Obese Med Students

[psipsina]

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.

Condescending and callous, what a winning personality. Boards don't certify compassion, which was lacking in your post. I'm sure your super smart and very good with what you do, and obviously picked a specialty that speaks to your strengths as a physician, and not your weakness. However, since you are posting on the boards for allopathic medical students, this discussion is targeted at many people who are going to choose specialites that patient communication skills are very important for. Many of us are going to end up as PCPs on the front lines battling the current obesity epidemic, and your particular take on the issue really wouldn't benefit their future patients. Obviously with the current epidemic spiraling out of control, our current tactics in dealing with obese patients just aren't working. Many physicians who are currently practicing take the same personal responsibility line that you did, but it just isn't working. The next generation of doctors needs to step outside of this box and start coming up with some new ideas, and I thought seeing a nutritionis was a perfectly good one. Not the cure all to the epidemic but a step in the right direction.

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[vtucci]

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

This was not directed at you Hodad. However, as some of our "learned" colleagues seem to think that obesity is merely a lack of self-control where food is concerned. It is not that simple. No one chooses to be fat. Our lives would be much easier if we were thin and accepted by society.

We just want our colleagues to recognize that there are exceptions and each patient should be treated as an individual. Don't make assumptions. Listen to your patients. If they tell you that they are not overeating, don't assume that they are lying. Treat them humanely. They will not listen to your advice or seek your counsel if they sense you are condescending. Trust me when I say that fat people know if their doctor does not believe them or holds them in disdain.

 

[militarymd]

.........Many of us are going to end up as PCPs on the front lines battling the current obesity epidemic, and your particular take on the issue really wouldn't benefit their future patients. Obviously with the current epidemic spiraling out of control, our current tactics in dealing with obese patients just aren't working......

the "current tactics"....are the ones that you fatty advocates are espousing.....it isn't the patient's fault....it is the envirnoment...it is the media...it is the stress of work...blah, blah, blah.....That is not working....

Let's get back to square one....PERSONAL responsbiliblity.....teach people to keep their mouths shut....teach people to exercise....

The approaches that are being advocated by you younglings....ARE EXACTLY the approaches/mindset that has CAUSED the problem.....

It's not your fault....Let's find a better way...blah, blah, blah.....and not the direct way.....YOU"RE FAT...YOU're LAZY...STOP EATING SO MUCH...TAKE RESPONSBILITY.....CHANGE YOUR SLOVENLY LIFESTYLE...

IF you don't want to change your slovely lifestyile.....then accept being FAT and all that goes with it.

 

[vtucci]

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.

There is a danger in thinking of it in terms of what the majority of fat people do. It is inevitable that many doctors make assumptions based on what they have seen. It is even natural. However, too frequently, doctors lack compassion when treating obese patients and are not open to those patients who are in the minority.

 

[Hodad]

No one chooses to be fat.

Well, strictly speaking, I'm pretty sure that no one makes a conscious active choice to be fat. But you have to admit that most of the evidence points at a decadent lifestyle. Like someone said above, your lifestyle isn't holding you at gunpoint to follow it, it is chosen freely.

I do agree with you that there are exceptions, but they are exceptions. A vast minority of individuals affected by a concrete aetiology. But for the vast majority, the problem is their lifestyle. Lack of exercise, bad eating habits, ignorance, poverty, you name it.

The main qualms people have with overweight patients is that, in many cases, they may not have chosen to be fat, but they lack the will to lose their weight too. Others seek refuge in the "It must be genetic! It's not my fault!", and everyday we find more "Fat Pride" kind of stuff. Sure, being overweight means an added psychological baggage regarding social acceptance and what not (Done that, been there, got the ****ing scars), but to go as far and pretend that the problem can't be solved because "It's my genes, it's not my fault"? Or even to pretend that you can still be fat and healthy? I mean, what kind of rubbish is that?

I sympathise with your earlier plight with regards to doctors disbelieving that you were not overeating. Sure. I do not agree that "gaping at the patient in disbelief" is anywhere near the professionalism expected from a physician, and that if it was discounted out of handedly, then perhaps we have practicing physicians that probably ought not to be practicing. But look at it from the other guy's shoes as well. A majority of overweight people are overweight because of lifestyle choices, and the failure of diet and exercise regimens is lack of adherence. From a statistical point of view, the genetically obese are a statistical anomaly, and while one must not forget that they exist, it is an exceptional occurance in the practice that a patient, firstly, adhere to the regimen to begin with and, secondly, doesn't lose weight. Of course, there are ways and ways, and a good physician would explore the patient more fully and find more subtle ways of detecting whether the problem is a lack of adherence, or it could be ignorance in the implementation of the regimen.

On the issue of having a condescending attitude, I do strongly believe that no treatment regimen of any kind will work if the patient isn't "on board" with the plan, the objectives of the treatment and fully understands how it works and what must be done on the part of the patient and on the part of the physician for the treatment to be successful. The patient that doesn't make a commitment to lose weight, won't. Just like one can take a horse to water, we can't force it to drink, we can offer diets and exercise plans, but we can't force the patients to follow them.

 

[psipsina]

the "current tactics"....are the ones that you fatty advocates are espousing.....it isn't the patient's fault....it is the envirnoment...it is the media...it is the stress of work...blah, blah, blah.....That is not working....

Let's get back to square one....PERSONAL responsbiliblity.....teach people to keep their mouths shut....teach people to exercise....

