Should Nurses even ‘Treat’ Obesity?
It’s constantly in the news and media. It divides opinion across society. Even the very definition of the word is contentious. Obesity is front and centre of healthcare concerns in the 21st century, there is no escaping it.
Gov.uk estimates that cost of obesity to wider society is £27bn per year, around one quarter (23%) of the NHS budget in 2015/16. In England, the proportion who were categorised as obese increased from 13.2% of men in 1993 to 26.9% in 2015 and from 16.4% of women in 1993 to 26.8% in 2015. The rate of increase has slowed down since 2001, although the trend is still upwards. The prevalence of obesity is similar among men and women, but men are more likely to be overweight. It is estimated that obesity is responsible for more than 30,000 deaths each year.
The National Obesity Forum describe themselves as a “group of health professionals and specialists who are sickened by the appalling obesity epidemics in the country – particularly the one which affects children – and are determined to do what we can to reverse the situation.” They put pressure on the government and seek to influence policy in order to achieve their objectives. The also state that “Only 10% of our time is spent on ” lobbying “. By far the greatest proportion [some 70%] is aimed at persuading those of our fellow professional to treat obesity as a disease.” The provide a care plan for treating obesity which can be found here.
This statement gets to the very heart of this article. We don’t pose the question “Should nurses treat obesity?” in order to be inflammatory, but it seems, to us, a genuinely reasonable question. It’s a bit of a mind bender when you think about it. Obesity, in the UK, means you have a BMI of 30 or over. You are “overweight” if you have a BMI of 25 or over. You can calculate your BMI here. So, you’ve been diagnosed, right?
Well, this is just the problem. Obesity, like cancer, isn’t just one thing? The weight gain appears to be the symptom of the problem as opposed to the problem itself. So weight loss, like tumor removal, may only see short term benefits if the cause is not addressed.
So, if we are really going to attempt to help people who are classed as obese, we must have the training, time and resources to properly assess, plan, implement and evaluate care for obese patients. However, the causal factors for one persons obesity may vary widely when compared to another. From socioeconomic factors to mental health conditions, medications, genetics and comorbidities the potential list of causal factors is vast. So where do you even start? How do you even address the issue, if at all?
Another factor to consider is simply one of perspective. How a person perceives themselves is often different to the perception others have of them. In a BBC News article Dr Stuart Flint, a senior research fellow in public health and obesity at Leeds Beckett University, said overweight people were routinely discriminated against and stigmatised – or “fat shamed” – in the media, school, the workplace and even by health professionals. He argues that the way people – including clinicians – view and talk about obesity “massively” needs to change. This gets us thinking even more about how to start talking to people about their weight. Once you start such a conversation you need to be sure you know how to continue it. Dr Flint also states “It’s suggested to us that people can reduce their weight very quickly and that’s clearly not the case,”.
As nurses, considering the potential perspectives of others is often considered a key skill in building a relationship with your patients. So, what if your patient is positively proud of their weight? Across many countries in the world there is a “Fat Pride” movement which seeks to gain “Fat Acceptance” for overweight people.
As the video shows, views on obesity come from both ends of the spectrum. This is also why we ask not “How do nurses treat obesity?” but “Should nurses treat obesity?”. The blog of the lady in the video can be found here. Sadly it would appear that the pressure of kicking against the tide of public opinion got too much for this activist and she no longer blogs.
So we know that obesity in itself is not a treatable condition, but the many various causes may be addressed. We know that the perception of obesity and being overweight varies widely across society, which means there is unlikely to be universal consensus on whether, on a personal level, it is even a problem. There is little doubt that the verdict is in on the health implications of being overweight, but there are varying degrees of healthiness amongst those who are considered obese, which means the treatment of obesity itself will vary in priority when treating patients. So, as nurses how do we even begin to address this, if at all?
We don’t have the answers. We’re genuinely interested in starting a discussion on this one.