January 27, 2013

Another risk of fatness: health-care professional who too readily attribute any health problem to fatness.

UCLA sociology professor Abigail Saguy explains :
Scores of studies have shown that medical providers typically regard fat patients as lazy, self-indulgent and noncompliant. As a result, heavy patients don’t always receive the health care they deserve....

Many heavy women told me that doctors routinely blamed any ailment, from a fall to a sore throat, on their weight....
So there may be mistakes in treating fat people. That's plainly wrong and easy to condemn. It's harder to know how to react to criticisms like this:
One woman I talked to visited a new gynecologist, who, during her annual exam, began lecturing her about her weight. When the patient said she did not want to discuss weight loss, the doctor backed off. She resumed her lecture, however, during the pelvic exam, when the patient had her feet in stirrups and a speculum inside her. She told me she felt as if she were mentally “going somewhere else” — not unlike how many women feel while being sexually abused.
This is close to an etiquette consideration: What can you say to a woman while penetrating her vagina? From the patient's perspective, it's hard to know how tolerant or outraged to be. I think some doctors are obtuse about what they can say while they're probing a woman's intimate parts. They might think it's a good time for casual conversation, precisely to demonstrate how nonsexual what they are doing is. The woman might endure the situation, then feel bad about it afterwards. But I don't see much connection to that problem and the fact that one of the casual conversation topics the doctor might introduce is the way you need to lose weight. It's not a good time to try to take advantage of your close connection to the patient!

Finally, there's the health issue of stress, which can grow out of the problem of being overweight. Prof. Saguy seems to say that any message to fat people about the problem of fatness might only make matters worse. Elsewhere, I've seen commentary suggesting that it's the other way around. Lessening the social pressure leads more people to get and stay fat. Who knows where the greatest health risks lie? And should our decisions about how to talk to fat people be based on what's best for their health? Maybe not!

165 comments:

Synova said...

The doctor was probably thinking... "this would be so much easier if she wasn't so fat."

rhhardin said...

This is close to an etiquette consideration: What can you say to a woman while penetrating her vagina?

Sociologist Joan P. Emerson had an essay, "Behavior in Private Places: Sustaining Definitions of Reality in Gynecological Examinations"

It'a one of the things sociologists call a precarious situation.

a SWVA liz said...

No question that many doctors reach for the fastest and easiest way to get the patient out the door, and the bill rendered. A lecture given many times before does not solve the patients problems. Of course, generations ago, Doctors considered all women hypochondriacs, and treated them accordingly. So we have made some progress. Now it's fat women who are being ignored, not all women.

Fortunately I have found a doctor who listens. Doctors willing to listen are difficult to find. I am sorry for those who are not so lucky.

Edgehopper said...

I recommend First, Do No Harm, a blog that collects stories of this kind of doctor behavior, and also My OB Said What?, a blog focusing on awful doctor behavior towards women concerning pregnancy and childbirth, with a large amount of such incidents being directed towards fat women.

The top post at First, Do No Harm at the moment features a women who at 11, complained of headaches, tiredness, blurred vision, and dizziness. The doctors blamed on either puberty or weight and told her to go home. Only after passing out did doctors actually perform a thorough examination and discover an eye infection that, had it been ignored for much longer, would have caused blindness, deafness, or even death. Later in life, the same sort of fat-hating malpractice resulted in doctors missing a huge, painful ovarian cyst.

BDNYC said...

If your doctor is lecturing you about your weight, you're probably fat enough that you're unhealthy. So stop whining and lose some weight, lard butt.

Ann Althouse said...

It's the doctor's (and nurse's) job to treat the patient. Not to wish for a different patient.

Yet the doctors and nurses are human beings. We don't like to think about what they are thinking or even about the fact that they do have minds of their own. We deny their humanity. How dare they have any ideas about my worthiness!

And underlying that: the fear. They might not think that I am worthy of this care. They might think everyone would be better off if I disappeared.

Chase said...

Careful Ann - don't join the willful idiots of all stripes who believe overweight and obesity are all the same and that the cure is the same for everyone.

Everyone believing such things will in future years be shown to be idiots as big as those who believed - as so much of the medical community did stubbornly for years even after it was proven differently - that "stress" caused most stomach and esophageal ulcers.

You are only getting or choosing to only believe partial information on this politically correct issue of the moment

ironrailsironweights said...

This is close to an etiquette consideration: What can you say to a woman while penetrating her vagina?

"Maybe you should let it grow back."

Peter

Storkdoc said...

when I am doing the pelvic I defer all conversation until I am finished. I tell my patients that I prefer to speak to them face to face, rather than speaking to their bottom.

Sometime you need to discuss the weight. I had a patient who came in with irregular periods and infertility. She had PCOS. She told me that she didn't want to hear about weight loss, she said that was the only thing that the other doctors said.

So after the exam, I sat her up and said you need to loose weight and this is why. I then launched into the explanation as to why weight loss is the primary treatment for PCOS. When I was done, she said no else every gave her the reason, but now she would try and lose the weight.

So as my wife tells me from time to time, its not always what you say, but how you say it.

Ann Althouse said...

One time, I had a gynecological examination by a male doctor who remarked on the unusual "succulence" of my cervix. I gave no particular reaction, but afterward this was a huge topic of discussion between me and my feminist professor friends. Should I have jumped up and protested?

Ann Althouse said...

"Maybe you should let it grow back."

Peter, if you don't know the difference between a vagina and a vulva, I'm going to be very annoyed. No one has a hairy vagina.

Maguro said...

Say "a succulent cervix". Then imagine Sylvester the Cat saying it.

