Adult obesity is an incredibly complicated matter for health care providers because it brings so many other treatment issues with it.
There are multiple chronic diseases like high blood pressure and diabetes, a raft of medications to track, the physical size of the patients, and, of course, time limitations.
Now imagine how hard it is for the obese patients, says Amber Richert, MSN, RN and a Doctor of Nursing Practice student at the Johns Hopkins University School of Nursing (JHUSON). Throw in a gritty urban setting and low-income status, with cultural mores and biases, and it’s even tougher to combat obesity.
At the Community Health Center Inc. (CHC) in New Britain, Conn., Richert hopes to develop a plan of action and education that would remove hurdles that cause so many anti-obesity efforts to fail. She understands the frustration of health care providers who “have 15 minutes for a patient who has multiple chronic conditions and takes a dozen medications … treating the obesity is low on the list.” And she knows the challenges in finding a one-size-fits-all treatment method.
“The patients are really complex,” Richert says of the people who visit CHC, a Federally Qualified Health Center. They may work multiple jobs or be on state assistance. Most have limited transportation options and little access to fruits and vegetables in so-called “food deserts,” inner-city zones like parts of New Britain or Baltimore, Md. more likely to feature convenience stores and fried chicken chains than high-end supermarkets and apple carts. It can mean that a calorie-rich fast-food hamburger makes more sense for dinner than hunting, gathering, and preparing a more balanced, nutritious meal. And it can mean that forcing patients to check in regularly at the clinic instead drives them away.
So, the idea is to educate, counsel, encourage, and treat obese, poor, urban patients where they live, respectfully, and to do it without increasing the workload of a health care staff or requiring vast expertise in obesity management. As part of the effort, built on work she did as a Master of Science in Nursing student at JHUSON, Richert is developing a pilot study that would offer patients several weeks of intervention (education and counseling on diet and exercise and self-monitoring) followed by weeks of “maintenance” with the clinic doing the checking in (by text or other electronic means). She’s hoping to find a program that’s sustainable--for those who can’t get to the clinic as well as those who can. (Studies have shown that both groups, treated successfully, tend to lose roughly equal amounts of weight.)
It’s a difficult task but a necessary one, Richert says, because current options, even advanced surgery, aren’t enough without behavior changes. “One thing we’re seeing is, post bariatric surgery, patients are still morbidly obese,” meaning their habits don’t change even after an operation meant to limit caloric intake by constricting the digestive system. Richert says she has seen patients with body mass index (BMI) numbers greater than 70 at the clinic. For a person who’s 5-foot-10, that would mean weighing 500 pounds or more.
It could leave a health care provider, or an obese patient, asking, “Why try?”
Because, Richert says, sustained, meaningful weight loss (10 percent reduction in total mass) improves lives measurably and, by halting chronic diseases, saves money. It’s that simple.