Help!!! Need advice on telling people they are fat!

[Sleeved36 356]

I know this is a loaded subject, but here goes: I am a nurse and the physicians I work with often recommend weight loss to thier patients. Some approach this conversation better than others.

As a nurse I understand that losing weight makes patients healthier and the obesity epidemic can not be ignored . . . . BUT as a patient I hated being told to lose weight, in fact I kinda wanted to lash out at the skinny wench. Duh, if it was so easy I wouldn't be fat bc it is SUPER fun not being able to: find clothes that fit, reach my toes, breath while I put on shoes, or fit in a small chair.

So here are my questions for you all:

How should a doctor tell you to lose weight? Or should they just not say anything? Who can you help by ignoring it?

Would it be better if nutrition classes or a healthy lifestyle program was offered at the same time?

Should the conversation only happen with another big person? Would you feel less judged that way?

Or does it seem silly for a fat person to tell another fat person to lose weight? Empathy or irony?

Would it be better or worse if bariatric surgery was mentioned? Would it help if I flashed my scars?

Tell me about times when a medical professional told you to lose weight. How did it feel? What would have made it better?

I can change how this is done where I work, but need input. You can PM me if you want, too.

Second guessing this post, might belong in the rant and rave section.

[anonbaribabe 236]

Obesity can cause health issues—we, of course, know this. However, it would be erroneous to assume that every patient knows all of the complications and health risks that come with obesity, which is why it's part of a doctor's job to educate their patients about this. It might not be something that patients want to hear, but it's the harsh reality of it. My PCP brought up my weight when I first starting seeing her and I'm glad that she did. I'm obese—it wasn't rude for her to say this, it's just a fact. She asked me what I was doing about it, I told her that I was counting calories, exercising, etc. and she told me to keep it up. It was a positive conversation. She didn't reprimand me and I didn't feel belittled. I'm a sensitive person, but appreciated her honesty. I think this is information that must be told to patients, but that the way in which it is delivered is important.

I don't think it helps to skirt around this type of information because a patient might not be as willing to look into a nutrition class/healthy lifestyle program if they're told "you're just a little overweight," when in reality they're morbidly obese. They might not see it as an actual issue if they're not told the truth about their weight. I totally understand that this is a tough issue and that many who are obese don't want to be confronted with this information, but I also think that it's important that doctors are transparent with their patients.

[S@ssen@ch 745]

The answer to how a doctor should tell a patient they need to lose weight would be entirely dependent upon the patient (the recipient of the info). Their reaction will be based on past experience, their mental health status, and their personality.

In a perfect scenario, the doctor would have had a good relationship with the patient and they can have an honest, productive discussion. But, we live in the real world where patients are often part of the assembly line of healthcare. So, the doctor wouldn't know the patient well enough to know how best to approach with the patient in front of them.

In my opinion, there is no perfect way to approach the subject. And I agree with anonbaribabe (above) that doctors are obligated to educate their patients about their health, the risks involved, and their options to treat.

My advice, take the approach of being informative and try to be empathetic. You won't win them all, but you'll win some. Besides, your conscience can be clear that you did the best you could.

In my own personal experience, I didn't like being told I was overweight. It's not like I didn't KNOW, it just stings to have someone else point it out to me and it was a blow to my self esteem. At my worst, I was guilty of avoiding doctors primarily for that reason. I didn't really want to face it.

[Orchids&Dragons 9,047]

Just my 2 cents:

How should a doctor tell you to lose weight? Or should they just not say anything? Who can you help by ignoring it? I think it should be brought up when discussing any health concerns related to weight. If there are no health concerns yet, don't go there. It's not like they haven't noticed. However, opposite answer for pediatricians. Parent do seem to have a blind spot for "baby fat". Not sure how to broach the subject, though.

Would it be better if nutrition classes or a healthy lifestyle program was offered at the same time? Yes, my doctor's office told me to lose weight every time they saw me. But when I asked for help, they said they didn't advocate anything but diet and exercise. Well, gee whiz, they'd watched me go up and down hundreds of pounds during that time. Why did they think it would work this time? Some form of help would have been appreciated.

Should the conversation only happen with another big person? Would you feel less judged that way? I don't think that matters.

Or does it seem silly for a fat person to tell another fat person to lose weight? Empathy or irony? Depends, one may have co-morbidities that the other does not. Again, I don't think the size of the medical professional should matter. I mean, my obstetrician was male; he never experienced pregnancy.

Would it be better or worse if bariatric surgery was mentioned? Would it help if I flashed my scars? I think it could be mentioned among a list of alternatives. In fact, it wouldn't be a bad idea to have a handout that discussed pharmaceutical options, behavioral modification options and surgical options with pros/cons. This would include the weight ranges for which each was appropriate.

