Obese Med Students

[gostudy]

Why can't people accept the fact that by and large people are fat because they choose to be fat. It's not complicated.

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[Hodad]

I'm not saying that every fat person is healthy, I am saying that some fat people are healthy. If a patient has normal cholesterol, normal blood pressure, normal blood sugar, normal heart rate, exercises regularly, eats well, and happens to be fat ... then they are a healthy fat person. There are healthy fat people just as there are unhealthy thin people. I agree that there's generally a higher likelihood that someone who is fat is unhealthy (since being fat is a risk factor for various illnesses), but I don't consider someone who is fat to be automatically ill.

To say that a fat person can be healthy today is to lose the entire scope of what preventive medicine is all about: prevention. It is a fact that the healthy fat person of today is much more likely to become unhealthy tomorrow when compared to the average-weighing healthy person of today. Therefore, it is pretty much to betray the patient, and I would consider it an irresponsible practice in today's world to not actively encourage your fat patients to lose weight.

Because one is a doctor and the other is a patient! When someone complains that their doctor is fat and they won't go to them, they aren't talking about the doctor's health. They are talking about their doctor's looks. Their doctor's personal health is none of their business. A doctor-patient relationship is not symmetrical. When that doctor goes to his own doctor and discusses his weight, then it's an issue of his health, because then he's the patient.

How should it not be an issue of health? I remember a quote adscribed to Hippocrates, that stated that a physician that couldn't look after his own health was not fit to care for the health of others. A fat doctor, just like a chain smoking and an alcoholic doctor has a serious credibility problem.

How can a fat doctor who knows for a fact that this fat they carry around be a toll on their future health ask a fat patient to lose weight? I was quite overweight, and I decided to lose weight when I started medschool because I realised I wouldn't be able to look another person in the face and tell them that they had to lose weight if I couldn't make the effort to be healthy myself. In any case, this is the way I see it. I wouldn't be able to take a fat doctor telling me to lose weight seriously, just like I couldn't take a chain smoking doctor telling me to quit smoking seriously. Or a happily alcoholic doctor telling me to moderate my drink seriously. I adhere to that thought.

As to the health of the doctor not being the business of anyone, how so? Health is the most precious object a living human being has, and if I'm thinking as a patient, I want a doctor who believes in the medicine he preaches. A fat doctor either doesn't believe in the medicine he preaches (you need to lose weight, man!) or is down and out preaching the wrong medicine (You're fat but healthy. Enjoy your cheeseburger).

Why can't people accept the fact that by and large people are fat because they choose to be fat. It's not complicated.

People that are fat by choice should also be required to pay for the additional economic burden they are on the health system. It's only fair. That is my general take on the whole thing. The State should only ever cater to those who are willing to cater for themselves. If you choose to be fat, you choose to be unhealthy. In choosing to be unhealthy, you are mismanaging the economic resources of everyone. It is my firm belief that people should be free to be fat, but they should also in turn bear the responsibility of their choice when it is a freely taken choice, of course. When it wasn't a freely taken choice, then it is a different situation.

 

[rose1]

Why can't people accept the fact that by and large people are fat because they choose to be fat. It's not complicated.

Yeah, actually, it is complicated. If it wasn't, then there wouldn't be a multi-billion dollar industry failing to help more than a tiny percentage of people to lose weight.

I would consider it an irresponsible practice in today's world to not actively encourage your fat patients to lose weight.

And I would consider it an irresponsible practice in today's world to prescribe any course of treatment that has never been shown to be long-term successful in a reasonable study. There are no studies that show that any state-of-the-art lifestyle & nutrition counselling program can help more than a tiny percentage of patients to lose weight. There are studies, on the other hand, that show that Health at Every Size programs, encouraging patients to improve nutrition and increase activity without losing weight, have long-lasting improvements in patients' cholesterol and other disease markers.

There is also a large body of evidence establishing that 'yo-yo dieting' is far more dangerous than simply becoming and staying fat. By encouraging patients to diet, you are hugely increasing their chances of becoming yo-yo dieters, and of repeatedly losing and gaining weight. Given that likelihood, I believe the evidence shows that by encouraging patients to lose weight you are actually increasing their risk of illness. I will not recommend to my future patients a practice that is likely to harm their health in the long run.

If new studies come out that show the opposite, and establish an effective lifestyle-based weight loss program, then I'd consider following their suggestions. However, I plan to practice evidence-based-medicine. And while EBM, however weakly, shows increased risk in being fat (a risk that largely disappears when nutrition/exercise are improved), it also provides no reasonable solution, other than gastric bypass surgery which carries with it its own significant risks, to achieving sustained weight loss.

How can a fat doctor who knows for a fact that this fat they carry around be a toll on their future health ask a fat patient to lose weight?

Like I said in my first post in this thread, it is certainly hypocritical to be fat and to say to your fat patients "It's easy to lose weight, you absolutely need to do it to be healthy, so just diet and exercise more and you'll lose weight". I do not plan to say that to my fat patients.

 

[militarymd]

Why the debate?

We live in the "it's not your fault" age.

It's not your fault that you're fat because you eat too much.

That's what we've come to accept as life...

Get over it ..... people are fat ...will be fat....and it's not their fault...because things like "discipline", "self-control", "personal responsbility" are no longer values deemed important in modern day America.

Just accept the fact that people are going to be fat....and not accept responsiblity for it.

 

[gostudy]

Yeah, actually, it is complicated. If it wasn't, then there wouldn't be a multi-billion dollar industry failing to help more than a tiny percentage of people to lose weight.

Actually we have a multibillion dollar industry because we live in a culture of instant gratification. Are you fat and want to lose weight and not workout or eat right? Take our pill, you won't have to do jack. How many of those frikkin commercials do you see on late night infomercials? The fact is, there is ABSOLUTELY no need for the "weight loss" industry, no need at all. If you want to lose weight. Follow this simple plan: control calories in vs. calories out.

Like I said, by and large if you are fat it is because you made a conscious decision.

 

[Hodad]

And I would consider it an irresponsible practice in today's world to prescribe any course of treatment that has never been shown to be long-term successful in a reasonable study.

I already cited a paper in an earlier post that correlated BMI with increased mortality of all causes. How else would you propose that a patient gets a healthy BMI if not by losing weight?

There are no studies that show that any state-of-the-art lifestyle & nutrition counselling program can help more than a tiny percentage of patients to lose weight.

Firstly: just because there is no hard evidence doesn't mean a particular practice is necessarily detrimental. One must use the evidence available and hope for new evidence. But saying that one should not encourage a traditional practice simply on ground that there haven't been "serious studies"... really...

Secondly: Rather than discount lifestyle and nutrition counselling as worthless out of handedly, it would be a lot more reasonable to ask oneself why all this is so ineffective. For one, I have yet to meet a nutritionist that actually explains to their patients that to lose weight is to make a commitment for life. A lot of patients erroneously believe that once they lose weight they can resume their unhealthy lifestyle, no one ever took the time to explain that losing weight is a commitment for life, that necessitates important lifestyle changes so that it will take an effective form.

There is also a large body of evidence establishing that 'yo-yo dieting' is far more dangerous than simply becoming and staying fat. By encouraging patients to diet, you are hugely increasing their chances of becoming yo-yo dieters, and of repeatedly losing and gaining weight.

