How to care for an obese relative

**In the United States, obesity affects 35 percent of the adult population, according to 2014 statistics reported by the Centers for Disease Control and Prevention 4.

Obesity endangers people’s well-being by putting them at risk for serious health conditions. ** Chances are you have a friend, family member or coworker who is obese, and you want to help them get their health back on track. Lecturing and pressuring someone to lose weight rarely works; weight is a personal issue, and discussing it may raise tremendous emotion and frustration. Set a positive example by maintaining your own healthy lifestyle and support any efforts an obese person takes to improve their quality of life.

Know the Facts About Obesity

Simply put, being obese means having too much body fat; it’s technically defined as having a body mass index of 30 or greater. Body mass index, or BMI, is a ratio of your weight to your height expressed as the equation: BMI = weight in kilograms / [height in meters x height in meters].

Obesity increases the risk of developing heart disease, type 2 diabetes and some cancers.

An obese person most likely knows that making healthier choices, trimming portion sizes and moving more helps with weight loss.

But if they need a little guidance, know that a healthy rate of weight loss is 1 to 2 pounds per week, which requires a calorie deficit of 500 to 1,000 calories per day. ‘)7. Eating fewer calories than this amount is not a healthy, nor sustainable, strategy and may lead to complications such as nutrient deficiencies and gallstones.

  • Simply put, being obese means having too much body fat; it’s technically defined as having a body mass index of 30 or greater.
  • Body mass index, or BMI, is a ratio of your weight to your height expressed as the equation: BMI = weight in kilograms / [height in meters x height in meters].
  • Obesity increases the risk of developing heart disease, type 2 diabetes and some cancers.

Understand Your Relationship With the Obese Person

How to Persuade People to Eat Healthy

Before you approach an obese person with a conversation about her size, consider your relationship. Ask yourself if it’s your place to broach the subject with this individual. An obese person is likely aware that her size is not healthy and attracts attention, and you won’t help by confirming these obvious facts.

Express your real concern if you have a close relationship, but avoid coming across as condescending or judgmental. You might go into how much you care about the person and that your concern is not based on appearance, but on your sincere concern about his health.

If you sense discomfort or anger during the conversation, take a pause.

You might be able to revisit it hours, days or months later, but be patient.

Ultimately, you cannot force change on someone — no matter how much you care. Telling someone that they “should” or “need to” do something isn’t helpful.

  • Before you approach an obese person with a conversation about her size, consider your relationship.
  • An obese person is likely aware that her size is not healthy and attracts attention, and you won’t help by confirming these obvious facts.

Be a Source of Support for Healthy Eating and Exercise

Be a friend, spouse, sibling, coworker or parent first — not a weight-loss coach. Follow through on offers to support her weight-loss efforts; for example, you can accompany her to doctors’ visits or weight-loss meetings.

If the obese person lives in your home with you, help prepare healthy meals and don’t bring foods into the home that she’s trying to avoid. Make meals and snacks that focus on lean proteins, vegetables, fruit, whole grains and low-fat dairy.

Support an obese person’s efforts to move more, too. Invite her on a walk, for example, but not on the pretext of exercise — but just as a way to spend time together.

Recognize that an obese person, especially someone with extreme obesity, may be limited in movement. She may be restricted in the type and duration of exercise she can do.

  • Be a friend, spouse, sibling, coworker or parent first — not a weight-loss coach.
  • If the obese person lives in your home with you, help prepare healthy meals and don’t bring foods into the home that she’s trying to avoid.

Back Their Decisions on Weight Loss

How to Help My Girlfriend Lose Weight

Your heart may be in the best place, but recommending a specific diet, exercise plan or surgery to an obese person can backfire. If she tries your suggestion and fails, you may be blamed. You also don’t always know a person’s particular health issues, limitations and capabilities, so specific recommendations should be made by the obese person’s healthcare provider.

Although consuming too many calories, a sedentary lifestyle and genetic predisposition are often the causes of obesity, sometimes a person is heavy for reasons out of her control. Certain endocrine disorders, medications or psychiatric illnesses can be responsible.

Know that your support for healthy lifestyle behaviors is valuable, though, as shown by a study published in Obesity in 2014, involving 633 adults who were trying to lose weight. Those whose friends and coworkers supported their healthy eating and whose families supported their physical activity had more success in managing their weights.

Help! I don’t know what to do. My father is 61 years old and weighs about 500 pounds. He refuses to tell us exactly how much he weighs, but that is my best estimate. He’s about 5 feet 4 inches tall and his waist is 70 inches.

