Fat nurses, fat America?

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Unless you’ve been hiding under a rock for the last couple of years—or in nursing school, which amounts to the same thing—you’re aware that there’s an epidemic of overweight and obesity in America these days.

About a third of Americans have a BMI (Body Mass Index) of over 30, which is considered obese. A little more than half of nurses, according to one study, have a BMI of over 30, making us one of the “fatter” professions in this country.

Is it a nursing problem or a general American problem?

My hypothesis is that it’s a general American problem combined with the way BMI is calculated.

Nurses, like the general population, are aging. People over the age of 40 tend to have higher BMIs than people under 40. Nurses also tend to work swing shifts or nights more often than your average cubicle resident, and people who have rotating schedules or work at night are more prone to obesity (and other health problems, like cancer). Finally, nurses—especially in rural areas—tend to have both longer workdays and longer commutes, which cuts down on the time available for things like exercise and sleep, both prophylactics against getting fat.

All of these factors can be found in other professions; factory workers and janitorial staff, for example, often work second- or third-shift jobs. More and more people are falling into the category of “supercommuters,” meaning they spend more than 90 minutes on the road to get to or from work. And, of course, our population as a whole is aging—and age, unless you’re actively trying to do something about it—means a loss of lean muscle mass and a gain in fat percentage. All of this means that nurses as a profession aren’t doing anything outside the curve of the general American population (i.e., aging and getting fatter).

Still, I don’t know that there’s cause for panic. In a highly unscientific survey of my own critical care unit, I found that all but one of the nurses I work with on a regular basis would be considered “overweight” or “obese” if BMI were the only measurement used. The nurses I work with are, on average, a physically active bunch. Carrying a lot of muscle bumps you up on the BMI scale, which was originally intended to measure only sedentary individuals. The nurses on my unit are also mostly under 35, which means that we skew, as a group, more toward an “overweight” BMI than a more mixed-age group of people (see age and muscle loss, above). A couple of us are fat, several of us are fat-but-strong and one of us is perfectly fine according to BMI, but unable to lift patients.

I’d be interested to see a breakdown of the Nurses’ Health Study by things like cholesterol levels, preponderance of heart disease and stroke, cancer rates, and—most importantly—functional status of the people studied. I would bet that nurses, on the whole, are as good as or better than the average American in terms of overall health, and much better than the average American in terms of subjectively perceived health. After all, we have one of the most physically active jobs out there. We tend to be stronger and more mobile longer than people who sit in front of computers all day, despite the prevalence of donuts in the breakroom. We may ache at the end of the day, but our day is a whole lot more challenging, physically, than that of the average office worker.

What do you say?

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Agatha Lellis

Agatha Lellis is a nurse whose coffee is brought to her every morning by a chipmunk. Bluebirds help her to dress, and small woodland creatures sing her to sleep each night. She writes a monthly advice column, "Ask Aunt Agatha," here on Scrubs; you can send her questions to be answered at askauntieaggie@gmail.com.

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22 Responses to Fat nurses, fat America?

  1. Rosalinda

    As a skinny nurse who is currently on maternity leave….I attribute it to stress eating. It is VERY EASY for nurses to get fat, so I see the point of the article. But being that we are nurses, we should be extra careful about what we eat, and maintain a healthy weight.

  2. Tonya

    I think that we need to be aware of how our patients are perceiving us when we look overweight. We look like hypocrites. We can’t ask our patients to make an effort for their health if we look like we go home and sack out on the couch with a bag of chips.
    We have a huge responsibility to be a healthy role model for our patients, one which must not be taken lightly.

  3. ElizabethScala

    You know, you raise a great point. I admit I wondered why many of us are overweight… mainly because that is what I see where I work. That is what I hear from colleagues. That is what family/friends in the non-healthcare professions ask me about.

    But it IS America that is overweight.

    And I think the reason that nursing gets a bad name is because we are in the public eye. People come to us to get better, to get healing, to receive treatment and help.

    I would argue that while it IS America that is overweight… I do think since we are the eyes, ears, and breath of healthcare we owe it to ourselves to take better care. We can be role-models to our nation. We can influence the obesity of the whole country.

    Let’s take care of us!