Erika said...

I wouldn't have "protested," personally, but I might have said, "Succulent is an interesting choice of word," and thus invited him to explain.

RichardS said...

There seems to be a creeping essentialism here. Might this be something that varries from culture to culture? I am perfectly happy to think that it might be the same in all cultures, but, then again, I have serious doubts that Locke was right about human nature being a blank slate.

kentuckyliz said...

We were talking about this a few days ago.

The worst: an obgyn during pelvic exam, joking around, said, "OK I'll stop recording now. I'll upload that to YouTube tonight."

edutcher said...

The Blonde is fighting a weight gain (and a drop in metabolism) the result of her fall a couple of years ago (I OTOH have dropped about 25 pounds and the ads where the woman snarls at the man, "Whadya wanna weigh, zero?", are a source of considerable mirth on both sides).

She says she doesn't have to be told she's got to drop it, she feels it in her feet, knees, and back all the time.

She also worked a bariatric floor before she fell.

Ann Althouse said...

One time, I had a gynecological examination by a male doctor who remarked on the unusual "succulence" of my cervix. I gave no particular reaction, but afterward this was a huge topic of discussion between me and my feminist professor friends. Should I have jumped up and protested?

An odd way to put it, given that organ really isn't associated with that "activity".

Certainly, you have gotten more assertive since then.

kentuckyliz said...

A really beautiful secretary at my campus told me that her obgyn gave her a clinical breast exam that was sexual groping. Ladies, you know the difference.

She was in tears at home, her husband got the reason for the tears, and promptly hunted down that doc and beat the living crap out of him.

southcentralpa said...

Hmmm... Well, we know as a matter of historical record that there was a sharp decrease in obesity, heart disease, type II diabetes, and even MS in Belgium, the Netherlands, Denmark, Norway, and other European nations during the period 1939-45. All we have to find out what they did, and we're all set ...

kentuckyliz said...

If you look at human change dynamics, doctors nagging patients is particularly ineffective. When the doctor is overweight, it's even less effective.

Marshal said...

Ann Althouse said...
It's the doctor's (and nurse's) job to treat the patient. Not to wish for a different patient.

Yet the doctors and nurses are human beings.


Do we accept this level of humanity across the service provider universe? Or merely because we humanize medical professionals are we willing to accept such unbelievably offensive commentary.

ironrailsironweights said...

Peter, if you don't know the difference between a vagina and a vulva, I'm going to be very annoyed. No one has a hairy vagina.

No need to be annoyed, Ann. If you are peering into one you easily can see the other and its state of hirsuteness. Or, as is tragically almost always the case today, non-hirsuteness.

Peter

ironrailsironweights said...

One time, I had a gynecological examination by a male doctor who remarked on the unusual "succulence" of my cervix.

JERRY (clearly creeped out by having to shake Poppie's hand): Hello, Poppie. This is Elaine.

ELAINE: Nice to meet you, Poppie.

POPPIE: Let me show you to your table. (Leads Jerry and Elaine to the table.) Your duck is cooking as we speak. It is so succulent...so succulent!

Peter

Edgehopper said...

So, Storkdoc, when you launched into your explanation as to why weight loss was the primary treatment for PCOS, did you bother to offer a scientifically proven weight loss plan that would reliably work in the long term for someone with PCOS? I rather doubt it, since there aren't any weight loss plans scientifically shown to reliably work in the long term for anyone, let alone for someone with a condition such as PCOS that causes insulin resistance.

I certainly hope you prescribed metformin or something similar rather than just sending the patient home with an admonition to "eat less and move more." Or at a minimum discussed a low-carb diet, which at least has slightly more promise as a treatment for PCOS than the general admonition to eat less.

Ann:

"Yet the doctors and nurses are human beings. We don't like to think about what they are thinking or even about the fact that they do have minds of their own. We deny their humanity. How dare they have any ideas about my worthiness!"

And you, a law professor! Or at one point, anyways, a practicing lawyer! The physician behavior here is akin to a lawyer telling a drug-addict client on trial for narcotics possession, "Just stop doing drugs, it'll be OK," rather than defending him in court. Or actually, closer to telling a drug-addict client "Just stop doing drugs, it'll be OK," without bothering to look at the police report indicating that he's on trial for statutory rape. Professionals subject to regulation, particularly doctors and lawyers, don't have a right to provide substandard service based on their personal opinions of their clients/patients. The difference is that when lawyers treat their clients like the doctors described at "First, Do No Harm" do, they get disciplined. The doctors don't.

bearing said...

Oh, I have to tell my favorite in-the-stirrups conversation.

Imagine: the speculum is being applied. The physician is female and about my age (35 at the time).

PHYSICIAN: "So -- you have three children? And you homeschool?"

ME: "Yes."

PHYSICIAN: "Where are they now?"

ME: "Uh, my husband stayed home from work."

PHYSICIAN: "Well then, this must be a nice little vacation for you!"

Inga said...
This comment has been removed by the author.
Synova said...

"It's the doctor's (and nurse's) job to treat the patient. Not to wish for a different patient."

True.

I was just thinking that, generally, people tend to talk about what pops into their minds, even subconsciously, and the doctor choosing that moment to resume a lecture about being fat because, possibly not even consciously, the fatness impacted the ability of the doctor to complete the exam.

Inga said...

Yes this is absolutely true. I've seen it many times in my career, it's bad bedside manner and reveals the bias of the care giver. It's cruel to make a sick patient feel even worse about a condition that may have absolutely nothing to do with their weight.

Anti obesity sentiment is one of the last great prejudices. I'm not advocating not working with the obese patient at another time to get the weight into a healthier range. Health care providers need to respect the dignity of the patient, while caring for them.

