Sort of a special case. Wrestled in high school and I was a real lightweight. Skin and bones. We had to walk past a doctor and get weighed at the start of the season. (They didn’t want anyone going too low. It was thought that weighing as little as possible was an advantage up to a point. Not sure about that.)
I was told to lose a couple pounds to drop down to the next weight class. The coach wanted me to drop even more to go down to a still lower class.
Keep in mind I was at least 10, maybe 20 pounds under the average weight for my height.
Well, it was a doctor and he told me to lose weight.
Accepting that docs sometimes (oftentimes?) don’t have the best skills/tools to bring up the subjects and are sometimes offbase in their assessments, do the TMs believe
-that a doctor who was correctly assessing a patient to be overweight if not obese should identify that health risk factor to a patient or not?
-at what point do you feel such should be brought up? Only when the information is requested? (The MD is a technician only mentality.) Or proactively? When clinically obese or prior to the adiposity becoming as difficult of a problem to address?
-If you think it should be brought up, in what way should it be brought up?
I think it should be brought up if a weight problem is enough to potentially cause problems (and especially if problems exacerbated by weight are already in existence).
I think that conversations about weight should be just as technical and personal-opinion free as every other medical problem. I don’t want my Gyn telling me all the facts and figures about having PCOS and then go on a rant about how fat people get it the worst and it’s so important for me to lose weight or it’ll never get better (especially when the only 2 other people I know personally who have PCOS are NOT overweight and never have been). Just give me the facts and leave it at that.
I don’t think the subject should be broached any differently than any other medical issue. I go to my doctor so he can tell me what to do to keep myself healthy (or get myself healthy). Therefore, I expect him to tell me everything that needs to be addressed.
I think my neurologist handled it perfectly. He basically said,
“You have pseudotumor cerebri. You might need to get off the birth control at some point because it can make it worse. You may need a spinal tap at some point to find out your CSF level and sometimes the spinal tap actually makes the symptoms a lot better. You should try to lose weight because it might make it better and it definitely wont make it worse. I’m not super worried about your weight because it usually only makes it worse when the excess weight is greater than yours. But, losing any weight will be good for your general well-being even if it doesn’t help the headaches so it’s not like you have anything to lose. In the meantime, keep taking your diuretic twice a day and call me immediately if the headaches start getting bad again.”
He treated me as an intelligent person who has researched my condition and who isn’t unaware of my excess weight. I appreciated that. I felt like he was talking TO me, not down to me. I also felt like he wasn’t on a personal mission to abolish fatness.
Why does that make your doctor an idiot? Most kids do gain weight their first year of college, and it’s because of the dorm cafeteria food (and pizza and beer). Your doctor was warning you to watch out for weight gain, as he would tell most any kid. You seem to have heeded his advice and then some. Yay you, idiot doctor?
As for me I’ve always been fat. Like, 100lbs or more overweight. I actually don’t get lectured much - probably because I was a smoker since before I left my pediatrician. I haven’t had many issues that could be solely from weight and not smoking.
My BP and cholesterol were fine, until I got into my late 20s then they became not fine and then I got more shit about smoking.
Then I quit smoking and gained a little weight, and then they were like “ok, stop gaining weight” and I agreed.
I did get a lecture from a surgeon once, who got rid of an infected sweat gland in my armpit. If you look at my skin it’s just horrible, awful skin. It’s sensitive, it breaks out in weird ways. I learned later that there’s actually a name for the condition I have that causes my sweat glands to get infected like that - I had the other arm done some 15 years later. But according to the first surgeon, my problem was that I was fat.
I had a doctor encourage me to lose weight. I had lost about 10 kg, and she advised about 3-4 more, which would have been about right. She was pretty good about it, in that it was a recommendation and wasn’t talking down to me.
I was in college at the time. I was about 143-145 lbs and 5’7". Not skinny, but far from fat. The nurse who examined me told me I needed to lose 5 lbs. Since no one had ever uttered those words to me before, I was horrifed.
But I guess it wasn’t all bad. Her words motivated me to watch my diet and exercise more. I was ten lbs lighter when I started graduate school two years later.
I think nurses are the worst. I’m about 6’1"-6’2" and at my highest weight I was 225 or so. No doctor has ever said anything to me, even though I know I’m at least a bit over. Even friends say that I can’t be fat because I don’t look it as all the fat grows on my torso. Almost every nurse I’ve gone to see has said I need to lose weight. I think it’s some sort of little spiel they have learned in school or something.
The thing is, beyond the fat thing, I’m actually really healthy. My blood pressure’s great, my cholesterol is all within acceptable levels, yadda yadda. So i think they see all that and figure I exercise. Which I do. And eat healthy. Which I also do.
Much of the hoopla about “obesity” such as the BMI is bogus. (and in fact Bullshit covered this and so have several books like “The Great Fat Fraud”. Quite a few professional althetes rate as “obese”.
If your BP and cholesterol are fine, you can go up 2-3 flights of stairs with no problems, and you are active (20 min of rigorous exercise or 30+ minutes of walking, 5X a week), then absolute weight is not much of a problem.