How is "suggesting a patient lose weight" somehow twisted into meaning "suggesting that a patient end up yo-yo dieting"? Yo-yo dieting is the product of ignorance on the part of the patient, and an omission on the part of the practitioner. I already explained earlier what I consider to be the problem with yo-yo dieting as has been my perception. But to say "I'm not going to suggest that my patient lose weight because they might end up being yo-yo dieters" is a bit like saying "I won't give my MI patient an aspirin to chew on because it might give him an ulcer".

Given that likelihood, I believe the evidence shows that by encouraging patients to lose weight you are actually increasing their risk of illness. I will not recommend to my future patients a practice that is likely to harm their health in the long run.

If you're going to say "I believe the evidence" on anything, I will ask you to quote it. Please do.

If new studies come out that show the opposite, and establish an effective lifestyle-based weight loss program, then I'd consider following their suggestions. However, I plan to practice evidence-based-medicine. And while EBM, however weakly, shows increased risk in being fat (a risk that largely disappears when nutrition/exercise are improved), it also provides no reasonable solution, other than gastric bypass surgery which carries with it its own significant risks, to achieving sustained weight loss.

That makes no sense. You know why? Because even though you're saying you will practice Evidence Based Medicine, evidence that correlates an increased chance of a myriad of morbilities and mortality with excess weight and obesity you insist that you will just let your fat patients be fat, blissfully ignorant in the notion that they are "healthy", reinforcing the counterfactual idea that being fat is not being unhealthy, only because "there have been no clinical studies determining the best treatment for losing weight"?!

I mean, WTF! All the major cardiology, hypertension, diabetes, and what not associations reach the consensus that the first line of treatment in obesity related pathology profilaxis and treatment is weight loss through hypocaloric diets and exercise... and you fly out in the face of the general consensus simply because there haven't been any prospective cohort studies determining the most effective way of losing weight?!

Diet and exercise works. Otherwise you wouldn't get millions of people across the world doing it without going to see their doctors.

Like I said in my first post in this thread, it is certainly hypocritical to be fat and to say to your fat patients "It's easy to lose weight, you absolutely need to do it to be healthy, so just diet and exercise more and you'll lose weight". I do not plan to say that to my fat patients.

Like I said above: A fat doctor either doesn't believe in the medicine he preaches (you need to lose weight, man!) or is down and out preaching the wrong medicine (You're fat but healthy. Enjoy your cheeseburger).

 

[Bertelman]

You're fat but healthy. Enjoy your cheeseburger[/i]

I'm too busy on another thread , so I'll keep this short. I think the point being made is that there are people (not the majority, I know) that do all the right things, but are still >25 bmi or whatever. What's the healthy option for them? Some crash diet?

Our country aside, I think this was intially brought up to shed some light on the OP, who was making generalizations on obese folks in the class. Otherwise, sure, we're fatter because we eat more and do less. But don't think your entire med school class (or mine) could be IBW with simply a proper diet, exercise and motivation. Obesity existed long before Ronald McDonald came to town.

 

[Hodad]

I think the point being made is that there are people (not the majority, I know) that do all the right things, but are still >25 bmi or whatever. What's the healthy option for them? Some crash diet?

First of all, congratulations for decontextualising the quote.

"Not the majority"? Talk about an understatement. Assuming that the patient has done everything recommended and still cannot lose weight, then well, shucks. You'll have to manage like this then, there's nothing more I can do to help. Your excess weight is incurable, we'll try other stuff so that your comorbilities are at least kept at bay for as long as possible.

But give me a break. What are we to expect the prevalence of people refractory to hypocaloric diets and exercise regimens and all other treatable endocrine weight-adding disorders to be, eh? And how many of those are med students?

But to go as far and not encourage patients to lose weight, and to not educate patients as to the increased morbility and mortality risk of excess weight is downright irresponsible.

As to me, I am not opposed to people being fat. What I do with my life should be an informed choice, which is how I'm pretty much going to go about my practice. As long as you make an informed decision, it's your decision in the end, I'm just here to advise you on the decisions to take, not here to take your decisions for you. But I am appalled that people, especially medical students, do not see the responsibility of the individual factored in the increased prevalence and incidence of obesity. What I would suppose, is huge taxes on fatty and refined sugar foodstuffs that will, in Pigovian fashion, go towards supplementing the health budget. You're going to get fat and have a heart attack before you're 50? Fine. But you're sure as hell going to contribute more tax money than healthy people to the health budget, since you're much more likely to use it because of that choice. With every right there is a responsibility.

 

[rose1]

How else would you propose that a patient gets a healthy BMI if not by losing weight?

I don't know. Nobody knows. That's why I won't recommend that my patients diet.

But saying that one should not encourage a traditional practice simply on ground that there haven't been "serious studies"... really...

But there have been tons of studies on weight loss, and they consistently show that nothing works. The dropout rates are huge, and the successes are minimal over, say, 5 year periods.

For one, I have yet to meet a nutritionist that actually explains to their patients that to lose weight is to make a commitment for life. A lot of patients erroneously believe that once they lose weight they can resume their unhealthy lifestyle

I don't really believe that most fat people think that. And I've never met a nutritionist who tells people that they can just change their lives for six months or a year and that'll make them thin forever. I'm fat, I know a lot of people who are fat, and I have never met anybody who believes that. Fat people tend to read a lot and know a lot about weight loss and its methods.

Yo-yo dieting is the product of ignorance on the part of the patient, and an omission on the part of the practitioner.

Or, it's a physiological response to prolonged calorie reduction. Tons of very clever knowledgable people yo-yo diet. Some yo-yo dieters may be ignorant, but they certainly aren't all ignorant. Check out the fatdoctor blog, for example, at http://fatdoctor.blogspot.com/ -- this family doctor for the most part believes exactly what you believe about dieting, she's extremely knowledgable, and yet she's a yo-yo dieter.

But to say "I'm not going to suggest that my patient lose weight because they might end up being yo-yo dieters" is a bit like saying "I won't give my MI patient an aspirin to chew on because it might give him an ulcer".

You're right, it's somewhat like that. We don't give everybody daily aspirin because it has GI risks, and we weigh the pros and cons. I think that for most fat people the cons of dieting are more significant than the potential pros.

If you're going to say "I believe the evidence" on anything, I will ask you to quote it. Please do.

I really don't have the time to spend several hours putting together a thorough literature review, but the following blog post has several relevant citations: http://www.amptoons.com/blog/archives/2006/04/03/the-case-against-weight-loss-dieting/
The books "The Obesity Myth" and "Big Fat Lies" each have dozens more.

you insist that you will just let your fat patients be fat, blissfully ignorant in the notion that they are "healthy", reinforcing the counterfactual idea that being fat is not being unhealthy, only because "there have been no clinical studies determining the best treatment for losing weight"?!

No. I am not saying that at all. I am saying that instead of using BMI is a primary indicator of health, I will use more objective values such as cholesterol, blood sugar, and blood pressure. I am saying that instead of having weight targets, such as losing 10% of body weight, I would ask my patients to have behavioural targets, such as exercising daily, and incorporating healthy foods into their diets, and minimizing unhealthy foods.

For example, check out the first citation from the Health at Every Size article on Wikipedia. They compared the effect of (1) a best practices dieting/lifestyle change program, against (2) a Health at Every Size approach, telling women they should be happy with their fat bodies, and encouraging them to exercise more and eat more nutritiously. The second group had substantial lasting health improvements; the first group did not. I would prefer to practice in the model of the second group.

http://en.wikipedia.org/wiki/HAES

and you fly out in the face of the general consensus simply because there haven't been any prospective cohort studies determining the most effective way of losing weight?!

