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Dealing with the overweight patient?

Discussion in 'General Issues and Discussion Forum' started by BJ Laidlaw, Nov 28, 2010.

  1. BJ Laidlaw

    BJ Laidlaw Member

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    Hi all,
    I'm a newbie here so hello to all, just entering my 2nd year at Uni so wanting some trade secrets if you would care to educate me from experience please.
    Curious to know how the subject of someones weight (a sensitive subject) can be ethically spoken about when dealing with Obese patients who have a "I can't exercise" mentality?

    A relative of mine ( quite a big lady) suffers from Fibromyalgia, has a history of depression and thyroid problems. In her 50's now, she has always been size 18+, no exercise, and despite her efforts to control her weight (lose weight) through shakes etc, she physically does not cope considering the joint pain she obviously must endure.

    Having initiated my degree, I would like to learn more to help people such as her overcome the mental/physical barriers preventing her from leading a healthier/more active lifestyle. I have been told walking causes too much pain and I am met with a great deal of negativity...BUT I really want to help!

    Please share your educated thoughts with me, it is my personal mission to help her but I clearly lack the education and knowledge I desire to put her on the right track.
    Look forward to your replies and my thanks for your time,

  2. airamasor

    airamasor Active Member

    Hi BJ
    In my opinion we should address this issue, we are health professionals after all. However, it is up to the patient to follow your advice or not.
    For this family member/ pacient I would try to find out what sort of things she would enjoy, maybe a dancing class, yoga, pilates or similar.
    Sometimes patients think that when we advice them to walk we mean long hard walks. However for patients like yours, I tell them to start with a short & easy walk, just to the corner and back, or 5 minutes walk. This would make it more achievable and when they realise they can do it people tend to want to improve themselves.

    THe most important thing I learnt is if people don't want to change, they won't.

    I hopes it helps.
  3. BJ the answer to this question should be broken in 2

    1 - being professional and medicially trained the discussion of weight and the effects on loads taken by the body should be discussed with patients when doing this I try and not refer to their weight but discuss extra loads and this seems to help them think, he is not just saying I´m fat and I should lose weight, hes trying to explain how this extra weight is effecting my body.

    2- I would suggest that while very nobel I TRY not to treat family members, and those I do are the ones that want my help, not I want to offer them advice. The reason for this is that if they don´t follow your advice it seems more personal than if a patient does not. Also Family can be very demanding.

    BJ I would suggest getting stuck into your biomechanics 1st before offering any advice, but if you want to start consider suggesting water areobics with a physio, all this after a check with her GP to get the go ahead.

    Also a consult with someone who can help with diet- eating the right foods is very important.

    That might be a good 1st step- then as time goes on Non-water trainig can slowly be used- again maybe seek professional help, until you think you can take over

    Hope that helps some
  4. twirly

    twirly Well-Known Member

    Hi BJ & :welcome: to Podiatry Arena.

    Only my thoughts:

    Obese patients often struggle with physical activity due to a plethora of potential barriers. Not all of which are physical. Often mental attitude may present the greatest challenge.

    Weight gain may also become cyclical involving low mood & depression which in turn can cause further over eating & additional weight gain.

    My thoughts & advice to patients who suffer from obesity & also have the additional problems potentially with inability to exercise are to encourage other activities. These activities may not decrease weight initially but may improve overall well-being.

    There is no quick fix to long term problems. Patients cannot lose stones of excess weight without addressing underlying issues first. Personally I think patients with extreme weight issues could need the additional support of a counsellor.

    Kindest regards,

  5. bpod

    bpod Active Member

    Maybe taking the tactic as a family and not as a practitioner or expert would be better. Spend time with this person and go walking with them or whatever activity they can enjoy. Its always better to have a partner to help, and it gives you both time together where you dont have to be the expert. But as everyone has said, this person has to want to do this, you cant do it for them, you can be their cheering sectionthough.

    Sue Davidge
  6. 1. Treating family members is a bad idea. Treating family members about something as potentially sensitive as weight is a Terminally bad idea.

    What she said!! Are you qualified to treat those issues? Even if you were, is it ethical to treat a family member where matters psychological are concerned? Hell no.
  7. blinda

    blinda MVP

    :rolleyes: hmmmm....especially with TTO, eh?

    Agree with Mand`though. Wise girl.
  8. Brilliant !!!!
  9. DTT

    DTT Well-Known Member


    Bel there are times when you can be heartless !!! Taking the mick out of RI like that!!
    Your turning it into a national sport !!