Tell me about times when a medical professional told you to lose weight. How did it feel? What would have made it better? Generally, I got angry because I'm overall in good health, no-comorbidities, etc. I felt like they used that as the catch-all excuse to not look into the actual causes of my issues. Hangnail? Lose weight, it'll get better. Pneumonia, lose weight, it'll help. Pimple on my a$$, lose weight, it'll help. You know what? Even if the weight did contribute to the problem, telling me that it might improve in a year or two after I lost an unlikely amount of weight was not helpful. Especially if you would have sent a non-obese person for some actual treatment. I stopped going to doctors entirely. They weren't going to help me lose the weight, just document my suffering.

/Rant over/

Edited July 8, 2018 by Orchids&Dragons

[Creekimp13 5,840]

1 hour ago, Sleeved36 said:

So here are my questions for you all:

How should a doctor tell you to lose weight?

They should become a doctor, first. As a nurse, you are not typically in a position to comment on patient's weight.

Like any other health condition....Doctors should present factual information about the health risks of obesity and offer treatment advice, lifestyle advice, and referrals.

Edited July 8, 2018 by Creekimp13

[Bryn910 519]

6 minutes ago, Creekimp13 said:

They should become a doctor, first. As a nurse, you are not typically in a position to comment on patient's weight.

Period.

I am gonna chime in on this part. There are a variety of healthcare professionals that indeed deal with weight and it is within their scope of practice to discuss weight and weight loss.

I am not entirely sure about nursing but I work with NP’s that discuss weight all the time. And I, as a physical therapy assistant discuss weight with patients as well as part of their plan of care. Weight affects a lot of aspects of healthcare, not just when they see a doctor. If my patient came to me saying every joint in their leg was aching and they had no diagnosis of arthritis or joint problems & they were overweight, I would be doing a disservice to them by not telling them how weight affects their joints and causes pain.

[Laura7 334]

So, I think people need to be told. I also think people need options. I think a brochure would be nice, or a flyer. You could include the bypass for over a certain BMI and show how to calculate your BMI. There could be a recommended healthy weight and/or a few diet plans recommended. Maybe a list of tips for healthy eating and exercise. I’m a teacher so I respond to things I can read on my own and things I can make choices about. I don’t like being told what to do but sometimes it needs to be done.

[Sleeved36 356]

3 hours ago, Creekimp13 said:

They should become a doctor, first. As a nurse, you are not typically in a position to comment on patient's weight.

Health promotion and maintenance is absolutely my role. More than half of my job at work is education.

It is condescending and rude of you to assume that you know my job description, nurses do all kinds of things. I have lots of other fancy letters behind my name besides RN that relate to my professional role, but that isn't the point for this forum.

I didn't think I would have to include all of my credentials to have a discussion about how people felt about weight conversations in a healthcare setting.

[Bryn910 519]

I also want to say that when I was concerned about my weight, my family practitioner just told me to count calories and log what I eat. That was the worst advice I could have ever gotten. Sure, I was knowledgeable about doing that but what if I weren’t?

Education is key with everything, especially nutrition and weight loss. Our healthcare providers can tell us we are overweight and how to fix it. We need to be told of the possibilities that can affect us because of weight: joint problems, diabetes, high bp, etc. it’s ok to scare people a bit, it’s the truth. The same way people encourage one not to do drugs, smoke or drink.

I believe offering nutrition classes should be the next step after educating someone on their obesity. Alongside that should be meeting with an exercise physiologist or physics therapist to educate them on proper exercises for their body types and current health status. I think the combination of these two things can help the obese person to see change and become motivated. And if WLS is an option, then the data is there for the surgeon/team

[sideeye 1,440]

I would say, assume that the patient knows they're fat. Assume that they've been told this many times, by multiple doctors, with varying levels of condescension and exasperation. Assume they understand it's healthier overall not to be fat. Assume that they probably know the basics of how humans are advised to lose weight.

Then treat them like a rational human being and say "At your height and weight, you're falling into the [overweight/obese] category for BMI. That's only one metric for overall health, but excess weight does tend to impact other health issues negatively, so I want to make sure we cover this early - would you like to talk about weight management today? Or would you like to continue on with the rest of your physical?"

If they want to talk about it, great. If not, let them know you're happy to discuss it anytime, then move the hell on. What got me most was doctors who seemed to think I didn't understand I was fat, didn't know what that meant for overall health, and thought I had to be lectured like a child who is just being stubborn about not eating broccoli. Also bad: doctors who returned to the "of course, it would help if you lost weight" diagnosis for EVERY ailment - I know! We covered the whole "be thinner" thing already, now tell me the OTHER things I can do right now to fix this problem!

