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

[TakingABreak 2,733]

17 hours ago, Orchids&Dragons said:

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/

I didn't answer that last question at first, because I didn't know exactly how I felt. But after reading your response, I agree with you. I think I ignored the "you need to lose weight" because it had become a catch-all. Every. single. thing. was due to weight. Strep throat, ear infection, ingrown toenails... you name it. It became increasingly hard for me to take my doctor serious when they say.. "losing weight will cure you from all your ailments".

[TakingABreak 2,733]

16 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.

I've had my fair share of physical therapy. For my back injury and foot surgery. My PT talked to me about weight quite a bit. I never thought it was outside her scope of expertise. If she was giving me advice on medications or surgical intervention, I may feel differently. But my PT discussed ways to do low impact exercise and stretching for my injuries that would help me get back to working out. It was all relevant to her qualifications.

[Bryn910 519]

3 minutes ago, AshAsh1 said:

I've had my fair share of physical therapy. For my back injury and foot surgery. My PT talked to me about weight quite a bit. I never thought it was outside her scope of expertise. If she was giving me advice on medications or surgical intervention, I may feel differently. But my PT discussed ways to do low impact exercise and stretching for my injuries that would help me get back to working out. It was all relevant to her qualifications.

But PT’s are allowed to give advice on pharmacology and surgical intervention. I just think people trust medical doctors more. We deal with surgeries and meds all the time. We take pharmacology classes and continuing education. I just think people don’t understand the field quite as much and that is ok.

i understand people trusting those whom they are co for table with. I do it as well. I would never see a chiropractor and that is ok. lol

[FluffyChix 17,409]

17 minutes ago, AshAsh1 said:

I've had my fair share of physical therapy. For my back injury and foot surgery. My PT talked to me about weight quite a bit. I never thought it was outside her scope of expertise. If she was giving me advice on medications or surgical intervention, I may feel differently. But my PT discussed ways to do low impact exercise and stretching for my injuries that would help me get back to working out. It was all relevant to her qualifications.

A PT absolutely! A PT Assistant? Not in my lifetime...

[Bryn910 519]

Just now, FluffyChix said:

A PT absolutely! A PT Assistant? Not in my lifetime...

Man you’re harsh lol. But i ain’t mad at you

[TakingABreak 2,733]

24 minutes ago, Bryn910 said:

But PT’s are allowed to give advice on pharmacology and surgical intervention. I just think people trust medical doctors more. We deal with surgeries and meds all the time. We take pharmacology classes and continuing education. I just think people don’t understand the field quite as much and that is ok.

i understand people trusting those whom they are co for table with. I do it as well. I would never see a chiropractor and that is ok. lol

I guess the reasoning behind feeling uncomfortable discussing medication, surgical intervention.... If the PT can't prescribe medication, I don't want to discuss it. I also wouldn't have an in depth conversation with my PCP about surgery either, I'd ask for a referral to speak with a surgeon. Nor have I ever had a PCP who offered info about surgery. They always ask if I'd like a referral.

I know that PT's are knowledgeable, but I think I'd feel better talking with experts in the area in which I have need.

Edited July 9, 2018 by AshAsh1

[TakingABreak 2,733]

8 minutes ago, FluffyChix said:

A PT absolutely! A PT Assistant? Not in my lifetime...

Again, if it was advice on medication or surgical intervention... I agree with you. But a PT assistant is typically still going through education to become a PT. They aren't completely uneducated, and probably more so than myself. If they gave advice on exercise or core strengthening, ect. I wouldn't think it was inappropriate. Hell, if you allow a PT assistant to do exercises with you (while doing physical therapy) then why not take advice if it's within their realm of expertise? Just my opinion.

[Bryn910 519]

PT assistants treat patients. No more schooling after that.

PT techs set up, can oversee exercises and clean up

[NobodyYouKnow 15]

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.

That was a year ago to the week, and in the intervening time I've dropped ~75 lbs on my own, and am mostly through the six-month program at my bariatric clinic. I haven't had surgery yet, but I anticipate that I will sometime in late August, or maybe early September.

This probably wouldn't work on every patient -- those with less extra weight might be a little shocked at the suggestion that they look into bariatric surgery. But even a referral to a nutritionist might be a simple, positive thing you could offer patients to help them start making a little progress.

[GreenTealael 24,857]

It needs to be addressed matter of factly like smoking, substance abuse and other medical concerns.

[Sleeved36 356]

4 hours 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.

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.

You said your NP talked to you, NPs are nurses too. I also went to school for 9 years. It is my job in a cardiology center.

Please don't make this thread about technical medical credentials, I just wanted to discuss the weight loss conversation.

[FluffyChix 17,409]

21 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.

I'm telling you from a patient perspective how I received this suggestion/discussion.

