Just Tell it Like it is
Old Doc at Maggie's Farm blog replies to my post about whether or not doctors should address their patients as fat:
Read the whole thing.
Final word: If you are too fat, I will say that. And, if you care, I will tell you how to deal with it. But your life choices are not my problem, beyond that: your doctor is not your Momma, nor is he/she responsible for your health. Your health is in your hands, and God's, and nature's. My only responsibility is to give you advice as your friend, and to try to help you when you get sick.
Read the whole thing.
posted by Helen at 8:02 AM
30 Comments:
Well yes. Doctors should tell it how it is.
Though I don't know how professional it is to say "You are fat."
Perhaps, "You are obese." or "Yes, you have a weight problem."
But perhaps I am just way too PC!
I doubt eupemisms are going to help much. If your weight is jeopardizing your health, your doctor should tell you. Yes, of course said doctor should be polite and helpful, but part of being helpful is saying: "Look, you need to eat less and move more, or you're going to live a limited life and die a painful death."
Self-esteem be damned here. A person's self-esteem is their own responsibility, no one else's.
The important problem with all this is--how many fat people come into doctors' offices not knowing they're fat? From his post:
"However, I also understand that the flesh is weak, and that staying in youthful shape after 45 is no mean feat. It takes work and discipline, and the evidence that it leads to longevity or health is minimal. However, being in good shape adds a lot to quality of life. On the other hand, being obsessed with health is for the crazies.
Plus there is the vanity factor: few guys will look at a fat girl, and no gals will look at a fat guy - unless he is rich or powerful. But, at some point, unless we are narcissists, we accept reality and don't care all that much."
How many fat people don't know that and have to live it every day? (And calling it vanity is a huge understatement, there's a high correlation between obesity and depression for this very reason. Enhancing the problem, one of the symptoms of depression can be "comfort eating", leading to a vicious circle.) The point is, don't doctors have better things to do than calling their patients fat? Like, oh, coming up with practical weight loss methods (as opposed to the 800 cal/day diet the last doctor I went to prescribed?)
Here's an interesting question--how many doctors would think to first screen their obese patients for depression and refer them to a psychiatrist? Diets succeed when people are driven, not when they're depressed.
anonymous 2:53, good point. Usually people are obese because there is another serious problem, usually psychiatric. (I put on 30 pounds during my last serious bout with chronic depression. Just as you mentioned, I comforted myself with food.)
Part of it may be that the word "fat" is still shrouded in the language of moral judgement. Obesity is thought to be a sign of moral weakness, when in reality it's more likely the symptom of an underlying problem that doesn't go away even after the obesity is cured. Drug addiction is still viewed in a similar way-- people turn to drugs to compensate for a psychiatric ailment.
Still, a patient is responsible for seeking proper treatment and sticking to that treatment. Part of doing this is letting a doctor or therapist know when the prescribed treatment isn't working-- or getting a second opinion.
So, if I were a doctor, I would still say, "Yes, you are fat. Doesn't make you a bad person, but your weight will kill you if you keep this up."
But if I were that obese patient, I'd have the right to respond, "Look, you're not telling me anything I don't already know. That's why I came here, so I could find out how not to be fat anymore. Can you suggest something for me?"
ok once again its one size fits all situation, i am fat, all the males in my family on my dads side are fat, yes i am fat, i know it..
but i am otherwise obscenely healthy, the dr had to do tests 3 times as they didnt beleive i was this healthy..
yes fat people get depressed, do you really know why.. its because people are constantly on us to lose weight, you will live 5 more years if you loose 10 stone.. bullshit,
no one knows how long you live, fat or thin, there is no cut off date, meaning your over due for death.. if they are obese and they wish to lose weight, then thats their choice, do not force your idea of what thin onto someone like me is happier than i have ever been. its a revelation knowing, you can eat drink be merry, for tomorrow we die.. everyone dies, eventually, why live a supposed extra 5 years, in misery instead of living and enjoying life.
and jenny i would also say its the right of the obese patient to tell the dr non of your business how i live my life, would you tell a gay man to not be gay coz it may shorten his life.. no fatness is the only discrimination that is lauded by society. whatever happened to individuality. by genes i am fat but all my fat ancestors lived to over 80, i may live to that age or less.
fat but i am happy. isnt that what people want to be happy, if your not happy with me then thats your problem, not mine,
I don't mind that Doctors mention "hey btw you're fat".. if they feel the need to do so.. fine.
