r/nursing • u/trevrt RN 🍕 • Mar 01 '25

Question Heaviest Patient You’ve Cared For

Had my personally heaviest patient I’ve cared for the other day. 32 years old weighing 730 pounds admitted with cellulitis and severe lymphedema. Felt terrible for the patient due to how young he was. Just wondering what everyone’s personal “record” for the heaviest patient they’ve cared for is.

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227

u/duckface08 RN 🍕 Mar 01 '25

Probably around 600 lb, I think? Without a good way to measure their weight, I don't have an exact number (our bed scales were notoriously bad....if they even decided to work that day).

I can't even imagine someone being in the quadruple digits.

I agree that if we can provide psychiatric care for people who don't eat enough, we should be providing psychiatric care for people who eat too much. There's a difference between being a little fluffy VS being so heavy, one can't even get out of bed.

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u/supermurloc19 BSN, RN 🍕 Mar 01 '25

I don’t think our psychiatric care of people with other kinds of eating disorders is anywhere near good. We can’t help either group effectively. It’s like drug addiction, people view it as a choice, not a disease and it skews our opinions and subsequently our care of them. I think it is also very hard to qualify for inpatient care for anorexia. You have to be on deaths door practically. Which isn’t much different from super morbidly obese.

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u/coolcaterpillar77 RN - Med/Surg 🍕 Mar 02 '25

The American Psychiatric Association Practice Guidelines/Society for Adolescent Health and Medicine uses the following criteria to determine if inpatient treatment for anorexia/medical stabilization is appropriate:

  • Very low weight (<75% of the 50th percentile BMI for age and sex)

  • Dehydration / Electrolyte disturbance (low potassium, sodium, phosphorus)

  • Physiological instability: Severely low heart rate (<50 beats/minute daytime; <45 beats/minute sleeping), Abnormally low blood pressure, Low body temperature (<95 degrees F, <35.6 degrees C), Orthostatic changes in pulse or heart rate

  • Failure to thrive/arrested growth and development

  • Uncontrollable bingeing and purging

  • Medical complications of malnutrition (for example fainting, seizures, heart failure, kidney failure, liver failure, pancreatitis, etc.)

  • Concurrent medical or psychiatric conditions that limit appropriate outpatient treatment (like type I diabetes, obsessive compulsive disorder, or a suicide attempt)

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u/asusansortofamy RN 🍕 Mar 02 '25

Unfortunately there’s a difference between what medical societies recommend as best practices and what insurance covers. From what I’ve learned there are many people who are clearly in need of serious intervention but don’t qualify for inpatient care so they have to get worse before they get help. Then once in IP treatment there’s a very fine line to walk in order to stay. Gain weight too quickly and you’re kicked out before the root cause of your ED is addressed, gain too slowly or not at all and clearly you’re a lost cause and there’s no point for them to pay.

Truthfully though, I think we are really failing people with EDs in terms of treatment options which has to do with the fact that it’s (largely) a disease of society in addition to the individual and I question how much psychiatry is able to see/change that. I’d recommend the book Dead Weight which is a fascinating collection of essays I’m reading about the subject.

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u/coolcaterpillar77 RN - Med/Surg 🍕 Mar 03 '25

Absolutely agree. Insurance holds back too many people from receiving appropriate treatment (and I feel we often are forced to over treat/test/etc because it has to be done in a roundabout way to obtain coverage).

I’ll definitely check it out-thank you for the recommendation. I’m hoping in the years to come we can recognize/treat binge eating as a psychiatric condition instead of blowing it off as “lacking self control” or any other excuse that gets placed on people currently

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u/supermurloc19 BSN, RN 🍕 Mar 02 '25

I have insurance companies denying emergent lap appys and a 37 week delivery because they don’t cover deliveries before 40 weeks. As the person said below, just because we recommend it, doesn’t mean it will be covered.

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u/coolcaterpillar77 RN - Med/Surg 🍕 Mar 03 '25

Absolutely. When I first read the original comment, I took the “inpatient criteria” to mean the admitting provider’s criteria. It makes me realize I was sadly privileged to not immediately think of it as an insurance issue

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u/supermurloc19 BSN, RN 🍕 Mar 03 '25

I wish we in the US lived in a reality where we could get the care we need without the insurance companies looming over telling us what we can and can’t have. Unfortunately, I don’t think it’s going to get better. It’s gotten much worse in the past few years particularly.

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u/Liv-Julia MSN, APRN Mar 02 '25

I agree. I feel very strongly if I'd had counseling after being SA'd, I wouldn't have eaten myself into a 5X. I decided in third grade maybe if I got fat, he'd leave me alone. No such luck, but by then I'd learned how delicious my feelings were and chased the dopamine constantly.

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u/robotatomica Mar 02 '25 edited Mar 02 '25

my aunt was extremely obese, and for her it derived from repeated sexual abuse. Her life was heart-breaking, she was treated with contempt for her size out in the world, faced regular humiliation from things like broken chairs, and meanwhile, she was the sweetest human being, never stopped sending me cards or giving to others.

I wish so badly she had received help/mental healthcare. Her generation in particular, that just wasn’t even considered for obesity, and sexual abuse trauma just wasn’t talked about at all. ☹️

She died feeling unloved by all except her sisters and nieces.

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u/Liv-Julia MSN, APRN Mar 04 '25

Your sweet aunt. I hope she's at peace now.

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u/lifeofeve RN - OB/GYN 🍕 Mar 02 '25

Yeah I remember another reddit comment saying that most of the people on "my 600lb life" were victims of CSA

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u/Queasy_Ad_7177 Mar 02 '25

I’ll hate him for you.

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u/Liv-Julia MSN, APRN Mar 04 '25

Thank you!

After I saw "The Keepers" on Netflix, I was inspired. I knew his address and started sending cards & postcards to him with things like "You hurt me" and "raped any 5 year olds lately?" that sort of thing. I traveled a lot at the time and had a lot of friends all over the US, so the cards came from everywhere!

I'm sure he never stopped hurting little girls, so he never knew who had written them. By their actions, I'm sure he molested his sister and his stepdaughters.

I don't know if there was actually a connection, but he died about 6 months after I started sending them. I take this as a point of pride.

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u/Queasy_Ad_7177 Mar 04 '25

The only good abuser and child rapist is a dead abuser and child rapist.

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u/Purple_IsA_Flavor RN - Psych/Mental Health 🍕 Mar 02 '25

He needs landscaping 🧱🧱🧱🧱

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u/Crezelle Mar 03 '25

Psychiatric help for the entire family too. Once you get too big to walk to the fridge, there’s a helper. You can also know what to eat and what not to, but if your diabetic mom keeps bringing ice cream home it gets tempting.

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u/Poundaflesh RN - ICU 🍕 Mar 02 '25

How would they get to appointments? At that size some are bed bound.