Synova said...

When I was in the Air Force a pelvic exam always included a second person in the room. Female, certainly. She stood up by your head someplace.

I believe it made no difference if the person doing the pelvic exam was male or female.

kentuckyliz said...

The BMI table undercounts obesity as defined by body fat percentage. It shows obesity for heavily muscled athletes who may have a very low bf%. It under counts obesity in people who have apparently normal weight but no fitness (thin but flabby).

Also, overweight but not obese BMIs often have better outcomes, especially in older age groups.

kentuckyliz said...

We were comparing notes on a particularly horrific anesthesiologist who intentionally let the window go by so that teen moms in labor couldn't get an epidural. She'd openly say maybe they'll keep their legs closed next time. This is in recent years, not the 50s.

wyo sis said...

"And should our decisions about how to talk to fat people be based on what's best for their health?"

Let's not talk to fat people at all. They'll feel a very subtle form of social pressure and lose weight in response. That will work with all forms of socially unaccepted behaviors. We can clearly see how well this works.

fivewheels said...

So I googled "succulent cervix" and there's plenty of results, even a Facebook page. It might be a commonly used term medically but odd-sounding to lay people.

Inga said...

I don't want to pile on to Storkdoc, but physicians really need to get up to snuff on treating obesity. Dieticians are no better. I had a discussion with a registered dietician about my low carb diet last summer during a hospitalization for an unrelated issue, oy was that frustrating.

Dust Bunny Queen said...

I don't want to pile on to Storkdoc, but physicians really need to get up to snuff on treating obesity.

And some better advice on what to do IF you are diagnosed with diabetes. When my husband was diagnosed, about 12 years ago when he was turned down for a life insurance policy, we had no idea what we should be doing for a healthier lifestyle.

Sure, the Dr. prescribed some oral drugs, but that was IT. Other than being told to drop some weight and exercise. No instructions on blood sugar monitoring. No dietary instructions. No call back for future blood sugar monitoring. WE had to schedule those things. WE had to look up information on the internet and buy books to help with dietary plans.

Other people who don't have the resources to do those things are really in trouble. THEN they want to continue to blame you for not getting 'better'.

DADvocate said...

Finally, there's the health issue of stress, which can grow out of the problem of being overweight.

It's more likely obesity results from stress, not vice versa. You feel stressed, you eat comfort foods and try to rest to combat the stress. Instead you get fat.

I suppose health professionals often miss-attribute health issues. My father knew a woman whose doctor kept blaming her severe headaches on her being a hysterical woman. When one night she went to the ER due to one of the headaches it was discovered the headaches were due to a brain tumor. But, by then, it was too late and she died.

AllenS said...

Very good response, Peter. I'm proud of you.

Kit said...

I can really only imagine that talking to a patient about their weight-related health issues is similar to talking to patient with drinking-related issues. The patient may or may not be ready or willing to take in what the healthcare provider is speaking to. I know the better providers are studying and implementing new methods to open up patients to these conversations.

AllenS said...

I have a woman doctor. She's fatter than me. I enjoy talking to her. She knows her stuff. I'd be embarassed if she ever said to me: "What happened to the hair?"

edutcher said...

Ann's doctor was clearly commenting on the level of mucosity she had.

Interesting way to put it, though.

AllenS said...

I Googled speculum. Man, that's a scarey looking tool. That instrument could use a design change.

Sorun said...

Poor ladies. I've never had a doctor want to chit-chat while giving me a prostate exam.

AllenS said...

When a speculum is inserted, is it put in horizontally or vertically?

MadisonMan said...

My prostate exams take about 5 seconds. The ones I've had done to me, that is, I'm not giving them. Not much can be said in that time.

I think a doctor should ask a patient if they want to talk about weight loss -- mine did at my last physical, and I said I wanted to lose 20 pounds, and I've lost 10 so far. Hard to keep it off during the winter. But hearing NO should be an acceptable answer to any question.

Michael Haz said...

Mrs. Haz's MD is a long-time neighbor of ours. Good guy. When she goes in for her regular exam I leave notes written in magic marker for him.

"Hey Den. Dinner next Sat?"

And he'll add a note. "Sure. Where?"

If you knew us you'd understand.

My MD is a Serbian man in his seventies. Best doc I've ever known. Caught two things that could have killed me. Always takes plenty of time. He says the height/weight charts are bogus. "Lose some weight, but not too much. Too skinny is as bad as being too fat."

AllenS said...

My doctor is from India. For those you know me, she, for whatever reason, cannot pronounce my last name. So she said: "Can I call you Ah-len?"

bagoh20 said...

How about a little concern and maybe some legislative protections for the rest of us who suffer from second hand fat.

bagoh20 said...

"Sociologist Joan P. Emerson had an essay, "Behavior in Private Places: Sustaining Definitions of Reality in Gynecological Examinations"

RH, Please tell me you didn't know about that until reading this post and getting a little gycurious. Otherwise, you have too much free time. The Dobbie should not have to sit around waiting for you to read that.

Carol said...

My last two internists never raised the issue with me, even when I was way up there, but congratulate me when I lose weight. I guess because they're both fat themselves.

bagoh20 said...

"When a speculum is inserted, is it put in horizontally or vertically?"

I think the patient is usually laying down, but I guess you could use a mechanics creeper to just roll under the ones who you might not want to risk laying down for fear they could not be righted again.

Carol said...

heavily muscled athletes who may have a very low bf%.

Oh yeah, here we go "it's muscle not fat blah blah..."