But don't let it cloud your diagnosis. Too many times have my concerns about my health issues been rationalized as "you're too fat", because the doctor was too lazy to actually look further and find a real diagnosis.
No one wants to be 400lbs, or look like a "beached whale".. we'd all like to be 6'0, thin as a rail, and be able to shop and buy clothes in any store we pass. But thats not the case for a lot of us. That doesn't mean that our concerns shouldn't be heard just as loudly.
I just read these comments that are already here and I can't help but add.
"Usually people are obese because there is another serious problem, usually psychiatric."
Yes.. usually people who are seriously obese (you know the people who can't move because they're too fat, etc) have some major health problem which is probably the root of their weight issue.
I don't agree with you that people are fat because they're mental.
Its a lot like the chicken and the egg debate. Which is the cause of which? Are people depressed because they're fat? or are they fat because they're depressed? I think that differs from person to person and cannot be definitively said as a general assumption either way.
There are many reasons that people can be obese. Food allergies, diabetes, thyroid, celiac, insulin resistance.. none of which are mental problems. And a lot of those, aren't even tested unless you (the fatty) insist on it.
Actually, food allergies can cause a multitude of problems, many of them mental. Including depression.
Its easy to get caught up in curing the symptoms and not actually finding the cause.
but dante, that was you, you will die just like me, but you dont know, the guy who invented jogging died youngish, while jogging.
it could happen anytime fit or not.
would you rather, sit and watch every moment of your life in case you have an extra calorie there are people like that, they get scared if they put on one ounce.. cant people understand everyone is different, what works for you, wotn work for me..
now i am a contrary person the more someone pressures me to change myself, the more i stay the same, if i make a decision to change myself then thats my decision and only i should make those. yes get information, but realise the anti fat bias there is out there
I hope Old Doc's method works for his patients. I suspect not. Generally, I believe we're barking up the wrong tree when trying to use fear, logic, or other motivational approaches to weight loss.
Granted, a few people find them effective, but overall "advice" has a terrible track record for achieving weight loss. (And the Old Testament hard-hearted tell-it-like-it-is Doc will find some takers, and some complainers. Not his problem, though, when patients are plentiful.)
When people know what they should do, but do it not, we have to use some other method. My guess? Medicines that adress the hunger drive or the sense of satiety. Everything else until then will be at best a partial success.
Honestly. That's how they need to address their patients.
aj
Hmmm, how about the doc saying something like "I am a little concerned about your weight. Would you like to talk about that? Is there anything I can do to assist you in loosing a few pounds?"
As a psychologist, I always tell my patients that part of why I get paid is that I will tell them the truth. I am nice by choice, I am honest by profession. This helps them trust me when I offer support and understand that I am doing my job when I tell them that it sounds like they are trying to blame someone else for their problems.
I work in a pediatrician's office, and my dear friend and the head of the practice used to bug me about my smoking a few cigars a week. She did this because she wants me to live a happy, healthy life. I appreciate that, and I said a little prayer of thanksgiving for such a caring, honest friend last night as I smoked a cigar on the front porch.
Trey
Trey,
I must admit that I love the smell of cigar smoke. I have never smoked but if I did, it would be cigars or maybe chewing tobacco. Luckily, I have never even smoked a cigarette before, mainly because I figured I would like it too much and not be able to quit. Enjoy your few cigars while you contemplate your luck in having a good friend.
Part of the problem is the "diseaseification" of a conduct problem. While I have known people who had physiological reason for being overweight, many times it is simply a lack of self control when eating. Go to any buffett restaurant and see what the large people eat and contrast it with what the trimmer people eat. You will find that the fatter ones are eating huge portions of the "fat" foods and the fitter looking ones are eating less or more healthily.
