Re-examining obesity in long-term care
Elizabeth Leis Newman
What is your responsibility to those around you who choose to be unhealthy?
In a blog by John O'Connor this week, he explored the issue of obesity in long-term care facilities, including the startling fact that facilities with higher rates of obese patients are less likely to provide good care.
But it also raised a subtle point around assumptions about people who are obese. Whether they are a coworker or a resident, we tend to assume people we know who obese either want to lose weight, are trying to lose weight, or have failed most of their lives at losing weight.
Some recent essays around fat acceptance, such as this one in Slate, have led me to think about what we owe both the people we employ, and long-term care residents.
On the employer side, is it fair to judge nurses or other caregivers whose weight is putting them at risk for diseases, or that may be impacting their job? Is the increasing popularity of “wellness programs” a reasonable way to keep your health insurance premiums down? What is your obligation to your employee? In my experience, while we don't generally have a problem with a workforce having smoking cessation classes, we become squeamish at the idea of our employers promoting weight loss.
On the resident side, weight management is a tough section of the MDS. Often, the worry is that the resident is losing weight. But what if the resident is obese and shows no incentive to lose weight? Is there a difference between a 30-year-old nurse who works with you, 75 pounds overweight, saying “Weight loss is not for me,” compared to an 80-year-old resident, 100 pounds overweight, saying, “I'm old and I'm going to have that extra piece of chocolate cake, thanks?”
On either side, it becomes trickier when a physician is involved, especially with the American Medical Association recently recognizing obesity as a disease.
When physicians have to tell people tough news, such as that they need to lose weight, a New Yorker article points out it's often met with embarrassment, hostility or resistance. Putting aside the horrible stories about physicians having fat bias against the people they are supposed to be helping, we also need to give doctors more support to broach it with their patients. There is no way around the fact that being obese puts a person at risk for a host of complications, ranging from diabetes to gallstones, not to mention a horror show of cardiovascular problems.
There shouldn't be any more moral judgments around obesity than there is having cancer. Neither is something to be ashamed or, but nor does either one make you braver, or more noble. We need to destigmatize the question among ourselves, and with our residents. Yet at the same time, we need to find a way to address obesity — with residents, patients or ourselves — in a way that is respectful but honest.
Elizabeth Newman is the senior editor at McKnight's Long-Term Care News. Follow her on Twitter at @TigerELN.