The approaches that are being advocated by you younglings....ARE EXACTLY the approaches/mindset that has CAUSED the problem.....

It's not your fault....Let's find a better way...blah, blah, blah.....and not the direct way.....YOU"RE FAT...YOU're LAZY...STOP EATING SO MUCH...TAKE RESPONSBILITY.....CHANGE YOUR SLOVENLY LIFESTYLE...

IF you don't want to change your slovely lifestyile.....then accept being FAT and all that goes with it.

Wow. I never said that it wasn't the patients responsibility. I actually said that ultimately it was their responsibility, but that we as physicians have the responsibility to motivate and educate them, and to provide whatever tools (such as nutitional counsuling) to help them on their path. Having compassion for a patient doesn't mean we make excuses for them, we just try to have an understanding of their personal obstacles to success so we can better tailor our approach to help them. If you have a noncompliant patient you try to understand why they are noncompliant and how you can help them. Sure in the end it comes down to them, but you do everything in your power before relinquishing responsibility. Responding to patients in the way your recommending will only alienate them from you, which does nothing to help them, which is what they come to you for in the first place. Calling doctors who are trying to actually help these people "fatty advocates" speaks volumes for your bedside manner. Maybe there should be compassion boards. . . .

 

[militarymd]

I took THEATER 101 too ....along with PSYCH 101....I have Excellent bedside manners.....to lie to and to encourage slovely people to do what they SHOULD be doing on their own....

It is quite pathetic what the practice of medicine has become.



Fortunately, for me, most of my patients are deathly ill...have a good chance of dying....cannot make decisions for themselves....and I make them for them....

Unfortunately...if they survive the ICU...they will likely go back to their slovenly ways.

 

[Hodad]

I took THEATER 101 too ....along with PSYCH 101....I have Excellent bedside manners.....to lie to and to encourage slovely people to do what they SHOULD be doing on their own....

It is quite pathetic what the practice of medicine has become.



Fortunately, for me, most of my patients are deathly ill...have a good chance of dying....cannot make decisions for themselves....and I make them for them....

Unfortunately...if they survive the ICU...they will likely go back to their slovenly ways.

Classic.

 

[vtucci]

the "current tactics"....are the ones that you fatty advocates are espousing.....it isn't the patient's fault....it is the envirnoment...it is the media...it is the stress of work...blah, blah, blah.....That is not working....

Let's get back to square one....PERSONAL responsbiliblity.....teach people to keep their mouths shut....teach people to exercise....

The approaches that are being advocated by you younglings....ARE EXACTLY the approaches/mindset that has CAUSED the problem.....

It's not your fault....Let's find a better way...blah, blah, blah.....and not the direct way.....YOU"RE FAT...YOU're LAZY...STOP EATING SO MUCH...TAKE RESPONSBILITY.....CHANGE YOUR SLOVENLY LIFESTYLE...

IF you don't want to change your slovely lifestyile.....then accept being FAT and all that goes with it.

Wow- my level of self-control should be evident as I am refraining from profanity or flamming you even though you have seen fit to flame us. So you have been practicing for 10 years, you are probably all of 4 years older than me. Let me bow down to my elder. I think most of us will be relieved that you are in anesthesiology and not in a specialty that requires any meaningful patient interaction.

I hope you like inhabiting a world that is black and white. You are fat so you must be lazy. Brillant assessment doctor. You have spent absolutely no time with the patient, know nothing about their history, how much they eat or exercise, personal philosphy, career, family history. When you need a malpractice lawyer, PM me and I will refer one of my law school colleagues.

 

[psipsina]

I took THEATER 101 too ....along with PSYCH 101....I have Excellent bedside manners.....to lie to and to encourage slovely people to do what they SHOULD be doing on their own....

It is quite pathetic what the practice of medicine has become.

Fortunately, for me, most of my patients are deathly ill...have a good chance of dying....cannot make decisions for themselves....and I make them for them....

Unfortunately...if they survive the ICU...they will likely go back to their slovenly ways.

You sound like you are profoundly fulfilled and content with your practice. Congrats.
I'm not going to debate any further because you aren't answering my points. I never said it wasn't the patients responsibility. I never said that you should lie to them. I was only advocating treating your patient as an individual with individual challenges and therefore individual needs so as you could best help them and keep them out of your ICU.

 

[militarymd]

Wow- my level of self-control should be evident as I am refraining from profanity or flamming you even though you have seen fit to flame us. So you have been practicing for 10 years, you are probably all of 4 years older than me. Let me bow down to my elder. I think most of us will be relieved that you are in anesthesiology and not in a specialty that requires any meaningful patient interaction.

I hope you like inhabiting a world that is black and white. You are fat so you must be lazy. Brillant assessment doctor. You have spent absolutely no time with the patient, know nothing about their history, how much they eat or exercise, personal philosphy, career, family history. When you need a malpractice lawyer, PM me and I will refer one of my law school colleagues.

Denial.....the first road block to any cures.

Acceptance....the first step to any cures.

 

[militarymd]

You sound like you are profoundly fulfilled and content with your practice. Congrats.
I'm not going to debate any further because you aren't answering my points. I never said it wasn't the patients responsibility. I never said that you should lie to them. I was only advocating treating your patient as an individual with individual challenges and therefore individual needs so as you could best help them and keep them out of your ICU.

