I’m not sure how pointing out reality is shaming. I got a gut. I know I need to lose it and it doesn’t hurt my feelings if others don’t pretend it’s not there.
That said, I know how to lose weight and am losing weight. I can see how it would be terribly frustrating if one is not sure how to lose weight.
A Research study showed that quite a few Drs. are more reluctant to tell a woman to lose weight than a man. The Drs. in the study felt that a woman would take the advice as an insult rather than as medical advice.
Seems to me it should be entirely results based. If you can show that health warnings about obesity actually do anything to reduce obesity, then they should totally run them, even if some people are offended. If not then, don’t, its just a waste of money that offends people.
Same goes for any PSA, health warning, training course, whatever. Seems to me very little results-based analysis this kind of warning is actually done (though could be wrong).
Doesn’t sound like the Drs responsibility to coddle anyone.
Whether accurate advice is productive or counterproductive is always up to the person receiving the advice.
Not at all. If he’s giving factually correct advice to a patient, then its his duty to do so. Otherwise its violating the principle of informed consent. Regardless of what the research says the average affect is of being told that my obesity will negatively effect my health, they can’t withhold that information from me.
There are pretty negative outcomes associated with being told you have completely untreatable terminal cancer. But your doctor has a duty to tell you nonetheless.
Here’s another thing. I was at the doctor, and she looks at the weight her attendant had written down after weighing me. And she says, “You really should try to lose some weight. Being so heavy is not good for you.”
All I could say was, “If you would check my records, you’d see that I’m twenty-four pounds lighter than the last time I was here.”
She apologized. I accepted. But I was still pissed off.
I am 6’2" and 260. I was as heavy as 290 some years ago but these days I usually hover around 250. I am active and healthy, but I decided to do a few things to slim down, such as cutting back on alcohol and sweets. I mentioned this to my doctor during my last routine checkup. He offered to refer me to a dietitian and I declined.
Later, when I looked at the doctor’s notes of my visit on my online chart, it said “Reason for Visit: OBESITY.” Fuck you.
Speaking as a physician, really no. This has nothing to do with informed consent.
We have a goal to improve our patients’ health outcomes. For me, dealing with kids, it means preventing adult obesity by intervening early in the process, but the mindset of improved long term health outcomes as the goal is shared across primary care.
Patients (or parents) feeling stigmatized, or judged, or insulted, or “shamed”, does not serve achieving that goal. Neither does ignoring the issue.
What can realistically be accomplished for an obese adult that will give huge long term health benefits is a modest weight loss, like 10%, achieved and maintained long term with a healthy nutrition plan and exercise. What must be noted is that that realistic goal will often result in an individual still having a BMI of over 30 and thus still officially being “obese”. But from a health perspective the individual who is 5’3" and 210 (BMI 37) and the same individual who has lost 24# maintaining it with continued nutritional discipline and regular exercise, now with a BMI of 32, is huge, even though both can be called “obese.” For my side of the world the difference between a child who has been moving up across BMI percentiles consistently from 85% to 92% to 97% to 99% who keeps crossing up into 99.5% vs one who goes back to 97% (while gaining weight, just now slower than height gain) is cause for celebration … even though they are still obese. You identify what has been done right and build on those behaviors. The focus has to be the behaviors. A bit over simplifying but get the behaviors in place and let the scale take care of itself. It likely will but even if it does not major health benefits will be accomplished.
(290# at 6’3" is a BMI of 34 btw and that 10% plus weight loss to 250 - 260 with nutrition changes maintained and exercise plan in place, while still an “obese” over 31 BMI, is similarly cause for trumpets to blare btw. That’s standing ovation shit man!)
Just looking at the scale, calling someone “fat” or “obese” and telling them to lose weight because being fat is bad for you, without listening to the individual, without understanding the context, overtaking the main reason the individual feels they are there, is not going to be of any good and may be of real harm.
If you fail to tell me (as someone who is in fact overweight) when I end up in your office that my weight is unhealthy, may well lead to negative health outcomes, and that I should lose weight. Then that is a failure to keep me fully informed as a patient of the risks and benefits of treatment and the lack of it.