    Oh and congratulations michael on the Birth of Oliver..ENJOY

  10. Thank you Sir.

    BJ sorry for the bi-play happens a bit around here, if you have anymore thoughts questions or anything else you want to bring up please do, people will help as much as they can.
  11. Indeed ;)

    But notwithstanding, there is an important issue here. Treating family members is always trouble. Trying to get involved in something as complex as chronic obesity is doubly so. This advice (the first bit at least) comes from experiance. Learn from others mistakes.
  12. BJ Laidlaw

    BJ Laidlaw Member

    Thanks everyone for your thoughts....
    I understand the complexities of the situation, a very touchy subject and too personal to deal with from a family member's perspective.
    Naturally I would love to help her, given the feedback I have received, I shall as a student perhaps shed some light on her position when she enquires about my study and then suggest she perhaps seeks qualified professional treatment from non-family qualified people who I am sure will do all to help her overcome the barriers she currently has in place.
    That said however, how does the average professional deal with the overweight patient that clearly needs the obvious 'look after yourself' conversation? When I begin my career in years to come, I am sure governing people's fight against obesity, that this will be on-going issue! From my inexperienced position, I see overweight people struggling to move let alone walk...for these people who might seek podiatric care, are clinician's in their right as health professionals, to raise the subject of a patient's weight in consultation.

    I'm not wanting to personally treat my relative, as a 2nd yr student I am sure you would have guessed that I am not even in a position to do so? I do however want to help those in a similar position find a way back to living a more active lifestyle....keep 'em moving with minimal discomfort. This is what made me look to Podiatry as a late career change....I want to learn, I want to help people.

    Thank you again for the replies, I am grateful for your efforts to help out a Newbie on this wonderful Arena...


  13. BJ you would need a team approach to this.

    Podiatry - Biomechanics if required

    Physio - water training and keeping the body going from general training pain

    personal trainer- this person must have experience with overweight people

    GP - general health check ups

    nutritionist - diet

    physcologist - someone who can help with the mind , alot of people over eat for personal reasons which may be very traumatic. They will need more help on the mental side than the Physical

    in this team the Pod maybe the least important depending on if there are biomechanical issues or not. ie thye may not be required.
  14. Gail15

    Gail15 Welcome New Poster

    Hi, it's my first post - so I apologise if I'm about to offend anyone. There's been some great advice here about what to do for fat patients (and not treating relatives!) BUT

    For those of you who are slim and sylph-like please be aware that weight - especially extreme overweight is a very tricky subject. Every healthcare professional is aware of the health implications of obesity and actually so are many obese people too. If losing weight was easy then the multi-billion pound anti-fat industry wouldn't exist. Your relative probably has done every diet under the sun and found each time that she's even fatter than before (sorry I'm assuming she). Thyroid issues work to compound the problem.

    In my experience most folk who can't even put their own shoes on because of their weight want to do something about their situation - but just think how you would feel if you were always being lectured (even nicely) or having fun made of you (or much worse) about your size (swimming pools are not kind places!).

    Help your relative IF you are asked to but most of all be KIND. Leave off some of the lectures and give them support - be positive and tell them that they look like they've lost weight - or if they're looking good. Boosting their self esteem might just help them tackle today's challenges a little better.

  15. The fundamental thing which is missing is motivation. Everyone knows HOW to lose weight. Eat less pie, take more exercise. Though we might procrastinate and claim its glandular, the middle and both ends is that those of us who don't lose weight, its because we like the idea of pie more than we like the idea of being healthy.

    Unfortunatly society has evolved in such a way that we expect to be able to have our cake but not get fat from eating it. It seems "unfair".

    Whatever else we may do for a patient and whoever else we may refer them to, if they lack the motivation, it won't work.
  16. BJ Laidlaw

    BJ Laidlaw Member

    I'm sure it must be awful to be talked about, unfairly pointed or even laughed at...I know she hates the 'beached whale' tag she has heard whilst trying to fit in and enjoy the sunshine.
    Point is however, she is quick to snap at these people for their obviously unpleasantries but just as quick to devour a block of chocolate when the urge arises.
    I tend to agree with Robert, she knows the 'Pie" isn't good for her but despite the consequences, she will knowingly add fuel to the fire so to speak.
    And...all this happens on the couch. I have suggested (not lectured) that she and her husband engage in a short walk up the road (slight incline) to get the heart rate up and try and burn some of the fat she tries to remove with 'shakes' instead! Liquid diets, not an ounce of desire to exercise coz it is all too hard.
    So despite the pain she informs me exercise/any physical effort causes her, and despite my mention of the fact that things WILL NOT change unless her actions do, I am met with negativity and an 'what would I know' attitude. I can't bring myself to give her compliments either or suggest she 'looks like she has lost weight' when in my mind, that is encouraging her to continue on path she has chosen....shakes, late night food, no exercise at all...but hey it looks like it's working!! ??
    I do agree that the mental health practitioner is a prominent player in this on-going battle against obesity....it clearly is a sickness and when it then leads to immobility and pain associated with any form of physical effort, as Robert said, no one can help unless they have the motivation necessary for change.
    Interesting feedback people and thanks again...

