Wednesday August 27th 2014

An issue of weight

Calling all nurses to get healthy and reverse a trend

A troubling trend is continuing: More Americans are on a path toward becoming overweight and obese. And that translates to more patients and nurses weighing in at higher, less healthy numbers.

Like many Americans with high-stress jobs and lots of responsibilities, it sometimes seems like the odds are against nurses to eat right, exercise and get enough sleep.

Through its Healthy Nurse program, the American Nurses Association (ANA) is working to turn the tide by helping nurses attain healthier lifestyles and workplace practices, and in turn be strong role models for their patients. In yet another series of educational sessions, ANA’s Department for Health, Safety and Wellness is hosting Healthy Nurse workshops Feb. 6, in conjunction with its Nursing Quality Conference, on making the case for safe patient handling and self-care for nurses. (Go to www.nursingworld.org/healthynurse.org for resources and more ANA activities.)

“The weight of our nation’s population is increasing, causing a rise in the incidence of noncommunicable diseases, such as cardiovascular conditions and diabetes,” said Suzy Harrington, DNP, RN, MCHES, director of ANA’s Department for Health, Safety and Wellness. “And it is affecting the health of nurses personally and professionally.”

Added Susan Gallagher, PhD, RN, CSPHP, CBN, “Certainly there are many very healthy nurses who happen to be overweight or obese. However, the data suggest that, like the general population, nurses of size may face some obesity-related health risks.”

Beyond the potential for chronic diseases, a maldistribution of weight can affect balance and place nurses at risk for falling themselves while they are moving patients, according to Gallagher, a national expert on improving care for patients of size and an ANA member.

Further, obese persons report more musculoskeletal pain than do those within normal ranges of weight and body mass index. This additional weight increases the potential for trauma to joints and the musculoskeletal system, as well as chronic inflammation.

Additionally, sleep — which is often a premium for nurses — can be adversely affected.

As much as 77 percent of people who are obese suffer from obstructive sleep apnea, which can compound fatigue-related symptoms such as inattentiveness and poor concentration, Gallagher said.

What the numbers say

About one-third of adults age 20 and older in this country are overweight, and about 35.7 percent are obese, according to statistics from the Centers for Disease Control and Prevention. If these patterns continue unabated, by 2030 adult obesity rates could exceed 60 percent in 13 states, slightly more than 50 percent in 39 states, and 44 percent in all 50 states, according to a report released by the Robert Wood Johnson Foundation and Trust for America’s Health in September 2012. Further, obesity could lead to more than 6 million cases of type 2 diabetes, 5 million cases of coronary heart disease and stroke, and more than 400,000 cases of cancer in the next two decades.

Results from the Harvard Nurses’ Health Study showed that 60 percent of respondents reported being either overweight or obese, more than half said they exercised less than two hours a week and more than half said they eat less fruit than the minimum daily standards.

ANA also captured a snapshot of the health of some 350 nurses who agreed to take a Health Risk Assessment at its Healthy Nurse Conference and business meeting in June 2012.

The results were a mixed bag. Although most did not smoke or drink alcohol to excess, 70 percent of the respondents were either overweight or obese — with 40 percent falling into the latter category. The age group with the highest incidence was those 30 to 39 years old. Only 35 percent exercise more than four to five times a week, and only 40 percent manage to eat the recommended four or more servings of fruits and vegetables a day.

“It’s become very challenging to take care of patients these days because their care has become so complex,” Harrington said. And those high stress levels can lead to nurses engaging in unhealthy behaviors, such as stress eating.

In ANA’s 2011 Health and Safety survey of more than 4,500 nurses, RNs listed the acute and chronic effects of stress and overwork as their No. 1 concern. ANA hopes to soon be able to more closely examine nurses’ overall health and health concerns to provide even more resources and educational opportunities to help them meet their needs.

Additionally, shift work and the sheer physicality of the job can make nurses inclined to eat more and exercise less, Gallagher added.

Research also has shown that shift work disrupts a person’s body clock and can lead to a less healthy lifestyle, increased blood pressure and diabetes.

Gallagher added that although many in the general public are overweight, they still notice when nurses are overweight and expect them to be healthier.

So what can nurses do?

There are many strategies for nurses to start on a path toward healthier habits, as well as ways that employers can invest in having a healthier workforce. In some cases it might mean redesigning the work culture, according to Gallagher.

Health care facilities can develop and maintain clear policies and procedures that reduce stress and hazards in the environment, such as having safe patient handling and anti-bullying programs, according to Gallagher. (Being bullied can result in a nurse engaging in unhealthy behaviors.) They also can offer nurses and other employees ongoing programs that focus on health and wellness, such as nutrition counseling, fitness programs and healthy food choices in the cafeteria.

These types of programs are gaining traction. A Dec. 6, 2012, poll of human resource executives — through a project called The States of Wellness — found that nearly nine out of 10 executives nationally perceive the benefits of worksite wellness initiatives.

Gallagher added that employers also may have to rethink certain practices, for example, allowing staff to engage in deep meditative rest during their breaks.

Harrington said that nurses, themselves, can start on a path toward healthier lifestyles by identifying some of the barriers that prevent them from eating right or exercising, and then develop practical strategies to overcome those barriers.

For example, some nurses who work shifts when the cafeteria is closed rely on vending machines to get them through the night, she said. One simple way to overcome that barrier is to bring healthy snacks to work.

Nurses also need to make sure they are well-hydrated, be more conscious of their meal portions and set positive goals, Harrington said.

“A lot of behaviors are habits, and anything can be overcome,” she said. “And just making small changes can make a difference — such as taking the stairs instead of the elevator or eating one more serving of fruits or vegetables a day.”

Besides ANA’s Healthy Nurse website, Harrington said there are many other online resources that can help nurses engage in healthy behaviors and become healthy role models to help end the trend of obesity in this country.

— Susan Trossman is the senior reporter for The American Nurse.

Resources to help nurses get informed, get started

For ANA’s Healthy Nurse Tool Kit and other resources, visit ANA’s Healthy Nurse website: www.nursingworld.org/healthynurse.

For recommendations on healthy eating and physical activity, as well as a tool that looks at weight and health risks: www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/phy_act.htm.

To figure out whether you have portion distortion: www.choosemyplate.gov/supertracker-tools/portion-distortion.

To take a sleep assessment at the National Sleep Foundation website: www.sleepfoundation.org.

For access to a free CE module on shift work sleep disorder available via the American Nurse Today website, visit http://eo2.commpartners.com/users/swsd/.

For a diabetes risk test: www.diabetes.org.

To learn more about obesity and to view a documentary on this trend, “The Weight of the Nation”: www.cdc.gov/obesity and www.theweightofthenation.hbo.com.

For details on the United States’ health promotion agenda, Healthy People 2020: www.healthypeople.gov/2020.

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