But when they stop juicing that muscle WILL shrivel up and fat take its place.

bagoh20 said...

"My prostate exams take about 5 seconds."

Oh no, I insist on dinner and movie.

AllenS said...

According to the woman that Hugh Hefner eventually married, he was able to perform the sex act in about "2 seconds." So, 5 seconds might be way too long. Is he smiling?

bagoh20 said...

" No one has a hairy vagina."

Look, I bet every guy on here has seen more of them than you. If one of us says there are hairy ones, then there are. Don't make him go Google for a "study" to prove it, because you know damned well there is proof of everything on the internet, and he could find one if he needed to, and no doubt it was done at some university known for it's party life.

Big Mike said...

What can you say to a woman while penetrating her vagina?

"I love you" is probably good. Oh! You meant doctors.

Couldn't resist. If I was an honorable man I would have been able to resist, but I am utterly without honor


Big Mike said...

@bag, she's right. STFU before you make a total idiot out of yourself.

Palladian said...

Look, I bet every guy on here has seen more of them than you.

Um... every?

bagoh20 said...

Sorry Palladian, I should have said every guy with poor fashion sense.

And Big Mike, She may be right, but she can't possibly know for sure. Besides, I saw a bearded lady once, and she wasn't suppose to have hair there either, so who knows.

And when it comes to making a fool of myself, I'm fearless. Eye of the Tiger.

david7134 said...

As a physician, I can assure you that 90% of people over weight could alter their behavior and assume a healthy life style. It is amazing the reaction that you get when you tell these people to exercise. Not anything that would strain an normal person, just walking 45 minutes per day. You try to explain to them that the obesity leads to metabolic syndrome, that in turn leads to inflamation, which leads to CAD. Walking would reduce the inflamation and reduce the possibilty of an MI. Yet none of them can walk, there is always a problem, they can't swim, ride a bike or anything active. So, yes, they are fat and lazy and killing themselves. Then they blame you when something happens.

Pogo said...

I find it interesting that many women physicians work at reducing the number of female patients they see.

I will leave it to your imagination why that might be.

Palladian said...

It is amazing the reaction that you get when you tell these people to exercise.

THESE people!

So, yes, they are fat and lazy and killing themselves. Then they blame you when something happens.

There's that wonderful bedside manner that makes everyone like and respect physicians so much!

wyo sis said...

Over 90% of people with any problem that's costly to society could alter their behavior.
Let's tell only the fat ones to do it. Let's tell all the others we'll find a way to "normalize" it.
It's best to be the one who decides. No conservatives, fatties, or non-privileged need apply.

wyo sis said...

Pogo, does it work the other way as well?

Pogo said...

It's much easier for docs to have compassion for people by recognizing how very flawed one is oneself. To have felt real pain helps one empathize as well.

All fall short, all have sinned. I give advice, take it or leave it. Judgment is not mine to make.

Palladian said...

All fall short, all have sinned. I give advice, take it or leave it. Judgment is not mine to make.

You're a rare one, and probably an excellent physician as a result.

Inga said...

Wow david, I have a hard time believing you are a physician. I feel sorry for your obese patients.

Have you counseled your patients to follow a lowcarb diet, or simply told them to go exercise? Hearing this attitude from a physician is disgusting.

Pogo said...

"Pogo, does it work the other way as well?"

No. Guys are easier.

It's an issue of time. Female patients take longer than males in most encounters.

Women now ask for women MDs, and a practice of largely female patients can be quite difficult, as the time slot is no different by sex.

Pogo said...
This comment has been removed by the author.
Pogo said...

@Palladian:

People's lives are hard enough. Some of the stories I have heard are beyond words.

So I try not to burden them further, by word or deed or neglect.

Yet I fail often enough in this effort, to make humility a requirement.

wyo sis said...

Interesting Pogo. It makes sense. The one unforgivable sin as a patient seems to be being complicated and predictable.

Inga said...

And David, there are dietary things that reduce inflammation in blood vessels. Reduction of omega 6 fatty acids, increase of omega 3s, which means avoiding vegetable and seed oils. Use butter, lard, or olive oil, is a good start.

And most definitely reduce refined foods.

Pogo said...

@wyo sis

...or full of questions.

wyo sis said...

Well, it sure won't get better under Obamacare.
I appreciate your honesty.

Deb said...

David sounds like a neurologist. If he is a doctor at all.

wildswan said...

If the "the irresponsibles" don't change - fine them, heavily, obesely. The AP had a story on this today - picked up by the Sheboygan Press. www.sheboyganpress.com/article/20130127/SHE0101/301270346
And what interested me was the "health care researchers" mentioned were all supporters of biodemography, the new form of eugenics. SJ Olshansky is a former President of the American eugenics society, Daniel Callahan is a former Director and John Cawley has written for Biodemography and Social Biology, the Society journal.
Eugenics is always about selection and we can see in this AP article how the new eugenics will use Obamacare for a new round of selections. And see, the selections target the poor mainly. Because the largest group of people who are overweight and smoke are found among the poor. But Obamacare was supposed to help the poor!
But what does it matter?

bagoh20 said...

If you want to be fat, that's fine, but it does create problems for you and others, and it is fixable for nearly everyone who wants to

What I don't understand is when people who don't want to be fat get pissed off by people telling them how to fix it. I don't do it unless someone brings it up, because I assume everybody knows how it's done by now, and probably always have. Yea, there are better and worse ways, but it's no mystery. It's just hard, and harder for some, but impossible for none.

I've struggled with weight most of my life, and it has never been anything other than a problem of habits and discipline.

But if you really prefer being big, then more power to you. Freedom.

