that approach is how I will help solve it. I most certainly never think of human beings in monetary terms, I would be a very unhappy and cynical person if I did that. We all cost what we cost, we all give what we give. Probably why I'll never be financially rich.

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  • This is a very emotive subject. I completely agree with those who assert that obesity is one of the most serious health challenges facing us today. It creates complex problems with apparently no easy solutions. All healthcare costs, whether or not anyone wants to talk about it and it should be obvious to anybody working in health that there aren't limitless funds. The responsibility starts with the individual.

    Anonymous | 10-Sep-2013 9:37 pm

    Good luck in your efforts to lose weight and congratulations on what you have achieved thus far. I only hope that you were not referring to the post by Anonymous | 10-Sep-2013 7:06 pm, when you wrote, "I would spitefully eat a big bar of galaxy between the sobs if someone told me to get off my fat arse and go for a walk." That was clearly NOT what was said and it is important that it is not twisted.

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  • Hi, thanks! oh no I wasn't referring to Anonymous 7.06 I understand that in the general public that's what some people think and say when they see me. I should have clarified, nurses who take a firm but understanding view of obesity are what drove me to lose weight in the first place. Sorry about that.
    With regards to healthcare costs, it is something I avoid thinking about you're right, i wouldnt be wasteful but when i start thinking of how much people cost us all i turn into a slightly militant and ill informed individual...and that's why someone like me who has been accused by my other half whilst watching question time of being a closet communist should never be in management. I can't see the bigger picture, it's something to work on I suppose lol.

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  • tinkerbell

    Anonymous | 10-Sep-2013 9:37 pm

    Good for you! Wishing you every continued success.

    The fast food industry that promotes 'do you want to go large? well it seems a shame not to when it only costs 40p more. How about taking 40p off a normal portion instead?

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