  4. Fastedyzgrl

    I think that for many many years I worked HARD to take care of critically I’ll patients. They don’t wait for me to go take lunch in an appropriate fashion. At the end of a very long day with only quick food that’s processed or junky but very fulfilling when you’re starved I would find myself starving and too tired to eat properly. This equals weight gain. Throw in chronic stress and lack of sleep and u have a perfect recipe for obesity with cortisol levels elevated and abdominal fat/inflammation…….. Whew. I finally got a hold of myself and spend a great deal of mental energy on personal wellness. I found the crossfit community and eat a paleo diet which has reversed blood pressure and lipid problems. I have gained self respect, a ton of energy and it’s hard to sustain at times but I feel it must be done. I wish I could light a fire under loads of my nurse colleagues but it is a very personal journey for each individual. We do need to take care of each other. Let’s stop bringing in cake cookie and junk and bring in healthy stuff. Takes a mindset change.

  5. angiec

    As an overweight nurse, age and lack of exercise has caught up with me this year, forcing me to make changes. But up until this year I think I was a healthy obese person. I could hold out longer, lift stronger, and had more gumption than those half my size because I was used to 12 hour shifts of giving it my all with little time to care for myself. Big mistake! Young nurses, take care of yourself first!! Take your lunch break, go to the bathroom, and don’t overwork yourself to the point where you don’t have the energy to care for yourselves. It does catch up with you!

    • I think all nurses could stand to spend more time caring for themselves. Hard to do when many of us by nature think of others first.

  6. jalynnro13

    Another factor is this equation is that most nurses are women. Women tend to have higher body fats, therefore higher BMI’s, due to our hormones. Someone didn’t do their proper statistics. Great DNP research…does being a nurse make you fat or does being fat make you a nurse??

    • KitCat

      What a stupid research question! Reaching for unhealthy foods and stuffing your face like a trash compactor, coupled with lack of exercise, makes you fat. End of story. Eat healthier, get off your a$$, and you Won’t. Be. Fat.

      • Terri

        I can only guess why anyone would feel the need to verbally abuse their nursing peers. Trash talking and calling names is not relevant here and I can only guess that this subject pushed some button related to a personal issue.

  7. QLittlestar

    As nurses we should also know that health is not just about weight. I am trying to drop some weight before nursing school, because as an older student, I want to be able to run rings around my much younger competition. I am a big woman and have better than normal bp, cholesterol, you name it but I have become less active since leaving NYC for LA. We have to be careful with these labels because if we don’t be careful, many nurses will be out of work. Health at all sizes.

  8. Nursedude

    I think it is a combination of things. I do think the fact we are an overweight nation cannot be denied. When I was a new nurse 23 years ago, a beriatric/300+ pound patient was pretty rare. Now? When I worked on a spinal cord unit at the VA in Minneapolis, we had an overhead lift system because the patients had become so big, that moving them was a health risk to nursing staff.

    That said, I put on a lot of weight working the night shift. I did not get much sleep, and ate too many carbs. My weight ballooned up to 255. I lost 35 lbs when I cut down on carbs, and working a monday-Friday day shift clinic job has helped immensly. I am also getting close to 8 hours a sleep a night-which did not happen when I worked nights: I was lucky to get 5 hours of sleep.

    There is no doubt in my mind that the combo of sleep deprivation and eating a high carb diet on nights contribute to the number of overweight nurses.

    I lift weights, walk and use an eliptical-the latter is more tolerable to my 53 year old knees.

    If you are working in a hospital, you have got to take care of yourself in terms of eating better and doing some type of work out to help your core muscles to prevent back injury. I also agree with the point that when you have a really overweight and out of shape nurse, you lose some serious street cred with your patients.

  9. neonghost7

    This always bothers me. I am shorter and very very busty (36F). My BMI has me in the middle 30’s. I don’t “feel” fat. I don’t think I look morbidly obese either. I tend to retain a lot of water from a thyroid problem and the fact I recently started a new birth control pill, but I feel like the BMI scale is unfair. People carry weight differently. My husband is 6’2″ and just at 200, he may be a little over. He has very little muscle mass so he has a little pot belly. Brother in law is 6’3″ and around 220, but because of his muscle mass he ‘looks’ smaller. His BMI is higher. I have always equated fat with ugly. Usually smelly or lazy. I don’t feel ugly, I don’t smell, and I am sure as hell not lazy. (Full time nursing student with a Full time over night job at Mosaic. If you are familiar with Mosaic you know it isn’t a sit around sort of job) I don’t go by BMI. I go by my personal assessment of myself.

    • The real problem here is the image that weight carries with it. Why does fat have to equal lazy and smelling?

      Just why?