Inga said...

Bagoh, obesity is far more complicated than habits and behavior.

Big Mike said...

@Inga, now you're on my side. Please make it a habit. Thanks.

Big Mike said...

I'm fearless. Eye of the Tiger.

It's not the tiger's eyes you need to worry about, it's his teeth.

Si tenes Tigris caudam eius nonne melius consilium habent dentes

Big Mike said...

Which is supposed to be Latin for "if you catch a tiger by the tail, you had better have a plan for dealing with its teeth."

Your English to Latin translators may vary.

bagoh20 said...

"No. Guys are easier."

Everybody knows that most men won't even go to the doctor unless someone pushes us. I assume we don't want to hang around any longer than needed either.

Fighting cancer for over a decade now, I have to go to the doctor a lot, but almost all he does is act as gatekeeper. Just recently, they installed a system where I can see my entire history and chart online. I can see blood tests as soon as they come from the lab. I can read pathology reports immediately after they are written. I can make appointments, and email my doctor directly.

Today it's all scans, blood tests, xrays, and written opinions of what the results mean. I don't see why I would need to see my GP much at all in person. I think it's more for his protection.

bagoh20 said...

"Bagoh, obesity is far more complicated than habits and behavior."

Only in degree. And following a certain set of habits and behaviors, it can become impossible for any person to be obese. People deprived of calories do not stay large. There are no exceptions when lost at sea, or imprisoned, or living in extreme poverty. It's not mysterious, counterintuitive, or complicated in the principle, only in execution.

William said...

In a triumph of hope over experience, I read through this thread thinking someone might say something prurient. Nada as usual....I wonder what kind of small talk women make with their bikini waxer. Are they disassociative or do they try to relieve embarassment by prattling on. What type of personality goes in for bikini waxing as a job? Are they warm, outgoing people orthe quiet, contemplative types? There's a job that didn't even exist ten or fifteen years ago, and now they're all over. Does a professional job look better than an at home treatment. Are some bikini waxers more in demand than others? This whole, brave new world of bikini waxing is a mystery.

Pogo said...

@bagoh
I find the personal narrative still essential, as lacking a reliable tricorder, the data answer only the questions asked of them.

William said...

There's a saying that the difference between a good haircut and a bad haircut is two weeks. I wonder if that hold true for bikini waxing. Do you tip a bikini waxer at the same rate as you do a hair stylist? Do bikini waxer charge more for Italians and less for Asians? There's so much about bikini waxing that I do not know.

Kensington said...

Over the last twenty years or so, I've lost HUGE amounts of weight on at least five separate occasions.

The first time I restricted calories and walked 18-24 miles per day. At some point I started to go crazy and develop a compulsive eating disorder.

The second time I restricted fat and walked four miles per day.

The third time I did a sort of proto-low carb diet w/out quite realizing that's what I was doing.

The fourth time I restricted nothing but only ate when I could feel a real strong physical hunger, and then I stopped eating after only eating just enough of whatever I wanted to sate that feeling.

The fifth time I did Atkins.

They all worked. And all of them proved unsustainable in the long run, and every single time, eventually I regained all the weight plus more.

I'm honestly terrified to do anything anymore because I can't bear the thought of regaining the weight plus more.

And if nothing else I'm convinced of this: nobody knows a goddamned thing about weight loss, and everyone who insists otherwise is a damn fool.

And I can't wait to be officially demonized by ObamaCare at some point in the near future, as soon as they're done with the smokers.

Inga said...

Bagoh, since food is plentiful, people with deranged metabolisms cannot stay on a calorie reduction diet. Their hunger signals are abnormal for many reasons, hormones being one of them. Leptin, Ghrelin, Insulin.


Kensington said...

So we all know the stats: that 95% of people who lose weight will regain it, that only 5% ever successfully sustain a weight loss.

But by all means, let's pretend it's easy and uncomplicated and only prevented by weak character.

Kensington said...

And let's pretend that it's clear and easy to understand and quantify hunger. And let's pretend that everyone experiences hunger in exactly the same way, so that one person's control of their hunger means that everyone else can just as easily control their hunger, because they're having the exact same, easily measured and understood experience of hunger.

Inga said...

Kensington, I've been on a low carb diet for two years now, it's not a cure, one still has to control overall calorie intake, but because it's high fat the satiety level is reached and maintained( because insulin levels stay lower) so it's easier to not go back to overeating, in my experience.

Inga said...

Kensington, I've worked with people who have had bariatric surgery. They were so relieved at the extremely diminished hunger levels.

bagoh20 said...

Kensington, It's simply not complicated. People regain the weight because they revert to the old behavior after the diet.

I agree that for most changing your behavior PERMANENTLY is very hard, but that's all that needs to be done, period. It may be one of the hardest things for humans in our land of plenty to do. It's not easy, not common, but not complicated either. You simply cannot regain the weight if calories stay sufficiently restricted.

Kensington said...

I'm glad you've got it all sorted out bagoh! I'm sure they'll be eager to load up the death panels with folks like you!

Edgehopper said...

I would have responded to David the physician sooner, but I was out playing in a curling match. But I'm sure he'd say I was lying about that, along with my half hour walk each way to work and back every day, because I'm fat and therefore lazy and immobile.

autothreads said...

Many heavy women told me that doctors routinely blamed any ailment, from a fall to a sore throat, on their weight....

Funny how my doctors have told me that losing weight would help with my back pain, my carpal tunnel problem, plantar fasciitis, and other medical issues, and I've never even had ovaries.

A lot of fat women look for any excuse to justify being fat. Blaming their doctors is part of a pattern.

