Why being an overweight nurse matters - and what to do about it
Management support and simple steps can make a big difference to a growing problem
Management support and simple steps can make a big difference to a growing problem
- Incidence of obesity and overweight in nurses is an issue for individuals as well as the wider workforce and profession, research shows
- Most nurses say their employer provides little or no support to help them maintain a healthy weight and lifestyle
- Tips on how to access healthy food and plan for night shifts - and share your views on access to healthy food
Obesity continues to be among the most significant health problems facing the general population, and nursing staff are mirroring the trend.
Poor access to nutritious food, especially for staff working at night or in the community, and long, often understaffed, shifts leading to inadequate breaks are key issues.
In January, a review of hospital food for all people, including staff, was announced by the government. It is seeking NHS employees' views with the aim of improving access to healthy food, especially on night shifts.
Access to nutritious food and breaks to have more than a 'grab and run' snack are among the main barriers to maintaining a healthy weight, nurses have reported via Nursing Standard surveys.
What’s the scale of obesity and overweight among the UK’s nursing staff?
One in four nurses in England are obese, and rates are higher for older staff, according to research published in 2017 – the first study to provide reliable estimates of the prevalence of obesity among healthcare professionals in England.
‘When we carried out our study, the prevalence of obesity among nurses and unregistered healthcare professionals was higher than among other groups, and that’s a concern,’ says professor of health promotion Jane Wills, of London Southbank University.
‘It’s not that nurses don’t know what they should eat or aren’t motivated to eat it, it’s just not available. Even if they bring food from home, there’s often nowhere to go’
Jane Wills, professor of health promotion, London Southbank University
A Nursing Standard survey published in November 2018, which attracted responses from 3,035 nurses, echoes these findings. A quarter classed themselves as obese, while a third said they were overweight. Just over 40% said they were a healthy weight.
Are you a healthy weight?
A healthy weight for an adult with a height of 5'4 (164.5cm) is between 7 stone 10 lbs (49kg) and 10 stone 6 lbs (66kg)
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Why does obesity in healthcare professionals matter?
‘Obesity among healthcare professionals has potentially negative implications for the capacity, efficacy, sustainability and safety of healthcare services…’ says the 2017 study.
For individuals, a variety of health issues may be associated with obesity, including diabetes, heart disease, fatigue, breathlessness, arthritis and increased risks of some cancers. Nurses who are obese may struggle with some physical aspects of patient care, including cardiopulmonary resuscitation, moving and handling, and carrying out tasks such as personal care in limited spaces.
‘It’s probably true too that there’s an impact on cognition if you’re not eating well or regularly,’ says Professor Wills. ‘But it’s probably of far more importance if someone hasn’t had a break and is working consistently long shifts.’
Healthy eating and well-being: RCNi resources
What challenges do nursing staff face in trying to choose nutritious food?
Lack of access to nutritious food at work was an issue raised by almost six in ten respondents to another Nursing Standard survey, carried out in May 2018. As well as inadequate breaks and long, sometimes understaffed, shifts, respondents listed barriers including high-fat food in hospital canteens, no healthy eating options outside office hours, few facilities to store or reheat food brought in from home, and health and welfare issues not being addressed in appraisals or one-to-ones.
‘Nurses told us they would make healthy choices if they could,’ says Professor Wills. ‘It’s not that they don’t know what they should eat or aren’t motivated to eat it, it’s just not available. Even if they bring food from home, there’s often nowhere to go and they are eating in store cupboards.’
In addition, many nurses do shift work, which is known to be a contributing factor in obesity, says Professor Wills. ‘There are physiological reasons, while access to healthy food at night can also often be restricted,’ she says.
The RCN’s Rest, Rehydrate, Refuel resource (see box below) says that good nutrition is particularly important for those who work nights, as this kind of work has been associated with digestive problems, obesity and poorer health outcomes. ‘Shift workers should be able to access healthy food options and/or store, refrigerate and reheat foods brought in from home during a night shift,’ says the RCN.
Nurses in the community also fare badly. ‘Community nurses have large caseloads and are in their cars all the time. As a result, they tend to go into a garage and pick up a sandwich,’ says Professor Wills.
