For years we have been hearing about and talking about an obesity crisis or epidemic in the United States. This week I want to dig deeper into the origins of this crisis and focus specifically on how this epidemic has started to increasingly affect healthcare workers. The motivation to investigate this issue more thoroughly comes from my perspective as a new graduate RN in residency, my personal commitment and interest in both living a healthier lifestyle and helping others learn how to do so, but what initates my interest to write about it publicly is the seeming contracdiction of unhealthy healthcare workers.
I am going to try to address this issue from many different lenses. First, there is the patient safety lense of nonmaleficence or the duty to do no harm. Second, there is the hypocrisy lense of being overweight while part of your job is encouraging and educating patients about how to manage their weight, make lifestyle changes, and not rely of pharmaceutical treatment to be the sole focus of their care plan- In addition, there is the employee perspective, and last but not least, there is the “big picture” lense that I will both define and discuss further.
In one study published through a mainstream media news corporation (you know by now how I feel about mainstream media), it refers to a distrubing statisitc. According to this study, “The mean Body Mass Index (BMI) of nurses surveyed was 27.2 with 54% of these nurses overweight or obese” (PubMed) and of these nurses “55% percent of these overweight and obese nurses say they lack the motivation to pursue lifestyle changes” (PubMed) and, furthermore, there is a consensus among the healthcare industry that obesity and overweight are “diagnoses requiring intervention, but 76% of nurses do not pursue this topic with overweight or obese patients” (PubMed). To me, this issue is not complicate. In relation to patient safety, and nonmaleficence or the duty to do no harm nurses have a responsibility to clearly outline the risks and potential complications that overweight and obesity pose to both short and longterm health. It is widely known that obesity contributes to such health conditions as heart disease and stroke, high blood pressure, insulin resistance or Diabetes Mellitus Type II, some cancers such as intenstinal and colon cancer, gallbladder disease from a diet high in fats, osteoarthritis from prolonged joint stress and strain and chronic inflammation, gout, and sleep apnea to name a few among the top (CDC). Not discussing overweight and obesity among healthcare workers is putting patients at risk and does cause harm because if more healthcare workers are obese and overweight, they may have a harder time discussing this topic with their patients for personal reasons. This creates a culture whereby healthcare overlooks a problem among it’s own employees, but publicly claims to be commited to fixing the problem among the general population. Well, nurses are part of the general population too and it seems to me that if the healthcare community wants to advance and progress in it’s true pursuit of erradicating obesity and overweight, it should walk the walk.
Another area under the do no harm lense is certain job requirements that may be impossible or difficult for someone who is obese or overweight to perform. For example, nurses are required to move quickly in the event of a code or rapid response alert on the unit or as part of a code team. If a nurse is overweight or obese, this could potentially interfere with that nurse mobilizing quickly enough and safely enough. It also means that during code situations certain roles may be limited because of that persons size, agility, and ability to maneuver around the room and in tight spaces. Obesity and overweight are also potential interferences when performing chest compressions during a resuscitation attempt. If a nurse is obese or overweight, they may not have the physical endurance or stamina required to perform this function of their job. Without generalizing, I would like to add a caveat which is that I am trying to explore obesity and overweight from a perspective of the RN role function, not from a personal attack on body type. It must be said that not everyone is skinny, thin, lean, in athletic shape, or a body builder. The glaring issue to me is exploring the whys behind the statistic. Why are so many nurses overweight and obese? What factors are contributing to a lack of motivation among obese and overweight nurses to pursue lifestyle changes? What ramifications does obesity and overweight among nurses have in the patient care setting?
That being said, another angle to explore this issue from is hypocrisy. Outside of healthcare many industries are held to the same standards that they profess to commit to and promote. For example, organizations that claim to be commited to environmental protection and wildlife must show through their actions that what they do and say are congruent. If not, people would stop trusting this environmental organization for saying one thing and doing another. That same logic applies here. It is hypocritical for the healthcare community to say it is trying to stop the obesity epidemic and allow nurses and healthcare professionals to not address their own health and wellbeing. During my training as a new grad resident, I have been startled by the number of instructors that have been overweight and obese. It says to me, something is wrong here. In today’s healthcare model, the idea and expectation of a multidimensional and patient centered care plan is growing and high. Ignoring the reality of obese and overweight nurses and how it affects the work environment is currently leading to harm of those individuals, patients, and families and eventually, the community.