Inga said...

Bagoh, really? Kensington, Bagoh is the obesity expert!

bagoh20 said...

"I'm sure they'll be eager to load up the death panels with folks like you!"

I would never give the government the power to decide if being fat was right or wrong in the first place, but I have no doubt that some people did just that in the last two elections. As I've been saying for 3 months, "Don't blame me I voted for the other guy" - even with his binders of women.

bagoh20 said...

"Bagoh, really? Kensington, Bagoh is the obesity expert!"

Well, that really is the problem. We've been listening to experts for half a century. They say the exact opposite things every few years and we say, that must be true, they're experts. How's that working out for you?

Inga said...

It worked out damn well for me Bagoh. I did the online research, ate low carb, lost the weight and kept it off by continuing to eat lowcarb for two years now.

Inga said...

And Bagoh, give modern medicine some credit, it saved your life.

bagoh20 said...

You see all those 95% who regained the weight were listening to experts - not to me.

Send me $29.95 and I'll send you the Bagoh20 weight loss plan. Money back Guarantee. You follow it - it will work? Want the address?

bagoh20 said...

"And Bagoh, give modern medicine some credit, it saved your life"

That's right, they did, and I'm very grateful, but if I stop taking my medication, it will all have been for nothing, just like a diet.

bagoh20 said...

"kept it off by continuing to eat lowcarb for two years now."

Excellent! So, was that complicated or simple?

Inga said...

Ah Baggy, my plan is better than yours cause ya get to eat good food on it and not be hungry. So send me the money folks, not Bagoh!

Inga said...

The mechanism is extremely complicated Bagoh. Nothing in life that is worthwhile is simple or easy.

bagoh20 said...

I've started trying to stick more to proteins, but carbs, oh my precious carbs how I love you.

I don't think there is anything more satisfying than a bottle of wine and loaf of great bread. That's all I need to be happy in this world.

bagoh20 said...

I'd rather be fat than give up bread. I hope to die by choking on bread.

Inga said...

I plan to die by chocolate overdose.

Inga said...

Don't overdo proteins either, there is something called glucogenesis, if you eat more protein than your body needs, your body so efficiently metabolizes the excess as if it were a carbohydrate!

See it's complicated.

Palladian said...

I love Inga in this thread.

Dante said...

It's the doctor's (and nurse's) job to treat the patient. Not to wish for a different patient.

Let's dispense with the "Too fat to treat effectively" issue.

Someone comes to the doctor, and for whatever reason the doctor has a serious problem with treating them. I don't care why.

Are you actually stating they must treat, in a way equivalent to anyone else?

If that's the case, let's give new livers to alcoholics. New lungs to smokers. And for certain, anyone who makes it into the US ought to have exactly the same treatment as anyone else.

The ninety year old about to die? The same treatment as the 12 year old.

Well, Ann, write it up in your law. When you are done, sell it to us.

Dante said...

And if nothing else I'm convinced of this: nobody knows a goddamned thing about weight loss, and everyone who insists otherwise is a damn fool.

And I can't wait to be officially demonized by ObamaCare at some point in the near future, as soon as they're done with the smokers.


Ann thinks Fat Chris Chrispie Creme ought to know. But, Obama is a thin smoker. Surprise.

mariner said...

I'm not sure whether this thread is about asshole doctors or obesity or something else, but I was intrigued by what I read in Wheat Belly.

Norman Borlaug was a great guy, but his work may have had some very serious unintended consequences.

ironrailsironweights said...

I wonder what kind of small talk women make with their bikini waxer. Are they disassociative or do they try to relieve embarassment by prattling on. What type of personality goes in for bikini waxing as a job? Are they warm, outgoing people orthe quiet, contemplative types? There's a job that didn't even exist ten or fifteen years ago, and now they're all over.

Do you think it would be okay for me to take double my usual dose of antidepressants?

Peter

SGT Ted said...

And all of them proved unsustainable in the long run, and every single time, eventually I regained all the weight plus more.

What does that part "proved to be unsustainable" mean? You couldn't afford the foods needed? You couldnt stay away from the foods that make you gain weight?

I gained around 35 extra pounds in the last couple of years in the Army, mainly a crappier diet and stress. It was close to 2 years after I got out that I finally lost the weight. Changing my diet, coupled with a physically active job and I lost the weight over a 4 month span. I've kept it off and eat what I like. But then again, I don't snack.

I have seen too many very big fat bodies in the Military lose and keep weight off to buy the notion that it isn't a lack of discipline, mostly mental, and diet that is the major problem. They lose the weight and then celebrate by going back to the crap diet that got them there.

One of the marked characteristics of a lot of fat folk I know who don't lose weight is their reliance on blaming things outside of themselves for not losing weight. Then I remember others that were exactly like them, until they got the mental discipline thing right to change their diet and exercise level for good.

It isn't "cruel" or "mean" to point this out. It the same thing as when getting fit using exersice and then quitting once you are finally in shape. You'll go right back to the prior fitness level. Lack of mental discipline. Its not a big secret. You just don't want to hear it.

gerry said...

I asked my MD if he would fire me for not following his instructions and not losing weight. I'd been going to him for about 10 years at that point. He told me that I'd decided to die earlier than necessary, but that he'd do his best to keep me alive. Besides, he said, he likes my jokes.

Now, occasionally, he and his wife have drinks and dinner with me and my wife. She's his patient, now, too.

Synova said...

Sgt Ted, no doubt you're right. But I think you'd admit that changing to a physically active job significantly changes the level of mental discipline necessary. I lost a bunch of weight when I got a factory job back in 2002. But it took zero mental discipline. I *couldn't* sit, and I *couldn't* eat.

gerry said...