  17. NeedingMassage

    NeedingMassage Active Member

    Interesting that you single out obesity as a single issue.
    Couple it with alcohol, animal and tobacco consumption and chronic diseases, from affluent lifestyle for an aging population, are ensured.
    As always, education and/for prevention is better than cure but you can't rescue anyone if they don't want to be and shouldn't try if they can do it for themselves.
    Once the first diabetic leg is off, her weight will be noticably less and her motivation may increase (or maybe not).
  18. BJ Laidlaw

    BJ Laidlaw Member

    This was the main issue I raised specific to a particular ladies' current health. Alcohol, tobacco and diabetes are not in this particular picture but I'm sure you have made a valid point for others perhaps Owen.But yes....I stick to my last response and as the old saying goes, 'you can lead a horse to water...".
    Last edited: Dec 5, 2010
  19. ELM14

    ELM14 Member

    In my first year as a student podiatrist, I had a lecturer explain to my patient...

    "Imagine your foot as a donut and your body like an artic truck; not good!"

    My thoughts - I think as a podiatrist your are in a position to say (to your patient) that their excessive weight plays a key part in their treatment. As I say to many of my patients, " I can only do so much, the rest lies with you and your weight will not improve... planter faciitis, etc" or words to that effect.

    Hope that helps!
  20. twirly

    twirly Well-Known Member

    There will be those who idolise this crass attempt at 'bedside manner'. Personally, if I were the patient I would take my problem to a more compassionate individual. Certainly comparison may work in highlighting a problem. For what it is worth though I prefer the more gentle approach that doesn't throw an individual off a bridge!

    Drawing similarities between an overweight individual & a heavy goods vehicle is tantamount to using your professional skills as an excuse to insult people!

    Analogies (if required) should be carefully considered!


  21. BJ Laidlaw

    BJ Laidlaw Member

    Well I did guess this would be a tricky one....a friend of mine (practicing chiropractor) has in the past found himself being quite blunt with an overweight patient as she was pointing the finger at him for not being able to single-handedly sort her out. As it was explained to me, he politely brought her weight issue/lifestyle choices to the forefront of the picture no doubt to his defence. She was extremely annoyed with him, left the clinic and was not seen again!

    Now I am sure he honestly wanted to help her, but as charming and polite/professional he may be, he upset and lost a client as she was offended. It seems raising the obvious truth didn't help him to retain her business, but would you be upset to lose a patient that doesn't respect your professional judgement?

    I am sure it would be hard to please everyone in this world. If someone behind the counter at McDonald's made the remark about a customers weight, they are asking for trouble! That's simple. But when the professional attention is sort from concerned health practitioners, I would have presumed honest feedback relevant to a patient's overall health (weight in this case) be necessary to confront the underlying medical issue.
    Truth hurts I'm sure....

    Thanks again everyone.
  22. NeedingMassage

    NeedingMassage Active Member

    see below
    Last edited: Dec 6, 2010
  23. NeedingMassage

    NeedingMassage Active Member

    Hi BJ,
    We seem to have moved onto discussing 'business models' rather than 'health issues'. Back to health.
    Excess weight is not a health issue in itself but it increases the risk of disease and dysfunction. If we don't raise the weight issue early then we perpetuate the slide into chronic disease (and that doesn't benefit your customer but could be good for business if that is part of the business model).
    If the customer didn't believe the chiropractor was helping, perhaps a referral was more appropriate rather than playing 'blame' games at this late stage.
    My heavier clients range from 150 to around 200+kg and the first comment after taking history is something like"you realise that your weight is mostly why you hurt" and then explain why (i.e. mass up = force up = pressure in joints up, etc) - I have yet to have anyone walk out and they choose to return. Over time, some even change their lifestyle (sometimes for the good, sometimes not - their choice). Plant the seed... who knows.
  24. BJ Laidlaw

    BJ Laidlaw Member

    Thanks so much Owen, great post...