Hey I don't care if someone is fat, but don't bitch about not being able to fit in airline or theater seats or being seen as a disgusting fat body while your calorie intake is 5000+ a day. Far too many fat people act like they have no control over their weight, and that is BS most of the time. They simply don't want to take responsibility for their unhealthy eating habits.
Helen, smart lady for never trying the cigarette thing. I would have never stopped had not my then wife told me I was an addict and could never stop. Pissed me off so much I never smoked another one. Yeah, I may have been manipulated, but if I was it was one of the most wonderful things she ever did to or for me so I will try to be grateful.
And I do enjoy the cigars I smoke (that is why I smoke em) and I only sometimes make sure that my doctor friend sees them so I can torture her.
Trey
Sgt Ted wrote: "Part of the problem is the "diseaseification" of a conduct problem. While I have known people who had physiological reason for being overweight, many times it is simply a lack of self control when eating."
Wow do I agree with you about the diseasification problem. About everything. It is part of the victim cult I think. Honestly, compulsive behaviors may be a brain illness: so? I have a brain dysfunction, ADD. No matter what the cause or where it comes from nobody can reduce the disruption it causes better than I can. Not my fault, but absolutely my responsibility to deal with it.
Oh look at the time, I gotta get back to work!!!!!!
Trey
it isnt just fat people that complain about airline seats, or theatre seats what about the tall, they cant fit either, no one tells them lose height..
some people have addictive personalities, some dont, i dont have to smoke, but sometimes i do, doesnt make me an addict, aint had one in 2 months, dont feel the need, sometimes i may fancy one.. but its not like i need one i crave it..
i love pipe smoke the sweet smell of them,, once again blame the fat. the could be genetic reasons to being a weight, etc.. once again you dont complain to the tall, lose height, or the short grow.. why is it ok to constantly harp on about fatness.
people are different sizes.. what works for me wouldnt work for you, i aint force feeding u to put on weight, but you are starving us all for your faith in a questionable medical "fact"
check these links out http://www.largesse.net/handouts.html but then again if you are so anti fat you wont want to read anything about it..
A doctor's statement to a patient: "Your current weight is jeopardizing your health" is not quite the same thing as telling his patient she has cancer and going on to describe appropriate treatment options.
Regarding obesity, he's probably echoing what the patient has been hearing from family and friends, and saying to herself, for years, and she knows she has been derelict in doing anything effective about it.
Regarding a cancer dx, she will not feel her character judged and will be terrified but eager to work with the doctor on ridding herself of the disease.
But actually, a doctor is obligated to tell a patient what is endangering her health regardless of the emotional impact. He could offer the obese patient a packet of material on nutrition and weight loss, but it's all going to be on her shoulders to follow through. No one else will have any responsibility to ensure her success. Few people will see this as extraordinarily empowering, which it is.
or you could be so brow beaten by the dr the press the society in general that you decided to lose weight and you get applaued for it, and u think if i lose more.. then i get more, and lose more and more and more.. until you die of anorexia/bullimia.
the problem people fail to see is that genetics plays a massive role in weight, and diets DO NOT WORK, for the majority of people in fact you can become fatter on diets.. unless you want to diet for the rest of your life. and take the enjoyment out of eating.
ONE size does not fit all people.
all the dr could say is its possible that they are damaging their health, but there it NO absolute proof that it will happen.
One size definately does not fit all. And scales are not "healthwise" objects.
I am and have always been big boned. No I'm not just saying that cuz i'm excusing that I'm fat, I honestly do have a heavy bone structure. On top of that I do have fat, but even if I lost all my "fat" and worked out.. I'd still be high on the list of weight vs my height.
In HS, I was very active in sports and at graduation I was 5'7 and 185lbs. I was extremely muscular, and with a near 6-pack which is pretty hard to do as a girl. Even with such "washboard" stomach, the doctors would berate me for being "fat" and that I needed to diet and excercise. I worked out nearly daily, ate mostly veggies, I looked fantastic (I had to beat the boys to keep them away) and all my health tests were very healthy. Yet because the scale said I was 20lbs over the limit, I got baraged with diet info.
