Discuss

There is enough here to offend just about everyone.

I’m seeing a few things here:

(1) Docs are inadequately trained in the area of nutrition. This is not a new fact.
(2) Docs largely have no idea how to address this issue in their patients. It’s easy enough to deal with matters such as cancer, asthma, and other medical conditions that are not often tied to behavior. But confronting obesity–which, with some exception, is a condition that is tied to behavior–usually means confronting lifestyle. No one likes to be told they are responsible for their condition.
(3) Many docs are harder on women than men, even though obesity stats are pretty much even between the sexes.
(4) Many women will be offended, no matter how the doc tries to address the (almost literal) 900 pound elephant in the room.

Author: Amir on July 1, 2011
Category: Health, Medical/Science
10 responses to “Discuss”
  1. ReconsDad says:

    My experience on this: the men don’t usually complain when they are told about their weight. In fact, the men will usually acknowledge their shortcomings here. (Whether they actually DO anything about it, that’s a different matter, but I’ve not seen a lot of excuse-making from the men.)

    OTOH, half of the women I have dealt with will make excuses, as if to suggest that it’s not their fault and therefore they don’t plan on dealing with the matter.

    While there are people–of both sexes–that medically cannot, for whatever reason, control their weight, I find it hard to believe that all, or even half for that matter, of the gravitationally-challenged are in that camp.

  2. Professor Hale says:

    1. How about we start this off with stating that weight, even obesity is not a medical problem? It is certainly not a public health issue and it is barely a private health issue. There is no reason doctors should be knowledgeble about this or about nutrition except in diagnosing and treating malnutrition.

    2. People go to doctors to get treatment for health problems, not to get advice on optimizing their physical performance, that’s what personal trainers are for and they don’t take medicare. If it ain’t broken, what are you going to a doctor for? The answer is that many fat people would like for their doctor to let them off the hook for overeating and undermoving by telling them that there is a medical reason why they are rotund and prescribing a daily pill to set things right.

    There is no silver bullet for fat. Eat less. Move more. If you have a broken bone, severe pain, or bleeding from an unexpected orifice, see your doctor. But stop expecting doctors to magically re-adjust your internal unique chemistry to make you skinny while you eat what you want.

    CLUE: Eating well is not a public health issue. Mass starvation is.

  3. ReconsDad says:

    @Professor Hale

    1. How about we start this off with stating that weight, even obesity is not a medical problem?

    Depends on what you mean by that. If by that you are suggesting that it is a matter that–with few exceptions–is largely the result of one’s lifestyle choice, then I agree.

    If by that you mean that obesity does not have medical consequences, then I’m not in agreement.

    It is certainly not a public health issue

    Agreed. This is not a place of government to meddle in our lives.

    and it is barely a private health issue.

    It’s enough of one that it merits frank doctor-patient discussions. But yeah, this is not a public health matter. After all, obesity is not a communicable disease like the flu.

    There is no reason doctors should be knowledgeble about this or about nutrition except in diagnosing and treating malnutrition.

    No agreement here. Physicians ought to know enough about nutrition to be able to speak intelligently to how certain regimens–combined with lifestyle factors–may impact a person’s health.

    One need not know how to fine-tune the diet of an Ironman triathlete–that’s a specialist’s duty, if one feels the need for that level of micro-management–but a doc ought to know how to deal with reasonable diet/exercise/activity factors, especially as they relate to other medical conditions.

    2. People go to doctors to get treatment for health problems, not to get advice on optimizing their physical performance, that’s what personal trainers are for and they don’t take medicare.

    Agreed. I’m not so much thinking in terms of optimizing performance; I’m thinking in terms of a doc helping a patient–with a family history of heart disease or diabetes–minimize his or her risks, which include getting one’s weight down.

    If it ain’t broken, what are you going to a doctor for? The answer is that many fat people would like for their doctor to let them off the hook for overeating and undermoving by telling them that there is a medical reason why they are rotund and prescribing a daily pill to set things right.

    That would be the case if obesity were not a precursor of a host of other matters, such as diabetes or heart disease. If you’re obese at age 20–and you have a family history of diabetes–then dealing with the matter now will prevent things from being broken later, and at little cost to you.