As stated by someone else already...

You can lead a cow to water, but you can't make the cow drink the water...

We ALL know what the answer is....but the doctor can't make the fat patient stop eating and start exercising...only the fat patient can do that.

Then there are the GASTRIC BYPASS surgeons....who are GLEEFULLY making 7 figures a year preying on the weak minded.....

Along with the anesthesiologists who are making mid 6 figures doing these cases even if they philosophically are opposed to it.

 

[Touchdown]

never mind

 

[vtucci]

As stated by someone else already...

You can lead a cow to water, but you can't make the cow drink the water...

We ALL know what the answer is....but the doctor can't make the fat patient stop eating and start exercising...only the fat patient can do that.

Then there are the GASTRIC BYPASS surgeons....who are GLEEFULLY making 7 figures a year preying on the weak minded.....

Along with the anesthesiologists who are making mid 6 figures doing these cases even if they philosophically are opposed to it.

We can bring you the fount of knowledge but can't make you drink.

This discussion is pointless.

 

[mommy2three]

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.



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

no it was not a cheap shot it was more of a mouth open agape i can not believe you would lump everyone together in one big ball of wax.
whiel something may or may not be likely you should never judge before you talk to someone...THAT is compassion. you should be willing to listen to their story before you lump them in with the "statistical mean"....THAT is compassion.
and even if you do run across soemone who is in the statistical mean, who is overeating that does not mean that they chose to be that way......we are just beginning to understand the psychology of overeating and obesity as well as the neurological signals involved. this is a disease that is in it's infancy as far as understanding...and that needs to be considered in dealing with any obese person.

but then again that would take compassion.

 

[mommy2three]

Then there are the GASTRIC BYPASS surgeons....who are GLEEFULLY making 7 figures a year preying on the weak minded.....

trust me when i say that gastric bypass is for ANYTHING BUT the weak minded. it is NOT.....i repeat NOT an easy way out.

 

[militarymd]

trust me when i say that gastric bypass is for ANYTHING BUT the weak minded. it is NOT.....i repeat NOT an easy way out.

No one said having gastric bypass surgery was easy....I've taken care of a few who have died after their anastamotic leak resulted in severe sepsis and ARDS.

BUT....it IS easier than doing it the non-surgical way.

That is a simple observational fact.....If one can't lose weight the regular way, having this surgery allows one to do what one couldn't do before.

 

[Hodad]

i can not believe you would lump everyone together in one big ball of wax.

*Bangs. Head. On wall. Repeatedly.*

No. I can't believe it. You've got to be kidding me if you're making these kinds of slanderous accusations. At this point, it's downright offensive that people are still saying RUBBISH like this this far.

 

[canadagirl]

Or even to pretend that you can still be fat and healthy? I mean, what kind of rubbish is that?

Okay, suppose I agree with you that the vast majority of fat patients are fat because they don't want to make the reasonable effort to be thin. Let's even add that they are stupid, gluttonous, and just generally evil with every epithet that we can throw at them. It still doesn't matter - the fact remains that the vast majority of fat patients are unlikely to become thin through lifestyle changes (because of "genetics", or because they are lazy, or whatever). What's wrong with taking a harm reduction approach, then? Helping them to eat better and exercise more will improve their health, even if it doesn't improve their health as much as losing weight would.

I mean, "healthy" describes a spectrum. Almost nobody is perfectly healthy: never stressed, perfect coping skills, ideal BMI, perfect blood pressure, never eats any junk food, etc, etc. Is a fat person with other normal health indicators "healthier" than a thin person with major depression? How about a person with cerebral palsy or Down syndrome, can they ever be "healthy"? A well-managed Type I diabetic? It's a meaningless question.

Our jobs as physicians, I believe, are to help every patient improve their health and functional abilities. I am wary of describing some conditions as incompatible with health - such as "fat people can never be healthy". Fat people can improve their health, just like any other patient.

From a statistical point of view, the genetically obese are a statistical anomaly, and while one must not forget that they exist, it is an exceptional occurance in the practice that a patient, firstly, adhere to the regimen to begin with and, secondly, doesn't lose weight

To bring this back to the first post in the thread ... okay, but then you have to define exceptional. Seems to me that if we agree that individual ideal weights fall on a bell curve, then some number of people are going to have a BMI of over 30 and even over 40 at their healthiest. Even a hundred years ago, before the supposed obesity epidemic began, some people were fat. In a medical school class of 100 or 200 students, doesn't it stand to reason that one or two are going to be fat just based on usual outliers of a normal distribution?

 

[Hodad]

Okay, suppose I agree with you that the vast majority of fat patients are fat because they don't want to make the reasonable effort to be thin. Let's even add that they are stupid, gluttonous, and just generally evil with every epithet that we can throw at them. It still doesn't matter - the fact remains that the vast majority of fat patients are unlikely to become thin through lifestyle changes (because of "genetics", or because they are lazy, or whatever). What's wrong with taking a harm reduction approach, then? Helping them to eat better and exercise more will improve their health, even if it doesn't improve their health as much as losing weight would.

First of all, I am going to ask you to burn the strawman you're arguing against. Secondly, my heated contestation was in condemnation of the claim that you can be "fat and healthy", which is demonstrated in a myriad of papers, studies, evidence of all sorts that nothing could be farther from the truth. To go out there and tell your fat patients that they're "healthy despite the fact that they are fat" I would go so far as to label malpractice. It is negligent to tell a fat patient that they can be fat and healthy. It would help perpetuate a lie, and one that may very well be harmful directly to the patient.