Diets don't work. If they did, we'd have tons of skinny people running around. Instead we have more and more fat people.
Now while I know not everyone is genetically programmed to live their life looking like a linebacker as I am, not everyone with extra poundage is unhealthy. Genetics play a big part, as well as other health issues.
Btw SGT Teddie - Most fat people don't eat 5000 calories. I know a lot of fatties, and I was definately "OBESE" for several years. During my most obese times, I kept a journal of the foods I ate, how much I ate, what I ate, how much I still gained. For 6 months, I ate no more than 1500 calories a day. I worked on my feet walking around all day for 10 hours a day/40 hours a week. I still gained 10 lbs.
When I went to buffet, I would eat a bit of meat, a ton of salad (all greens btw I can't stand croutons or meat stuff in my salads), and maybe a couple cookies if I felt brave. While all my skinny friends, would load up on mac & cheese, fried things, tons of meats, loaded baked taters, and huge slices of cakes and ice cream to top it off.
There are some fat people who compusively try to kill themselves by eating, like a smoker tries to kill himself by smoking. But a lot of the "fatties" are just that way despite all their efforts.
Don't expect a dr. to be a wise guide on nutrition and weight loss. They get little or no training on the subject. Get a referral to a registered dietician (RD) for that. If you are overweight/obese enough, with a doctor's referral, your insurance might pay for medically necessary diet and exercise costs, RD, PT, etc.
Many obese people don't go to the doctor at all because they have given up on getting decent health care. That has to account for some of the increased morbidity and mortality. Like another commenter mentioned, you have to beg for tests.
I am overweight, athletic, gorgeous, sexy, happy, and as healthy as a horse. I found out how healthy while being tested and treated for thyroid cancer last year. It's gone except for an elevated cell count in my bloodstream, which ThyCa patients can have for decades and their natural lives aren't shortened. ThyCa didn't cause my overweight, because it developed in just months; and overweight doesn't cause ThyCa. It's just one of those things. My BP, RHR, blood glucose, blood profiles, chest CT, bone density, and a bunch of other things are fantastic. I have the highest hemoglobin in a female that the hospital labs have ever seen. They were concerned about me having a "bounding" heartbeat (very powerful) until I explained my training regimen, then they understood I have a strong athlete's heart. They would have never guessed, to look at me. It's been very encouraging to learn how unbelievably healthy and strong I am througout this ThyCa process. The ThyCa seems unreal. I am monitored very closely on a lot of things now, I am my own science project. I amaze my docs...I'm a 20 year old athlete stuck in a middle age body. LOL
AND my food logs show that I eat too FEW kcalories. I can't bring myself to eat more, despite occasional carb consumption because a physiological need says I need to restore the glycogen in my muscles from all the training.
Fat and Fit is better than Fat and Unfit. My big peeps, keep on being active and proudly wear your spandex in public! *high five*
A lot of thin people don't exercise at all and their muscles and hearts are stringy with fat like a well marbled steak...they just don't have a lot of surface fat. Active larger people could well be healthier than sedentary thin people whose plaques can attack their hearts, veins, and brains just as much as anyone else.
I don't think doctors should say anything. If a doctor use the F word, he/she might get sued for hurting somebody's feelings. It's a huge liability and I would hate to see those medical liability insurance premiums rise even further than they already have.
Let's all keep our heads in the sand and not bother anyone about their smoking and widening girth. We end up with happy people and more social security dollars for me.
Here's a hypothetical for all of you:
Doctor sees an obese patient, and without screening for psychological disorders, says (as one doctor actually did,) "If you don't lose weight, the only guys who'll find you attractive are black." 2 weeks later, the patient commits suicide. In the suicide note, the patient bemoans that no one will ever love her because she's too fat and doesn't know what she can do about it.
