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

[Sleeved36 356]

Thank you for all of the thoughtful responses. I have a few options to refer patients to for help and will do so. Most people seem to agree that a weight loss discussion is better if help is offered at the same time.

I was trying to have a discussion on this thread without revealing all of my personal information. Instead this thread was hijacked by people wanting to tell me my scope of practice and what they think I am qualified to do.

Since no one can do that: I am a DNP. Which means that I have a doctoral degree. I can refer and prescribe, yes that can vary state to state. I am also a nurse, it is officially part of my title and the most generic way to describe myself on an online forum where I prefer to have some anonymity.

Going to unfollow my own thread now.

[Apple203 1,314]

On 7/8/2018 at 3:48 PM, 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.

I haven't read the rest of the replies yet, but I, too, hated getting that speech from thin, young doctors. But then, my relatively new (and thin and young and fabulous) doctor said, hey, have you thought about WLS? No, I hadn't -- that was for really big people. Turns out I was wrong. Best.discussion.ever. Almost 50#s down.

[GreenTealael 24,850]

I wish ANYONE would have just mentioned to me it was a possibility for me, ANYONE. I found out on my own after coming to my wits end trying to find my own course of action. I did not care about feelings at all, just my health. But not everyone feels that way.

[jess9395 5,448]

Wow! Interesting thread!!!

I’ve always believed that while doctors treat a condition or disease nurses treat a whole person, and usually have way more time to spend and discuss and explore. So I don’t mind at all when one opens up conversations. I mean I wouldn’t want them to keep on the topic if I didn’t “bite” but I’m totally up for them bringing it up.

And I love talking with all sorts of things with my PT for the same reason including diagnosis and medications ha. Same reason... and I honestly have had times I trusted my PT’s call more than my ortho and have discussed prescriptions too.

So yeah you clearly might piss some people off as this thread shows. But if you caught any someone else at the right moment and changed a life.... I dunno. This is a tough call. I never ft asked just bringing it up (not pushing) would be so polarizing.

Yikes

[Apple203 1,314]

16 hours ago, MIZ60 said:

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.

I dunno --- one of my kids refused to eat meat, and I didn't have much recourse other than to learn how to provide Protein to him. Teenagers are an extremely stubborn breed... Add a hormonal weight factor into the equation, and sometimes it might not be a fight worth fighting. I raised a boy with Type 1 diabetes and I never allowed food to be a weapon he used against me, which is quite common with kids with diabetes, and no doubt overweight kids, too.

[Apple203 1,314]

6 hours ago, NobodyYouKnow said:

Chiming in a little bit late, so you've already got a lot of replies, but here's how it went for me:

The first time I saw my current primary care provider -- an awesome nurse practitioner who made it clear from day one that she was on my side and just wanted the best for me -- she never said, "you need to lose weight." What she said instead was, "have you ever considered bariatric surgery? I would be so happy to make a referral if you'd like to go check it out and learn more."

And while I was very reluctant about the prospect of surgery, I took her recommendation seriously. The thing that I think made a difference was that she just didn't drop the command to lose weight into my lap, she started by offering me a potential solution. It probably made a difference that I was ready to be receptive to that kind of suggestion, and that at my weight then (464 lbs that day) there was really no question about the need to lose weight. But she didn't say it in a way that might come across as accusatory, or in a way that just stated the fact and then left me to work it out for myself. She was offering me a practical, simple step that I could take to start moving forward.

This times 1000 -- this is what my PCP did and I am so grateful! Don't tell me to lose weight, tell me HOW to do it!

[Apple203 1,314]

6 hours ago, Bryn910 said:

PT assistants treat patients. No more schooling after that.

PT techs set up, can oversee exercises and clean up

Exactly :-)

[Apple203 1,314]

I've gotten through the thread to-date, so happy to read that other Enlightened doctors, nurses, etc have stepped in to our lives and advocated surgery -- great recommendation!! And a pox on all thatsay "lose weight" with no instructive solutions!!

[MIZ60 1,291]

3 hours ago, Creekimp13 said:

If, specifically as a nurse practitioner (which requires a Master's degree), you are overseeing routine patient care under the supervision of a physician who you know will make the referral based on your recommendation and the patient's stats....this is a different sort of situation. Nurse Practitioners generally work in tandem with a supervising primary care physician. Ultimately, though, most insurance companies will require dietitian and bariatric surgery referrals to come from a physician. Your insurance will also almost universally want your referral to come from a medical doctor.

Not sure about Michigan but the places I have practiced (Texas and Nevada) in for the past 28 years are NOT like this. I am credentialed and empaneled with insurance companies as a nurse practitioner and assigned to patients as their primary care manager. I worked for several years on a military installation and was the only pediatric person in our area so there was no one supervising me. There is a collaborating relationship between a NP and a doctor that is pretty vague. Many states do not even require that. The Texas Board of Medicine dropped the requirement years ago that a doctor had to register the NPS that had a collaborative relationship with them.

I provide whatever level of care the patient needs, including ordering tests, treatments and medications and referring patients to specialists or other facilities as needed. A few situations (usually the school system or preop physical for sedation) require a physician signature on paper work and guess what, I have a signature stamp in my drawer for that.

I have stabilized very ill children while waiting for an ambulance when none of the doctors was even in the building. Say I have a child sick with the flu who also happens to have lupus. I call the pediatric rheumatologist to discuss with them the management of the child in terms of medications and labs. The only time one of the MDs in the office gets involved is if I want to discuss it with them. I have never been told that a referral had to come from one of the doctors I work with by an insurance company or a specialists' office.

What you are describing may still exist in some backwoods places but NPs are consistently found to be as good and often better at primary care than physicians, in terms of patient satisfaction and outcomes.