I mean, "healthy" describes a spectrum. Almost nobody is perfectly healthy: never stressed, perfect coping skills, ideal BMI, perfect blood pressure, never eats any junk food, etc, etc. Is a fat person with other normal health indicators "healthier" than a thin person with major depression? How about a person with cerebral palsy or Down syndrome, can they ever be "healthy"? A well-managed Type I diabetic? It's a meaningless question.

It's not a meaningless question. Honestly, ladies and gentlemen, you are looking at the tree and missing the entire forest. Well DUH health is transitory and, I would even venture to say inexistant if one takes the current WHO definition. But to look at the patient and say "You're healthy" is merely saying "You're healthy- today". But who has higher chances of being unhealthy tomorrow based on their aspect of today? The fat patient or the average patient? To look upon the today is failing to make a prognosis on tomorrow. You tell a fat patient "Hey, you're healthy, and you're fat." and you damn well know he's more likely to drop in at age 40 with kidney failure, an MI and heart failure on their back than the slim patient. It would be a lie to tell your patient that they can be fat and healthy, and it would be negligent to not encourage them to reverse their overweight situation in hopes of reversing their increased chances of suffering a myriad of different pathologies, diseases and complications related to their overweight.

A well managed Diabetic will never be considered healthy. Hell, for the sake of predicting their chances of cardiovascular disease, diabetics are considered to have already suffered a cardiovascular event when evaluating diagnostic algorithms and treatment plans. So I can just tell my diabetic to go off and be happy? No. I need to make him aware that he's at risk of a lot of stuff, and that alterations to their lifestyle are likely to greatly improve their current health and their prognosis for the future.

To bring this back to the first post in the thread ... okay, but then you have to define exceptional. Seems to me that if we agree that individual ideal weights fall on a bell curve, then some number of people are going to have a BMI of over 30 and even over 40 at their healthiest.

This is a complete fallacy. Why? Because it's like arguing that I shouldn't treat a non symptomatic, non complicated hypertense patient with 240/140 simply because "maybe he's that 2.5% of people that falls outside 97.5th quartile of normality". Just like target blood pressures are based on the prognosis of high blood pressure, the same happens with BMI. Hell, normal glycemia values have been inching their way down in the past few years. Why? Because all these are morbidity and mortality predictors. There is no such thing as a healthy person with a BMI of 40, just like there's no such thing as a healthy person with a glycemia of 350 mg/dl or a healthy person with a basal BP of 250/190.

 

[rose1]

Unless you think the genetics of 20% of the American population has changed drastically over the last 20 years?

Interestingly, it is indeed possible that epigenetics have been changing that rapidly.

https://notes.utk.edu/bio/greenberg.nsf/0/b360905554fdb7d985256ec5006a7755?OpenDocument

(It's obviously completely unclear at this point what the significance of this is, but I read an article about epigenetics tonight, and it reminded me of the particular remark quoted above. I thought others might find it interesting too -- we don't know nearly as much about inheritence as we think we do)

 

[8744]

I can't believe, in a previous post, I called the poor lazy and stupid and nobody said jack. This shows you how much progress we have made on SDN. When I first started posting this sort of thing would have lead to 30 pages of righteous indignation.

I think we know realize that there is an element of stupidity and sloth in the chronic poor.

 

[TexasRose]

Perhaps, PB, most people have realized that this thread has just turned into a "bait and insult" festival and didn't see the need to dignify your comments with a reply.

I would like to suggest that if no one else has anything productive or useful to say regarding the OP's original question, we should let this thread go now.

 

[8744]

...Perhaps, PB, most people have realized that this thread has just turned into a "bait and insult" festival and didn't see the need to dignify your comments with a reply...

Not at all. I think that a lot of the members of SDN have now actually worked with the poor and seen what lazy, sacks of **** many of them are.

 

[AmericanIMG]

Not at all. I think that a lot of the members of SDN have now actually worked with the poor and seen what lazy, sacks of **** many of them are.

i am guessing that your remarks are meant to be sarcastic and that you are not serious...

poverty is a viscious cycle in the US. poor families send their kids to local public schools which can be completely useless...they don't have guidance or support which leads to the kids becoming uneducated, poor adults. rinse, repeat.

 

[stinkycheese]

I'm fat and I don't think its anybody's fault but my own. Sure after awhile it has become unfortunately a part of my identity and I start to question whether I am really motivated enough to lose the weight, or whether I will just be fat and unhappy for the rest of my life. But I can't blame anyone but myself. In the past, when I have tried to lose weight, I have, successfully. So I can't say "oh its my genetics" and I am glad my doctor is hard on me - my goal is to have lost a good 40 pounds before 3rd year so that I don't look like a hypocrite on the wards.

 

[Mixtli]

For the past year, I was about 30-40 lbs overweight (but not obese). I really wanted to lose weight because I felt sluggish and lethargic at times. The first thing I did was change my eating habits.
1) No sugary drinks (extra sugar added)
2) No fried foods (except twice a month perhaps)
3) No snacking in between and after meals
4) Keep track of calorie intake (no more than 2000 calories per day)
5) No junk food (chips, candy)

It was hard resisting eating the good stuff, but I have lost around 10-15 lbs over the last 3 months. I feel lighter and less lethargic than before. It took self-discipline and responsibility more than anything else.

