My doctor informed me that I’d be more healthy and live longer if I stopped smoking.
He added an anecdote about how the ladies would appreciate not “kissing an ashtray”.
So I’m suing the motherfucker.
Don’t we need to know the context before we decide if she’s allowed to be offended?
Doc, help, I’ve got watery itchy eyes and a runny nose!
Well, you’re very fat and boys won’t wanna kiss you…
Sure, discussions of what constitutes a healthy lifestlye are all well and good, I expect my doctor to tell me to exercise and eat right and not smoke and take vitamins and get enough sleep, etc. But there are a lot of instances where the complaints of fat patients aren’t heard, there are doctors who’s answer to any complaint is ‘just lose weight’ without actually treating the patient.
My sister suffered from kidney stones and gallstones thru her first pregnancy. Since she was considerably overweight, her OB refused to even acknowledge there could be a cause for the pain attacks. She was told repeatedly that since she was heavy, her internal organs were already squished together and that the growing baby was putting pressure in an already full abdomen and that she would just have to suck it up. When she wound up having emergency surgery 2 weeks postpartum to remove the gallbladder and bust up the kidney stones to passable size, her doctor stiffly maintained that her weight would have made diagnosing her impossible anyway.
Doc, I’ve got back pain and shortness of breath = let’s talk about your weight.
Doc, I’ve got a painful ingrown toenail should not get the same response.
My HMO asks me about tobacco use every time I go in. I don’t think that there is any way that my allergic dermatitis could be caused by tobacco use, but they ask anyway. Right after they ask about drug allergies. Then the nice nurse always compliments me on my lack of tobacco use. They also take my weight every time I go in as well as my resting heart rate, resp. rate, and blood pressure. Then the nice nurse gets worried and takes my blood pressure again to make sure she didn’t mess up the first time and then relaxes and compliments me on my good vitals. I assume that if any of these values were not healthy, that they would say something more along the lines of ‘you really should quit chewing tobacco’ or ‘you could lose 15 pounds to get your blood pressure down a bit’ Sure, none of that has anything to do with the blisters on my legs, but they are treating the whole person, not just the complaint. A sore throat got me a course of Accutane because the nice PA gave me a referral to a dermatologist that would trust me enough to treat my acne and explained to me that my HMO covered the $500 a month for the Rx and all the blood tests. I never would have gone to the doctor and said ‘doctor I have acne’ because I had tried that for a decade or so with no improvement in the condition. Was I offended? A little, but then I realized that medical professionals who care about their patients treat the patient, not the complaint.
This is quite probably true, I know that when I worked for a vet, we diagnosed these things by palpation, which you can’t do through a thick fat layer. IIRC, they discourage excessive radiography for pregnant women, so how were they supposed to diagnose the problem? Perhaps a real doctor could weigh in as IANAD.
Well, one problem is that most doctors don’t know much about weight. Other than “that’s too much” most of them haven’t a clue. My experience has been that I have insulin resistance, which means that my body overproduces insulin. I take a medication that is used for diabetes for it. Lowering my insulin with this medication allowed me to lose weight through diet and exercise. Some experts estimate that at least 10% of the population has insulin resistance. Ok, here’s the kicker–out of all the MDs I have seen at various times (probably about 20 for various problems. plus I have moved twice and had to get new doctors), I have met exactly two who have even heard of this syndrome. Two. It might affect millions of people, people who could be helped to lose weight, and the mainstream medical community has never heard of it.
MDs have traditionally been taught next to nothing about how to help people with weight loss. fluiddruid’s experience sounds totally typical to me.
BTW, those of you with PCOS should look into this. It is much more common in women with PCOS. Email me if you like.
Cite please.
That depends. If the ingrown toenail is particularly painful and isn’t responding to normal treatment, AND the patient is well overweight, the doctor is justified in discussing weight and Type II diabetes (as well as how weight affects the diabetes and the way that the diabetes affects healing and foot & leg health).