Okay, stepping off my soapbox.

[MIZ60 1,291]

6 hours ago, FluffyChix said:

The NP is a nurse who basically went to mini med school for 3 years.

Okay, this made me laugh out loud...makes it sound like some kind of fly by night vocational school or something. I went to school at UT for both my baccalaureate and masters degrees in the School of Nursing. The nursing model and the medical model are completely different and while there is some overlap there are also key differences. I am proud to be a nurse first and foremost. Texas started referring to us as Advanced Practice Nurses (APNs) quite a few years back and I am okay with that.

[FluffyChix 17,409]

2 minutes ago, MIZ60 said:

Okay, this made me laugh out loud...makes it sound like some kind of fly by night vocational school or something. I went to school at UT for both my baccalaureate and masters degrees in the School of Nursing. The nursing model and the medical model are completely different and while there is some overlap there are also key differences. I am proud to be a nurse first and foremost. Texas started referring to us as Advanced Practice Nurses (APNs) quite a few years back and I am okay with that.

Thanks. Good to know. My niece is in PA school and they're working on cadavers right now among other things. I'm told she has 3 years of study. To me that feels like med school without doing a residency program--hence me describing as mini med school. Sorry.

[MIZ60 1,291]

1 hour ago, FluffyChix said:

Thanks. Good to know. My niece is in PA school and they're working on cadavers right now among other things. I'm told she has 3 years of study. To me that feels like med school without doing a residency program--hence me describing as mini med school. Sorry.

PA education is much more based on the medical model of care and it could be described as a mini med school I guess. Since most (but not all, sadly) nurse practitioners are already seasoned in the world of health care by practicing as an RN for at least several years they are not just brand new to the complexities of caring for patients. Even medical students do not actually lay hands on a breathing person until the 4th year, before starting the typical 3 year residency.

In my case, I had already been taking care of kids for 8 years before I started the NP program which I guess gave me a good foundation to build on.

Fluffy, please don't be sorry because I know you were not trying to be condescending or anything like that. It is important me to correct assumptions that are sometimes wrong about my profession.

[MeanSleevedMachine 277]

Honestly, I was told by several doctors I needed to lose weight. The only one I ever listened to was my current one because he didn’t just say “lose weight” but actually helped. He set me up with a nutritionist, provided reasonable meal plans of stuff I could and would eat.

Just telling someone to lose weight will likely get you a bad reaction. Lord knows I had my moments with doctors that said that — it’s like, gee, if someone had just told me to lose weight the 4,000 diets I have tried may have worked.

My current doctor approached it as a — “you know, not many 400 lb men are walking around at 50 and 60 years old. If we could get you help would you want to lose weight?”

Then he provided help. Eventually it led to me surgery. He built a lot of credibility with me by being willing to provide help and not just admonishment. It is easy to tell a far person to lose weight. It is much harder to help them lose it.

[nibble 201]

1 hour ago, MeanSleevedMachine said:

Honestly, I was told by several doctors I needed to lose weight. The only one I ever listened to was my current one because he didn’t just say “lose weight” but actually helped. He set me up with a nutritionist, provided reasonable meal plans of stuff I could and would eat.

Just telling someone to lose weight will likely get you a bad reaction. Lord knows I had my moments with doctors that said that — it’s like, gee, if someone had just told me to lose weight the 4,000 diets I have tried may have worked.

My current doctor approached it as a — “you know, not many 400 lb men are walking around at 50 and 60 years old. If we could get you help would you want to lose weight?”

Then he provided help. Eventually it led to me surgery. He built a lot of credibility with me by being willing to provide help and not just admonishment. It is easy to tell a far person to lose weight. It is much harder to help them lose it.

That's probably the best approach I've read on this thread! Were I the physician I'd offer something like "If you ever want to talk about some help for weight loss I'd be happy to work with you and outline some options. Just think about it, OK? That's the approach I longed for and never got.

[GotProlactinoma 458]

Let me add another angle to this, for all formerly obese here who had wls. Did a doctor talking about your obesity lead you toward getting the solution you needed??

Because I was the only one who had to get around to deciding this.

No doctor helped me decide. Maybe 2 out of a zillion doctors mentioned my weight, in indirect ways, and I was nothing but offended. For a different problem one doc suggested a pharmaceutical that “people love because they lose weight on it.” The drug had ghastly side effects.

i think that if the patient has a condition or symptom that would be helped by their losing weight, IT MUST BE MENTIONED. As in “here are some of the things you can do for your [knee, blood pressure, whatever]: rest, exercise, lose 10 lbs, ...” etc. Work it in and make it easy. Sure, they need to lose 50-100 lbs. No one can face that. But if you suggest losing 10 lbs, maybe they can do it.

If I were a doc or nurse and I’d HAD wls, I’d sure as poop tell everyone all the time. I talk to people who happen to be obese and DO casually mention I had wls last summer, and move on, but they often do ask me about it, and I RAVE. And I answer their specific questions. I am one of them, I was one of them. I want to share how kind of easy it was to get healthy, how good my experience has been. I used to dream the excess fat would melt away, and now it actually did. So sine you OP had this surgery and had success, you can talk about YOU and maybe you will stimulate more discussion. Not “you might like to hear about weight loss surgery” but “omg, I need to run out and have a bit of my peanuts, running low on protein” and follow it up with how you keep up on your breaks because you had wls and you need Protein every few hours, say. Make it totally about you and see what happens. It works for me, out in the world. Then pretty soon usually we two are “together” as obese only my obesity has recently slipped out. If that makes sense.

no doc or nurse would have had the right affect on me if they’d been heavy handed (whoops pun) with me on losing weight. It was when my blood pressure went sky high for several months that I came around to what I needed to do.