Sensitivity Training

1. Sensitivity Training Compassionate Healthcare for the Obese

2. What is Sensitivity Training? Sensitivity Training: Training to develop a sensitive awareness and understanding of oneself and of one’s relationship with others. Charlene J. Anderson, Bariatric Nurse Care Coordinator

3. Why is Obesity Sensitivity Training Important? • 64% of the US population is overweight • 30% of the US adult population is obese • Obesity causes at least 400,000 excess deaths each year in the US Charlene J. Anderson, Bariatric Nurse Care Coordinator

4. Who is the Bariatric Client? • BMI >35 with comorbidity • BMI >40 without • BMI <60 if female (non-pregnant), or <55 if male • Good surgical candidate (ASA I or II) • Have repeatedly tried and failed to lose weight • Physical limitations (mobility, respiratory, skin integrity, comorbidities) • Social/ Psych concerns (family dynamics, body image, social acceptance, lack of support system) Charlene J. Anderson, Bariatric Nurse Care Coordinator

5. Obesity Classification Charlene J. Anderson, Bariatric Nurse Care Coordinator

6. Obesity is a Multifactoral Disease Genetic • Hunter/Gatherer - Protection against famine • DNA Research Environmental • Availability of Food • Sedentary Lifestyles • Technology • Internet • Fast Food Behavioral • Bored • Depression • Happy • Celebration Charlene J. Anderson, Bariatric Nurse Care Coordinator

7. Effects of Obesity Respiratory • Airway problems • Decreased airway exchange efficiency • Decreased resting functional residual lung capacity • Obesity hypoventilation syndrome • Obstructive Sleep Apnea • Pulmonary Hypertension • Asthma/reactive airway disease Cardiovascular • Cardiac Disease • Hypertension • Congestive Heart Failure • Atherosclerotic Disease • Increased risk of coronary artery disease • Varicosities of the veins • Venous stasis or insufficiency Charlene J. Anderson, Bariatric Nurse Care Coordinator

8. Effects of Obesity Musculoskeletal • Osteoarthritis • Demineralization of the bone • Degeneration of knees and hips • Back pain (especially lower back) • Disc herniation • Carpal tunnel syndrome Neuropsychiatric • Stroke • Depression • Idiopathic intracranial hypertension Ophthalmologic • Glaucoma • Cataracts Charlene J. Anderson, Bariatric Nurse Care Coordinator

9. Cost of Obesity • $33 billion spent by Americans annually in attempts to control or lose weight • $117 billion spent on obesity-related healthcare issues • $77 Million spent per month for people covered by Social Security Disability Charlene J. Anderson, Bariatric Nurse Care Coordinator

10. Obesity Treatment Goals • Primary Goal is to protect the patient and yourself from injury • Secondary Goal is to provide care in an environment that fosters emotional and physical healing Charlene J. Anderson, Bariatric Nurse Care Coordinator

11. Treatment Diet and Exercise Behavioral Modification Medication • Prescription: Orlistat Meridia Rimonabant • Over the Counter: Alli Hydroxycut • Natural: Acai Studies have shown that medications have little effect on long term weight loss. Charlene J. Anderson, Bariatric Nurse Care Coordinator

12. Surgery Bariatric Procedures: • Malabsorptive • Restrictive • Combination The National Institutes of Health (NIH): “Only surgery has proven effective over the long term for most patients with clinically severe obesity.” Charlene J. Anderson, Bariatric Nurse Care Coordinator

13. Why Surgery? Obesity is a factor in 5 of the 10 leading causes of death… In the United States today, obesity is the MOST COMMON cause of EARLY and PREVENTABLE death Improved Quality of Life After Bariatric Surgery 95% of patients reported significant improvement in quality of life Charlene J. Anderson, Bariatric Nurse Care Coordinator

14. Cultural Influences • What perceptions do I bring to work from my personal background? • What biases do I hold toward others that may be different from me? • What challenges does the obese patient present when seeking healthcare? • How can I respond sensitively to the obese patient’s needs? Charlene J. Anderson, Bariatric Nurse Care Coordinator

15. Daily Issues for the Obese • Inadequate accommodations • Inaccessibility to Public Facilities • Lack of energy and stamina • Fear of rejection and ridicule • Basic safety needs Charlene J. Anderson, Bariatric Nurse Care Coordinator