 

[swpm]

I can't believe, in a previous post, I called the poor lazy and stupid and nobody said jack. This shows you how much progress we have made on SDN. When I first started posting this sort of thing would have lead to 30 pages of righteous indignation.

They're too busy sputtering, fixating, and speaking up in defense of the 1.3% of fat people who aren't overeaters, to get indignant and defensive on behalf of the 0.9% of welfare recipients who aren't lazy idiots. [1]

poverty is a viscious cycle in the US. poor families send their kids to local public schools which can be completely useless...they don't have guidance or support which leads to the kids becoming uneducated, poor adults. rinse, repeat.

I have a hard time believing it's the schools and not the stupid and lazy parents who don't care about their kids.

I have two kids in a public elementary school now, in an area that has some very poor people. This school lost its accreditation because a majority of the kids there can't read or add. But you know what? My kids always test 1-3 grades above their level, because we make them do their homework immediately after school, we won't tolerate a yellow note from the teacher (talking in class, incomplete homework, failed test), we praise their success and reinforce how important it is to do well in school. My kids aren't genetic superfreak geniuses. Yet they excel despite being in enrolled in a demonstrably poor public school.

To illustrate the real problem here: there are TWO new students in one of my kids' classes this month - because their parents forgot to enroll them back in September. It's ****ing October, and they forgot to enroll their kids! These kids are doomed, but it's not the school's fault. It's their stupid, lazy parents.

The reason half these kids can't add or spell isn't because their parents are poor - it's because their parents are *****s. Yes, it's a vicious cycle, and it's sad.


[1] Yes, these statistics were fabricated to make a point.

 

[liverotcod]

Wow, this thread is festering a bit. Can't we all just get along?

 

[gostudy]

Wow, this thread is festering a bit. Can't we all just get along?

Not until everyone agrees that most obese are obese because they choose to be.

 

[liverotcod]

Not until everyone agrees that most obese are obese because they choose to be.

That wasn't exactly helpful.

 

[gostudy]

That wasn't exactly helpful.

The thing is, this thread continues on because there are a select few that are presenting all kinds of epigenetic sociological etc. etc. reasons for why people are fat, when the fact of the matter is we as clinicians should be more worried about the real cause of the rise in obesity (ie miseducation, lack of self-control, and laziness) instead of incomplete hypotheses.

Look at it this way. If obese patients were educated about obesity, controlled what they ate, and exercised obesity would go down dramitically in this country. Why then should we not focus on these three factors.

 

[militarymd]

The thing is, this thread continues on because there are a select few that are presenting all kinds of epigenetic sociological etc. etc. reasons for why people are fat, when the fact of the matter is we as clinicians should be more worried about the real cause of the rise in obesity (ie miseducation, lack of self-control, and laziness) instead of incomplete hypotheses.

Look at it this way. If obese patients were educated about obesity, controlled what they ate, and exercised obesity would go down dramitically in this country. Why then should we not focus on these three factors.

Because then people would have to accept personal responsibility in an era when personal responsbility has gone bye-bye.

 

[Law2Doc]

Look at it this way. If obese patients were educated about obesity ...

Do you seriously think obese people don't know being obese is unhealthy? Even if you put aside any potential emotional/genetic/psychiatric issues, it's going to be an issue of motivation not information -- they already know they are fat and that being fat is bad for their health. There is nothing you can say on this point that will be a revelation.

 

[chocomorsel]

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.

Thank you!!!! I was gonna say just that. All these fat people keep getting offended when what we are merely saying is that the MAJORITY are fat because of lifestyle choices. Vtucci, mommytothree and others may not be in that majority and are simply exceptions to the rule.
Of course I can't personally relate, but I have a stepfamiliy that has some fat people in it, I see how these people eat and how much. It's quite disgusting if you ask me, but they seem not to have any problems with it. They don't mind being fat, and eat, I'd say at least 3000 calories a day without any exercise.
I hardly exercise, and may be an exception to the rule when it comes to thin people. But I cook about 2-3 times a week and pack my lunch 3-4 days a week, and eat plenty of veggies, fruit and drink juices and not too much meat. I don't drink soda, and hardly fry any thing I cook, except for sauteeing. Lots of sauteeing, steaming, stewing and baking. I'm sure if the majority of fat people out there ate what I ate without any exercise at all, they would still shed pounds. Not as much as with exercise, but there would still be a difference.
And that crap about nutritious food being so much more expensive, is a load of crap. People can buy lots of frozen veggies that are just as healthy as the fresh nonfrozen kind but tend to run cheaper. And cereal is way expensive all the time. And all that ice cream and cookies and doritos is pretty darn expensive if you ask me. Substitute some fruit for that, and I bet you'd save some money.

 

[chocomorsel]

Do you seriously think obese people don't know being obese is unhealthy? Even if you put aside any potential emotional/genetic/psychiatric issues, it's going to be an issue of motivation not information -- they already know they are fat and that being fat is bad for their health. There is nothing you can say on this point that will be a revelation.

Actually, I don't believe that they all know that being fat is necessarily unhealthy. Or at least they choose to be in denial about it. Haven't you ever met a fat person who says they are proud to be fat, and fat is beautiful etc, etc? I have. Not that fat cannot be beautiful but many are proud of their extra pounds and see nothing wrong with it. This can be easily seen in the black community. I, as a skinny black woman get a lot of negative comments that I'm too thin, and need "more meat on my bones", etc etc.
So no, I don't believe that all fat people know, or believe that being fat is unhealthy.