  10. I read this article and think of the 50% of nurses who are reading this who are embarrassed and made to feel shameful about their bodies. I know that Jo was not intending to do this, as she is highlighting that BMI may is not a true indication of health, but the stigma is there and its a tough one to shake.
    I think that rather than shaming overweight nurses we should offer them more options to improve their health, and if they are healthy, not shame them because they aren’t a size 8. Not everyone will fall within the guidelines of the magazine, but they are perfectly healthy.

    • Terri

      My BMI is around 35 – while it does embarrass me at times, I am healthy. I take no medications except for an occasional migraine. Other than an occasional higher than normal blood pressure (I teach nursing students – enough said?), my vitals are healthier than the rest of mine and my husband’s family – all of whom “look” healthier.

      I have been overweight since childhood and am consistently trying to lose weight with little success. I eat lean meats, lots of vegies, and all the other healthy choices. Please don’t assume that everyone can be a size 8…sometimes all the best choices still don’t get the results everyone expects.

      And before everyone suggests seeing a Dr. to see why I don’t lose the weight, I have seen many over the years. I am who I am and have the energy to do my job as well as help others do theirs.

  11. amt838

    When I started in nursing 35 years ago ,sure I was skinny,worked the rotating shifts.Then you get married still have to work rotating shifts,have kids but now you are in the ER where the stress is 5 times higher.Sleep maybe 4-5 hours a night .You turn forty and develop high blood pressure from working on adrenalin for a living.You stress eat because you live on stress ,the kids ,their schedules ,your schedules ,the holidays,your parents are older.You buy a house ,new car,forced overtime,promotions back to college ,oh the kids are in college too.extra overtime no rotating shift with promotions but more stress.Married over 30 years gained 5lbs a year OMG 150 lbs with every diet imaginable.Swim everyday treadmill and free weights.compete with youngest daughter to swim in family fun competition .only loose 35 lbs. Still strong as ox and fast.BMI 38,

  12. roswilliams

    I am 54 years old and have been struggling with my weight for MOST of my life. However, I will NOT let my weight make me lazy. I am NOT built to be a size 4. I DO know why Most nurses, especially RN’s, develop weight problems. It is because MOST RN’s do paperwork instead of dealing one on one with the patients. It is the LPN’s, CNA’s, and the HHA’s that deal mostly with the patients. Yes you do have SOME RN’s that are on their feet 99% of the time, but that is VERY rare. I want to be an RN because I Love being on my feet all the time.
    Now back to the problem at hand. Most nurses are bogged down in paper work which leads to most nurses being sedentary.

  13. roswilliams

    To ALL those nurses: Okay, change your diet to whole grains, eat baked or broiled instead of fried. Drink skim or low fat milk, yogurt, use Splenda, Sweet n’ Low. Light to moderate exercise depending on your physical capabilities. I walk up and down the stairs in my building twice a day. I don’t weigh myself because that adds MORE stress.

  14. Mercy RN

    I agree, after 34 years, most on 12 hour night shifts my weight has gone up. I do not remember the last time I got a proper lunch break, or even a 15 minute break. You eat on the run and if lucky get 5 hours of sleep a day. I finally realized I could not keep this up. I could still run circles around many of the young nurses, but it was killing me. I have lost 45 pounds and went to a 3 to 11 shift. I sleep 7 to 8 hours and eat healthy and walk daily. I still don’t get supper breaks or even the 15 minute breaks but the work is less stressful. And even though I am obese by todays standards I am on no medication and can easily walk 5 miles a day.
    The job is designed to kill you, the hours, the stress, the short staffing, the extra shifts and overtime. I finally decided to take care of the nurse taking care of the patients.

  15. rsp2054

    Instead of BMI, a person should really go by the fat percent of the body. There are several different types of monitors and not that expensive that one can get that tells you your true fat index. Yes some one can be big and healthy for a while. But sooner or later it will catch up with you and make even simple health problems that much worse.

  16. bellebeaut23

    I agree with your last paragraph! Absolutely! 80% of the staff in my Med/Tele unit is over 30% BMI, but, they are strong and exercise outside of work. Also, my hospital encourages, and even pays us to get healthy. For myself, I was tested, by the hospital with the following results: I weigh 246 lbs, Cholesterol is 118 (HDL 64 and LDL 32), I am not even Pre-diabetic according to 3 individualized blood tests, my flexibility is that of a yoga student, and I can lift up to 50lbs on my shoulders (think of the 40 lb fry boxes at McDonald’s on my shoulder). Cholesterol and Sugar are great! So, according to my doctor, I am Fit but Fat!