The problem isn't that there are no studies, it's that there have been tons of studies, and they all show that in the long run no existing programs result in sustained weight loss. Just because lots of people believe something, doesn't mean it's true!

Diet and exercise works. Otherwise you wouldn't get millions of people across the world doing it without going to see their doctors.

I agree that healthy eating and exercise work to lower cholesterol, to lower blood pressure, and generally to improve health. In the long run, though, for most people, it doesn't result in permanently lowered weights.

A fat doctor either doesn't believe in the medicine he preaches (you need to lose weight, man!) or is down and out preaching the wrong medicine (You're fat but healthy. Enjoy your cheeseburger).

Well, that's your opinion, and there are lots of doctors out there who treat their patients based on different fundamental views of health and healing. I'm glad we live in a country where patients have that choice.

And about the cheeseburger comment: eating healthy is not synonymous with eating calorie-reduced, and there are plenty of fat people out there who don't eat cheeseburgers or other stereotypically unhealthy foods.

 

[DwyaneWade]

I agree that healthy eating and exercise work to lower cholesterol, to lower blood pressure, and generally to improve health. In the long run, though, for most people, it doesn't result in permanently lowered weights.

That's Bs. Honestly, it is just that most people don't stick with diet plans. I am sure there are exceptions (e.g. Samoans have a thrifty gene which make them more susceptible to being fat) but if one has the socioeconomic advantages doctors enjoy you shouldn't be fat. Check out this guy www.johnstonefitness.com. There are tons of people who have remodeled their lives and lost weight. Diets and short-term exercise programs won't do it. It is a lifestyle choice.

And about the cheeseburger comment: eating healthy is not synonymous with eating calorie-reduced, and there are plenty of fat people out there who don't eat cheeseburgers or other stereotypically unhealthy foods.

Again those fat people who do not eat unhealthy are in the exception, as are the thin people who eat unhealthy. Most people in general eat unhealthy; some people just happen to store more as fat. It may be harder for some people, but it is doable.
[/QUOTE]

 

[vtucci]

The genetic predisposition to obesity is a joke. Sure there are fat kids with fat parents but that doesn't mean it’s heritable. Furthermore, most overweight people are overweight due to motivational issues, skipping exercise out of convenience, and plain gluttony. True medical disorders affecting metabolism exist but are rare when compared to the number of obese and overweight people.

I’ll rephrase the OP’s question more bluntly “Why are you fat if you know it’s bad for you and how do you expect your patients to take you seriously when the rest of society clearly doesn’t?”

Wow- how many stereotypes and oversimplifications can you pack into a post.

We are only now starting to understand the intracies of obesity. If you are anywhere along your curriculum in medical school, you should have learned that obesity is multi-factorial inheritence.

It is not as simple as overeating (the whole calories in v. calories out paradigm) and not being healthy and exercising for all patients or all students. Genetics certainly plays a role in the development of obesity, just like it does with diabetes mellitus, hyperlipidemia. We still do not have a handle on the hormonal causes of obesity. There are also nutritional issues including steroids in our products as compared to 50 years ago.

Try to be compassionate and not just assume that the person is lazy and the victim of a poor lifestyle. Even if they are, you will not be able to help them if they perceive you as hostile and unsympathetic.

Moreover, metabolic disorders are not as uncommon as you may think. You cannot simply say that they are uncommon when the experts in the field admit that we do not understand enough about the process.

Also, for you evidence-based junkies out there, the only long-term fix for obesity is weight-loss surgery. And before someone jumps down my throat about the calories in v. calories out theory, they now recognize the enormous hormonal impact of the surgery and not just the malabsorption process.

I have

 

[8744]

Wow- how many stereotypes and oversimplifications can you pack into a post.

We are only now starting to understand the intracies of obesity. If you are anywhere along your curriculum in medical school, you should have learned that obesity is multi-factorial inheritence.

It is not as simple as overeating (the whole calories in v. calories out paradigm) and not being healthy and exercising for all patients or all students. Genetics certainly plays a role in the development of obesity, just like it does with diabetes mellitus, hyperlipidemia. We still do not have a handle on the hormonal causes of obesity. There are also nutritional issues including steroids in our products as compared to 50 years ago.

Try to be compassionate and not just assume that the person is lazy and the victim of a poor lifestyle. Even if they are, you will not be able to help them if they perceive you as hostile and unsympathetic.

Moreover, metabolic disorders are not as uncommon as you may think. You cannot simply say that they are uncommon when the experts in the field admit that we do not understand enough about the process.

Also, for you evidence-based junkies out there, the only long-term fix for obesity is weight-loss surgery. And before someone jumps down my throat about the calories in v. calories out theory, they now recognize the enormous hormonal impact of the surgery and not just the malabsorption process.

I have

One of my fat patients (close to 600 pounds) related how she would order large pizzas, ask for them not to be sliced, and roll them up burrito-style for easier and quicker eating.

Clearly there is also a component of being a lard-ass and an ass-clown in many of the obese. Maybe it is a genetic predisposition to be lazy.

Just anecdotally, I see plenty of ward-monsters who are "s/p gastric bypass." Surgery is not enough. They just start with frequent small meals and eventually work their way back to Big Macs and Frito pie.

 

[8744]

No one is the "victim" of a poor lifestyle. Your lifestyle does not hold you at knife-point and force twinkies down your gullet.

On the other hand we have the fattest poor in the history of the world.

 

[8744]

Frito pie

Frito Pie:

Tear open bag of fritos. Spoon Chili on top. Cover with cheese and onions. Serve with chilled Dr. Pepper.

 

[Law2Doc]

One of my fat patients (close to 600 pounds) related how she would order large pizzas, ask for them not to be sliced, and roll them up burrito-style for easier and quicker eating.

What's the rush? If you like eating pizza wouldn't you want it to last longer? Also who could possibly roll a large pizza tight enough to fit the end into their mouth. This kind of behavior sounds more psychiatric than merely gluttonous.

 

[vtucci]

No doubt there are obese individuals who are slovenly and overeaters. There are also fat people who have psych disorders (like your 600 lb patient probably has) and emotional issues with food and they will not be able to lose weight until the underlying disorder is addressed.

My only point was it is far better not to assume that your given patient is one of these people. Laziness and obesity do not always go hand and hand.

I have a lot of personal experience in this area, having been overweight since I hit puberty (like the rest of my family for more than four generations). I have endured the jeers from students in junior high etc, the disapproval of general society and the disbelief from the medical profession. Trust me when I say that nothing will alienate your patient faster than calling them a liar (which I was when doctors did not believe how much I consumed in a given day-- it was impossible for me to only eat that much I was told because I was significantly overweight) or being generally condescending.

Too many physicians are wedded to the principle that all fat people eat excess calories and don't exercise. I will grant you that there are alot of people for who this is true but it is not everybody.

 

[vtucci]

No one is the "victim" of a poor lifestyle. Your lifestyle does not hold you at knife-point and force twinkies down your gullet.

On the other hand we have the fattest poor in the history of the world.

I was being sarcastic when I wrote victim of a poor lifestyle.

Yes, you are correct that we have the fattest poor in the world. It is worth looking into why that is. Could it be that healthier foods including lean meats and vegetables tend to cost a lot more than the crap like the burritos you mentioned or chef boyerdee etc? Many working poor are also juggling multiple jobs and eat on the fly- so that limits them to microwaveable crap. Do you really fault them this much? What would you choose if you had to pick between paying the rent or eating healthy and living on the street?