 

[racerx]

May I posit that obesity is neither caused mainly by genetics nor by pure laziness? Ingrained and long-learned BEHAVIORS are the root cause of much of the obesity. Culture, society, and upbringing are huge factors in developing deeply rooted behaviors.

Eating behaviors can be difficult to change. I would bet that most of you that have never possessed the behaviors that lead to obesity have never struggled with changing the behavior. It then becomes easy for you to simple say, "just don't eat." Well, as many psychologists and behavioral scientists will attest, behaviors do not change on a dime. Change takes time, and in some cases, many attempts.

But it's (a) easier to speak from on high about the simple laziness of the obese, and how easy it is for all people, regardless of ingrained behaviors, to simply not eat. And, (b) easier to simply blame genetics.

Not everything is black and white. . .on either side.

 

[militarymd]

........Not everything is black and white. . .on either side.

From a former fat person.

After all that is said and done....the final step before that twinkie becomes a part of your spare tire...

What are the choices at that final step???

1) put the twinkie in your mouth...

or

2) don't put that twinkie in your mouth...


I don't know...seems pretty black and white, very simple, dichotomous decision tree there.

 

[swpm]

Do you seriously think obese people don't know being obese is unhealthy? Even if you put aside any potential emotional/genetic/psychiatric issues, it's going to be an issue of motivation not information -- they already know they are fat and that being fat is bad for their health. There is nothing you can say on this point that will be a revelation.

Do you seriously think smokers don't know that smoking is unhealthy? Even if you put aside any potential emotional/genetic/psychiatric issues, it's going to be an issue of motivation not information -- they already know they are smokers and that smoking is bad for their health. There is nothing you can say on this point that will be a revelation.

It has been very well established that people who successfully stop smoking do so, on average, after multiple attempts. Attempts that are frequently prompted, inspired, or supported by family, friends, and their doctors. It is an irresponsible disservice to your patients to not address risky behavior - including those behaviors that contribute to obesity - at each visit. If it makes you or the patient uncomfortable, you both need to get over it.

We all know that the overwhelming majority of disease that afflicts people in their later years is self inflicted. There haven't been any prospective randomized studies, but I wonder which has more potential to reduce that suffering: A primary care physician who tweaks 10 obese patients' dose of lisinopril or starts a statin, rationalizing that the drugs will help make them "healthy" fat people ... or the PCP who talks to all 10 and helps one lose 50 pounds?

 

[Law2Doc]

Do you seriously think smokers don't know that smoking is unhealthy? Even if you put aside any potential emotional/genetic/psychiatric issues, it's going to be an issue of motivation not information -- they already know they are smokers and that smoking is bad for their health. There is nothing you can say on this point that will be a revelation.

If you want to compare obesity to something addictive, like nicotine, I think you are alligning with those on this thread who are saying there's more to the obesity problem than that folks should eat less and exercise more. In which case I agree with you.

 

[trustwomen]

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.

Can you please try to make some distinction between the morbidly obese and the "obese"? After all, by BMI standards, Panda, if you happen to be 6 ft tall, your 225# qualifies you as "obese". My size-18, healthy, mobile, and non-gluttonous self also qualifies as "obese". I'm fairly sure that the OP wasn't talking about the 600-pound students in his class - he was talking about folks like us.

I don't think anyone is going to deny that you need some exceptionally harmful eating behaviour to get to 600 lbs, like this lady you describe. But I personally know a fair number of 200+ pound people who don't live that differently from the majority - some, who have a long history of diets (and therefore a screwed-up metabolic rate) sometimes even live more healthily than most - and they still get judged so very harshly and unfairly. And some of them probably get into med school. (although in my class I am one of only three - yes, three - overweight girls, sigh - the rest nearly all have protruding ribs.)

 

[racerx]

From a former fat person.

After all that is said and done....the final step before that twinkie becomes a part of your spare tire...

What are the choices at that final step???

1) put the twinkie in your mouth...

or

2) don't put that twinkie in your mouth...


I don't know...seems pretty black and white, very simple, dichotomous decision tree there.

First, I like how you challenge the idea that everything is not B/W, yet ignore the major idea of my post, that not all obese are lazy, but that behavior can play a major role. You totally ignored that point. I guess those people that make it into medical school after busting their butts working, having small children and spouses, and still finding time to volunteer and maintain high GPA are still lazy to all you beautiful people.

Anyhow. . .

As one twinkie denied will not make you skinny, neither will one mmake you fat. It is the OVERALL eating habits and behaviors that make a person obese. Recently, the "mindful eating" technique to help people eat healthier has been quite successful. However, as I believe eating is often done without prior thought (hence the behavioral aspects) the person's behavior has to be changed to make it a success for an individual.

As weight loss and maintainence is not a linear one-twinkie process, it can get complicated from a behavioral change standpoint, hence it is not black and white. While it may be for you, do not assume that all people have identical behavioral traits and issues. You are then imposing your own personality's (strengths, weaknesses, etc.) upon everyone.

As all people are behaviorally complex individuals, it does make for many grey areas.

