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Talking openly about obesity and nursing

More nurses are obese than any other group of health professionals. Andrew Cole looks at a project aimed at 'normalising' conversations with staff about obesity.
obese

More nurses are obese than any other group of health professionals. Andrew Cole looks at a project aimed at 'normalising' conversations with staff about obesity

A significant proportion of nurses in the UK are overweight or obese and the problem is, in every sense, a growing one.

A study last year revealed that one quarter of all registered nurses in England are obese with a BMI of 30 or over and that in those over 55 this figure climbs to 38% (Box 1).

It means more nurses are obese than any other group of health professionals. Worryingly, there is anecdotal evidence that an increasing number of nursing students are overweight.

Some nurses attribute their weight problems to their own lifestyle. They are perfectly aware of the health messages but

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More nurses are obese than any other group of health professionals. Andrew Cole looks at a project aimed at 'normalising' conversations with staff about obesity

obese
Nurses will be nudged towards healthier eating choices. Picture: Neil O’Connor

A significant proportion of nurses in the UK are overweight or obese and the problem is, in every sense, a growing one.

A study last year revealed that one quarter of all registered nurses in England are obese – with a BMI of 30 or over – and that in those over 55 this figure climbs to 38% (Box 1).

It means more nurses are obese than any other group of health professionals. Worryingly, there is anecdotal evidence that an increasing number of nursing students are overweight.

‘Some nurses attribute their weight problems to their own lifestyle. They are perfectly aware of the health messages but find it very difficult to act on them’

Jane Wills

This is the backdrop to the Healthy Weight Initiative for Nurses (WIN), a collaboration between several organisations including C3 Collaborating for Health, the RCN and London South Bank University, which aims to work with nurses to uncover the root causes of the problem and begin to address them.

Being overweight is a problem first and foremost for the nurse’s own health, says Jane Wills, professor in health promotion at South Bank University. But she emphasises that it also affects patient care. ‘We know that obesity affects people’s ability to perform various roles. And we know it affects nurses’ willingness to engage in health promotion.’

The project, which began in 2015 and concludes next January, involves a range of activities including research studies, focus groups and workshops. On-the-spot surveys of nurses, many of them overweight, also ran at the last two RCN congresses.

All this is designed to answer the underlying question: why are so many nurses overweight and how can they be supported to lose weight?

‘Some nurses attribute their weight problems to their own lifestyle,’ says Ms Wills. ‘They are perfectly aware of the health messages but find it very difficult to act on them.’

Under pressure

But more blame the high-pressure environment in which they work. They find it difficult to access healthy food and don’t get regular or sufficiently long breaks. This can be exacerbated if they are working night shifts.

A survey of nurses’ eating habits at this year’s RCN congress in Liverpool, for example, showed that while most brought food from home to eat at work, students and healthcare assistants were more likely to order takeaways, while canteens did little to promote healthy eating and cakes and biscuits were widely available at work stations.

But there is disagreement about whether nurses should act as role models. ‘They agree they should practise what they preach,’ says Pat Hughes, a nursing associate at C3, which is a non-profit organisation. ‘Yet they also say, actually my private life is my affair and so long as I’m doing my job, it’s nobody else’s business.’

‘You’ve just done the shift from hell so you have a McDonald’s as a sort of reward. Or you miss out on breakfast but snack on biscuits on the way to work.’

Michaela Nuttall

One of the most encouraging things to emerge is that nurses do seem to want to engage with and talk openly about the issue, she says.

At last year’s congress, for example, researchers took the bold step of approaching delegates who looked obese and asking them to complete a survey on the subject. ‘Almost unanimously they told us, "thank God someone’s doing something about it." It’s a big problem.’

No one asked why

‘A lot of people were pleased we were doing this,’ agrees Michaela Nuttall, an associate colleague of Ms Hughes at C3. ‘One lady at a focus group said every year her weight had gone up by a stone but nobody at work ever asked what was wrong and what was going on in her life.’

The moral, she feels, is that it’s OK to ask people about weight issues – in fact it’s essential. Nurses spend a large part of their lives looking after people, at work and often at home. This project tries to encourage them to spend more time looking after themselves.

 ‘People are talking about the issue and don’t have the same sensitivity they used to, so slowly we’re making progress’

Jane Wills

One intervention to be launched later this year is a decision-making tool that helps nurses identify their own decision-making around food choices.

Nurses often make quick and unhealthy decisions about what to eat and drink in the pressure of the moment, says Ms Nuttall. ‘You’ve just done the shift from hell so you have a McDonald’s as a sort of reward. Or you miss out on breakfast but snack on biscuits on the way to work.’

The decision-making tool is an interactive PDF that helps nurses anticipate these pressure moments and nudges them towards healthier alternatives. The tool will be available to all nurses via trust intranets.

Another, more contentious initiative seeks to include healthy lifestyle issues – and especially weight problems – within the annual appraisal. It is expected to be piloted in one trust in the next few months.

Talking about obesity

The aim, says Ms Wills, is to ‘normalise’ conversations about obesity and make them part of everyday working life. Addressing this issue in an appraisal would have to be handled sensitively, she accepts, and appraisers would themselves need training in how to approach it and how to support nurses afterwards.

One thorny issue is nurses’ own knowledge about nutrition. People tend to assume nurses know about healthy eating and lifestyle but simply fail to put it into practice, says Ms Hughes. But that’s not always the case. It’s not helped by the lack of focus on diet and nutrition in the nursing curriculum. 

Despite this, the project team remains cautiously optimistic. ‘One of our biggest successes is that we have stimulated so much dialogue within nursing,’ says Ms Hughes.

Ms Wills agrees. ‘People are talking about the issue and don’t have the same sensitivity they used to, so slowly we’re making progress.’

 

The Healthy Weight Initiative is supported by funding from The Burdett Trust for Nursing, the Royal College of Nursing Foundation and the Royal College of Nursing


Box 1. Obesity among nurses in England

25% of nurses are obese compared with 16% of other healthcare professionals.
38% aged over 55 are obese.
31.6% of black and minority ethnic nurses are obese.
26% of female nurses are obese compared with 18% of men.
32% of unregistered carers are obese.

Source: Prevalence of obesity among nurses in England compared to other occupational Groups, WIN, 2016.


C3 Collaborating for Health

C3 works globally to encourage people to lead healthier lives. It focuses on the three major public health risk factors:

  • Unhealthy eating and drinking.
  • Lack of physical activity.
  • Smoking.

As a nurse – and former RCN general secretary – C3's founder and director Christine Hancock has a particular interest in the WIN project.

‘There are 19 million nurses in the world – and they are one of the most respected professions,’ she says. ‘If they understood and had the same strong feelings I have about public health they could change the world.’

Unfortunately, she says, many know little about prevention, while their own working conditions make eating healthily challenging. Turning things around will be hard ‘but at least a lot of people now recognise the problem and are thinking about what to do’.

 


Andrew Cole is a freelance health writer 

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