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Archive October 2019 XX, No. 10

Caring for Patients With High BMIs

One nurse's journey from patient to advocate should inspire you to treat obese individuals with clinical expertise and greater compassion.

Jared Bilski


DUAL PERSPECTIVE Surgical nurse Mandy Pate, RN, CBN, lost half her body weight after undergoing a sleeve gastrectomy procedure.

For Mandy Pate, RN, CBN, everything about the sleeve gastrectomy was familiar. She knew every square inch of the operating room at the University of Michigan Health System in Ann Arbor where it would be performed. She knew every staff member milling around the table preparing to start the case. They were following pre-op protocols she could recite in her sleep. But there was one major difference this time around. Ms. Pate was lying on the table, the patient during a procedure she had helped perform countless times before.

From the perspective of a patient, Ms. Pate observed some inherent biases even her most well-intentioned colleagues had toward high-BMI patients. "After my surgery, I wanted to get up and use the bathroom, and the nurses didn't want me to," she says. "I couldn't understand why." Her confusion was certainly justified. After all, Ms. Pate wasn't on a bed restriction, and she wasn't hypotensive or dizzy.

Didn't that mean she should be up and moving as soon as possible? A nurse's offhanded comment provided some context for the staff's overly cautious approach to her care.

"I remember one nurse saying, "You're really mobile,' like she was surprised," says Ms. Pate. "I think sometimes people make assumptions because of your weight that you can't do something, that you can't get up, or you can't walk, or you can't move."

If colleagues of Ms. Pate, an OR nurse who routinely logged 12-hour shifts, held misguided assumptions about her lack of mobility, imagine what they think of unfamiliar patients with high BMIs.

I think for a lot of people, even some within the medical community, obesity is still seen as a character flaw.
- Mandy Pate, RN, CBN

Ms. Pate, who weighed 330 pounds at her heaviest, is down to 165 pounds. Her journey from nurse to patient to advocate has inspired her to challenge facilities' approaches to treating high-BMI patients, especially as the nation's obesity epidemic is increasing the number of heavier individuals undergoing procedures in outpatient ORs. She believes it's time to change outdated mindsets and protocols in order to provide safe and satisfying care for this growing patient population.

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