He can’t stand, nor can he barely move. In the last 3 weeks, he has fallen FIVE times and couldn’t get up any of those times. He has had to call 911 each time to have them send the fire department to come lift him up. It’s taken five people each time to lift him up.

My mom has to bring all of his meals to him. My mother can’t take it anymore – I fear she is close to having a mental breakdown. She flies off the handle and starts snapping/yelling at me and my sister for the littlest and most minor of things because she is frustrated with taking care of my father.

He kind of rolls off the bed into a wheelchair and she has to push him to the bathroom where he walks the one step from the wheelchair to the toilet to use it. I have tried talking to his doctor numerous times and his doctor just tells him to take more pain medication for his problems. Hello? Pain medication is not going to help him lose weight, or move better. My father refuses to believe that his weight is a problem. He won’t listen to my mother, myself, or my brother.

I really think it’s time for him to move to some sort of assisted living facility, but he refuses to listen when I bring up this idea.

Expert Answer

Caring for an obese parent is challenging because there are two questions. One is how to deal with the extra weight and the other is why food is such an issue for this person.

To begin with the second part, I suggest that you look for a physician in your community that addresses weight and diet issues. Your father cannot see his weight as a problem because he cannot consider the possibility of living without whatever need the food is meeting. He shold be checked medically for metabolic conditions, such as diabetes and body chemistry imbalances. You can hire an ambulance service that transports wheelchair patients to take him to the doctor.

The goal of seeing a physician is to establish that he does or does not have a metabolic disorder that can be treated, and to help you and your father understand the long term consequences to his health of his curent weight. Almost certainly his heart is affected.

The point is not to try to scare him into losing weight but just to understand the consequences. If he could lose weight, he already would have; he has probably tried numerous times and failed. Understanding that he has a problem he he has not been able to fix will help you be more supportive.

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Next the question of how to deal with the additional weight. I tend to take a tough love position. While he may be helpless with regard to losing weight, you and your mother are also helpless to help him reduce the pounds. Help your mother set limits on what she will do for him. She can refuse to cook foods that are fatty. She can refuse to bring him his meals, and insist that he find a way to get to the table on his own. She can place a urinal near his wheelchair and insist that he manage that need without her assistance.

Your mother is enabling him to maintain his current weight. She probably doesn’t recognize her part in the problem but suggesting that she manage her responses may help her recognize that she is part of the problem.

Once the family is working together to solve a mutual problem, the results are morelikely to be postive. As it is now, you and your mother are on one side against your father. This really isn’t helpful. The family as a unit can decide whether he needs to live in a different setting. A facility will use a hoyer lift to transfer him. You might look into buying or renting this device or other assistive devices as part of the family effort to deal successfully with this very complex issue.

This article was co-authored by Ran D. Anbar, MD, FAAP. Dr. Ran D. Anbar is a pediatric medical counselor and is board certified in both pediatric pulmonology and general pediatrics, offering clinical hypnosis and counseling services at Center Point Medicine in La Jolla, California and Syracuse, New York. With over 30 years of medical training and practice, Dr. Anbar has also served as a professor of pediatrics and medicine and the Director of pediatric pulmonology at SUNY Upstate Medical University. Dr. Anbar holds a BS in Biology and Psychology from the University of California, San Diego and an MD from the University of Chicago Pritzker School of Medicine. Dr. Anbar completed his pediatric residency and pediatric pulmonary fellowship training at the Massachusetts General Hospital and Harvard Medical School and is also a past President, fellow and approved consultant of the American Society of Clinical Hypnosis.

There are 12 references cited in this article, which can be found at the bottom of the page.

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When a parent becomes bedridden, it can hit you hard. Whether you’re providing care or just finding someone to help with it, it can take an emotional toll on you. If you’re providing care, you need to know the basics, but you’ll also need to know when to ask for help from outside sources, such as friends, family members, and professional organizations. Whether you’re just supervising or doing the caring yourself, you also need to make sure that you stay healthy, both physically and emotionally.

How to care for an obese relative

Caring for a disabled family member can take away valuable time and personal income from caregivers. In fact, the demands may be so great that your own work and personal savings may be seriously impacted by being a caregiver. Providing care for a loved one is rewarding but can also be difficult. Some form of compensation can ease the burden.

About 29 percent of the U.S. Population, or 65 million people, are considered family caregivers. If you are of them, then you may ask the question, “Can I get paid to care for my disabled friend or family member?” The good news is that there are programs that can help you receive compensation for taking care of your family and friends.

