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Weight bias

Weight bias may impede care for patients with obesity

AACN Advanced Critical Care journal publishes symposium on caring for patients with obesity

Health care providers should look beyond BMI when providing care to patients with obesity, according to an article in American Association of Critical-Care Nurses (AACN) Advanced Critical Care. Since the American Medical Association voted to acknowledge obesity as a chronic disease in 2013, the healthcare profession has sought to change its approach to caring for patients with obesity.

The disease has reached epidemic levels, with every state in the United States having more than one in five residents considered obese. The fast-growing number of people with obesity means that hospitals are caring for more bariatric patients who are critically ill, recovering from surgery or have complex medical needs.

The paper, ‘Weight Bias and Psychosocial Implications for Acute Care of Patients With Obesity,’ describes psychosocial and environmental factors that contribute to obesity and the physiological needs related to their care. It also examines evidence of weight bias and stigmatisation in the health care setting for this patient population.

Clinical nurse specialist Rachel Smigelski-Theiss, nurse managers Malisa Gampong and Jill Kurasaki, of The Queen’s Medical Center in Honolulu, co-wrote the article.

“Clinicians and hospital administrators must understand the complex needs of bariatric patients and the implications for protocols, equipment and staffing,” said Smigelski-Theiss. “If ignored, our biases and misconceptions may impede how patients with obesity are diagnosed and cared for, leading to poor patient outcomes.”

According to the authors, weight bias and stigmatisation by healthcare providers and bedside cli­nicians negatively affect patients with obesity, hindering those patients from receiving appropriate care. To provide optimal care of patients with obesity, health care providers must understand the physiological needs and requirements of this population while recognizing and addressing their own biases.

The article includes online resources to help clinicians improve how they help patients with obesity manage their weight, including strategies to reduce weight bias among health care practitioners.

It also provides specific recommendations regarding the care of acutely ill patients with obesity, immobility, pressure ulcers, positioning and pharmacologic needs.

Hospitals should have appropriate equipment for bariatric patients, including larger blood pressure cuffs, scales that can accommodate up to 700lbs and appropriately sized gowns. Bariatric beds with power-drive assistance, wider commodes and appropriately sized wheelchairs, walkers and stretchers allow patients with obesity to feel more at ease and comfortable while hospitalized. Defibrillators with voltage up to 360 watts should also be available for emergency situations, since bariatric patients have thicker chest walls.

As hospitals renovate or build new facilities, bariatric care rooms with mechanical lift systems, stronger grab bars in shower stalls and other design elements also must accommodate patients with obesity.

The article is part of a symposium, published in the fall 2017 issue of the peer-reviewed journal, that explores the complexity and multitude of clinical and psychosocial challenges and considerations for bariatric patients. Other articles discuss complex nursing care for critically ill patients having weight-loss surgical procedures and the role neuroendocrine hormones play in regulating obesity and energy balance.

“Labelling obesity as a treatable disease is a paradigm shift for many health care providers and patients,” said clinical nurse specialist and education consultant, Angela Benefield, editor for the symposium. “Recognising its complexity is crucial to improving the health care systems and processes, so we can provide optimal care to bariatric patients.”

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