16. Psychological Impact of Obesity • Does someone choose to be fat? Or does it choose them? Complicated issue of genetic, environmental and behavioral • Embarrassment when attention is drawn to them. Most want to be anonymous, invisible. • Embarrassment masked as “difficult person” i.e. “You can’t hurt me if I hurt you first”. • Children are allowed to stare/comment without parental correction. • Surreptitious glances/overt staring/never making eye contact • People generally avoid touching them – “Fear that fat is contagious?”, “not the beautiful people”. • Repeated diet failure can lead to depression, despair. Charlene J. Anderson, Bariatric Nurse Care Coordinator

17. Business and Legal Implications of Insensitivity • Patient satisfaction • Litigation • Separation from employment (YOU!) Charlene J. Anderson, Bariatric Nurse Care Coordinator

18. Who may encounter the Bariatric Client? • Hospital Staff – Admissions/Registration, Transportation, Pre-Admission Testing, Lab, Radiology, Surgical Services (SDS, Holding Rm, OR, PACU), Nursing Unit, SICU, ER, Dietary/Nutrition, Social Services, Chaplaincy, etc. • Medical Plaza Staff – Patient Registration, Transportation, Auxiliary Svcs, Surgical Associates Clinic, Metabolic Medicine Clinic, Psychology Clinic, Other Providers, etc. Charlene J. Anderson, Bariatric Nurse Care Coordinator

19. Perceptions (or Biases) of the HealthCare Provider • Childhood influencesand family values • Obese client seen as lazy or unmotivated, unhygienic • Obesity may be seen as a weakness or failure of the individual • The obese are blamed for their condition • Obese persons are perceived as lazy and self-indulgent • People believe they lack character, will-power and self-discipline • It is implied that they take up more space & resources than they deserve Charlene J. Anderson, Bariatric Nurse Care Coordinator

20. Perceptions are Improving • Obesity is a disease with serious health risks • Diet and exercise remain the cornerstone of obesity treatment • However, surgery is accepted as a proven treatment for obesity • Surgical treatment is appropriate for qualified individuals • Bariatric surgery is a proven weight loss method Charlene J. Anderson, Bariatric Nurse Care Coordinator

21. Be Sensitive!!! • Avoid labeling • Do not judge • Become proactive • Be aware of HIPPA • Connect and respect • Reach out Charlene J. Anderson, Bariatric Nurse Care Coordinator

22. Scenarios A hospital environmental services worker sees a very obese person entering the facility. She notices that the person is having difficulty walking and needs to stop frequently. • What should that staff member do next? • What if the person is embarrassed or even refuses help? • What other challenges do the obese have to overcome in their every day lives? Charlene J. Anderson, Bariatric Nurse Care Coordinator

23. Realize the Issue • The worker should get help in the form of a wheelchair and notify a clinical staff member • If the person is embarrassed or refuses help, offer to walk with them • Walking may be difficult, as well as transportation Charlene J. Anderson, Bariatric Nurse Care Coordinator

24. Scenarios You have just overheard a fellow volunteer making a negative remark about pushing an obese patient in a wheelchair. • Do you agree with his attitude? • What is the real issue here? Why is he being negative in this situation? • Can you make a difference? • How would you respond? Charlene J. Anderson, Bariatric Nurse Care Coordinator

25. Determine Your Response Change your own attitude and respond in a positive manor: • She seemed like a very nice person who needed our help until she can get back on her feet • If you had asked me, I would have been glad to help you • Next time let’s work together if we need to Charlene J. Anderson, Bariatric Nurse Care Coordinator

26. Focus on Acceptance • Cultural diversity is a value in our facility • Respect the difficult journey that any patient, obese or not, has been traveling • Examine your own bias and opinion regarding the obese patient • Look closer to find the person hidden behind the obesity • Recognize and refuse to allow “insensitivities” to occur around you • Equal access to healthcare for all people, including the obese Charlene J. Anderson, Bariatric Nurse Care Coordinator

27. References: • http://www.obesity.org/subs/disability • Bariatric Times • Schauer PR et al: Outcomes after Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity. Ann Surg 2000. Charlene J. Anderson, Bariatric Nurse Care Coordinator