Conflating legit obesity health warnings with "fat shaming"

There is a trend of late where people are starting to take “fat shaming” to denote not only mockery of those who are obese, but also even health professionals who warn of genuine, legit health dangers that accompany obesity.

IMHO, this is a dangerous inability to recognize the difference between two things: Obesity in terms of **aesthetics **(where the obese person can say, “my fatness is none of your business”) and obesity in terms of health facts (where an obese person who says “my obesity does *not *affect my pancreas/insulin/arteries/heart” is simply living in denial.) Cancer, diabetes and heart disease do not care in the least about obesity politics.

(Random dump of URLs below):

I got fat shamed at 5’5" tall, 310 pounds by my cardiologist [he was trying to figure out why I suddenly got insanely high blood pressure during the night I was prepping for surgery. I still maintain my brain somehow rewired itself during the worst migraine of my life] til he got my bloodwork, and the echocardiogram showed the circulatory system of someone with no issues [heart wall thickness and condition of blood vessels] and my bloodwork was better than his skinny, marathon running vegetarian ass. He was horrified I was eating red meat, butter, drinking whole milk … I mandate that everything in moderation is way better than trying to substitute lab chemicals for fooling the mind and body into believing that whatever you are eating is palatable. He was whining about my not being on statins til I told him that my primary care doc said my cholesterol was fine, and he claimed that as a cardiologist he had ‘more stringent requirements’ so I told him to tap a vein and call me … oddly enough I never had statins shoved at me again. snicker

You may be shocked to hear this, but most seriously overweight people already know that their weight is bad for their health. But losing weight isn’t easy to do, and a regular drumbeat of people calling attention to one’s weight makes it harder, not easier, to find the will within oneself to make a major push to lose weight. And that includes when the drumbeat comes from one’s doctor.

If a doctor is warning of serious health risks in the short term (e.g. “you’re headed for a heart attack in the next year or two if you don’t shed some weight”), that’s one thing, but the usual “you need to lose weight or it’ll cause you problems down the road” is generally counterproductive.

I clicked on only one of the links, the second one. And the people running that campaign should fuck off.

My doctor and my dentist tell me I should quit smoking or else it will cause me problems down the road. Is that advice similarly counterproductive?

I don’t know. I guess it depends on the extent to which smoke-shaming is a problem in your life.

It is not okay for anyone’s body to work differently. Everyone’s got to be the same.

What do my feelings about medical advice have to do with the soundness of that advice?

Depends on what you mean by ‘soundness.’

If you mean ‘medical accuracy of the advice’ that doesn’t change. If you mean ‘expected effect of giving the advice’ that does.

If a doctor can give advice that is factually sound, but is more likely to result in counterproductive than positive behavior by his/her patient, under what circumstances should s/he give that advice?

Yeah, I’ve often wondered about that myself, and I say that as a fat guy. There seems to be a massive difference between the two- in other terms, you might say it’s the difference between a doctor telling someone that promiscuity leads to STDs, versus saying they’re a slut and are going to get a disease.

A doctor telling someone they’re overweight/obese, and that they may face unpleasant conditions as a result isn’t fat shaming, as long as there’s no implied mockery or lack of virtue commentary involved. In other words, him saying you are X lbs overweight for your height and build, which puts you at a higher risk for Y, Z and AA, and that you should really concentrate on losing that weight so you reduce your risk isn’t shaming. Him saying you are X lbs overweight for your height and build, which puts you at a higher risk for Y, Z and AA, and that you should get off your lazy ass and put down the eclairs so that you don’t have Y, Z and AA happen to you *is *fat shaming. One is merely stating the facts or at worst, their informed medical opinion, and the other is being abusive about it.

How can the giving of factually sound medical advice be counterproductive? If a person doesn’t want to hear factually sound medical advice because it’s make them feel bad, then that seems to be a problem with them, and not the medical advice.

If the average effect of giving the advice, averaged over the doctor’s clientele, is negative, and the doctor insists in giving that advice across the board anyway, then the problem is with the doctor. He’s violating “first, do no harm.”

nm…

Fair enough. Are there any studies that show that a doctor advising people “you need to lose weight or it’ll cause you problems down the road” has a net negative effect?

Sheesh. Next thing you know, they’ll have “opioid abuse shaming.”

While a doctor giving sound medical advice is NOT fat shaming, there are ways that SOME medical professional might shame their patients.

For some obese people, even when they are working to shed weight, every visit to the doctor because about their weight. Maybe they are there because they have a cut they need the sutures taken out of, maybe they need a prescription for a UTI, maybe they have strep, who knows. But the doctor will sometimes ignore what the patient is there for to instead talk about their weight. If I’m at the doctor because I need a prescription for a UTI, I do not need a lecture about my weight right now.

Doctors will sometimes jump to conclusions, leaving people suffering longer than necessary. Sometimes, the reason you are having a problem is your weight and sometimes it not. Assuming all problems are caused by your weight and refusing to treat those issues until the person loses weight can leave people suffering longer. If I am having knee pain and my doctor will not investigate causes other than weight, I might have an even harder time losing weight without at least trying the treat the pain.