Whatever the statistical mean effect of telling overweight patients that their weight is likely unhealthy and they should lose weight, failing to do so is a breech of trust. I might be one of the outliers who decides “crap I need to lose weight” and does it. You’ve robbed me of that option by not telling me.
Though actually this is a sidetrack to OP. The examples in the OP weren’t individual doctors telling individual patients to lose weight. They were PSAs about the dangers of obesity.
If we’re talking about doctor’s visits, then telling me about my weight is off limits unless I went in for something that’s related to my weight, or it’s a general wellness checkup. It is not relevant when I come in for, say, an upper respiratory infection. And when I’ve said that I have so many problems that I don’t feel I can take on the stress of losing weight, too, I expect them to listen and not bring it up. While I value their advice, ultimately it is my health, and I decide, and badgering me only means I’ll go to someone else. Doctor’s visits make me uncomfortable enough as is, and I don’t need the added stress of people who can’t respect my bodily autonomy.
As for the ads, it depends on what they say and how they say it. I will say that the form the ads took was quite obnoxious. I also note the lack of actual information available in the ad, so it doesn’t seem to really serve any purpose. An ad needs to be actionable. It needs to tell you something to do, not just try to spread info.
I mean, I now know that obesity can increase cancer risk. Okay. That’s not going to make it any easier for me to lose weight. We all already know there are tons of ways obesity can be a problem. Using the big-C as a scare tactic isn’t going to help us in any way.
And getting into fights with the anti-fatshaming crowd isn’t going to win you any favors. You should be trying to ingratiate yourself to the people you feel the need to help, not make them angry. Push a message of “Accept you for who you are, but here’s some stuff you can do for your health.”
For years, I lived right next a major interstate highway. This is a known risk factor for a number of health conditions.
Yet no doctor ever sat me down and talked to me about the risks associated with my unhealthy lifestyle. Even when I was coming to them with strange symptoms.
Should we really expect doctors to be walking relative risk calculators? Do I really need a doctor to tell me I’m at-risk of being victimized by violent crime, since I walk late at night through densely populated urban neighborhoods? And I don’t even wear good walking shoes, which means I’m probably at-risk for some orthopedic condition. Shouldn’t they warn me about this? No doctor has ever scolded me about all the cured meat I eat, even though that too is unhealthy. No doctor has ever informed me that I have a higher risk of reproductive cancers as a childless woman. Shouldn’t they be informing me of this so I can run out and have some babies? Shouldn’t they also be telling me not to go swimming in natural bodies of water right after it rains? I know better than to do that, but my doctor doesn’t know that. Imagine all the danger I could be putting myself into!
My last physical lasted all of 15 minutes, with most of the time being spent with the nurse. There just isn’t a whole lot of time to be lectured to about every single health risk. Doctors focus on obesity because it is the most obvious risk factor. But because it is the most obvious one, patients already know about it. There is no benefit for them to hear the same lecture again.
Yes, that is literally their job. To tell us what factors may be causing the illnesses we are suffering from, what risk factors may cause future illness, and what treatments most like likely cure, reduce or prevent those illness.
And for that reason, failure to mention it to me is a failure in their duty of care, even if they haven’t mentioned solar rays, having a swimming pool, or any other less significant risk factors.
What sort of diet and exercise advice do you recommend if you see someone for weight related issues?
Actually your primary care doctor should be using every visit to cover wellness items. You haven’t had a colonoscopy yet and it is indicated? They ideally should be bringing that up, suggesting it, even though you are there for an upper respiratory infection.
No, “health maintenance” is not off limits during sick visits.
Not saying that the subject is not brought up, but HOW it is brought up. “You are fat and being fat is bad for you. Lose weight.” is not an effective way to bring it up. Not by doctors and as a PSA it is simplistic to the point of being unhelpful. Again, the person who has changed lifestyle, is now exercising regularly and eating healthily, but who is, with 10% weight loss, still in the obese BMI range, is still labelled and called out in this formulation.
Bringing something up after it has been brought up before, in a way that demonstrates that you are not listening to or respecting them, maybe not even reviewing their history, is not the job of a healthcare provider.
Finally let’s be very clear. There is a strong association of obesity with cancer rates that strongly supports avoiding obesity in the first place.That’s the most effective approach most strongly supported by the evidence. How is obesity best prevented? Does pointing out that someone IS fat prevent it? No, it has already occurred. Is a PSA warning of the dangers of obesity prevent it? I doubt it. Focus on the healthy behaviors for everyone and we prevent it best.