Making it an optional conversation and making it clear that the doctor is not JUST focused on weight would be helpful. This should definitely be a conversation with the doctor, but if a nurse and doctor talk about it beforehand and the doctor's conversation with the patient results in the patient opting into more info, there's absolutely no reason I can see that the doctor can't say as part of that conversation "Do you want to talk to Nurse Sleeve? IF you're thinking about surgery, she can give you a better idea of what that process involved."

Edited July 9, 2018 by sideeye

[Orchids&Dragons 9,047]

7 minutes ago, sideeye said:

I would say, assume that the patient knows they're fat. Assume that they've been told this many times, by multiple doctors, with varying levels of condescension and exasperation. Assume they understand it's healthier overall not to be fat. Assume that they probably know the basics of how humans are advised to lose weight.

Then treat them like a rational human being and say "At your height and weight, you're falling into the [overweight/obese] category for BMI. That's only one metric for overall health, but excess weight does tend to impact other health issues negatively, so I want to make sure we cover this early - would you like to talk about weight management today? Or would you like to continue on with the rest of your physical?"

If they want to talk about it, great. If not, let them know you're happy to discuss it anytime, then move the hell on. What got me most was doctors who seemed to think I didn't understand I was fat, didn't know what that meant for overall health, and thought I had to be lectured like a child who is just being stubborn about not eating broccoli. Also bad: doctors who returned to the "of course, it would help if you lost weight" diagnosis for EVERY ailment - I know! We covered the whole "be thinner" thing already, now tell me the OTHER things I can do right now to fix this problem!

Making it an optional conversation and making it clear that the doctor is not JUST focused on weight would be helpful. This should definitely be a conversation with the doctor, but if a nurse and doctor talk about it beforehand and the doctor's conversation with the patient results in the patient opting into more info, there's absolutely no reason I can see that the doctor can't say as part of that conversation "Do you want to talk to Nurse Sleeve? IF you're thinking about surgery, she can give you a better idea of what that process involved."

YES! to all of it!

[MIZ60 1,291]

I have had the same primary care doc for about 14 years and he has never said anything about my weight, even when it rose pretty rapidly over the last several years. He was always willing to order labs when I requested them but never offered anything at all in regards to weight loss. When I asked him for a referral to the bariatric clinic he seemed a little surprised but just said that I met all the criteria and he would make the referral. I assume this is because I am a nurse practitioner myself and obviously aware that I was becoming increasingly obese.

As my asthma and back pain got worse even though I was seeing specialists it was never suggested to me that I lose weight. I KNEW that the weight was a big part of the problem but I guess I was in denial. But no doctor ever told me.

Now I will say that discussing a child's overweight issues with them and their parents is very difficult but I do it when necessary. I try to be really gentle but parents for the most part get very defensive but the truth is until a child is earning their own money and providing their own food the parent IS responsible for what foods are available to them. Kids can be very manipulative and just because they want 2 liters of soda and a huge bag of chips every day does not mean the parent needs to provide them.

All nurses are educated about nutrition and certainly qualified to discuss concerns about a patients' weight in the context of their other health problems and to provide them with information and referrals about weight loss options in their community. Nurses educate parents about nutrition in prenatal and WIC classes.

[FluffyChix 17,415]

15 hours ago, Bryn910 said:

I am gonna chime in on this part. There are a variety of healthcare professionals that indeed deal with weight and it is within their scope of practice to discuss weight and weight loss.

I am not entirely sure about nursing but I work with NP’s that discuss weight all the time. And I, as a physical therapy assistant discuss weight with patients as well as part of their plan of care. Weight affects a lot of aspects of healthcare, not just when they see a doctor. If my patient came to me saying every joint in their leg was aching and they had no diagnosis of arthritis or joint problems & they were overweight, I would be doing a disservice to them by not telling them how weight affects their joints and causes pain.

If a physical therapy ASSISTANT talked to me about weight, I would give you such a poor review and mention your name on every survey the facility sent me. I would take it to your superiors. And it would be the last time I saw you. It's noneya as in "noneyabusiness."

My PT ONLY talks to me about my weight when I ask her direct questions about it related to my diseases she is seeing me for--and she's has a doctorate. Dr. Lindsey is her name. LOL.

My oncologist and NP at the oncologist who see me as a patient, talked to me about WLS for 2 years before I was mentally ready. It took me 2 YEARS! At first I was mad, then horrified, then sad, then I actually got to work thinking and researching. It was THEIR responsibility to do it because I have a fat mediated cancer that is in remission. They are both normal weight.

First, if you have a doc talking WL with patients, honestly, he needs to do the whole physician heal thy self thing first. It is NOT a nurse's place to have that discussion unless the patient opens that door and asks for information from her or him. And I can't imagine that would happen very often. If I had wanted WLS info, I would have asked my physician who went to school for 10 years to tell me that kinda stuff.