    My dad had an “if it ain’t broke…” relationship with his docs up until he was 36. They never got onto him about his diet or exercise regimen, let alone his weight (which had ballooned pretty badly.) He worked in the hotel/restaurant industry, ate and drank freely, worked long hours, exercised little. He had a heart attack out of nowhere in 1980. Eventually, he got serious about health and fitness. Today, he’s a marathoner with body fat at about 5%, and cholesterol well under 200.

    There is no silver bullet for fat. Eat less. Move more. If you have a broken bone, severe pain, or bleeding from an unexpected orifice, see your doctor. But stop expecting doctors to magically re-adjust your internal unique chemistry to make you skinny while you eat what you want.

    Agreed. Not only is there no silver bullet for fat; it is not reasonable to expect one–that doesn’t have side effects that carry more risks than obesity itself–in the foreseeable future. A doc can help an obese person as he or she adjusts diet and activity, but those adjustments are necessary for long-term weight control.

    CLUE: Eating well is not a public health issue. Mass starvation is.

    Agreed.

  4. Professor Hale says:

    Agreed. I’m not so much thinking in terms of optimizing performance; I’m thinking in terms of a doc helping a patient

    It is because of sentiments like this that doctors feel empowered to ask about your drinking habits, gun ownership, life vest wearing, bicycle helmet wearing and other nanny-state for-your-own-good intrusiveness.

    Doctors should limit their nowledge of nutrition to just being able to identify poisons and allergic responses. You don’t need X years of medical school to know that eating less makes you thinner, drinking more alcohol makes you drunk, and not coming up for air often enough makes you drown.

  5. ReconsDad says:

    @Professor Hale
    The problem is that, if a patient has a family history of diabetes–or, worse, has diabetes–then there is an obligation on the part of the doctor to advise the patient about mitigating his or her risks. In the case of diabetes, that means (a) getting the weight down and (b) controlling blood sugar. It’s kind of hard to do both without a functional knowledge of nutrition.

    If the patient has found weight control to be elusive–and this is harder for some than for others–then a doc can recommend activity levels and a nutritional regimen that have a better chance than what has already been tried.

    If the patient wishes to live an unhealthy lifestyle, then that is the choice of the patient.

    I’ll give you an example…

    Let’s say John Doe is obese and is starting to show blood sugar issues. Let’s say JD walks 2 miles a day (does little or no strength work), works a sedentary job, and eats what he thinks is a balanced diet. He doesn’t go hog-wild at the Golden Corral anymore, but his activity level is not commensurate with his diet. Moreover, he’s eating too many simple carbs, and that is contributing to his blood sugar issues. He’s frustrated because–in spite of changes he has made, his weight is still going up.

    Now if I’m the doc, I can just take a general “how often do you exercise?” approach, and get an affirmative, “Every day, doc!” Or I can ask him, “What do you do for strength and cardio?”

    If I have better information, I can recommend to him, “John…I recommend a full hour of cardio. You might consider a spin class at the YMCA, or an hour on the elliptical. You might also get with one of their trainers and get a strength regimen 3 times a week.”

    And with the nutrition, it would be a matter of due diligence to caution him about simple carbs versus complex carbs. A doughnut has about the same calorie value as a whole grain bagel, but the latter gives better blood sugar control than the former.

    As for life vests, guns, and bicycle (or even motorcycle) helmets–or whether I like to wrestle alligators or go skydiving or even base jumping–those are irrelevant, even if the ACLU thinks otherwise.

    Now if I show up with a broken leg–or with an arm missing–the doc is right to ask how it happened. It is also my right to say, “I could tell you, but then I’d have to kill you.”

  6. Cubbie says:

    Amir, we ought to try to get Da Sis to guest-post on this topic… even though her specialty isn’t in nutrition, she should certainly know a good bit about it.

  7. Rev. Russ Westbrook says:

    I grew up in a home that was hyper concious about MY weight; my mother has always been on the plump side, but she harped on me incessently. It was distructive and horrible; it made me extrememly self-concious, and caused me to be awkward around people, because I was embarrassed about being (in reality, only a bit) overweight. Being fat may have to do with lifestyle; however, its not usually connected to moral standing. Today I really resent all the pain that was inflicted on me back in the day over that sort of thing, and kick up mightilly when someone else (or myself) is condemend over appearance. Now, wether a person wanted to DATE me would be up to them- there’s no accounting for taste, and we all know what we like- but wether they saw me as “weak willed” or “non-compliant” or “lazy” because of my appearance I might take a might personal………….