    Thanks once again everyone for the input thus far....
  25. ELM14

    ELM14 Member

    I certainly would not use the above analogy to one of my patients. I only quoted it as it sticks out in my memory of how one of my lecturer treated my patient.
    Therefore I do not idolise clinicians who come away with 'crass' comments, it would be most unkind.

    However... I would bring up the subject of weight, if it were one of the key factors in causing the C/O. As long as you can relate it back to the C/O.
    By avoiding the subject of the patients weight you would not be helping them, therefore you would not be doing your job properly.
  26. With respect, I think this is a bit optimistic. Of all the medical professionals they will have telling them about their weight, and all the "standard" advice which exists in the media and public helath I struggle to believe that our input, or lack thereof, will greatly influence the "slide into chronic disease." I doubt anyone will be thinking "well I was going to ignore my GP's advice, and the chest pain, and the fact that my clothes don't fit and the fact that my A**e has its own gravitational field, but if my chiropodist tells me to lose weight then by giminie I will".

    I think that we have a finite amount of currency in terms of credibility and time to educate patients. I think one has to be careful of where one spends that.
  27. twirly

    twirly Well-Known Member

    In agreement with Robert here,

    In my experience (limited though it may be). By the time an overweight individual seeks help with a foot problem they will likely have been given pearls of wisdom from their Doctor, nurse, family, friend, neighbour & possibly uncle Tom Cobbly n all about how their weight is the sole cause of every ill that may befall them.

    I can guarantee that regardless of their presenting problem the very first resolution (to most clinicians etc.) to any presenting problem will start with their weight.

    Indeed weight /foot related problems will impact potentially on the lower limb but if you wish to treat a patient never automatically assume that the sum total of the resolution to their symptoms (& possibly all their life's ills) is to lose weight.

    Treat people gently. We are here but once. (In my world any road).

    Kindest regards,

  28. cornmerchant

    cornmerchant Well-Known Member

    I am with Robert and Mandy on this one.

    It is unrealistic to think that you can change the world or the way obese patients lead their lives. It is presumptious of you to think that you can just tell someone to lose weight- that is something they do for themselves when they are ready- do you really think an obese patient loves being fat and uncomfortable and restricted in the physical exercise in which they can partake?
    For goodness sake, treat their feet and keep your opinions to yourself- dont treat everyone as an idiot.

  29. Strong words, but true I think. There is a fine line between educating patients and nagging them.
  30. Airlie

    Airlie Active Member

    There was a great show on the ABC last week called sleek geeks. http://www.abc.net.au/tv/sleekgeeks/ with adam spencer and dr Karl. Very scientific and also layman friendly!! pointed out some interesting stats re: kilojoules in and kilojoules out, also pointed out the amount of kj that can be used with low impact activites. a very impressive prac with a gummy bear too!!!
    It is always hard to try and motivate the inactive patient, but i find if you look around enough there is an exercise option for everyone. Diet seems to be the tricky part! and thats what the epc and dietitians are for....
  31. bobbyelesky

    bobbyelesky Welcome New Poster

    Hey BJ,
    You need to understand you can't help those who won't help themselves. Chances are if she is 50 she knows what she should do, and what she did to get herself in the situation she is in. You can't fix her, only she can. All you can do is provide support if she decides to do what she already knows she should, and granted maybe she just has health problems that are what they are. You can't save the world BJ.

    Bobby Elesky C-PED Medford, OR
    Last edited: Mar 24, 2011
  32. footdrcb

    footdrcb Active Member

    Two good questions to ask..

    1 What is your ideal weight?

    2 How much crap do you eat??

    3 Is your belt size "equator"

    4 Is you bloody type "rocky road"??
  33. footdrcb

    footdrcb Active Member

    That was 4 questions.....Sorry , my stomach got in the way of the keyboard
  34. blinda

    blinda MVP

    Just a heads up for a FREE two day CPD event in May, which happens to have a lecture on "Talking to Podiatry Patients About Their Weight, No Mean Feat"....


  35. NewsBot

    NewsBot The Admin that posts the news.

    Press Release:
    Britain’s obese in denial about their weight
    Do weight perceptions among obese adults in Great Britain match clinical definitions? Analysis of cross-sectional surveys from 2007 and 2012
    Fiona Johnson, Rebecca J Beeken, Helen Croker, Jane Wardle
    BMJ Open 2014;4:e005561 doi:10.1136/bmjopen-2014-005561
  36. NewsBot

    NewsBot The Admin that posts the news.

    Press Release:
    Obesity may shorten life expectancy up to eight years
    Canadian researchers put numbers on health risk

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