Sorry. No offense meant to any allied healthcare professionals...but bottom line? This is a doc to patient issue.

Edited July 9, 2018 by FluffyChix

[Bryn910 519]

38 minutes ago, FluffyChix said:

If a physical therapy ASSISTANT talked to me about weight, I would give you such a poor review and mention your name on every survey the facility sent me. I would take it to your superiors. And it would be the last time I saw you. It's noneya as in "noneyabusiness."

My PT ONLY talks to me about my weight when I ask her direct questions about it related to my diseases she is seeing me for--and she's has a doctorate. Dr. Lindsey is her name. LOL.

My oncologist and NP at the oncologist who see me as a patient, talked to me about WLS for 2 years before I was mentally ready. It took me 2 YEARS! At first I was mad, then horrified, then sad, then I actually got to work thinking and researching. It was THEIR responsibility to do it because I have a fat mediated cancer that is in remission. They are both normal weight.

First, if you have a doc talking WL with patients, honestly, he needs to do the whole physician heal thy self thing first. It is NOT a nurse's place to have that discussion unless the patient opens that door and asks for information from her or him. And I can't imagine that would happen very often. If I had wanted WLS info, I would have asked my physician who went to school for 10 years to tell me that kinda stuff.

Sorry. No offense meant to any allied healthcare professionals...but bottom line? This is a doc to patient issue.

We as assistants follow the plan of care that a PT prescribes...so if it’s on there, we discuss it.

sorry you feel that way

[TakingABreak 2,733]

17 hours ago, Sleeved36 said:

I know this is a loaded subject, but here goes: I am a nurse and the physicians I work with often recommend weight loss to thier patients. Some approach this conversation better than others.

As a nurse I understand that losing weight makes patients healthier and the obesity epidemic can not be ignored . . . . BUT as a patient I hated being told to lose weight, in fact I kinda wanted to lash out at the skinny wench. Duh, if it was so easy I wouldn't be fat bc it is SUPER fun not being able to: find clothes that fit, reach my toes, breath while I put on shoes, or fit in a small chair.

So here are my questions for you all:

How should a doctor tell you to lose weight? Or should they just not say anything? Who can you help by ignoring it?

Would it be better if nutrition classes or a healthy lifestyle program was offered at the same time?

Should the conversation only happen with another big person? Would you feel less judged that way?

Or does it seem silly for a fat person to tell another fat person to lose weight? Empathy or irony?

Would it be better or worse if bariatric surgery was mentioned? Would it help if I flashed my scars?

Tell me about times when a medical professional told you to lose weight. How did it feel? What would have made it better?

I can change how this is done where I work, but need input. You can PM me if you want, too.

Second guessing this post, might belong in the rant and rave section.

How should a doctor tell you to lose weight? Or should they just not say anything? Who can you help by ignoring it?

I think they should say something, but it should be said in a way that is advocating for the patient. There were so many times that I went to the doctor and they said that I needed to, but offered no resources to me on how to move forward. There were many times that my doctor didn't say anything at all.

Would it be better if nutrition classes or a healthy lifestyle program was offered at the same time?

I never even thought about going to a nutritionist prior to this journey. I think had the benefits been explained to me and I knew how helpful it was, I would have went a long time ago. Even when I got diagnosed with diabetes, I took a mini course in nutrition, but it wasn't nearly as thorough as the one for WLS.

Should the conversation only happen with another big person? Would you feel less judged that way?

I don't think that its necessary to have another large person present. In fact, if my doctor brought an overweight nurse in to discuss my weight problem, I'd probably be offended. Side note, I once had a doctor who was overweight, and I honestly didn't take his advice very seriously because he clearly wasn't taking his own advice. Shallow of me, yes, but that's how I felt at the time.

Or does it seem silly for a fat person to tell another fat person to lose weight? Empathy or irony?

I think two fat people can relate to one another, and you know if someone who is overweight brings yours up it comes from a genuine place. However, I could see how it could be hypocritical. Prior to my WLS surgery, my girlfriend who is overweight, and I used to talk about our weight all the time. We offered empathy and advice. But now that I'm headed down this path of success, I don't talk to her as much. I don't want to come across as judgmental.

Would it be better or worse if bariatric surgery was mentioned? Would it help if I flashed my scars?

I wish any doctor would have talked to me about this years and years ago. I think I always knew that people had WLS but didn't know enough about it. I always thought over the years, I'm not that big yet, or I wouldn't qualify. I couldn't afford it.... blah blah blah. Little did I know, my surgery was paid 100% besides my in hospital copay of $450. And I more than qualified. I would have never done this if it hadn't been from someone I know doing it.