You keep assuming that all fat people are shoveling twinkies down their throats. Some, sure. All, absolutely not!! That is simply false image but one that is unfortunately common in our society.

 

[8744]

I was being sarcastic when I wrote victim of a poor lifestyle.

Yes, you are correct that we have the fattest poor in the world. It is worth looking into why that is. Could it be that healthier foods including lean meats and vegetables tend to cost a lot more than the crap like the burritos you mentioned or chef boyerdee etc? Many working poor are also juggling multiple jobs and eat on the fly- so that limits them to microwaveable crap. Do you really fault them this much? What would you choose if you had to pick between paying the rent or eating healthy and living on the street?

You keep assuming that all fat people are shoveling twinkies down their throats. Some, sure. All, absolutely not!! That is simply false image but one that is unfortunately common in our society.

The fat patients I have known are poor but they are definitely not working. The only things they juggle are the numerous friends they have on the speed-dial of their cell-phones.

We have fat, non-working poor because most social programs discourage self-sufficiency and personal responsibiity. Additionally, nachos with extra cheese just taste better than endive salad. Since many of the poor have the intellectual and emotional developement of children, largely due to our enabling of their irresponsibiity, they will always choose to eat candy over vegetables.

I am somewhat sturdy myself but this is because of eating. I am 225 now but was only 180 when I was a Marine strictly because although I probably ate more I also was a lot more physically active. If I ate now how I ate then I'd be a behemouth.

 

[8744]

What's the rush? If you like eating pizza wouldn't you want it to last longer? Also who could possibly roll a large pizza tight enough to fit the end into their mouth. This kind of behavior sounds more psychiatric than merely gluttonous.

Pizzas. Not Pizza.

When you're 700 pounds eating developes strange logistical complexities.

 

[militarymd]

Wow- how many stereotypes and oversimplifications can you pack into a post.

We are only now starting to understand the intracies of obesity. If you are anywhere along your curriculum in medical school, you should have learned that obesity is multi-factorial inheritence.

It is not as simple as overeating (the whole calories in v. calories out paradigm) and not being healthy and exercising for all patients or all students. Genetics certainly plays a role in the development of obesity, just like it does with diabetes mellitus, hyperlipidemia. We still do not have a handle on the hormonal causes of obesity. There are also nutritional issues including steroids in our products as compared to 50 years ago.

.........

......................
Also, for you evidence-based junkies out there, the only long-term fix for obesity is weight-loss surgery. And before someone jumps down my throat about the calories in v. calories out theory, they now recognize the enormous hormonal impact of the surgery and not just the malabsorption process.

I have

I guess I don't understand all this.....I'm kind of a history buff, and one of the things that I have noticed is that in the historical photos of WWII prisoners of war camps......where caloric intake was restricted because of the camp environment....

There were surprisingly NO fat people.....if what you say were true....obesity is multifactorial....and caloric intake is JUST ONE componet of the big equation, then, in those historical photos....of thousands of prisoners of war.....there would HAVE TO BE at LEAST ONE fat person....

but, nope....they were all skinny....

I guess, in the last 60 years (2 generations), us humans have mutated beyond simple "calorie in/calorie out" physics....we can now defy the laws of thermodynamics.

X-men style.....I can't wait until the day when my son hits puberty...and sprouts knives from his wrists.

 

[Law2Doc]

Pizzas. Not Pizza.

When you're 700 pounds eating developes strange logistical complexities.

Perhaps, but it sounds more like in this case we are discussing a form of dementia, not just someone who tends to overeat the wrong foods.

 

[vtucci]

Why the debate?

We live in the "it's not your fault" age.

It's not your fault that you're fat because you eat too much.

That's what we've come to accept as life...

Get over it ..... people are fat ...will be fat....and it's not their fault...because things like "discipline", "self-control", "personal responsbility" are no longer values deemed important in modern day America.

Just accept the fact that people are going to be fat....and not accept responsiblity for it.

Okay- if all fat people are responsible for being overweight, then why did redux and phen phen work so well for so many obese people without any concomitant dietary modification (these patients most of whom gained the weight back in a fraction of the time when it was pulled from the market by the FDA)?

It is not a simple problem that can be overcome by self-discipline or self-control. There are genetic predispositions for some. There are psych issues for others. Do you honestly believe that if self-control is all it took, there would be so many fat people in America? Do you believe that we want to be fat? That life would not be easier if we were all slim and beautiful- society's ideal?

 

[vtucci]

I guess I don't understand all this.....I'm kind of a history buff, and one of the things that I have noticed is that in the historical photos of WWII prisoners of war camps......where caloric intake was restricted because of the camp environment....

There were surprisingly NO fat people.....if what you say were true....obesity is multifactorial....and caloric intake is JUST ONE componet of the big equation, then, in those historical photos....of thousands of prisoners of war.....there would HAVE TO BE at LEAST ONE fat person....

but, nope....they were all skinny....

I guess, in the last 60 years (2 generations), us humans have mutated beyond simple "calorie in/calorie out" physics....we can now defy the laws of thermodynamics.

X-men style.....I can't wait until the day when my son hits puberty...and sprouts knives from his wrists.

I was a history major and am a history buff as well. First off, it was not merely a restricted caloric intake- call it what it was- starvation. If you starve anyone like they did in the concentration camps for an extended period of time (years in most cases), they will lose weight if they do not die outright of malnutrition or the infectious diseases that are associated with malnutrition. What did they look like years after? How long-lived was the effect? You are offering an extreme example to try to prove your point. So what is your solution- have fat people starve themselves? That opens up a whole host of problems. Malnutrition can be as detrimental if not more so than excess caloric intake.

I will simplify the issues for you. The problem with setting up the calories in v. calories out in modern society is that we do not have an effective way of measuring calories out. If we could, then we could tailor the right diet and exercise and perhaps, medication to reduce the obesity epidemic. Unfortuntately, at present, we cannot accurately measure a person's resting metabolic rate. If you doubt that there is significant variation, ask your professors why some patients' resting temperature is 96 F as opposed to the standard 98.6. We do not understand the intracacies yet but differences certainly exist. Exercise calories are only one portion of the calories out. Also, not everyone burns calories at the same rate (even among people at the same weight). Different muscle v. fat mass is thought to play a role but it has not been quantified. People also have different hormonal levels that are thought to impact the development and maintenance of obesity. 5 years ago, endocrinologists had very little idea that fat cells generate hormones that could contribute to obesity and we still do not understand the nuances even now.

I do not mean to dismiss the sociological components to obesity. I completely agree with you that Americans live a more sedentary life style than 50+ years ago. The TV and computer certainly play major roles in that phenomenon as does the more intellectual occupations (as compared to the physical labors like farming etc). But there are also other factors including increased steroids in our meat and dairy products that were not present 50 years ago. No one has a clue as to the long term effects of this and it is unlikely that we will see much in the peer-reviewed literature.

 

[vtucci]

The fat patients I have known are poor but they are definitely not working. The only things they juggle are the numerous friends they have on the speed-dial of their cell-phones.

We have fat, non-working poor because most social programs discourage self-sufficiency and personal responsibiity. Additionally, nachos with extra cheese just taste better than endive salad. Since many of the poor have the intellectual and emotional developement of children, largely due to our enabling of their irresponsibiity, they will always choose to eat candy over vegetables.