On top of all this, sometimes obese people will forego medical help for problems much longer than they should because they fear what their doctor will say. If I am having breathing problems, I might avoid the doctor because I’m really heavy and out of shape right now so I think I already know what the advice will be. I might think it will avoid wasting money and time to be told something I already know.

In the end, as an obese person, I have felt both shamed by my doctors for my weight and have been given sound medical advice. For me, I need a doctor who is willing to empathize with me and give me actual, scientifically proven advice. (My doctor recommended WW because it was what she used and what science and shown to work. She also showed me what about it works.) She also encouraged me to get mental health help so that I could help tackle the whys of my obesity beyond just that I eat too much.

That said, that ad campaign sucks. Ad campaigns like that don’t seem to encourage people to change by informing them. I think it just gives others more fuel to shame fat people around them into dieting.

A friend of the family is seriously overweight and is more than a little sensitive/defensive about it. My wife recently accompanied her to a doctor’s appointment concerning a recurring knee problem where the doctor pointed out that this friend’s joints were ‘not designed to carry that much weight’ and in addition to giving orders concerning specific knee treatment also recommended she lose a significant amount of weight to make things easier on her knees. After the appointment she started bawling and when my wife asked why she responded “why did the doctor have to shove that [obvious fact] in my face? Does he think I’m not reminded of how heavy I am every day of my life? Or how painful it is on my knees every time I have to stand?” From her viewpoint, the doctor was needlessly restating the obvious, and hearing this unwelcome reminder from yet another source was every bit as demoralizing to her as the endless stream of weight loss commercials on tv or even in-your-face fat shaming.

It didn’t sound to me like the doctor was trying to be hurtful, but I can kinda see things from her perspective. Namely, when one is surrounded with negative messages from so many different quarters, simply re-stating the obvious can hurt. Not unlike someone going to see a financial advisor or attorney about the debts they can’t pay off and being told ‘hey, you should get a higher paying job’

How should the doctor have handled that situation? I don’t have an answer.

About a week after my last physical, my doctor directed me to a report that was on some nifty web portal that summarized the results of my bloodwork and assessed each analyte result according to risk.

I wonder if a similar approach would work for obesity. Instead of the doctor telling you face-to-face that your weight is unhealthy, the doctor’s report would do this, thereby allowing you to process the information in private.

It would also be great if multiple obesity metrics were assessed whenever you get a physical. Like, there are many BMI skeptics out there. It misses the “skinny fat” and isn’t meaningful for folks with muscular builds. But the waist-to-height ratio is harder to refute. A person with a BMI of 29 with a 30" waist has a different risk level than the person with the same BMI and a 37" waist.

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If a patient understands obesity is bad for them but either they cannot lose weight or don’t want to, and they accept the risks, that should be accepted.

Obesity is bad for you, but so are endless other things. The life expectancy gap between the the morbidly obese and those with healthy weights is smaller than the life expectancy gap between the upper class vs poor, or between colleges educated vs high school educated (about 7 years vs 10-13).

Well, I’m gonna pipe up even though I’m hesitant to. But as RTFirefly mentioned, we already know. But everyone it seems, assumes we don’t and it’s their job to tell us. Not just doctors. But since this thread is about doctors specifically, I’ll stick with that.

What’s wrong with a doctor telling you it would be in your best interest, health wise, to lose some weight? Inherently, nothing. But when EVERY visit to the doctor includes a comment about your weight, it starts to feel less and less like ‘medical advice’ and more and more like trying to make you feel like shit. Having severe stomach cramps? Must be your weight. Foot in so much pain you can barely walk? Lose weight. Ear infection? It’s your weight.

When you’re overweight, doctors will almost always immediately assume that whatever problem you are seeing them for is because of your weight. This is done to the point that they will refuse to do or even suggest any other tests or treatment because they’ve already come to the conclusion that once you lose weight, everything will be better. All those examples listed above I’ve personally experienced. I was in tears by the end of my ENT doctor appointment because he wouldn’t stop bringing up how my weight was detrimental to my health. I was almost forced into getting a C-section because the doctor was convinced since I was obese, my baby would be too big to deliver.

We know we should lose weight. We know it will make our bodies healthier. We know the risks that are associated with being obese. We don’t need people constantly trying to remind us over and over again, running campaigns that seem to want to shame us into magically losing weight. Society as a whole has hammered into our minds (especially women) that being overweight is bad. Only thin people are happy/healthy/successful. It’s not easy to lose weight, and more and more studies are finding it’s NOT as simple as ‘eat less, move more’. There’s so many other factors at play. We don’t need to be constantly bombarded with ‘advice’ and ‘warnings’. It’s not helpful.

We need support, mentally, emotionally, socially. Help us feel like normal people and not some fat, lazy slob. Do things to help make the process of losing weight easier. Teach healthy cooking classes in schools. Help make healthy foods more accessible/affordable. There’s so many better ways of doing things than to try and make us feel worse about ourselves than many of us already do. I don’t know if any of this makes sense, as I feel I’ve rambled a bit but…hopefully it at least sheds some light on things.

Supposedly waist to height ratio is a better metric of the health risks of obesity than bmi.

Ideal is 50% or less (ie a waist 36" or smaller if you are 72" tall) however the risks of up to a 60% metric aren’t that bad. But they seem to grow rapidly above that.