Shouldn't the doctor have some liability for her death, either for intentional infliction of emotional distress or for medical malpractice? If so, then that should tell you a bit about how doctors should treat patients. If not, then what are the limits on what doctors can say to patients? When does medical advice cross the line into verbal abuse?
ok rowena i diasgree with the spandex.. no one looks good in that.. ;-)..
but yes, my dr had to take all the tests 3 times, because she was certain it was a mistake.. then i said to her look i am happy, i am fine with my weight, i am other wise healthy as you see.. and she left me alone..
cham i think u were being sarcastic but i am not sure if you werent fine, if you were then but yes why not, society is full of people short and tall, fat and thin, black and white.. just imagine if someone says to one person you need to be blacker, or whiter.. dear god the backlash would be horrendous, its about changing a persons identity, if someone wants too, then ok.. not a problem.. but those who are genetically, psychologically more fit to be fat shouldnt we have the same rights as thin people short people, black or white or any colour.
but fat is the only discriminatory practice that is legally accepted.. would that be right for any other matter, skin colour, height, no.. but weight.. thats fine.. they only fatties, they must be morally degenerates or they would be thin, they must be slothful, as they are fat, they are greedy, they are.. and so on.. thats the real problem,
Hey "Vonnie", I put in the physiology caveat and if the shoe doesn't fit, why complain? Can I be condescending to you too?
But being in the military, I have seen and known many enormously bloated people lose the weight and keep it off by simply eating less and exercizing. Lack of self control was the key to alot of this.
I don't try to generalise, but when some people start crying about discrimination and what others think of you; well, thats life, deal with it. If you can't lose the weight due to physiology, fine. Fit and fat is cool.
But too many fatties use the "I'm big boned" or other cheap excuse rather than stepping away from the donuts and taking responsibility for their eating and excercise habits. Then they demand that they be given special status as some sort of victim constituency, and infere that the rest of us mean bigots for noticing that they're fat. Do I really have to list all of the disease and health risks of being overweight to make the point?
but there is no direct link to such diseases.
check out this site sgt ted,
http://www.techcentralstation.com/071403A.html
but i am sure you wont read it sgt ted. did you treat the enormously bloated people differently, did you follow their lives out of the army to see if they put the weight back on.. i doubt it..
**According to the U.S. Department of Agriculture (USDA) Center for Nutrition Policy and Promotion, total caloric intake, as well as total fat intake, steadily decreased from 1965 to 1990
**
**
"Most commercial weight loss programs range from 945 to 1,200 calories a day. The World Health Organization (WHO) defines starvation (the point at which the body is dying) as 900 calories or less a day. That means that most programs are starvation or semi-starvation programs," Atkins said.**
**Anorexia is the third most common chronic illness among American teens, states the USDHHS Office on Women's Health. Bulimia is 20 times more common still, affecting 8 to 20 percent of young women, according to the AAP. Together they have the highest premature mortality rates of any psychiatric diagnosis, reported Dr. Pauline Powers, founding president of the Academy for Eating Disorders**
but thats ok they are literally dying to be thin. its fat thats bad evil etc..
Drs. Jerome Knittle and David Katz of Mount Sinai School of Medicine in Total Nutrition (St. Martin's Griffin, 1995) said 10 to 15 percent of anorexics die of starvation or related problems, including heart or kidney failure, and another 2 to 5 percent commit suicide. They're 12 times more likely to die than the general population of similar ages, according to a study published in the New England Journal of Medicine, April 8, 1999. It's estimated that in the United States alone as many as 150,000 die annually from eating disorders.
theres more about it, look for yourself but then i doubt you will as its against you own ingrained bias against fat people
** Pills are not without risks just because they're sold over-the-counter or are all-natural. Those containing the appetite suppressant PPA (phenylpropanolamine hydrochloride) or benzocaine, for example, can dangerously raise blood pressure and cause heart arrhythmias, according to Weight Loss Products and Program) (Colorado Extension Service). U.S. Food and Drug Administration (FDA) Medical Bulletins have reported increasing numbers and severities of adverse reactions with dietary supplements promoted for weight loss or fat-burning, such as those containing ephedra (Ma huang), guarana or Kola nut, white willow and chromium. The side effects include chest pain, heart attacks, strokes, hepatitis, seizures, high blood pressure or heart rates, psychosis and death**
** Sure, some people, especially at the most extremes of obesity, suffer health problems because of their weight. But the soundest studies have found that for most people being overweight has nothing to do with poor health, fatness isn't a disease, and most fat people can be perfectly healthy.