Five tips for making healthier choices
- Planning your food is important, suggests Jane Wills, professor of health promotion at London Southbank University. Professor Wills recommends the Nursing You app, which has lots of practical and realistic advice (see box below) – for example, consider batch cooking on your days off and freezing food for when you come home exhausted at the end of a long shift
- Don’t worry too much about detailed nutrition, advises Christine Hancock, founder and director of C3 Collaborating for Health. ‘Eat less, with smaller portions, and have more fruit and vegetables. They don’t have to be fresh – frozen peas are as good. It’s simple to do and easy to follow,’ she says. ‘Green vegetables are important, both because they’re nutritious and they fill you up, so you eat less of everything else’
- Don’t go to work hungry, as that may lead to unhealthy choices later in your shift, says the RCN in its Rest, Rehydrate, Refuel resource
- Take your breaks Remember that, by law, you are entitled to an uninterrupted break of at least 20 minutes away from your immediate work station, if you work more than six hours
- Choose light meals and healthy snacks for night shifts The Health and Safety Executive (HSE) offers a range of dietary tips and other advice for those working night shifts. These include: choose regular light meals and snacks rather than a single heavy meal, which can lead to drowsiness; avoid sugary foods that provide a short-term energy boost followed by a dip; eat fruit and vegetables as snacks, as they also provide minerals, vitamins and fibre
Are overweight or obese nurses judged more harshly than other people? Should nurses be role models?
‘The response to our study from the tabloid press and media was very much along the lines of “they should know better”,’ says Professor Wills.
But research shows the nursing workforce has equivocal views on whether they should be modelling healthy behaviours.
‘Some obese nurses said they were more likely to raise the issue with patients because they understood the difficulties and challenges. Others felt they wouldn’t be listened to’
‘When we asked nurses whether they thought they should be role models, there was overwhelming agreement,’ she says.
Yet when researchers trialled a campaign concept called ‘first impressions count’, nurses found the introduction of professional expectations around personal behaviours unacceptable. ‘They felt it was their private life and not a professional matter,’ says Professor Wills.
Does being overweight or obese make nurses less likely to raise weight with patients and be taken seriously?
For Professor Wills, the issue is far from clear cut. ‘We heard stories from some obese nurses that they were more likely to raise the issue because they understood the difficulties and challenges,’ she says. ‘Others felt that patients would be critical of them or they wouldn’t be listened to. It’s a very mixed bag.’
According to the study looking at nurses as role models, almost half – 48% – thought being an obese nurse made the public less likely to trust their public health messages. That view is reinforced by Professor Wills, who says: ‘The little we do know from patients is they don’t think advice from someone who is obese has much credibility. It’s the same as a smoking nurse. They are observable behaviours.’
Realistic, achievable ideas – and a lifestyle app designed for nurses
Founder and director of the charity C3 Collaborating for Health Christine Hancock admits they were nervous when first approached to investigate obesity among nurses.
‘It’s a sensitive subject for the person concerned,’ she says. ‘But what we found is that obese nurses really wanted to talk about it.’
At RCN Congress in 2018, the charity carried out a simple survey. ‘We had people queuing up to take it,’ she recalls.
Nurses’ working lives make weight loss difficult
Research they commissioned showed that 94% had tried to lose weight, with around three quarters believing being obese affected their work. ‘Clearly it was a very significant issue,’ she says.
In response, the charity held focus groups around the country with nurses who were obese, listening to what they thought should be done. ‘There was a real desire for their management to face up to the fact that aspects of their working lives made things really difficult,’ says Ms Hancock.
This included long shifts without breaks. ‘We heard countless times from nurses saying they didn’t drink water when they were at work because they didn’t have time to go to the toilet,’ she says. Others reported that by the time they were able to get to the canteen, cakes were all that was left.
Free app offers ideas and cues to encourage healthy eating
Last spring, in partnership with MAXIMUS UK, the charity launched a free app, Nursing You, which gives messages, cues and ideas to help nurses maintain a healthy weight and drink more water.
The app tackles questions such as: how do you make decisions about what to eat or drink before, during and after work?; which triggers during a shift – situations, feelings or experiences – lead you to make unhealthy eating choices?; what are the healthier alternatives?; and how do you incorporate them into a busy life? In addition, it now offers free, one-to-one health coaching run over 12 weeks.
The app has proved both popular and effective. ‘We have real evidence that people using it are losing weight, based on the management information that comes out,’ says Ms Hancock. ‘There isn’t any point in saying to a nurse “at the end of a 12-hour shift, go home and buy and cook fresh vegetables”. The app suggests things that are realistic and achievable in the context of nurses’ lives.’