From the employee perspective, or the RN perspective, there is more nuance in relation to weight. For example, research into obesity and overweight among healthcare workers and nurses points to long work hours, high stress levels, and lack of/inadequate sleep. In a profession that claims to use evidence based practices, I am left questioning why it doesn’t apply here. As is commonly known, there is a shortage of nurses and healthcare workers across the country. This has created a culture of scarcity where people work longer hours and sometimes have a variable schedule with hours that frequently change. It is important to recognize this as a factor when considering obesity and overweight nurses, not as a way to excuse and further allow it to continue, but as a tool to decrease the number of nurses that are considered overweight or obese. According to an article written by Zach Friedman for the United States today is that “78% of Americans are living paycheck to paycheck” (Friedman) and what this means is that as the cost of living rises and wages continue to stagnate people are having to expend larger amounts of their income for basic needs with less and less left over. In addition, many people can’t afford to save money each month, are trying to pay off debt at a rate of “3 out of 4 workers” (Friedman) with many workers holding the belief that their debt is not possible to pay off. In a culture of scarcity people tend to enter survival mode where the cheapest option is the only viable option whether it will cause hypertension or diabetes type II or not. Some nurses may feel as though they do not want to cook after a long day at work and decide to stop and get fast food instead. Others skip meals in order to stay on their night work schedule and end up eating less frequently but snacking more or taking in more overall calories. On breaks I have noticed that on some units there is an “eat what you want” mentality or an “eat to stay awake” culture. Often snacks on the unit are chocolates, candies, donuts, other baked items, and other sweet things. When coupled with working odd hours and nights this can cause “inadequate sleep that triggers the release of a stress hormone called cortisol. This has a direct correlation with weight gain around the abodominal area, as well as disrupting circadian rhythms which have been shown to slow down one’s metabolic rate” (Livescience.com). So what is the employee perspective? I think it should be founded in ethics, in evidence and science. All of these factors show that from an ethical standpoint facilities should be required to have a weightloss program for all overweight and obese healthcare workers that is mandatory, but not punitive. It should be able to be customized and self-paced, but it should be required. From a scientific perspective the research is clear and cut and dry. There is consensus about the damage and detriment that obesity and overweight does to the body in the short and long term upon many factors of a person from their overall quality of life, self esteem and confidence, mood and motivation, relationships, and lifestyle habbits. It is important that the culture of evidence based practice not stop before it reaches healthcare workers who are putting their bodies on the line everyday with sometimes high physical demand, and who are in a profession with a high level of social and psychological demand that requires someone to be able to maintain self esteem and mood in order to establish rapport and trust with patients and their families, and make decisions and think clearly. If we have plenty of research on leptin and grehlin, sleep-wake cycles, metabolism and night shift, poverty and diet, then we need to mobilize this research and this evidence more effectively in order to protect patient safety, but also to protect the people who are performing healthcare work.
This leads to my last area of focus which is the big picture because these social issues do not occur in isolation from one another, nor do they occur in a vaccum. Contributing factors to this crisis of obesity within nurses as a population is income inequality, wage stagnation, tax allocation, and war. What does income inequality have to do with obesity among healthcare workers, more specifically nurses? Well, more than you might realize. In 2019, the United States has “the largest income inequality in 50 years” (Business Insider) which contributes to this issue because it causes people at the bottom to have less expendable income, more debt, and less agency to advocate for better food quality because they have no leverage against a large corporation.
According to the Pew Research Center, “for most Americans real wages have barely budged in decades” while the cost of living has risen and the wages of the wealthiest have grown exponentially. This contributes to the obesity epidemic because many of our social programs are becoming or have been privatized which has been shown to cost more, but produce worse outcomes. In otherwords we live in a society that privatizes health and wellness as a privelage only accessible to the wealthiest of people. This means that for those working a minimum wage job and couldn’t afford to pay for college out of pocket the budget is a lot tighter and time to workout and relax more limited. The effect of this is showing in the number of overweight and obese nurses.
If we consider how much of our money goes to taxes, then we would naturally wonder where it goes and what it is being spent on, right? Let’s find out.
This video encapsulates several points about healthcare worker obesity and overweight. First, that the distributed of tax dollars is wildly disproportionate and places a lower economic value and investment on social wellbeing, health, and education, and in addition commits a large amount of economic value and investment to expanding the military. The military industrial complex is very much related to healthcare worker obesity because with more money being spent on a $1 trillion military budget, we neglect to hold accountable the largest consumer of fossil fuels globally and we fail to grasp the connection between war and natural resources and wellbeing. A militarized society is a stressed and injured society. Recent research has shown that as unemployement and joblessness rises military enlistment rises as well. It follows that, in a capitalist society, where profit comes before people, this system refuses to fix social inequity and disparities of race, gender, and socioeconomic level because it is more profitable not to.
Apparently, there is a nursing shortage, and yet the amount of education required to become a nurse keeps getting longer which also means it costs more in a society that still has yet to make education a right and not an expensive privelage. In reality there are plenty of people who could become nurses, but these people have been dismissed. People who have a former criminal record, the poor and homeless. Among this population there are enough people to curb the nursing shortage easily, but this world makes many people invisible. The reason I bring this into the discussion about healthcare worker obesity is because a candid conversation about connecting the dots and filling in the large gaps in social wellbeing is long overdue. Research shows that in times of war and war based societies women are disproportionately affected. Nursing is a majority female profession and in a war based society with large income inequality it is women that disproportionately suffer from homelessness, hunger, and the wage gap. If we want to fix healthcare worker obesity, we need to take a look at all the contributing factors and not just oversimplify. As a country and as a global healthcare community, one of our responsibilities is to be able to take in information and connect the dots in order to get a cohesive picture.
This post is just one attempt to advocate for real solutions to social disparities that have large consequences. The real solutions are:
1)Single Payer Healthcare
2)The Real Food Challenge for Healthcare (bringing local healthy food into hospitals and patient care facilities)
3)Closing the wage gap and income inequality
4)Commitment to ending a war based society