Of course, generations ago, Doctors considered all women hypochondriacs

I have some antique medical textbooks ca. 1890. One of them states that menses was not understood, but that in severe cases trips to the seashore might be helpful.

"Hysteria" has its root meaning in hyster - the womb - after all! Egad.

Bob R said...

SGT Ted - You talk of "mental discipline" as if it is a pill or an injection that works magically to cure everything. But surely you have observed people who have mental discipline in one area of their lives and not in others. I've known military men who were fit, focused, the very definition of "discipline" who were drunks, philanderers, or drug addicts. The question isn't, "why is Chris Christie fat?," its why is he so disciplined in other ways? Why are Lindsey Lohan and Charlie Sheen thin? Do they have lots of mental discipline?

The fact is that we know very little about how the human body works and less about how the human brain works. We all use shorthand descriptions and fairy tales to simplify complex phenomena and hide our ignorance from ourselves. No one is better at this than people who deal with life and death situations like doctors and soldiers. (People go to Gary Taubes' books for diet advice, but the best thing in them is the descriptions of just how bad the "science" of diet is. Doctors - often wrong, but never uncertain.)

gerry said...

My wife's OB/GYN is a woman. When we were trying to get pregnant, during one of the procedures, the doc was gazing through the speculum and remarked "Wow, what great mucus!"

To which my wife replied, "Yes, and I make my own clothes, too!"

The doc apologized, saying, "I guess that was a bit too clinical..."

My wife and I still laugh about that.

SGT Ted said...

I didnt say that mental discipline was easy. If it were, there'd be less fat people and fewer drunks, etc etc. Diets would have a higher success rate because the dieters wouldn't go right back to eating the crap that got them fat to begin with.

But, then again, I don't buy the "disease" model of shifting blame from the person to the condition factual. I find that to be an avoidance technique that shows lack of mental disciple and seriousness.

Mental discipline is hard. That's why Hollywood types hire personal trainers; so there's someone there to kick them in the butt and keep them on track. Thats why the Military makes you all exercise together, because it's easier for many when its all done in a group and they are told what to do, rather than having to get up by themselves and do it alone.

Changing habits is hard, but the failure to do so lies in a lack of mental discipline of the individual and not the donuts flying into their mouths on their own as if their "disease" attracts them like a gravity field.

Ans Synona, the difference in a factory floor job where you have no access to snacks and one where you ride a desk with geedunk machines nearby or fast food restaurants nearby is where the mental discipline not to indulge in useless eating comes in.

Pogo said...

"Doctors - often wrong, but never uncertain."

Not a fault unique to physicians, really.

SGT Ted said...

I've known military men who were fit, focused, the very definition of "discipline" who were drunks, philanderers, or drug addicts.



All of these share the commonality that it requires mental discipline to avoid the conduct, whether its not drinking, or keeping their dick their pants or not buying and using drugs. Or overeating. So, in reality, they lacked discipline in those areas of their lives. It doesn't excuse their destructive behavior.

Inga said...

Arggg, more science deniers.

SGT Ted said...

yes, because diet "science" is never wrong.

Inga said...

Diet science may be wrong, but I'm talking about the science of metabolism.

SGT Ted said...

So am I.

Observed in the field, with fat bodies becoming fit and losing weight.

Using mental discipline overall to push themselves in exercise and forbid themselves useless eating as an indulgence.

The Gold Digger said...

What can you say to a woman while penetrating her vagina?

My doc talks about the Packers. That's fine with me.

SGT Ted said...

I think most people make the mistake of thinking that they will use a diet and exercise to lose weight and once they do so, they will be able to go right back to the crap eating and exercise habits that got them fat in the first place.

I've seen that happen too.

Jay said...


A lot of fat women look for any excuse to justify being fat. Blaming their doctors is part of a pattern.


Yes.

They act like it is some sort of Force majeure or something.

SGT Ted said...

Diet and exercise works.

Excuse making does not. Nor does blame shifting.

Mitchell the Bat said...

"Many heavy women told me that doctors routinely blamed any ailment, from a fall to a sore throat, on their weight...."

Looks like obesity causes hysteria, as well.

SGT Ted said...

Maybe I shouldn't believe my lying eyes. Go with the new, PC "it's not your fault" line.

Naaaaaahhhh.

Inga said...

What is Metabolic Syndrome?

Inga said...

Obesity, metabolic syndrome and adipocytes

SGT Ted said...

"It is possible to prevent or delay metabolic syndrome, mainly with lifestyle changes."

Thats at the bottom of pg 1 at that link you posted. It also says:

"The risk of having metabolic syndrome is closely linked to overweight and obesity and a lack of physical activity."

and

"A healthy lifestyle is a lifelong commitment."

That is not inconsistent with my observations and experience with diet and exercise and weight loss.

I bear no ill will towards People of Heft.

But I will not indulge their PC fiction that they cannot change their condition without some special, magic medical "treatment", rather than getting off the couch and putting the extra food down.

SGT Ted said...

"Our modern lifestyle has led to the diminished use of consumed energy and to an increasing population of obese individuals."

Thats sciencey language that means "we eat more than we burn and our bodies convert it to fat and store it".

Inga said...

Yes, but what you are missing is WHY hunger signals are abnormal in obese people and there ARE scientific discoveries as to what goes wrong and why. Then weightloss and maintenance can be succesful in yet more people who don't have god like self control.

Just think if we rejected the notion that because we couldn't see germs they didn't exist?

jr565 said...

