Nursing Standard survey reveals extent of obesity among nurses
Does being overweight or obese hamper nurses' ability to offer healthy lifestyle advice?
Does being overweight or obese hamper nurses' ability to offer healthy lifestyle advice?
Weight gain and obesity are major issues for the nursing profession and may be undermining the health advice nurses give to patients, according to a Nursing Standard survey.
The poll shows employers that support nursing staff to maintain a healthy lifestyle are thin on the ground.
There are some exemplary organisations that offer their staff Pilates, mindfulness and healthy eating classes, even access to gyms and swimming pools. But too many others sound almost Dickensian in their approach to staff welfare, with long shifts, few breaks and workplace ‘nutrition’ restricted to salty or sugary snacks from a vending machine.
Protected mealtimes 'a distant memory'
More than 70% of survey respondents felt their employer provided little or no support to help them maintain a healthy weight or lifestyle. ‘Protected meal times are a dim and distant memory,’ one respondent wrote. ‘Nurses generally grab and run.’
A similar proportion (63%) of the 3,035 nurses who took part in the survey feel nurses' weight can affect the health advice they are able to give patients.
The consequences of not being able to eat healthy meals and take regular exercise are well known and serious.
Obesity, in the UK and internationally, is a major problem for individuals and economies. The World Health Organization says obesity has tripled since 1975. In 2016, more than 1.9 billion adults worldwide were overweight and more than 650 million obese.
And figures published this year by NHS Digital show that in England in 2016, 26% of adults were classed as obese. In 2016-17, there were 617,000 admissions to NHS hospitals where obesity was a factor, up by 18% on the previous year.
Minority of nurses report a healthy weight
Using the NHS BMI calculator, about a quarter of respondents (738) to the Nursing Standard survey classed themselves as obese and a third (1,029) said they were overweight. A little over 40% (1,224) said they were a healthy weight.
‘This is a tricky subject to deal with and one we had a lot of trepidation about’
Michaela Nuttall, nursing associate, C3 Collaborating for Health
Many contributory factors featured in the survey responses. As well as those long, sometimes understaffed shifts and inadequate breaks, respondents described:
- High-fat food in hospital canteens.
- No healthy eating options outside office hours.
- Few facilities to store or reheat food brought from home.
- Health and welfare not being addressed in appraisals or one-to-ones.
This combination of factors that mitigate against nurses' maintenance of healthy weight is now well documented. A previous Nursing Standard survey showed that almost 60% of nursing staff did not have access to nutritious food at work.
But as Michaela Nuttall, nursing associate for the charity C3 Collaborating for Health, points out, addressing the issue is difficult, not least because of the risk of being seen to blame nurses for putting on weight.
C3 Collaborating for Health was a partner in the Healthy Weight Initiative for Nurses (WIN), which ran for two years from 2015. Its aim to was to work with nurses who were obese to design initiatives to help them and others reach and maintain a healthy weight.
‘We quickly realised it’s a tricky subject to deal with and one we had a lot of trepidation about,’ Ms Nuttall says. ‘But we felt it was such an important issue we had to move forward with it.
‘It’s absolutely not about blaming or victimisation. It’s about helping. We spent a long time engaging with nurses and bringing them with us every step of the conversation.’
The role of the working environment
As with the latest Nursing Standard survey, it emerged from the WIN work that working environment has an enormous effect on nurses’ ability to make healthy choices.
And with the evidence clear that many nurses have difficulties controlling their own weight, a key question is whether the credibility of any health promotion work they undertake will be compromised as a result.
‘It’s quite easy to blame or start thinking it’s all about the nurse’s own behaviours, when actually it comes down to something structural in the health service itself’
Richard Kyle, public health expert, Edinburgh Napier University
Richard Kyle is head of population and public health in the school of health and social care at Edinburgh Napier University. He led research funded by WIN into the prevalence of obesity among healthcare professionals in England.
Like Ms Nuttall, he is keen to stress that research into obesity among nurses is not about pointing fingers. ‘It’s quite easy to blame or start thinking it’s all about the nurse’s own behaviours or lifestyle choices, when actually it comes down to something structural in the health service itself.’
That said, he cites evidence showing that some patients are reluctant to take advice about healthy eating from someone who is overweight.