I am somewhat sturdy myself but this is because of eating. I am 225 now but was only 180 when I was a Marine strictly because although I probably ate more I also was a lot more physically active. If I ate now how I ate then I'd be a behemouth.

Panda- there are certainly alot of lazy, fat people but I hope that I can convince you and some others here that it is not the rule. Some people are ill-informed about healthy choices. True, some don't care. Also, true that some have tried everything to no avail.

After listening to a lot of the conversation, it is also clear to me that many of you have never struggled with your weight and may, therefore, find it hard to understand where your patients (or I) are coming from. I know that my classmates find it amusing that even before my surgery I ate a mere fraction (less than 20%) of what my roommate does and she is 114 pounds and I was over 300 pounds before my surgery (and before you ask, we both have blackbelts in karate and have the same amount of exercise each day). The reaction is that either they don;t believe me or they don;t understand how we could not know why this is the case yet.

Classmates marvel that I never could eat more than 2 slices of pizza without getting sick when they could eat an entire pie. I also exercised regularly for my whole life. As I mentioned, I have a blackbelt. I took classes for hours a day for years. High impact, high energy. I had jobs where I was running as a waitress for 18 hour days. It never mattered I was always fat.

I opted for the gastric bypass surgery instead of lap ban because of the hormonal component (not just the malabsorption that you get with the lap band). My doctors and the faculty at my school after reviewing my case all agreed that it was the best option. I had tried diets before where I was on 500 calories/day and did not lose much weight (granted this was not a prolonged starvation as seen in the example of the concentration camps mentioned earlier but a medically supervised diet). Now, if I have the 500 calories, I also get the alteration in my hormone levels. And I can't tell you why it works this way- my surgeon, all the endocrinologists, simply don't know yet. I am doing very well with it and have lost over 77 pounds in a little over 3 months.

Before you assume that the weight loss is just a combination of restriction and that I can't eat crap, please note that I can if I want to, I have no dumping syndrome with sugar and could eat candy, cake, cookies or milkshakes if I so desired. But as it happens, I did not like that stuff before I had the surgery and I like it even less now. (I prefer salty items like pickles and most have 5 calories a pop). I also never ate any sauces (that is right- no mayo, no cream sauces, no ketchup, mustard- nothing. I look at it as God's way of keeping me from being 600 pounds).

I opted for the surgery because it was the best decision for me with my family history. I also hope to join the military one day because I believe it would be a privilege to serve as a doctor for our men and women in uniform.

As an aside... I don't agree with you that Nachos with extra cheese taste better than a salad. I personally can't think of anything more disgusting. Not all fat people are hoarding cookies and cake and other crap in their pantries like alcoholics stashing bottles.

 

[EMT2RN2MD]

I guess I don't understand all this.....I'm kind of a history buff, and one of the things that I have noticed is that in the historical photos of WWII prisoners of war camps......where caloric intake was restricted because of the camp environment....

There were surprisingly NO fat people.....if what you say were true....obesity is multifactorial....and caloric intake is JUST ONE componet of the big equation, then, in those historical photos....of thousands of prisoners of war.....there would HAVE TO BE at LEAST ONE fat person....

but, nope....they were all skinny....

I guess, in the last 60 years (2 generations), us humans have mutated beyond simple "calorie in/calorie out" physics....we can now defy the laws of thermodynamics.

QUOTE]

Exactly. I would love to hear about those people who can burn 2500kCal a day and only take in 2000kCal and still gain weight. Btw, it's hard to stand in an exam room listening to some hefty person professing their strict adherence to a prescribed diet while noting the empty KFC box in her puse and a fresh twinkie wrapper on the floor. I just smiled and nodded my head in agreement, wondering if I should say something about the twinkie spooge on her lip.

 

[swpm]

Could it be that healthier foods including lean meats and vegetables tend to cost a lot more than the crap like the burritos you mentioned or chef boyerdee etc?

No, they don't.

Certainly that nice thick sirloin steak costs more than the "steak" burrito at Taco Bell, but supermarkets are full of inexpensive, healthy foods.

Many working poor are also juggling multiple jobs and eat on the fly- so that limits them to microwaveable crap.

Oh, bull****.

Are you actually posting this ridiculous assertion - that the working poor are too busy to eat a healthy diet - on a forum full of medical students, interns, residents, and physicians?

If I can avoid the convenience of a deliciously atherosclerosis-inducing bacon cheeseburger meal, made "fresh" daily at the hospital food court, then the working poor can pack a lunch too. If you can't pack a reasonably healthy, filling, tasty lunch for less than the $5-7 Burger McFastfood combo meal, you're not poor - you're stupid or lazy.

Do you really fault them this much? What would you choose if you had to pick between paying the rent or eating healthy and living on the street?

The choice being made isn't a "pay the rent" vs "eat healthy food" issue - it's an "eat convenient tasty crap" vs "eat less convenient healthy food" issue.

 

[mommy2three]

Why can't people accept the fact that by and large people are fat because they choose to be fat. It's not complicated.

uh huh i CHOSE for years to be fat...sure i did. i spent thousands of dollars of MY hard eard money on almost every diet and excersise program out there to have them ALL FAIL. i followed every diet...every nutritionist suggestion...even went on a 1000 calorie a day strict diet and STILL would only lose 50 or so pounds to gain it all back and then some more. i did all that because i WANTED To be fat...give me a friggen break. if i wanted to be fat then why did i finally resort to bariatric surgery to lose weight when all other options had failed me??? why did i try everything under the sun before permanently altering my digestive system if i WANTED to be fat??? i am sure all that money i spent trying to lose weight was all because i wanted to be fat....yep that must be why everything i tried before bariatric surgery failed.
i feel incredibly sorry for your future patients if this is the type of compassion you have...or should i say lack.

 

[psipsina]

At my school we have a self care elective in which we target our own unhealthy behaviors (physical, mental, social and spiritual) and try to heal ourselves. We set goals every two weeks for each subcategory of health and report how we did and set new goals etc etc. We also attend lectures on our health in medschool. The major goal of the course, besides keeping us healthy and sane thru medschool, is to actively think about our own struggles with our personal health to gain insight in how best to help our patients overcome their struggles. Everyone has things they know they should be doing for themselves healthwise that are just really hard to do for many reasons and it is a really good exercize to try and change those things and actively think about the experience you have trying to change your health habits. I think alot of doctors could benefit from some compassion for their patients. Sure, maybe you're not fat but theres probably something else that you do that you know is bad for you but you do it anyway. Maybe you procrastinate so much you end up pulling all nighters before a test, maybe you binge drink after tests, maybe you smoke because you're stressed, maybe you use stimulants to stay up, maybe you don't excersize as much as you should be, maybe you stress out way too much . . . if you actively think about your own struggles and failures concerning your health you may be more inclined to compassion when you are helping a patient face their struggles and failuers, even if they are different battles than the ones you are fighting.

 

[EMT2RN2MD]

No fat people after fininshing my BASIC training, either.(And, there were lots at the begining.) Reduced calories (strictly enforced) and increased activity (again strictly enforced) works very well for those capable of exercising. No body starves in basic training. Besides, it's hard to starve someone carrying around 50lbs worth of cheeseburgers.

 

[vtucci]

For some people, it is just that- pay your rent or buy healthier food.