Lord Ashtar Cites regarding physicians’ lack of education regarding nutrition:
“Why has obesity been a blind spot for American medicine until recent years? Our medical schools are based on allopathy, the use of drugs and surgery to treat disease. Prevention and nutrition have only recently been introduced into the curriculum of a minority of American medical schools” and "Most American physicians today ignore the problem of obesity. They will treat patients for high blood pressure, high cholesterol or diabetes with drugs, without addressing the underlying nutritional etiology of these diseases. When asked why this is so, they respond with the following :
I don’t have the time
Nothing works anyway
I am paid to see my patients for diseases
I don’t know much about obesity
Even if they lose weight, they will regain the weight "
both from http://www.cellinteractive.com/ucla/nutrition_101/phys_lect5.html
“Doctors, however, have traditionally received little if any nutrition training during their medical education, residency training, or time in actual practice (Committee on Nutrition in Medical Education, 1985).” from here:
www.beyondveg.com/novick-j/nutrition-education/physicians-2.shtml
"However, GPs’ perception that they lack nutrition knowledge appears to be well founded. When tested for nutritional knowledge, rural GPs scored poorly 9. In an inter-professional comparative survey, GP nutritional knowledge scores were low in comparison to dietitians and even naturopathic students, whilst medical students scored very poorly indeed (table 5 ref: 8) from here:
http://www.arborcom.com/test/frame/oz_nut.htm
"However, despite these recommendations, the status of nutrition education in U.S. medical schools has remained mostly unchanged over the past 30 years. In 1976, approximately one out of every five (19%) U.S. medical schools required a separate course in nutrition. By 1981, the number of schools that required a separate nutrition course increased to one out of every four (26%)6. Most U.S. medical schools now report that nutrition in integrated into other courses in the curriculum and two-thirds of all schools provide an elective course in nutrition. "
from here:
http://www.uth.tmc.edu/nutrition/history.htm
Not to mention my experience, which you ignored. I have a serious medical condition that is very related to weight gain. Many, many people have it and don’t know it. Most doctors seem to be clueless about it, although my endocrinologist says the syndrome has been in the literature for 10 years. If more physicians knew about it, they could properly diagnose and counsel those who have it. They don’t, so they just say “Hey, you need to lose weight.”
IF the patient actually has diabetes. Not all overweight people are diabetic.
I got to think you’ve have some reading comprehension issues that need to be addressed. I explained in some detail that “willpower” was certainly required, but to think that “willpower” is the main issue for people with serious appetite control problems, and that overeating (or smoking for that matter) is really just a matter of summoning the right amount of “sustained willpower” is willful ignorance.
Physical and emotional habits that wind themselves into your life and brain chemistry need to be unwound, and strategies for successfully doing this are a lot more involved than “just saying no” to more food. To get to the point that you can say “no” you need to be able to say “yes” to something else, and constructing that behavioral context in a modern society filled with cheap, calorie dense food, is more a complex psychological and physical strategy and tactics problem than a binary eat /don’t eat “willpower” problem.
I don’t control my appetite through summoning some level of “sustained willpower”. That’s almost always a stupid and unsuccessful way to diet.
My appetite is manged by making sure (via lots of background effort and preparation) ) I’ve got lots of filling, healthy alternatives. They only times I have to "gut it out " is when I’m hungry and stuck in a place with no healthy food and the only nutrition options are bad ones. I try to make sure these times are quite rare.
Your comic book simple notions of the way long term, ingrained addictive, behaviors can be successfully dealt with would be humorous if they weren’t so pernicious. I don’t smoke, and I don’t drink to excess, but I grew up around people that did, and these behaviors were as tightly wound to their lives as my over active appetite is to mine. There are people who can quit various behaviors cold, but for the vast majority of people behaviors of this type need both willpower and comprehensive management, not sneering admonitions to just “put the fork down”.
True. But not everyone who has it knows they have it. And those who recognize symptoms often play it off because they don’t want to face facts. I’m just saying that a doctor with a patient who’s having healing problems with their feet and is overweight has a legitimate reason to bring up the weight in relation to the ingrown nail. Even if the patient hasn’t been diagnosed with diabetes yet, you want to look at that symptom and maybe get some testing done just in case.
I was wondering how long it would take for this thread to turn into a combination of overweight-apologetics and flaming of those too body-insensitive to realize that all people are beautiful and on and on and whatever.
No one disputes that a certain percentage of those who are overweight are that way because of genetics or conditions that are not best treated by diet/exercise modification.
But that does not change the fact that being overweigh is unhealthy.
If your doctor is not addressing the correct cause of your size, that doesn’t mean it’s OK to be that size, it means it’s time to go to a specialist.