  8. ame says:

    Russ – i grew up hyper-sensitive to my appearance b/c of how my dad abused me and how he ‘looked’ at women, including myself. it’s a miracle, truly, that i did not become anorexic or bulemic. however, i did live for many, many years knowing every bite i put into my body and stressing over it … and i would weigh myself multiple times every day – perhaps ten or so times a day.

    i am very careful how i approach weight with my daughters. i concentrate on health and healthy eating and balance rather than weight. i doubt either knows their clothing size. one of my daughters has a body type that has ‘grown’ and ‘shrunk’ every other year with adolesence. i am careful about how i approach that. my other daughter takes meds that have caused her to gain some weight. i would not consider either of my girls overweight, but neither are ‘thin,’ either. i want them to view their bodies in light of “this is how God made me” rather than “i need to look like *her*” … or “i need to be a certain size.”

    i am still hypersensitive about my body b/c of things my dad did, and especially because of how he looked me over all the time and how he talked about women’s bodies.

    ***

    “but wether they saw me as “weak willed” or “non-compliant” or “lazy” because of my appearance I might take a might personal………….”

    i would say that most people who have a weight “problem” have an underlying problem that is the cause. the weight is not the cause, it is the symptom. what is challenging in this society is defining what weight is a “problem” and what is not. as a mom of two daughters, i strive to train them NOT to think about their bodies and weight all the time. i want them to be healthy and balanced, but i do not want them to be anorexic or bulemic or stressed about clothing size.

  9. ame says:

    ok … i had time to read the article.

    the reality is that bias’s exist … all over the place. weight, whether thin or overweight, creates bias. i had a few bad experiences with physicians when i was thin.

    i’ve found that there are some health issues i have that i thought were the result of certain things, and now that those things no longer exist the health issues remain. so everyone was wrong – me, the physicians.

    there are those who abuse their bodies and live for forever, it seems. there are those who take incredible care of their bodies and die young. somewhere in there is a balance. we have marginal control over so many things. depending on a plethora of factors, we may or may not have as much control over our health and length of life as we desire or think we do.

    sometimes we take more credit than we should; other times we don’t take enough responsibility. it’s about balance. i think becoming a mom taught me this more than anything. there are many things i can control with my girls, but there are also many more things i cannot. there are many things i can teach them, there are many ways i can guide them. but they are each individuals with their own personalities and their own ‘bent,’ and they get to make their own choices in this life. and this is the truth i try to instill into each of them.

    i can do my best to take care of my body, but i cannot guarantee the outcome. society has always been harsh and judgemental; that will not end till Jesus returns.

  10. ReconsDad says:

    @Rev. Russ Westbrook
    There are a couple of issues that are in conflict here:

    (1) the fact that many people endure no small amount of harassment over the issue of weight;

    (2) the fact that–at some point–weight is a legitimate medical issue that may require attention, in particular when (a) there are health issues involved (i.e. diabetes, heart disease, gout), or (b) when a person seeks to embark on an exercise/dietary regimen and may need medical advice about that choice.

    If I’m a doc and I have a patient who is clearly obese and is showing evidence of health problems that can be alleviated by weight loss, then it is my responsibility to raise the issue, no matter how unpleasant it is.

    If I’m a doc and a patient who is seeking to embark on a dietary regimen tells me of it, then it is on me to either (a) advise that patient about advantages and disadvantages to that approach, and/or (b) refer the patient to someone who knows this–such as a nutritionist–who is better-qualified in such matters.

    Example 1: if you are obese and have been determined to have Type 2 diabetes, then you can bet your bottom dollar that any doc worth their license will be advising you to get your weight down. Why? While correlation is not causation, we do know that weight loss almost always allows such a one to control–if not eliminate altogether–the diabetes.

    Example 2: Let’s say I am your doc, and you tell me you are seeking to lose weight by embarking on a vegetarian diet. That sounds safe, right? Well…it can be, but it’s not foolproof. Making sure you get enough protein, iron, and vitamin B-12 can be challenging. A doc can advise the patient about those issues, and perhaps refer the patient to a nutritionist–perhaps even one who is a vegetarian–for more detailed feedback.

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