What would you have them buy that is healthy and cheap? Tang and sugar drinks are cheaper than juice, meat is ridiculously expensive in most places, esp the leaner cuts instead of hot dogs and other crap like cold cuts. Fruit and vegetables are also more expensive if you are thinking portion size than a bag of chips. Dairy products are not that cheap but can be worked into the budget. Most cereals are crap, high refined sugar.

Also, I worked in the ED in the second poorest congregational district in the country and was able to listen to people day in and day out about their dietary habits and lamenting about it. I am not the one suggesting that McDonald's is what the poor all opt for- it is $5-7/meal as was mentioned by the poster as is not something that the poor all do on a daily basis. I agree that eating at McDonald's on a daily basis is stupid. However, many poor do opt for quick, easy meals like hot pockets (that cost a lot less than $5/meal) or pop tarts. I agree convenience is an issue.

I think it is great that you brown bag your lunch. But do not assume that as a doctor or even resident that you will work harder and longer than everyone else. It is not true. There are other professions where people work just as long. There are a lot of people out there working two-three jobs a day. There are also a lot of older people doing this and if we are being honest, the energy that you have may not be the same amount of energy that a 44 year old waitress has. This is not an excuse. I agree that it would be preferrable to have our patients eat healthy but it is an explanation. These patients deserve our compassion and we need to work with them, not against them.

There may also some cultural hurdles that need to be overcome in terms of high carb and sugar meals.

 

[vtucci]

uh huh i CHOSE for years to be fat...sure i did. i spent thousands of dollars of MY hard eard money on almost every diet and excersise program out there to have them ALL FAIL. i followed every diet...every nutritionist suggestion...even went on a 1000 calorie a day strict diet and STILL would only lose 50 or so pounds to gain it all back and then some more. i did all that because i WANTED To be fat...give me a friggen break. if i wanted to be fat then why did i finally resort to bariatric surgery to lose weight when all other options had failed me??? why did i try everything under the sun before permanently altering my digestive system if i WANTED to be fat??? i am sure all that money i spent trying to lose weight was all because i wanted to be fat....yep that must be why everything i tried before bariatric surgery failed.
i feel incredibly sorry for your future patients if this is the type of compassion you have...or should i say lack.

I am totally with you and am frustrated by the lack of understanding and compassion displayed by some of our colleagues. PM me if you want to chat about your bariatric surgery. I am 4 months post-op now.

 

[vtucci]

No fat people after fininshing my BASIC training, either.(And, there were lots at the begining.) Reduced calories (strictly enforced) and increased activity (again strictly enforced) works very well for those capable of exercising. No body starves in basic training. Besides, it's hard to starve someone carrying around 50lbs worth of cheeseburgers.

Obese people are not able to get into the military. The military has extremely strict height/weight standards as I am sure you know along with a body fat percentage, the formula for which, does not correspond to any other used anywhere else (neck size, forearm and hips).

The recruits you entered basic with may have been a little overweight but it is less likely that they suffered from a really significant genetic legacy as many obese people do or other hormonal issues.

Obese people are capable of exercising and many of us do. I worked out for hours and hours daily to get my blackbelt. I have run miles on a treadmill daily. Guess what? I was still over 200 pounds. Have you any idea how frustrating that is to work out and not lose anything? I am as physically fit (or perhaps more so) than most of the students in my class and I weigh 100 pounds more than some of them (the girls anyway).

Not everyone who is fat overeats or eats cheeseburgers and crap. Even if we are not as common as the obese people who do, we are out here. Try recognizing that. You want to motivate your patients and work with them not turn them off.

 

[8744]

For some people, it is just that- pay your rent or buy healthier food.

What would you have them buy that is healthy and cheap? Tang and sugar drinks are cheaper than juice, meat is ridiculously expensive in most places, esp the leaner cuts instead of hot dogs and other crap like cold cuts. Fruit and vegetables are also more expensive if you are thinking portion size than a bag of chips. Dairy products are not that cheap but can be worked into the budget. Most cereals are crap, high refined sugar.

Also, I worked in the ED in the second poorest congregational district in the country and was able to listen to people day in and day out about their dietary habits and lamenting about it. I am not the one suggesting that McDonald's is what the poor all opt for- it is $5-7/meal as was mentioned by the poster as is not something that the poor all do on a daily basis. I agree that eating at McDonald's on a daily basis is stupid. However, many poor do opt for quick, easy meals like hot pockets (that cost a lot less than $5/meal) or pop tarts. I agree convenience is an issue.

I think it is great that you brown bag your lunch. But do not assume that as a doctor or even resident that you will work harder and longer than everyone else. It is not true. There are other professions where people work just as long. There are a lot of people out there working two-three jobs a day. There are also a lot of older people doing this and if we are being honest, the energy that you have may not be the same amount of energy that a 44 year old waitress has. This is not an excuse. I agree that it would be preferrable to have our patients eat healthy but it is an explanation. These patients deserve our compassion and we need to work with them, not against them.

There may also some cultural hurdles that need to be overcome in terms of high carb and sugar meals.

I struggle with my weight now and then. Intern year last year was the worst and I am only now getting back to eating right so I understand the effort required to lose weight.

The healthiest foods in the supermarket are not the most expensive. I can make enough lentil soup, rice pilaf, mousaka, and bean soup to choke a platoon for 15 bucks. All extremelt healthy and extremely tasty. It jsut takes a little effort and planning to soak the beans overnight and dessicate the eggplant.

A good-sized hen costs about five bucks and will feed four. Add a little salad an potatoes and you've got a very cheap, nutritious meal if you can be bothered to roast a chicken. It's not rocket science.

 

[vtucci]

I agree that it takes effort and planning and I will assist my obese patients any way I can with their dietary modifications as I hope we all will.

You make some excellent recommendations for some lower cost, healthy items. Unfortunately, many of the items that you are list are not part of the traditional American diet (e.g., hens, mousaka, eggplant or even lentils) and many patients and dare I say, medical students, would not think to look for such items. How many students would list eggplant in their top 10 items for vegetables? Or mousaka? Or hens when thinking about protein? It is natural for us to think cucumbers, peppers, salads, celery, carrots, peas, green beans etc. first. It requires education on what to choose and how to prepare it.

Also, consider how many packs of raman noodles you could get for $15 but we know that they are hardly nutritious. Probably enough for a battalion.

 

[Hodad]

Hmm, tucci, making it a personal issue then? Becuase from your posts all I see is "We're not all lazy, damnit! We're not all fat because we want to!" And yet I haven't seen, anywhere, a post where anyone else claims that "All fat people are lazy overeaters". Yep, look through the posts and look for it, and quote that if you can, because I can't find it.

From that: I don't think anyone here believes that "All Fat People Are Fat By Choice Because They Are Lazy Overeaters." The point everyone here is trying to make is that:

1) The majority of overweight people are lazy overeaters. Not all. Not every single one. But a majority.
2) A majority of overweight people blame their genes, without acknowledging that, maybe, they simply eat too much and exercise too little, trying to blame someone other than themselves for the sanitary problem they have.

Just that.

 

[Hodad]

As to the history buff questions here... Have you not considered the engravings and pictures from the Renaissance onwards? How is it explained that the rich are always caricaturised as fat and gouty? Is there a correlation between wealth and endocrine problems? How come the poor are always pictured thin?