It doesn’t mater what congenital issue you have as far as your ligaments and joints are concerned.
And it doesn’t even matter what congenital issue you have to the random member of your preferred sex on the street who doesn’t look twice at you because you look like you’re shilling for Kool-Aid in that red jacket of yours.
Being overweight is not good for you.
I don’t participate in those threads and I try not to join in the North American female obsession with food and diets and talking about same because obsessing about food and diets and losing weight isn’t any healthier than ignoring your diet and weight.
What does hypoglycemia and polycystic ovaries have to do with the calorie intake vs. metabolic burn equation?
People grasp at any excuse for being fat. Why can’t they just admit they eat too much and/or do not get enough exercise?
Uh, because they are related.
http://www.aafp.org/afp/20010315/1159.html
High insulin levels affect blood sugar. Blood sugar affects appetite. When my blood sugar and insulin were at abnormal levels, I would get “I am going to kill you” hungry. It was hard to diet when I was that miserable. Once my insulin was at a more normal level, I was able to get just normally hungry, which I could tolerate. That allowed me to diet and exercise, to the tune of a significant weight loss.
You can’t imagine how frustrating it is to understand this, and have people who don’t constantly criticize and oversimplify.
And one more for you, Crafter Man, just because you have pissed me off:
"Weight gain. Many women with PCOS experience weight gain, have a high hip to waist ratio (“apple” rather than “pear” shape), and have more than normal difficulty losing weight. " From the Medical College of Wisconsin, by the way, at this site:
http://healthlink.mcw.edu/article/964648419.html
Seriously, I am so tired of this “oh, losing weight is easy and you guys are a bunch of pussies” shit. From my other cite, you can learn that the author of that article estimates that 70 to 80 million people have insulin resistance, which is the thing that makes weight loss difficult. So it isn’t just a few of us.
Oh, and one more thing–above I made the claim that most doctors don’t know much about weight loss. This syndrome that 70 to 80 million of us are estimated to have? That I have? Read what I said about the doctors I have seen. Surgeons, family physicians, etc–at least 20 of them who were clueless when I said I have insulin resistance. Had no idea what it was, until I explained it to them. Don’t tell me that most doctors know crap about weight loss.
I have no idea what underlying story there may or may not be with this doctor and patient.
Certainly there are good and bad ways to address patients’ weight problems.
My classic example is an ER doc with whom I did an emergency med rotation. His succinct comment to a morbidly obese woman (who came in with an unrelated complaint): “You need to eat less.”
Just a real warm and fuzzy guy.
I used to feel hungry much of the time, too. When I was fat. I’m sure I could have invented some medical excuses on why I craved food so much, but I didn’t… I instead decided to impliment a strict diet and exercise program. That was 10 years ago. The weight came off, and it’s still off.
Like I said, people grasp at any excuse for being fat.
Not really. If you want to loose weight, you need to make yourself eat less and excercise more. You do this by using willpower. People can give any number of excuses about how difficult it is, but ultimately there’s nothing physically making them eat as much as they do, and (except in the case of the physically disabled) lead sedentary lives–they eat what they do and live as they do because they choose to do so.
Yup. You need to use willpower to make yourself do all these things.
Yup, it ain’t easy.
Bullshit. Willpower is what it ultimately boils down to. Everyone knows how to lose weight, yet very few people do what is necessary to do so. Because it’s hard, and they don’t will themselves to do it. I used to be quite the porker (215 lbs, 5’7"), until I… Started excercising and watching what I ate. It was very difficult, especially because I had to eliminate strongly engrained old habits and add some new ones. But I lost about 50 lbs and have consistenly kept it off for 5 years. I did it by making myself change, not by whining about how my apettite was a deeply engrained part of my brain, etc.
Oops. My bad. I forgot you can’t read big words, so of course you didn’t read any of my links. Or my post, apparently.
It isn’t possible to “invent” blood insulin levels. Mine were 5 times normal. At that time, when I was hungry, I was miserably hungry. Not normal hungry. I know this because when I took medication to normalize my insulin levels, I got hungry like normal people do. That hunger I tolerated (oops, put up with) and lost weight through diet and exercise. What part of that is an excuse?
Many, many people have high insulin levels and don’t know it. For them, it is very hard to tolerate the miserable hunger that they experience. If you didn’t have high insulin levels, you don’t know what it feels like.