I’m in peds so my emphasis may be slightly different that adults. But nothing dramatic. You’ve heard it before.
Avoid added sugar drinks and limit juices to the level of special treats. No soda or Gatorade.
Half of every plate is vegetables and fruits, the other half divided up with a complex carb (like baked potato or brown rice, not white bread) and a protein.
Avoid the highly processed food-like products created by the food industrial complex. They’ve researched the exact right combinations of salty, sweet, and fats that hit the parts of the brain that say eat more/yum hard while hardly hitting the filled up now centers at all. Harder to overeat a bunch of bananas than a bag of Oreos for example.
If you eat quickly slow it down. Give your stomach a chance to tell your brain enough. One approach is to take a serving 1/4th of what you think you want and wait a few minutes before taking another, asking yourself first if you really are still hungry. Don’t stop hungry but don’t eat more if not.
Try to avoid snacking after dinner.
Find something to do for exercise that you will keep up with.
They’ve heard it before too. The conversation is more figuring out what of these things they are not doing and what few changes they can initially commit to. How the family can support it. For many kids the sweet beverage change is of major impact in and of itself.
The emphasis is not the scale (or the BMI number) for its sake but as a sign that there may be behaviors that should be and can be improved upon.
Perhaps the majority of fat people already know that they should lose weight for optimal health and are trying as hard as they can. But that still leaves some people who:
If even 5-10% of people fit into these categories, then it’s worth it from a societal perspective for doctors to remind people whenever possible, including for unrelated visits (after all, visits about obesity won’t even happen for ignorant patients). Sure, ideally your doctor would take your history into account and tune their advice for your particular situation, but with the amount of time doctors tend to have with their patients, that’s probably an unreasonable demand.
Thank you for that. I wasn’t trying to make a big deal of it though. When I realized I was pushing 300 I thought to myself “enough is enough” and made some changes. No fad diets, nothing extreme; just smaller portions and more activity.
~250 has worked OK for me for several years, but lately I’ve caught myself sliding back into some old bad habits, and my knees hurt all the time. So I figure it’s about time to make another effort to drop a few pounds.
I’m not stupid - I know I’m bigger than I should be. But I’m also not interested in living on celery sticks. So I seek a balance of a healthy life and an enjoyable one. I take responsibility for myself, and tsk-tsk-ing over my weight is not the way to get me to change anything.
(By the way, all of my blood work, including cholesterol and blood sugar, came back smack dab in the middle of standard ranges. I do pay attention to those kinds of things.)
The fat-shaming comes from the unspoken, “You wouldn’t be a fucking fatass if you put down the fork once in a while.” Most people equate obesity with a moral weakness and will not even consider other reasons than too many calories. Hell 95% of the people on this board say something similar and to just eat less and exercise more and imply the obesity is your fault for not obeying the law of calories in and calories out.
You’re at significantly increased risk for early death, just because you haven’t had a breakdown yet.
At this weight, just your joints must hurt you to move. You are a perfect example of someone who is legitimately in high risk, regardless of how relatively sexy you look.
This is factually true. No one is exempt from the laws of thermodynamics. An overweight person who claims they don’t eat too much is lying. What isn’t true is we don’t genuinely know how much free will humans have. I only succeeded in weight loss myself, recently, and I did it by taking a drug off label that suppresses appetite. I could not do it without the pharmaceutical assistance. Before that point I tried for a couple years and only lost 10 lbs.
I think it just comes down to different things work for different people. Years ago I lived with my grandfather and he made fun of me for being fat and even challenged me to eat more, like finish leftover French fries for example. It’s just the time the guy grew up in, I think deep down he wanted me to lose weight but being a prick and reverse psychology was the only way he knew how to try and help me.
I did start losing weight after a few months of the prodding, I lost 60 pounds in 6 months, mostly because I wanted to prove to him I could do it, it was an anger diet of sorts. That’s been many years ago and I’ve gained weight since but I’ve never gotten as fat as I was during that time.
I guess his anti-motivation worked for me at that specific time in my life, not everything works for every type of person though.