Historically, the only ones that had access to red meat in any abundance were the rich. The only ones that had access to large meals were the rich. Who did the most exercise because they were manual labourers? The poor. Is it not strongly indicative, even in this extremely unscientific observation, that the main problem is caloric intake and lack of exercise and NOT genetic?

 

[militarymd]

When you look at historical evidence/data.....there can be only one answer to the obesity epidemic that we have now....and it is NOT because of mutant X genes.

 

[kesse]

For some people, it is just that- pay your rent or buy healthier food.

What would you have them buy that is healthy and cheap? Tang and sugar drinks are cheaper than juice, meat is ridiculously expensive in most places, esp the leaner cuts instead of hot dogs and other crap like cold cuts. Fruit and vegetables are also more expensive if you are thinking portion size than a bag of chips. Dairy products are not that cheap but can be worked into the budget. Most cereals are crap, high refined sugar.

From this, it seems like you probably never really had an example of how to eat right growing up or within your social sphere. I think that's common in many parts of this country- people with parents who overindulge or go for processed and pre-packaged (and often heavily marketed) foods start to see that as the norm.
I go to med school on the west coast, where I have yet to see an overweight med student or even an overweight physician. It's just in the culture here to eat healthy foods and take care of yourself. I drink water (NOT juice or -gasp- Tang). I can't even imagine any of my fellow students eating McDonald's. Lots of people here go for lean meats and lots of veggies. High fiber oatmeal instead of cereal. It's not expensive...I spend about $40 a week on food. When you see examples of how to eat correctly, it makes it seem a lot easier.
Good luck with your weight struggles. It seems like you have been through quite an ordeal. However, you might benefit from meeting with a nutritionist in order to learn what an ideal diet looks like.

 

[Hodad]

From this, it seems like you probably never really had an example of how to eat right growing up or within your social sphere. I think that's common in many parts of this country- people with parents who overindulge or go for processed and pre-packaged (and often heavily marketed) foods start to see that as the norm.

This is very much the norm. Especially because eating habits are developed in the earlyest parts of infancy.

 

[militarymd]

......However, you might benefit from meeting with a nutritionist in order to learn what an ideal diet looks like.

Wrong!!!!

Fat people WILL (not MIGHT) BENEFIT from a healthy dose of SELF-disciple, SELF-awareness, PERSONAL responsibility.

They DID NOT have nutritionists in the 1940's.....and there WAS NOT an obesity epidemic back then.

I USED to be fat....then I realized that I needed to change my lifestyle....now I'm not.

Accept responsibility for YOUR problems....DO NOT blame everyone else.

 

[gostudy]

uh huh i CHOSE for years to be fat...sure i did. i spent thousands of dollars of MY hard eard money on almost every diet and excersise program out there to have them ALL FAIL. i followed every diet...every nutritionist suggestion...even went on a 1000 calorie a day strict diet and STILL would only lose 50 or so pounds to gain it all back and then some more. i did all that because i WANTED To be fat...give me a friggen break. if i wanted to be fat then why did i finally resort to bariatric surgery to lose weight when all other options had failed me??? why did i try everything under the sun before permanently altering my digestive system if i WANTED to be fat??? i am sure all that money i spent trying to lose weight was all because i wanted to be fat....yep that must be why everything i tried before bariatric surgery failed.
i feel incredibly sorry for your future patients if this is the type of compassion you have...or should i say lack.

Come on now. Please read and re-read my post. I say that BY AND LARGE i.e. in general, i.e. more likely than not, i.e. the arithmetic mean:

Given a sample of overweight individuals, I am more likely to find overeating fat people than non-overeating fat people.

Now, did I say that ALL fat people eat too much? Absolutely not. If you, your baby's mama's mamas, and your mama's mama eat right and don't lose weight, you are statistical outliers and in no way change the fact that most fat people are fat because they make a decision to be fat.

i feel incredibly sorry for your future patients if this is the type of compassion you have...or should i say lack.

Classic, classic SDN cheapshot. When all else fails hit em were it hurts..."well, well, your just going to be a bad doctor then!"

 

[psipsina]

Wrong!!!!

Fat people WILL (not MIGHT) BENEFIT from a healthy dose of SELF-disciple, SELF-awareness, PERSONAL responsibility.

They DID NOT have nutritionists in the 1940's.....and there WAS NOT an obesity epidemic back then.

I USED to be fat....then I realized that I needed to change my lifestyle....now I'm not.

Accept responsibility for YOUR problems....DO NOT blame everyone else.

Is this what you're going to tell your patients?? And you are expecting them to respond to this miraculous relevation?

Congrats on your own personal discovery, but your approach isn't going to work for all your patients and you need to be little more open minded about obesity. One of my proffs told us that when we react strongly to a patient (as you seem to be doing to an entire patient population btw) it is not because of the patient, but because of your own personal baggage, which in order to be a good clinician, you need to learn to leave at the door when you enter an exam room. Your callousness is only going to push your patients further away from you which will do nothing to help them, which is after all your goal as a physician. . .

What on earth is wrong with suggesting an obese person seek advice on diet from a nutritionist? Alot of people have no idea how to eat right because they have never seen it done within their family and friends. Education is one of the greatest tools we can use to help our patients. Of course in the end its their responsibility, but it is our responsibility as a physician to do everything possible to help our patients.

As to your 1940's comment, the social food culture in our country was quite a different beast and really not comparable. Most families had a stay at home mom who prepared meals from scratch that were nutritionally balanced. Everyone sat down together and had a meal. Microwavable dinners, pizza hut, and mcdonalds were not options, never mind the dinner of choice for many families. Single parents or families with two working families were rare so time to prepare food wasn't an issue. Also the junk food culture was very different, kids weren't given unlimited access to junk food filled pantries where they learned to fill emotional gaps with food at a young age, as many kids today do. So of course obesity wasn't as big a problem, the entire culture viewed food differently. I think we all know the cause of the current epidemic, which arose post 1940. Now the goal is to learn how to help our patients, instead of just judging them based on our own personal baggage.

 

[vtucci]

From this, it seems like you probably never really had an example of how to eat right growing up or within your social sphere. I think that's common in many parts of this country- people with parents who overindulge or go for processed and pre-packaged (and often heavily marketed) foods start to see that as the norm.
I go to med school on the west coast, where I have yet to see an overweight med student or even an overweight physician. It's just in the culture here to eat healthy foods and take care of yourself. I drink water (NOT juice or -gasp- Tang). I can't even imagine any of my fellow students eating McDonald's. Lots of people here go for lean meats and lots of veggies. High fiber oatmeal instead of cereal. It's not expensive...I spend about $40 a week on food. When you see examples of how to eat correctly, it makes it seem a lot easier.
Good luck with your weight struggles. It seems like you have been through quite an ordeal. However, you might benefit from meeting with a nutritionist in order to learn what an ideal diet looks like.

Actually, I have worked with nutritionists on and off since I was 10 and am very well-versed on how to choose and prepare healthy cuisine. For example, I drink more than 64 ounces of water each day and have always had a well-balanced diet (protein, carbs and fat are carefully monitored) and have abundant fiber in my diet. I have lived in NYC for years and am well-acquianted with a variety of ethnic cuisines and variations from the traditional American diet. You may have missed my earlier posts and assumed that I referring to my habits. What you mentioned could not be farther from my personal habits but those are the habits of many of our patients. Like you, I cannot imagine eating at MacDonalds and do not understand the obsession with all the fast-food crap. Yuck!

