Are nurses too fat?

The most recent issue of Canadian Nurse contains an article about the sad state of nurses’ health but I don’t think it provided the whole picture.  Although I am a nurse, my background is in exercise science and personal training so I have a few things I’d like to add.

1. Most nurses are middle-aged women.  This affects nurses’ health for a few reasons.  Physiologically women have higher body fat percentages than men because of our hormone profile which supports our reproductive role.  Having less muscle mass and high levels of estrogens in our bodies influence our metabolic rate and our body composition.

From a sociocultural perspective, women are still (!) bombarded with messages that they should be thin, rather than fit, making many prone to following fad diets and restricting calories.  This generally results in a “yo-yo dieting” pattern whereby the dieter loses weight while restricting, only to regain it all back, plus a little extra.  Over time, this can make you heavier than you were to start with and make it more difficult to lose weight.  Another thing that people often don’t think about is that the number on the scale does not tell you if you’ve lost fat or muscle. If you lose weight too quickly or are not eating enough calories you are likely losing muscle as well as fat.  As mentioned earlier, this reduces your metabolic rate and doesn’t help you over the long run.  As we age, our metabolism slows down naturally so keeping muscle is a good thing!

As if we don’t have enough on our plate, women generally take on the roles of caregiver, organizer, cleaner, cooker, etc. at home.  So after taking care of patients for 12-hour shifts women often take on their “second shift”, leaving little time for sleeping, let alone physical activity.  And yes, this can apply to men who take on these roles as well but generally speaking our profession is still dominated by women.

2. Most people don’t really understand exercise and nutrition.

Before I knew what a peer-reviewed journal article was, I sought out expert advice about fitness and nutrition from my local library.  While the information from magazines and books isn’t all bad, there is a lot of misinformation out there.  Just because some celebrity follows a certain regime doesn’t mean that it is healthy or appropriate for everyone!

I truly believe that there is no one-size-fits-all approach.  Individuals have different preferences, activity levels, genetics, and budgets to consider.  I am a big advocate of exercise and nutrition as medicine, unfortunately the fitness and nutrition industries are largely unregulated, making it challenging to find professionals who actually know what they are doing.

Which brings me to my next question: how much do most nurses actually know about exercise and nutrition?  Should we be providing advice to patients if we are not experts in this area?  I have mixed feelings about this.  On one hand, as nurses we are often asked to provide general information to our patients and we are readily accessed by the public. Our services are covered under our public health care plan.  On the other hand, we have lots of keen people graduating with degrees in kinesiology and nutrition who ARE experts in these areas but their services are largely available only through the private sector.  Yes, we have physiotherapists and dieticians working in hospitals and clinics, but the opportunities to use them are limited. If you want to hire a personal trainer and invest in healthy food, you are largely on your own.

Really this comes down to the current system’s general focus on disease management rather than preventative health care.  We spend millions on rehab, surgeries, cancer care, etc. and I’m not saying that we don’t need those things too but if we focused more on preventative health care and influencing the social determinants of change that affect people’s everyday lives we could save a lot of suffering and a lot of money down the road.  That applies to nurses too!

We need to create healthy work environments with the structure and culture to support nurses’ health and wellbeing.  Personal choices are also important, but there are real barriers to being able to take good care of yourself when you are a staff nurse working shifts.  Colleagues call in sick so you work short-staffed or work extra-hours to fill in for them – often this results in you becoming run down and getting sick, perpetuating the vicious cycle.  Patients are getting heavier, older, and sicker, adding to the workload we are expected to handle.  There are physiological effects of working nights, not getting enough sleep, and working in a high-stress environment.  To add insult to injury, the less fit we are, the lower our capacity to handle our workloads and the physical and mental strain from working.  Unlike machines, nurses do need time to rest and recover. Unfortunately working out is another stressor added to the mix. Sometimes what your body needs most is sleep.

I hope this doesn’t sound too negative.  There are nurses who manage to take very good care of themselves despite the obstacles.  I am one of them.  I’m not perfect by any means but after a few years of running around trying to be everything to everyone, I have found what works for me.  I have my road bike set up on a trainer in my bedroom and free weights kicking around so I can always do a quick workout at home if I can’t make it to the gym. I make my own food and bring it to work and I eat vegetarian most of the time.  I don’t have cable (but I do watch movies sometimes).  And yes, sometimes I choose sleep or a warm bath over exercise but I feel refreshed and ready to go the next day.  It is about finding balance and for each of us that is going to mean something individual.

Regardless of public perceptions, health is not about being skinny or having a certain BMI (according to which, almost every athlete would be considered overweight or obese!).  Are we role models for health because we are nurses?  Absolutely, whether it is fair or not.  But how is it that we define health?  Are we embracing the unrealistic body image ideals of our culture instead of a holistic view that appreciates multiple dimensions of well being?

While I think that we need to raise awareness of nurses’ health issues through articles such as the one in the current issue of Canadian Nurse, there are a lot of things to consider that were not brought up in the article.  I hope my thoughts contribute to the discussion and I would love to hear what others have to say on this topic!

Have a terrific day!

-Emily

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