My two primary care people are my oncologist and the NP. The NP is a nurse who basically went to mini med school for 3 years. She and the doctor alternate visits on their patients. They are AUTHORIZED to discuss this stuff with me. Sorry but I wigged out then with their conversations. I would have totally gone nuts if a practice nurse had brought this up. They are NOT docs. They are not NPs. There is an implicit authority and level of magnitude. There is. I'm just tellin you straight up from a patient perspective or at least MY patient perspective. I would not go to my nurse for WLS advice/recs. I go to someone with the authority to prescribe and that's the doc and the NP. The only thing my NP can't do is write a narc script.

You asked: How should a doctor tell you to lose weight? Or should they just not say anything? Who can you help by ignoring it? Sorry, but as a nurse you are there to answer questions from the patients and carryout doctor treatment instructions, not make care decisions and care suggestions. If my doc didn't care enough to have the conversation with me and instead palmed it off on his nurse? That would be the last time that doc saw me.

[Diana_in_Philly 1,426]

FWIW, my primary of 20 years told me over and over - try this diet, try that diet, you aren't trying hard enough, you need to lose weight - never once in 20 years mentioned bariatric surgery. When one of the newer doctors at the practice who I was seeing for an asthma attack started telling me all the hazards of being obese, I pulled the nebulizer away from my face and said - don't you think i know I'm fat and it's a problem - because her tone was so judgmental. Never went back to the practice after that. My practice had a bias against obese patients - no one wanted to spend the time to work through the issues which might be causing the over-eating or other problems. They wanted to hand you a sheet about Portion Control and tell you to exercise (which when you BMI is 48 and you have arthritis in both knees ain't easy.)

At my new practice, at my first visit, my doc, after listening to my history and talking to me, and hearing me be so frustrated because I had been on weight watchers and weighing and counting and nothing was happening looked at me and said - have you ever considered bariatric surgery? I never knew it was an option for me because I never thought of myself as "that" fat. Then she told me her VSG story. A week later I was at a seminar by the surgical group who did my surgery less than 6 months later.

If I nurse had ever raised the issue with me, I would have been in the practice manager's office before I left advising that she needed to be fired for overstepping. A nurse practitioner - yes. A PA - yes. An MD/DO other person with medical license - yes. An RN - nope. An LPN - nope.

On the Physical Therapist issue - I look to my PT to advise me on the best ways to move to avoid pain (I'm bone on bone in both knees). The sports-based PT group I use does not use assistants - my PT works with me around my specific needs for my sport (fencing). I don't need/want their opinion on my weight and I already know that every pound on my body feels like 5-7 pounds to my knees.

[Ylime 453]

I've been on the opposite end of topic for many years now. Specifically for the past 15 years I have had my annual physical without fail. I have a primary care physician, an OB, and a neurologist, all of whom I see at least once a year. Obesity has been a hot medical topic for a long time now. But I'm always disappointed/frustrated that it never appears to be a concern of any of my doctors. In fact, the first time I ever brought my weight up to my primary her response was, "You're only 10lbs more than you were at this time last year." Well, yeah but that's on top of the extra 50lbs I'm carrying around! She didn't seem concerned at all. Most recently I told my new primary I was getting WLS and her response was positive and she stated she had a lot of patients doing that. So I thought, she's obviously aware of the benefits and the outcomes, so why hasn't this ever been brought up to me? She's been well aware of my high BMI for a long time. I had never even heard about options other than Bypass so I didn't know enough to even ask.

I feel like if any of my physicians had broached the subject with me, I might be offended or embarrased at first, but they would have laid the groundwork for me to bring the subject back up when I felt comfortable. But the complete lack of any concern is not only frustrating but probably also led to my inability to lose weight because I so often felt like it was hopeless and if my doctors didn't care then why should I?

[Creekimp13 5,838]

Medical rule of thumb: if it is not within your scope of licensed practice to assess medical conditions and write the appropriate referral or medical recommendation, you are opening yourself and your institution up to liability by discussing said condition.

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.

What Nurse Practitioners are authorized to do, and what they cannot do varies widely state to state...and also insurance company to insurance company.

Obesity treatment, diet and exercise recommendations can have grave consequences if given by someone who doesn't have the skillset to evaluate a patient's whole health profile.

If you are a nurse and a doctor has not specifically asked you to discuss weight issues with clients, you really have no business doing so. You cannot make recommendations. You cannot write referrals to dietitians . You cannot prescribe medication. You cannot make a surgery referral. You cannot even give out a printed diet or suggest Jenny Craig...unless a physician has authorized you to do so.

Your best course of action as a nurse is to advise patients you are concerned about to discuss how their weight could be affecting their medical issues with their primary physician and advise them to consider asking what options might be available for them.