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It is a jarring image: the nurse who is treating us and whom we might expect to exemplify a healthy lifestyle, is him or herself not just overweight but obese.
As the conditions associated with carrying too many extra kilos exact an ever greater toll on stretched health budgets, the irony of clinical professionals whose own weight is further straining limited resources is becoming harder to ignore.
Yet tackling so delicate a subject is never going to be easy, nor is the task of working out what to do. Is it simply a matter of individual willpower, or is the environment in which nurses work playing a substantial role, putting an onus on employers to do more?
What is not in question is the scale of the problem. Research commissioned by the Healthy Weight Initiative for Nurses (WIN), a multi-agency project, found 25 per cent of UK nurses have an estimated body mass index of more than 30. This places them in the obese category and is in line with the British population overall — an equivalence that “provides little solace, given that prevalence is so worryingly high”, say academics Richard Kyle and Iain Atherton, who carried out the research last year. Even more concerning, they say, is the higher prevalence of obesity among unregistered care workers: almost a third are estimated to be overweight. In Scotland, almost 40 per cent of nurses are obese, a significantly higher proportion than the general population where the figure is about 30 per cent.
While the data may suggest the environment of a hospital or other healthcare setting is “obesogenic” for its staff, other health professionals are not overweight to the same degree, according to the researchers. They point out, however, that the proportion of doctors, physiotherapists and other professionals indicated to be obese is still “notable” at 16 per cent.
This is not only a British problem. Kyle and Atherton say previous work has found nurses in other countries are also more likely to be obese than the general working population.
Other academic researchers, they say, have found a similar pattern of obesity among nurses in the UK, Australia and New Zealand. However, they say there is a lower prevalence of obesity among nurses compared with the general population in the US.
Christine Hancock, who runs C3 Collaborating for Health — a non-profit body that along with London’s South Bank University, the UK’s Royal College of Nursing (RCN) Foundation and the Burdett Trust for Nursing makes up WIN — says that, to deepen its understanding, her charity interviewed more than 400 obese nurses.
“Almost without exception they want to lose weight and have tried to, and a very high percentage think it affects their work: either their ability to do their work [or] how they communicate with patients about eating more healthily,” she says.
Given the sensitivity of the issue, “we were very surprised at the enthusiasm with which nurses wanted to talk about this”, adds Hancock, who for 12 years, until 2001, was general secretary of the RCN. Her charity subsequently set up focus groups of obese nurses to investigate potential solutions “that nurses themselves think might work”, she says.
Hancock says the discussions threw up “some really quite shocking anecdotes” about hospitals and other health premises where there is nowhere to store food, or canteens that are either too far from wards to allow nurses to get there easily in their breaks or are closed during night shifts. “Some people were even saying they didn’t have access to drinks or water while working,” she adds.
The groups came up with the idea of a service to deliver healthy food to hospitals, but the charity ruled it out as unworkable within the timescale and budget of the project. However, a second, and unexpected, idea has gained traction, Hancock says: the notion that weight should be a factor in career appraisals.
Far from seeing this as an intrusion, the nurses in the focus groups envisaged it as a way to seek the support of their line managers in addressing the issues at work that might be hindering them from shedding the pounds, she says.
Some hospital executives are looking favourably on the plan, she says, although the high degree of consultation through which any changes to appraisal regimes have to pass means it might be tricky to spread the approach widely.
The squeeze on the finances of Britain’s National Health Service (NHS) is also making it harder for nurses to live healthily, suggests Kim Sunley, senior employment relations adviser at the RCN. “Because of pressure on the system at the moment, our members tell us shift patterns have gone to pot.” Nurses might be called in do a night shift, then two days later find themselves back on an early shift. “There is no time to rest and recuperate”, Sunley says.
A lack of resources has also affected whether nurses have somewhere to keep food or eat a meal during a break, she suggests, since in some hospitals rest facilities have been commandeered for use as storerooms or clinical areas.
Meanwhile, there is a “hidden workforce” of community nurses, who lack a physical base and often end up buying unhealthy snacks as they drive between patient appointments.
Sunley welcomes a scheme that has been introduced by NHS England to combat the number of sugary snacks on sale in canteens by introducing an NHS-wide “sugar tax”. However, she adds that “you can have all the healthy options in the canteen, but if work is so pressurised that you can’t get to that canteen or have breaks”, its impact will be limited.
While staff make their own decisions about any food they bring to work, “hospitals across England are now being incentivised to offer healthy, tasty and affordable meals, [and] health and exercise facilities, and to work with retailers to ban the sale of sugary drinks in hospitals and curb the sale of unhealthy foods”, NHS England says.
A total of £250m has been made available over three years for all NHS providers that improve food and drink on their premises, with hospitals receiving a percentage of the contract value to spend elsewhere on their budgets if they meet their targets.