If your relative qualifies according to state requirements you can get help from Medicaid. Under Medicaid’s Cash & Counseling Program (also referred to as Consumer Direction, Participant Direction and Self Directed Care), low-income individuals are given the freedom to choose their own health care agency. This includes the option to hire a relatives or friends as their “employees.”

The Cash & Counseling Program is available in 48 states (excluding North and South Dakota). However, eligibility requirements and program rules vary. States also often call their programs by different names. Refer to the National Resource Center for Participant-Directed Services to know requirements in your state. In Minnesota, the program that allows individuals to hire their relatives or friends to be their caregivers is the Minnesota PCA Program.

States have their own restrictions as to who can be a paid patient care assistant or caregiver. However, most states generally do not allow first-degree relatives to be hired as a paid patient care assistant/attendant or PCA by their senior or disabled family member.

Minnesota allows family members to be the paid caregiver except for spouses, parents, and stepparents of children under 18. Massachusetts does not allow spouses, surrogates, legally responsible relatives, and the parents of a minor child (including adoptive and foster parents) to be hired as PCAs.

Under the Cash & Counseling Program you may receive direct payments from Medicaid or from the state as a family caregiver. As a PCA you may get payment directly from the state after submitting some forms, or you can get payment from a Home Care Agency. In Minnesota PCAs receive payment from an agency after their relative or friend has been approved for PCA Services. Please contact our Minnesota PCA Agency to see if your friend or relative is eligible to receive services.

Background: Obesity, race/ethnicity, and other correlated characteristics have emerged as high-profile risk factors for adverse coronavirus disease 2019 (COVID-19)-associated outcomes, yet studies have not adequately disentangled their effects.

Objective: To determine the adjusted effect of body mass index (BMI), associated comorbidities, time, neighborhood-level sociodemographic factors, and other factors on risk for death due to COVID-19.

Design: Retrospective cohort study.

Setting: Kaiser Permanente Southern California, a large integrated health care organization.

Patients: Kaiser Permanente Southern California members diagnosed with COVID-19 from 13 February to 2 May 2020.

Measurements: Multivariable Poisson regression estimated the adjusted effect of BMI and other factors on risk for death at 21 days; models were also stratified by age and sex.

Results: Among 6916 patients with COVID-19, there was a J-shaped association between BMI and risk for death, even after adjustment for obesity-related comorbidities. Compared with patients with a BMI of 18.5 to 24 kg/m 2 , those with BMIs of 40 to 44 kg/m 2 and greater than 45 kg/m 2 had relative risks of 2.68 (95% CI, 1.43 to 5.04) and 4.18 (CI, 2.12 to 8.26), respectively. This risk was most striking among those aged 60 years or younger and men. Increased risk for death associated with Black or Latino race/ethnicity or other sociodemographic characteristics was not detected.

Limitation: Deaths occurring outside a health care setting and not captured in membership files may have been missed.

Conclusion: Obesity plays a profound role in risk for death from COVID-19, particularly in male patients and younger populations. Our capitated system with more equalized health care access may explain the absence of effect of racial/ethnic and socioeconomic disparities on death. Our data highlight the leading role of severe obesity over correlated risk factors, providing a target for early intervention.

The prevalence of severe obesity in the United States has increased dramatically, not only among adults but also among children. The increase in childhood severe obesity, defined as 120% of the age-specific 95th percentile of body-mass index (BMI), has been alarming; the prevalence has risen from 4% during 1999–2004 to 6% during 2011–2012. 1,2

Although the use of healthy lifestyle approaches to treat younger children with obesity can successfully reduce BMI, the implementation of these approaches among adolescents and adults is much less effective. 3 Unfortunately, approximately 90% of children with severe obesity will become obese adults with a BMI (the weight in kilograms divided by the square of the height in meters) of 35 or higher. Marked obesity in children leads to earlier development of atherosclerosis and type 2 diabetes because of the coexistence of cardiometabolic risk factors associated with obesity. 4

There is good evidence indicating that although obesity may start as a lifestyle-driven problem, it can rapidly lead to disturbed energy-balance regulation as a result of impaired hypothalamic signaling, which leads to a higher body-weight set point. 5 Thus, obesity may be considered a disease initiated by a complex interaction of genetics and the environment.