Should employers and managers be doing more?
In Nursing Standard’s survey of May 2018, more than 70% of nurses said their employer provided little or no support to help maintain a healthy weight and lifestyle.
Improving hospital food is key, says Professor Wills. ‘We know it’s not as healthy as it should be. Some trusts have introduced specifications, but generally there’s a low level of nutrition and it’s expensive.’ Any health and well-being initiatives must be geared towards nurses specifically, she believes. ‘Many of the offers are not available for those who work shifts, so the take-up is principally from those in desk jobs.’
Raising the issue of weight directly with staff is challenging. ‘Managers have many concerns about being insensitive or discriminatory,’ says Professor Wills.
Would a free, 24-7 staff gym make a difference to you?
A free, on-site gym is among the staff benefits an NHS trust is promoting to potential recruits.
Sandwell and West Birmingham NHS Trust’s newly renovated gym for staff at its City Hospital will be open 24 hours a day, seven days a week.
The gym is part of the trust’s aim to improve access to exercise facilities for staff; a similar free gym is already open at its Sandwell General Hospital.
Trust head of engagement and retention Amir Alisays: ‘The City gym is a fantastic benefit for staff. With it open 24-7, it’s particularly beneficial to those members of staff working flexible shifts.’
More fitness and lifestyle initiatives
The trust also offers employees free yoga, Pilates and ‘bootcamp’ fitness sessions and hosts a weekly walking group.
Four years ago, it banned sales of high-sugar drinks, fried crisps, chips and chocolate at its catering outlets and reduced the cost of healthier foods.
Sandwell Hospital also holds a Slimming World class early every Saturday morning, arranged at a time convenient for shift workers, who can attend either just before an early shift or just after a night shift.
What does your employer do to help you have a healthy lifestyle?
Share what works at your workplace, using the comments bar at the end of the article
Is the government taking any action to improve nutritional standards in hospitals?
The government review of hospital food led by Philip Shelley, the former chair of the Hospital Caterers Association, will look at spreading good practice and setting out recommendations.
Staff are encouraged to share their own experiences of eating and drinking at work, whether they work in an acute or community hospital or mental health setting. Questions include: what would improve your experience of and access to food at work?; what facilities are available to prepare food at work?; what options are available to buy it? The review is particularly keen to hear people’s experiences during night shifts.
Access to healthy food, no matter where or when you work
The RCN’s 3Rs resource – Rest, Rehydrate, Refuel – was inspired by the experience of nurse Gillian Pick, who crashed her car while driving home after a 12-hour night shift.
Fortunately, no one died in the crash but the case attracted considerable media attention because of the light it shone on nurses’ working conditions.
‘That’s what kick-started our campaign,’ says RCN national officer Kim Sunley. Media reports at the time of the court case in 2017 said the respiratory nurse had been unable to take a break, or have anything to eat or drink during the shift, and was suffering from low blood sugar. ‘We know too that there have been a number of more serious, even fatal, car crashes involving nurses and junior doctors on their way home,’ Ms Sunley says.
Hydration stations are the just first step
Since the RCN resource was introduced three years ago, there has been significant progress on the rehydration front, with many wards setting up their own “hydration stations”, actively encouraging staff to drink water throughout their shift. ‘There’s been real uptake and enthusiasm,’ says Ms Sunley.
‘The major challenge is still achieving breaks that are long enough to access healthy food, including on night shifts’
Kim Sunley, RCN national officer
‘Having easy access to water in a ward area is great, but we mustn’t take our eye off the whole issue of adequate breaks.
‘The major challenge is still achieving breaks that are long enough to access healthy food, including on night shifts.’
Night workers face major hurdles to being able to eat healthily, with restaurants closed, vending machines not stocking healthy options and nowhere to store or warm up food brought from home. ‘We know that shift working is inevitable in nursing and the evidence shows those who do it have poorer health outcomes,’ says Ms Sunley.
‘As part of improving the health and well-being of the workforce, employers should be ensuring that whenever you work, you have access to food that’s healthy, have time to go and get it or prepare it, and a facility where you can eat in relative peace and quiet. If you ever eat with nurses, they’re always the first to finish,’ she says.
We’d love to hear the healthy-living and weight-loss tips that work for you – just use the comments bar below
Lynne Pearce is a health journalist