Sure, if you’re like 100# overweight, then you really do have problems, but it’s likely your BP, cholesterol , and active ability aren’t there either.
By far and away smoking is many times worse than weight gain. A ex-smoker usually gains 5#, which is nothing but even if you gained 10 or 20, the trade off between that and smoking would be like on a order of magnitude.
I was a kid and it was a military doctor, so no option to switch. He put me on a 1200 calorie a day diet and had a meeting with my folks (this was the 70’s and doctors were still gods). He wanted me down to 125, so I dieted at 1200 calories a day for about six months; in that time I hit 5’10" and stopped having periods. After that the doc “washed his hands of it” and sent me to a GYN, who promptly stopped the idiotic diet.
For what it’s worth, I have no problem having a discussion about weight before I get fat. But, in my opinion, other than asking the parents, “Does your child eat a varied diet?” at some point, the doctor needs to address the kid directly and talk about why a healthy diet is important. When I was younger, even up until the point I saw a gynocologist on my own at 16, my family doctor never talked to me about nutrition, except ridiculous sayings about butter, bread and jam that I didn’t get. My family wasn’t a good source of information because half of them were anorexic models (my mom’s sister’s family); the other half were overweight or obese (my mom and dad). My mom wanted me to emulate my cousin and constantly commented on what I ate while at the same time keeping little more than Dinty More chicken & dumplings and chips in the house. I used to eat hot dog buns with chocolate chips for breakfast, for God’s sake, and she was ok with that.
I’ve discussed healthy vs. unhealthy foods with my son for a couple of years now. He’s 6. Weight has never come up in the conversation, but I’ve let him know that certain foods make your body work better than others and if you eat too much of the bad foods, running, jumping and playing might be harder.
My doctor and I discuss my weight every year at my physical. We both know I am over. We both know I am doing what I can. She is happy when I keep my weight in the same ballpark year over year. If I lose some, that’s good, too.
She does try to get me to exercise more regardless of weight. She even helped me come up with creative ways to do so.
I have been 20-30 pounds over for the last 8 years so I guess 20 pounds is the lowest I get the discussion.
(Did I mention my doctor is awesome? It’s so nice to see the same person all the time. And she even laughs at my jokes.)
5’2 and was 118 pounds and the female obgyn told me to watch it (because I had gained). She was right, but the sad thing is she refused to think it could be for some other reason that WASN’T overeating. She wouldn’t order tests so I gave up, gained ten more pounds, and am still trying to get it off. I hateeeeeee my body and the fact that the doc didn’t believe me when I talked about my sudden weight gain (without increase in calories) has made me weary to try another doc. Plus it’s expensive. So when I have health insurance again, I’ll try. At least it’ll be cheaper.
Even though I was overweight, my doctor has never said anything until my glucose tested high (for several years, evidently; there were two doctors, one of whom was quick to note such things). I put myself on a diet and have lost 15 pounds since April.
I used to get it a lot before BMI became the standard. The old height/weight tables used to end with one number for 6’ and over. ISTR that it was 180#. I’m 6’5" Doc, do you have any freaking idea how emaciated a 6’5" male would be at 180#? I spent my teenage years pedaling a heavy, inefficient bicycle loaded with newspapers about 6 miles every single day. I had thighs not unlikeEric Heiden in his prime. I was 15 lbs over that weight when I finished college with hardly an ounce of fat on me.
I got up to nearly 300# before I started having to dread “the talk”. I am now on my bike every day again (missed 2 days in the last 3 months, including trips and weekends!) and have dropped about 50#. This puts me at the overweight/obese boundry in BMI conventions. I didn’t get “the talk” when I had the doc look at an ear issue last week. Yeah!
I’ve never had my doctor bring it up himself. I’ve mentioned on here a few times I used to be overweight and lost 65 lbs, when I’d go in for physicals one of the first things I’d be asked was “so is there anything going on with you medically?” and I’d always say “well aside from being overweight, nothing I can think of.” I also had some elevated BP at the time, so the doctor would just sort of acknowledge that yeah, I was overweight, and mention that if I could lose even 20 lb it could move me out of hypertensive levels and get me off the BP medication.
I dunno if he would have brought it up himself if I didn’t normally mention it at the beginning of the exam.
I’ve had doctors tell me that I needed to lose weight when I was about 10 pounds overweight (as an adult). Why yes, doctor, I HAVE gained two pounds since the last time I saw you…but my complaint isn’t about my weight, and gaining or losing weight isn’t going to affect my problem.
Now, short people have less room to gain weight than taller people, and an extra five or ten pounds on someone my height (five foot nothing) will look as bad as fifteen or twenty pounds on someone who is half a foot taller. But if I’m coming to see a doctor about migraines, I want help with my migraines. I don’t need a lecture on my weight, especially if the doctor NEVER ADDRESSES OR TREATS my migraine problem.
I think the biggest problem is just that. The asshole doctors who lecture you about your weight. The doctors who say, “let’s form a plan you can stick to that will get you to a healthy weight” are fine. They also need to actually look at their patients and not just at the BMI charts.