Although medication can help lower the body-weight set point in adults, none of the medications that have recently been approved for adult obesity, such as phentermine–topiramate, lorcaserin, naltrexone–bupropion, and liraglutide (3.0 mg), have been studied extensively in children and adolescents. In general, only orlistat (which has been approved by the Food and Drug Administration [FDA] for childhood obesity) and metformin are used in these age groups. 6 Exenatide, a glucagon-like peptide-1 (GLP-1) receptor agonist approved for type 2 diabetes, appears promising as a treatment for pediatric obesity, but it has not been approved by the FDA for this purpose. 7

Most experts in childhood obesity focus on primary prevention rather than on the treatment of extant obesity, possibly because treatment may seem increasingly futile as obese children mature. 8 However, that calculus does not include bariatric surgery, which leads to sustained weight loss, thereby altering signaling to the hypothalamus and leading to physiological satiety, at least in part through changes in the secretion of gut hormones such as GLP-1. 9

Assessing the benefits and risks of bariatric surgery in adolescents is challenging, because obesity is not invariably viewed as a disease and because many adolescents are less adherent than adults with regard to postoperative care and follow-up. In the United States, bariatric surgery in adolescents is performed only after an intensive screening process that includes the documentation of physiological maturation (puberty) and adequate psychological maturity.

In this issue of the Journal, Inge et al. report the long-term (3-year) results of the Teen-Longitudinal Assessment of Bariatric Surgery study (Teen-LABS), a multicenter prospective study of bariatric surgery in an adolescent population. 10 Surgery led to a mean total body-weight loss of 27% among participants, as well as to remission of type 2 diabetes in 95% of participants who had had the condition at baseline, of abnormal kidney function in 86%, of prediabetes in 76%, of hypertension in 74%, and of dyslipidemia in 66%. However, in their study, adverse events included ferritin deficiency in 57% and additional abdominal procedures in 13% of participants.

Does the Teen-LABS study inform therapeutic decision making for adolescents with severe obesity? Should a greater number of markedly obese teens undergo bariatric surgery, and at what point in their lives?

The prevention of severe obesity in adolescents is paramount, and bariatric surgery will not stop the progression of the disease. Continued efforts to work with government and the food industry to ensure that healthier food and increased physical activity are available for all children through communities, schools, and other avenues are important if the increase in severe obesity is to be halted. Because lifestyle interventions early in childhood may be effective, these should be instituted. But for adolescents with severe obesity for whom conservative medical treatment has failed, the present study indicates that surgery can result in substantial weight loss and resolution of coexisting conditions. Thus, it may be beneficial to consider such adolescents for bariatric surgery, before they reach adulthood, when some conditions become less reversible.

The management of obesity is difficult. Emerging evidence suggests that bariatric surgery may establish a new body-weight set point by altering the physiological mechanisms of body-weight regulation, thereby causing sustained weight loss. Continuing research may establish the biologic mechanisms through which bariatric surgery works and may uncover new nonsurgical options for the treatment of both adult and pediatric obesity. In the meantime, Inge et al. provide longer-term evidence that bariatric surgery can provide relief from the tremendous physical, social, and psychological burden that severe obesity causes in a growing number of American youth. However, even longer-term (>10-year) follow-up will be necessary to track the persistence of the associated micronutrient deficiencies, as well as the emergence of other deficiencies and other unanticipated long-term complications. Only then will providers be fully informed for the counseling of adolescents and their families with regard to the benefits, risks, and timing of bariatric surgery.

FRIDAY, Nov. 16, 2018 (HealthDay News) — A study that tracked the weight and survival of more than 6,000 Americans for 24 years reinforces the notion that piling on excess pounds can lead to an earlier grave.

Being statistically obese, but not simply overweight, was tied to a 27 percent increase in the odds of dying within the study period, according to a research team from Boston University.

People in the “obese” category had a body mass index (BMI) between 30 and 34, with 30 being the statistical threshold for obesity. For example, a 5-foot 4-inch person weighing 175 pounds has a BMI of 30.

The risk of dying young was also higher for “very” obese people — those with a BMI of 35 to 39. People in this weight category had nearly double the odds of dying during the 24-year study period compared to people with a normal weight, said biostatistician Ching-Ti Liu and colleagues.

The study was unique, Liu’s team believes, because it wasn’t based on a person’s BMI at one point in the life span, but instead tracked people’s “weight history” over time. That should “improve the accuracy of BMI data and thus lead to better estimates of the association between obesity and mortality,” the study authors reported.

The approach did turn up one finding that may be heartening to people fighting the “battle of the bulge”: Being overweight, but not past the BMI 30 threshold for obesity, did not seem to affect life span.

The study found that overweight people could expect roughly the same survival odds as those in the normal-weight category.

“There was no difference in mortality risk for those who remained overweight and those who remained normal weight,” noted Mark Pereira, an epidemiologist at the University of Minnesota. That could be because healthy lifestyle changes can stave off disease, even in overweight people, he suggested in a commentary accompanying the new study.