I was in no way asserting that tang was better than juice. Clearly, this is not the case. I merely was pointing out that many people opt for these instead of healthier options because of cost or inadequate education. It is naive to think most people are well-educated as we are. I know that my background is not the norm from working in the ED with poor patients. Most of patients likely never heard of eggplant or hens. Lentils will probably depend on ethnicity.

 

[8744]

A "hen" is a "chicken," by the way. I am sure that chicken is part of everybody's cultural heritage. It takes almost nothing to roast a chicken, just some salt, pepper, and a lemon if you go in for that kind of thing. You can throw some potatoes in and make some greens and can feed two adults and two children for eight bucks, tops. And you can make soup out of the bones and scrap if you are really motivated (which I seldom am).

My point is that the poor eat the way they do because they are habitually lazy and it is easier to get some fried chicken from Popeyes than to plan and execute a meal that I can make with one hand while reading my mail and talking to my wife. It is simple and cheap to eat well in America where the real cost of groceries has gone steadily down for the last twenty years.

Which goes to my original point. The poor are lazy and stupid. Stupid because our social programs have turned them all into overgrown children who are incapable of teaching their children how to roast a potato or boil some greens. Either that or we are being incredibly patronizing when we complain that it takes a college degree to roast a chicken and figure out how to get the skin off of a potato.

 

[vtucci]

Wrong!!!!

Fat people WILL (not MIGHT) BENEFIT from a healthy dose of SELF-disciple, SELF-awareness, PERSONAL responsibility.

They DID NOT have nutritionists in the 1940's.....and there WAS NOT an obesity epidemic back then.

I USED to be fat....then I realized that I needed to change my lifestyle....now I'm not.

Accept responsibility for YOUR problems....DO NOT blame everyone else.

Once again, you are oversimplifying the issue. It is not just self-discipline and self-awareness. I bet I am more self-aware and self-disciplined than 95% of the people who have been posting to this topic. And yes, that self-discipline extends to my dietary and exercise habits.

I think you should be applauded for losing weight. Maybe you had a genetic predisposition to obesity, maybe you just overate, maybe you did not exercise enough. Not all fat people overeat or have unhealthy lifestyles.

No one is blaming anyone. We are merely trying to teach our fellow students that it is not that simple. Do you want to be an advocate for your patients or an obstacle? There are more factors at play here. So your answer to the obesity epidemic is that over the last 60 years, the only difference is suddenly the human race developed a complete lack of self-control and that accounts for everything.

The excess portion sizes in restaurants, the steroids in everything we eat (which by the way, we have no idea how they interact with our own hormones), the decreased physical activity due to the different occupations undertaken in first world countries-- all of these have nothing to do with it?

 

[militarymd]

Is this what you're going to tell your patients?? And you are expecting them to respond to this miraculous relevation?

Congrats on your own personal discovery, but your approach isn't going to work for all your patients and you need to be little more open minded about obesity. One of my proffs told us that when we react strongly to a patient (as you seem to be doing to an entire patient population btw) it is not because of the patient, but because of your own personal baggage, which in order to be a good clinician, you need to learn to leave at the door when you enter an exam room. Your callousness is only going to push your patients further away from you which will do nothing to help them, which is after all your goal as a physician. . .

What on earth is wrong with suggesting an obese person seek advice on diet from a nutritionist? Alot of people have no idea how to eat right because they have never seen it done within their family and friends. Education is one of the greatest tools we can use to help our patients. Of course in the end its their responsibility, but it is our responsibility as a physician to do everything possible to help our patients.

As to your 1940's comment, the social food culture in our country was quite a different beast and really not comparable. Most families had a stay at home mom who prepared meals from scratch that were nutritionally balanced. Everyone sat down together and had a meal. Microwavable dinners, pizza hut, and mcdonalds were not options, never mind the dinner of choice for many families. Single parents or families with two working families were rare so time to prepare food wasn't an issue. Also the junk food culture was very different, kids weren't given unlimited access to junk food filled pantries where they learned to fill emotional gaps with food at a young age, as many kids today do. So of course obesity wasn't as big a problem, the entire culture viewed food differently. I think we all know the cause of the current epidemic, which arose post 1940. Now the goal is to learn how to help our patients, instead of just judging them based on our own personal baggage.

I see that you took PSYCH 101......thank you Dr. Freud for your PSYCH 101 level comments.

I've been in practice for 10 years. I'm board certified in anesthesiology and critical care medicine..........I don't deal in primary care.....I just deal with it's consequences...in the OR...and in the ICU....when none of the primary care docs are around to deal with disease processes that have up to 50% (or higher) mortality.

 

[militarymd]

.................................
The excess portion sizes in restaurants, the steroids in everything we eat (which by the way, we have no idea how they interact with our own hormones), the decreased physical activity due to the different occupations undertaken in first world countries-- all of these have nothing to do with it?

Like I said....you can either be responsible for YOUR behaviors....OR...you can blame the restaurants.

Obviously, you blame the restaurants, your job, and everybody else.

 

[vtucci]

A "hen" is a "chicken," by the way. I am sure that chicken is part of everybody's cultural heritage. It takes almost nothing to roast a chicken, just some salt, pepper, and a lemon if you go in for that kind of thing. You can throw some potatoes in and make some greens and can feed two adults and two children for eight bucks, tops. And you can make soup out of the bones and scrap if you are really motivated (which I seldom am).

My point is that the poor eat the way they do because they are habitually lazy and it is easier to get some fried chicken from Popeyes than to plan and execute a meal that I can make with one hand while reading my mail and talking to my wife. It is simple and cheap to eat well in America where the real cost of groceries has gone steadily down for the last twenty years.

Thanks for clarifying that. Of course, I know what a hen is. I have had them, along with duck, venison etc. However, if you tell a lot of the people living in the South Bronx to go pick up a "hen", many of them will look at you as if you have three heads. Chicken they understand. Hens not so much. There is an education and language gap with many of our patients. We need to be aware of this so we can help them. So they are poor because they are lazy, education has nothing to do with it right?

It is strikingly arrogant to assume that the poor as a class are lazy and just pick up Popeyes as a result. Certain individuals, sure but you cannot generalize even when there are welfare recipients who take advantage of the system and make you want to scream.

 

[Hodad]

Not all fat people overeat or have unhealthy lifestyles.

What's with the paranoid obsession that we think that ALL fat people are lazy overeaters?

 

[vtucci]

Like I said....you can either be responsible for YOUR behaviors....OR...you can blame the restaurants.

Obviously, you blame the restaurants, your job, and everybody else.

I do not blame anyone and you know nothing about me. You were successful in your endeavors, that is great. It is not as easy for everyone and not as simple.

I am pointing out that for most patients who are not as well educated as we are in regard to these matters. Consequently, there are a number of factors that come into play and that includes genetics. You stated that you deal in the after effects of obesity-don't you think you would be better served if you helped your patients and if our colleagues who enter primary care helped obese patients before they get on your table?

Most patients don't realize that portion sizes are much larger than 25 years ago and in many cultures, it is rude not to finish all the food on your plate. Also, as mentioned before, there are psychosocial issues at play with work schedules, family time, cost and knowledge. We need to recognize this reality and not hide our head in the sand.

Moreover, there are no studies that explore how all the chemicals and steroids we are pumping into everything. We do not know all the mechanisms of action or factors involved in the obesity process yet. If we have learned anything, we should know that we that we don't know enough. But if it makes you comfortable, keep to your party line that it is merely a matter of self-discipline.