Expectation to be a role model
According to research quoted in Dr Kyle’s research on behalf of WIN, role modelling is seen as a reasonable professional expectation of nurses. Patients are more likely to accept advice offered by a ‘visibly healthy’ healthcare professional compared with one who is overweight or obese.
‘But then there are others who will say because someone’s had experience of gaining weight, then actually it’s better because they create that sense of empathy,’ Dr Kyle says.
Respondents to the Nursing Standard survey who supported the view that nurse obesity undermined health promotion messages far outnumbered those who disagreed. More than 63% were on the side of NHS England, which has argued that health advice has less impact when delivered by nurses who are overweight.
Nutrition and weight: what nurses told us
Some of the questions and responses from the Nursing Standard survey:
- According to the NHS BMI calculator, what is your weight level?
Obese – 24.32%
Overweight – 33.9%
Healthy – 40.33%
Underweight – 1.45%
- NHS England has argued obesity among nurses undermines the ability of health staff to provide credible health advice to the public. Do you agree?
Yes – 63.61%
No – 28.18%
Don’t know – 8.9%
- What level of support, if any, does your employer provide to help to maintain a healthy weight and lifestyle?
A great deal of support – 4.06%
Some support – 24.96%
Little or no support – 70.98%
‘How can you deliver healthy eating messages when you are obese yourself?’ a survey respondent asked. ‘Patients will think that you do not practise what you preach.’ Another said: ‘Being obese and discussing healthy eating and portion sizes is just not credible.’
There is a risk that the problem of obesity among nurses is going to get worse before it gets better. Although the topic is now the focus of some initiatives to tackle it, Dr Kyle says workforce issues could have a further detrimental effect.
Higher prevalence among nurses
His research looked at obesity among four groups: nurses; other healthcare professionals; unregistered care workers; and the general population. The prevalence among nurses was significantly higher than among other health professionals, similar to the general population, but significantly lower than among care workers.
Policy shifts in England, with more of those care workers being encouraged to follow routes into nursing, suggest that the 25% or so of nurses who are already overweight or obese could soon be joined by more. ‘There’s going to have to be some work done to support those individuals to be healthier,’ says Dr Kyle. ‘Because if they’re coming into a system that’s not necessarily promoting their health, then that’s going to be hugely challenging for them.’
‘A lot of the initiatives target nine-to-five staff. But nurses working shifts need health and well-being initiatives more because there is a link between shift work and obesity’
Kim Sunley, RCN national officer
There is no obvious quick fix to the issue of obesity among nurses and other care workers. Leadership at local level can be part of the solution, and some Nursing Standard survey respondents also stressed nurses’ personal responsibility to maintain a healthy weight.
- RELATED: Obesity – RCNi resource
RCN national officer Kim Sunley says there is ‘lots of noise’ from on high about nurses’ health and well-being and many local projects designed to offer support.
‘But how targeted they are is questionable, she says. 'A lot of the initiatives are targeted at nine-to-five staff. But nurses working shifts need to access health and well-being initiatives more than non-shift workers because we know there is a link between shift work and obesity.’
Short-staffing and the pressure to skip breaks
And the fundamental problems need to be addressed too, she argues. Nursing shortages and the knock-on effect on ability to take breaks, for example. Workplace cultures also need to be changed so that the worst employers mirror the best – those where there are similar pressures but staff are still encouraged to take breaks.
There are simple solutions too. The WIN project, for instance, found that 89% of nurses it surveyed said access to free fruit at work would make a real difference. ‘A bowl of fruit is one small measure that may start people thinking differently,’ Ms Sunley says.
Dr Kyle also argues that more than local and individual action is required, calling instead for bold steps that demonstrate NHS support for its workforce. He cites last year’s Nursing 2030 Vision, published by the Scottish Government, which stressed the need for measures to protect and promote nurses’ physical and mental health and well-being.
Ms Nuttall agrees there are no simple answers and argues that currently a unique set of circumstances is combining to make healthy living a remote goal for many nurses as they face poor pay, long days and the need to work extra shifts.
For a workforce that is ageing but, in many cases, bearing the added burden of dependent children and dependent parents, getting through the next shift is the primary focus.
‘It’s like a perfect storm,’ Ms Nuttall says.