 

[militarymd]

First, I like how you challenge the idea that everything is not B/W, yet ignore the major idea of my post, that not all obese are lazy, but that behavior can play a major role. You totally ignored that point. I guess those people that make it into medical school after busting their butts working, having small children and spouses, and still finding time to volunteer and maintain high GPA are still lazy to all you beautiful people.

Just because you work at one thing doesn't mean you aren't lazy at something else.

Anyhow. . .

As one twinkie denied will not make you skinny, neither will one mmake you fat. It is the OVERALL eating habits and behaviors that make a person obese. Recently, the "mindful eating" technique to help people eat healthier has been quite successful. However, as I believe eating is often done without prior thought (hence the behavioral aspects) the person's behavior has to be changed to make it a success for an individual.

As weight loss and maintainence is not a linear one-twinkie process, it can get complicated from a behavioral change standpoint, hence it is not black and white. While it may be for you, do not assume that all people have identical behavioral traits and issues. You are then imposing your own personality's (strengths, weaknesses, etc.) upon everyone.

As all people are behaviorally complex individuals, it does make for many grey areas.

It is not complex....You pick out what you are going to eat for a day...and what exercise you are going to do for the day...and DO it....or DON'T do it.....

Fat people choose not to follow a plan....

You choose TO or NOT to.....simple...black and white and dichotomous.

If a plan doesn't work...then you modify it....low the caloric count more...or increase physical activity...and then YOU STICK TO IT...or NOT.

Fat people choose not to follow a plan....


At some point....caloric intake will be zero...and physical activity will be constant....you WILL LOSE weight...

ONLY way you don't is if you choose NOT to follow the plan...

Pretty black and white to me.....

Oh....and don't give me all the excuses that we've heard before........

 

[Hodad]

May I posit that obesity is neither caused mainly by genetics nor by pure laziness? Ingrained and long-learned BEHAVIORS are the root cause of much of the obesity. Culture, society, and upbringing are huge factors in developing deeply rooted behaviors.

Laziness/Overeating = behaviour.

Eating behaviors can be difficult to change. I would bet that most of you that have never possessed the behaviors that lead to obesity have never struggled with changing the behavior. It then becomes easy for you to simple say, "just don't eat." Well, as many psychologists and behavioral scientists will attest, behaviors do not change on a dime. Change takes time, and in some cases, many attempts.

I've done it. At home, we used to eat red meat every day. The portions were huge. We had cold cuts all the time, and, though we still ate a lot of vegetables (fresh, mostly) and fruit, we still had meat very very often, practically no fish or chicken, and ate a lot of potatoes. My mother used to bake cakes every weekend, and we'd have plenty of confectioned sugar carbohydrates there.

We weren't obese, mostly only overweight, but one day my mother said "stop, this is ridiculous". Our family doctor referred us to a nutritionist. We all got on board with the plan and it's been about five years since the change and...

We eat red meat... twice a week tops. We've halved the size of portions. Breakfasts, which used to be a confectioned sugar festival that would make a diabetic reel, are now mostly yoghurt, fresh fruit juice, a couple of pieces of toast, and soft cheeses. No more butter. Jam in winter. Coffee or tea or milk. Cakes are a rarity (birthdays only), and I haven't eaten a potato for months. Most of the meat is now fish or chicken. We eat huge portions of fresh vegetables everyday. Even bread is something we eat little of. We've stopped adding salt to food. We don't miss any of the stuff we used to eat, and when we feel like having a piece of cake or indulging in something in particular on ocassion, we can without problem or guilt.

We've all lost, on average, between 20 and 25 pounds. We're all happier, lighter, fitter. And nobody really suffered in the process. Change is easy, all it takes is the desire to change and a bit of self control.

 

[trustwomen]

the "current tactics"....are the ones that you fatty advocates are espousing.....it isn't the patient's fault....it is the envirnoment...it is the media...it is the stress of work...blah, blah, blah.....That is not working....

Let's get back to square one....PERSONAL responsbiliblity.....teach people to keep their mouths shut....teach people to exercise....

The approaches that are being advocated by you younglings....ARE EXACTLY the approaches/mindset that has CAUSED the problem.....

It's not your fault....Let's find a better way...blah, blah, blah.....and not the direct way.....YOU"RE FAT...YOU're LAZY...STOP EATING SO MUCH...TAKE RESPONSBILITY.....CHANGE YOUR SLOVENLY LIFESTYLE...

IF you don't want to change your slovely lifestyile.....then accept being FAT and all that goes with it.

Do you really think those are the tactics used today when doctors advise their patients on weight loss - "it's not your fault, it's stress, etc."? Have you been to see a doctor, as a fat person? That's just ridiculous. You're far more likely to hear "you're fat and lazy", or words to that effect.

Now, most doctors I've seen just haven't mentioned my weight at all - I've always had lowish blood pressure and my cholesterol etc.. is fine. I'm not that big, though; I'm sure it gets worse when you pass certain markers (250 or 300, for instance). One doctor said "you're healthy now, but don't gain any weight", which was OK. Some look at you with disdain, especially when they are physically examining you. Or pass hurtful little comments, not enough that you are justified in reacting angrily, but enough that you fight back tears after they are gone. Yes, most fat people are sensitive about their weight. They have probably endured a lot of grief about it and are hypersensitive to being judged for it. It doesn't mean you can't address the subject, but your advice should be caring and tactful. More so than, for example, your advice to smokers - smokers aren't nearly as stigmatized, and were probably not teased for smoking when they were young (and hadn't developed emotional defenses yet).