Prior studies “have clearly shown that decreases in disease incidence are possible through improved diet and physical activity among overweight and obese individuals, whether weight loss is achieved or not,” he added.

Continued

The Boston University study relied on detailed information collected every few years on the weight of nearly 6,200 adult participants in the ongoing Framingham Heart Study, with records stretching back over 24 years.

Overall, more than half (56 percent) of the study group had died by the end of 2014. Being obese or very obese seemed to have a significant impact on whether death arrived relatively early, Liu’s team found.

Because smoking could confound the results, his team also ran the numbers for only those 3,075 participants who had never smoked.

The trends appeared to be even stronger in the absence of smoking, the findings showed.

In this group, being obese was tied to 31 percent higher odds of death during the study period, while being very obese bumped up the risk to nearly 2.4 times that of normal-weight never-smokers.

Surprisingly, in the “never-smokers” group, being overweight (but not obese) did seem to have an effect in lowering life span, relative to normal-weight people.

Overall, all of these effects seemed more profound in men than in women, the researchers said.

There was one more intriguing finding: The impact obesity has on survival seems to have eased over the past few decades.

According to the Liu’s team, that may be due to better “risk factor control” — healthy lifestyle changes — or improvements in drug therapy (statins, for example), surgeries such as angioplasties or bypass, and hospital care.

All of those advances may be keeping obese Americans alive longer than in decades past, the researchers said.

Still, Pereira wrote, “the bottom line from these analyses was that the lowest mortality risk was observed among individuals who remained in the normal weight or overweight categories over time,” and never became obese.

Doing so may be becoming tougher, he added, since “to be overweight or mildly obese today, relative to four or more decades ago, appears to be the new normal.”

That doesn’t mean obese Americans are helpless to improve their health, however. According to Pereira, the study supports “lifestyle and environment changes to prevent chronic diseases and mortality among overweight and obese individuals.”

— Florida hospital’s experience goes against received wisdom

by John Gever, Contributing Writer, MedPage Today October 19, 2021

Published guidelines recommend against extracorporeal membrane oxygenation (ECMO) for morbidly obese COVID-19 patients in severe distress, but a Florida researcher said his center’s experience indicates that such advice needs another look.

At Advent Health Orlando, mortality in COVID patients with acute respiratory distress syndrome (ARDS) and body mass index (BMI) values above 40, while not good, was no worse than previously reported for all critically ill COVID patients in a large database, said Sergio Ramirez, MD, a critical care fellow now at Orlando Regional Medical Cente.

Speaking at CHEST 2021, the American College of Chest Physicians’ annual meeting, held online this year, Ramirez said centers participating in the Extracorporeal Life Support Organization (ELSO), which issued the guideline discouraging ECMO in the morbidly obese, should “consider not using BMI as a sole exclusion criteria [sic] for candidacy to ECMO support.”

ELSO released the guideline in May 2020 after reviewing more than 100 published papers related to ECMO; most of those did not address COVID-19 specifically, of course, since the novel coronavirus had only emerged a few months previously. The guideline included BMI >40 in a list of “relative contraindications” that also included age >65, advanced systolic heart failure, and immune deficiency, among others.

Faced with an onslaught of COVID-19 patients with high BMI values, Advent Health Orlando set its own ECMO eligibility criteria that allowed morbidly obese patients to receive the treatment if it wasn’t otherwise contraindicated. At CHEST, Ramirez reported outcomes for these patients treated from March 2020 to April 2021.

A total of 33 patients with BMI >40 underwent ECMO at the Orlando center. Of these, 11 died while on ECMO, and one other died in hospital after surviving ECMO, for an overall mortality rate of 36%. Nineteen were either transferred to another hospital or discharged to home or a rehab facility and were considered to be ECMO survivors (57%); two of the 33 remained at the Orlando center at data analysis with their final status uncertain.

Although the 36% mortality rate was disappointing, it matched up closely with registry data compiled by ELSO in September 2020 for COVID/ARDS patients with BMI values <37, Ramirez noted. This analysis covered 1,035 patients in 36 countries, yielding an estimated 90-day mortality rate of 37%.

Similarly, the ELSO data showed a survival rate of 60%.

Other highlights of the Orlando experience with morbidly obese patients included:

  • Age was not a factor in survival probability
  • Those who survived spent as long on ECMO as those who died
  • Overall hospital stays were longer in survivors, not unexpectedly

Ramirez acknowledged that his analysis should not be the last word, however; he called for additional research on ECMO for patients with high BMI values.

How to care for an obese relative

John Gever was Managing Editor from 2014 to 2021; he is now a regular contributor.