http://www.tcsdaily.com/article.aspx?id=081103D
**The ability to retain fat is a human adaptation to the prevalence of famine and starvation in human history; hence there are varying degrees of genetic fat traits in most of us. Science has long recognized that this fat-retention response is also triggered by exposure to starvation any time in one's life -- in utero, early childhood, adolescence or adulthood. With later nourishment, people become fat. Clinically, we see it in those born with low birth weights to undernourished mothers, be it inner city, minority, teen, or smoking mothers. We see it in immigrants from hunger-ridden countries and those who are emerging from poverty in underdeveloped regions. And, we see it in millions of Americans who've dieted. **
if nothing else read the last link
read this, http://www.tcsdaily.com/article.aspx?id=100704F
http://www.techcentralstation.com/093004E.html
You are about to learn of a beverage so dangerous, that we must ban or restrict its sales, or at least enact tax penalties on it to deter consumption. Here's what the research shows:
• Every American who drinks it dies.
• It's been linked to obesity: in fact, bigger people drink the most of it.
• It's associated with type 2 diabetes and all diabetics drink it in especially large amounts.
• All heart attack victims drink it and it's a known factor in heart failure.
There are been hundreds of studies finding these correlations -- correlations so strong they make the evidence irrefutable. This is bad stuff.
Everything you've just read is true. What is it?
should we ban this..di hydrogen monoxide, read the story and you will see.
also check out http://www.dhmo.org/facts.html
same substance..
And the evil substance is water.
I speak of what I've witnessed and yes those former fatties are still un-fat. They made a lifestyle change and stuck with it.
You keep throwing up extremes. Underweight isn't healthy either and I haven't seen where I argued FOR bulimia/anorexia, so Im not sure what that has to do with it other than to make yourself feel better that skinny people suffer more?
Ted, I believe the problem has more to do with your initial attitude that fat = lazy.. or fat = no self-control.
While it may be true for a few people, it is not generally true among all "fatties". No one likes stereotypes.
your initial comment on here about fat people complaining about airline seats etc. They are legitimate complaints, same as handicapped people fighting to get handicapped access (ramps, wider doors, bathroom stalls) to public buildings. While I wouldn't say fat people are handicapped, their complaints are just as legitimate.
To say that all fat people are lazy and their complaints aren't valid because of it, is unfair and biased. It is that very bias that we are trying to fight.
Maybe us "fatties" should go around whispering and making snide comments about the thinnies.
"omg she has got to be anorexic"
"Did you see her wolf down that ice cream? what a bulemic"
"Damn he's so vain, did you see those muscles? Bet he models in front of the mirror for an hour a day telling himself just how fabulous he is"
but by demonising fat men and women, turning them into nothing but fat walking, you are putting pressure on them, many ex fat people their personalities change, they become less nice, this is from personal experience, i lost a friend to a diet, she lost weight, she became borderline anorexic always convinced she was fat when she had lost a lot of weight. she became paranoid about fat, and trying to convert others to the diet cult.
now if you continually tell fat people and people who arent fat just a little bit larger than your idea of ideal shape, you may cause more cause of negative weight.
why do you think theres so many adverts for weight loss, diets, pills, surgery, its a between $30 BILLION and $60 BILLION industry. that why they push diets, they know they dont work for many people, follow the money.
exactly von, for anyone, airline seats are a tight fit unless you are as skinny as a rail, if your taller than usual, i got a friend 6 foot 7, he complains, but no one is saying to him, stop being so tall. the airlines make smaller seats, less leg room, for $$$$, more money, if a plane can fit 100 people, and they make a profit, if they reduce the leg room by 10%, they could add possible another 10 people.. more money.. look at the airlines they make a fortune by putting more people into a limited space like sardines..
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