What would have been helpful for my doctor to do, and which I noticed was advocated here at one point, would have been talking about habits and behaviours, period. How about encouraging all your patients to eat well, exercise, cease their addictions, etc.. without "deducing" what their habits are by the way they look? Ask them! I, for one, would readily admit that I should get more exercise, and plan my eating better so that I avoid buying lunch at the school cafeteria, and start eating breakfast every day, etc... But if my doctor walks in thinking that I roll up pizzas to stuff into my face, or eat at McDonalds regularly, or that I don't ever get up from my couch, we won't get very far together - because those are incorrect (and offensive) assumptions. I'm all for helping people improve their habits, and most fat people probably have some bad habits (heaven knows I do), but if you screen everyone for bad eating/exercise habits, you'll find that a whole lot of thin people have them too. I'm with the Health at Every Size poster - promote healthy eating and exercise in all your patients, without emphasizing "pound loss" - heavy people can get much, much healthier without that scale moving much (if at all), by improving their habits. Healthy eating might also result in some borderline anorexic people winding up fat, too. Who knows? Either way, they'll be better off with better habits.

 

[trustwomen]

Or even to pretend that you can still be fat and healthy? I mean, what kind of rubbish is that?

? I thought at least a few posters here mentioned that they are fat and healthy? Wasn't there someone training for a black belt at over 200 lbs? Then there's me and Panda, statistically obese but healthy. Others?

It's also a mistake to assume that someone is healthy just because they aren't fat. They might have disordered eating that is just as harmful as the pizza-rolling thing, they might have a terrible diet and live a totally sedentary lifestyle and have high cholesterol, diabetes, etc...

 

[trustwomen]

There is no such thing as a healthy person with a BMI of 40, just like there's no such thing as a healthy person with a glycemia of 350 mg/dl or a healthy person with a basal BP of 250/190.

BMI 40 is morbidly obese. BMI 30, however, is "obese" but there are people who can be very healthy at that weight - say, 6' and 225# - at any age.

So - maybe we can agree to say that you can be fat and healthy, but you can't be morbidly obese and healthy?

 

[Hodad]

I thought at least a few posters here mentioned that they are fat and healthy?

Do I need to repeat myself? BMI, just like BP, should be used as a health predictor. It would be asinine to insist that one can be fat and healthy, if that excess grease is giving you double the chance of becoming a diabetic or dieing of a heart attack in ten years time.

It's also a mistake to assume that someone is healthy just because they aren't fat.

Well, duh.

So - maybe we can agree to say that you can be fat and healthy, but you can't be morbidly obese and healthy?

No. Because it's asinine to use health predictors ignoring the point they were invented for. To predict your future health. Honestly: I'm getting fed up of having to justify and rejustify this point. Unless you're going to bring up a valid refutation of my point, please stop arguing that "But you can still be fat and healthy" if you aren't going to construct a functioning refutation.

 

[trustwomen]

It has been very well established that people who successfully stop smoking do so, on average, after multiple attempts. Attempts that are frequently prompted, inspired, or supported by family, friends, and their doctors. It is an irresponsible disservice to your patients to not address risky behavior - including those behaviors that contribute to obesity - at each visit. If it makes you or the patient uncomfortable, you both need to get over it.

I agree with the need to address behaviour - in all patients, please, not just the fat ones.

About the smoking comparison: after each failed attempt to quit smoking, does the smoker wind up smoking 10 more cigarettes per day than they did before they tried to quit? Does going through several cycles of quitting and restarting greatly increase their health risks, compared to never having quit? Does it leave them smoking a lot more than they used to, as well? Does it get physically harder and harder to stop smoking after each failed attempt, as the body adjusts and, say, prolongs your cig cravings? Does the human body actively resist the quitting of smoking, because it evolved at a time when nobody had enough, let alone too much, nicotine? These are the comparable truths with dieting. Considering the failure rate of diets (failure of the diet or of compliance, whatever, it's still a failure rate for the treatment), is it safe or advisable for us to push dieting on them?

If the above were true for smoking, I would not advise the patient to quit until I knew they were really ready to do it forever, and that they would stick to it - a premature attempt would hurt rather than help. Kind of how you don't pressure an abused woman to leave until you and she are VERY sure she won't go back - otherwise, you are just increasing her risk of being murdered. I'm not trying to say that fat people are directly comparable to abused spouses! Just that with dieting, there is a serious risk of harming your health when you "go off prematurely" into a diet, only to fall back into your old habits.

 

[trustwomen]

Do I need to repeat myself? BMI, just like BP, should be used as a health predictor. It would be asinine to insist that one can be fat and healthy, if that excess grease is giving you double the chance of becoming a diabetic or dieing of a heart attack in ten years time.
it's asinine to use health predictors ignoring the point they were invented for. To predict your future health.

Show me where fat alone, minus any other normally associated markers (high BP, abnormal blood sugar, high cholesterol) is indicative of future disease. I'd love to see the study.

If all their numbers are fine other than the scale, and their habits are reasonably normal, what's wrong with telling them that they are healthy? If they are among the fat people who eventually start getting wonky blood sugars or high BP, sure, nip it in the bud when it starts getting wonky or high and make sure they get it under control (which does not mean becoming unfat; losing just 10% of body weight will often do it).