Inga wrote:
obesity sentiment is one of the last great prejudices. I'm not advocating not working with the obese patient at another time to get the weight into a healthier range. Health care providers need to respect the dignity of the patient, while caring for them.

I tough anti gay marriage was one of. Te last great prejudices.

But, I will say this. If you are morbidly obese your doctor needs to tell you to cut you weight down. He can stress low carbs, he can offer omega 3's but he has to bring it up. Unless he is a specialist, and you're going to him for something unrelated like say a sore throat.
And he then brings up how you need to lose weight..

But if its your primary doctor,it should be part of the conversation.

Inga said...

Read Gary Taubes books. Read Dr. Davis's book "Wheat Belly".

jr565 said...

Sgt Ted wrote:

Diet and exercise works.

Excuse making does not. Nor does blame shifting.


What Kind of diet? And what kind of excercise? That's really the issue. If you are dieting wrong, then you may not lose weight. If you aren't doing the right exercises you may not lose weight.

I'm believing more and more that calorie in calorie out doesnt work. And what you need is meat and vegetables. I slim drives fat, so eating things that don't cause your insulin levels to spike is the best way to stop weight gain.
Atkins was right, though it sounds counterintuitive.

Inga said...

The Perfect Health Diet

Written by a husband and wife team, both of whom are scientists. It's a well rounded diet, even includes "safe starches" such as rice and potatoes. Avoids all gluten and sugar, PUFAs, fructose.

jr565 said...

Inga wrote:

Read Gary Taubes books. Read Dr. Davis's book "Wheat Belly".
I did and I agree with those books.
However, perhaps a doctor should be discussing the things in those books when dealing with morbidly obese patients.
As in, up you need to lose the weight. Here is what some people are suggesting as ways to lose the weight,p here are the salient points.
. Your doctor will also tell smokers to stop smoking and drinkers to stop drinking. Why should obese people have their "dignity" protected if their obesity is actually impacting their health.

Inga said...

Because Jr. It's very possible for a doctor to treat an obese patient for obesity without being rude, thoughtless, or cruel.

In fact the outcome is usually more succesful if your doctor isn't a jerk :)

SGT Ted said...

I agree that meat and veggies are better than high carbs, unless you are doing heavy manual labor, like working on a farm. I avoid excess carbs in my diet. I eat lots of meat and veggies and rice and spuds. Mostly BBQ and smoked meats, with winter time being stews and soups.

We have cookies and desserts, but only rarely will I eat that during the day.

You have to do aerobic exercise for at least over 20 minutes to get to fat-burning metabolic rate. Ive watched the Biggest Loser a few times and the type of hard workouts and dieting there work good, I think.

I also had a SGT that worked for me that, when he exercised every day moderately and cut out sodas and snacks, he lost 70 lbs within 6 months or so.

The biggest factor in this happening was the mental discipline to do it every day. IOW, his commitment to it. He could have cheated and had sodas and cake and crap. But he didn't.

And the other Big Factor is the ability to keep at it or adjust it if it isn't working, rather than to go all "Eeyore" and quit all together.

jr565 said...

Inga wrote:
Because Jr. It's very possible for a doctor to treat an obese patient for obesity without being rude, thoughtless, or cruel.

that kind of goes without saying. Who is saying that doctors should treat their patients in any way but cordially?

But saying what needs to be done to maintain doesnt have to mean that you are acting like a jerk when you do it.

jr565 said...

Sgt Ted wrote:

I also had a SGT that worked for me that, when he exercised every day moderately and cut out sodas and snacks, he lost 70 lbs within 6 months or so.

I think it was probably more the giving up the soda and snacks than the moderate excercise that did it.

SGT Ted said...

Pasta is rare with me, kinda 'meh'. To me, pasta is a delivery system for the sauce.

But, bread is my achilles heel. So, I go with sourdoughs mainly. Usually artisinal breads locally baked, as the flavor is just devine. But I don't eat lots of it, either.

I've read parts of wheat belly and I get think that is closer to good diet than the BS Gov't "Food Pyramid".

There wasn't any childhood obesity epidemic when the 4 Food Groups was the Word.

I don't buy all the "gluten is bad" stuff tho. I think that is a metabular thing and dependant on the individual.

In fact, I tend to think that there is really no set blanket diet for all of us. I think it all really depends on individual metabolism, genetics and lifestyle as to what your diet should be. Soldiers in the field can burn 4-5k calories a day, so their diet isn't a good fit for a desk job lifestyle.

SGT Ted said...

Lots of bread really fits an agrarian diet where you are working hard all day long, burning the calories.

Inga said...

Continuous eating during the day keeps insulin levels high, in turn keeping hunger levels high. Best to eat two meals, eat to satiety, but eat fat, protein, veggies and a bt of starch, have a fruit and dairy for desert, stay away from naturally high glycemic index fruits, don't overdo fruits, they are natural but their sugar is fructose.

Do not snack. If you are eating correctly, in a few weeks time your hunger levels will be in control and you won't be tempted to eat the furniture.

Inga said...

If you break down and must have something inbetween meals have some nuts, cheese, sausage, high fat. Fat will make you feel full and you can only eat so much fat without being grossed out.

Inga said...

And don't avoid eggs.

Inga said...

Deviled eggs are the perfect snack actually.

Inga said...

Be creative, learn how to bake gluten free low carb goodies and breads, you won't feel deprived if you use your brain and create comfort foods that won't make you fat and are delicious.

Inga said...

No charge, I do it cause I love ya.

MadisonMan said...

Last summer, the wife went Gluten free, which meant she stopped baking. That and exercise and I lost 15 pounds. Okay, 13.

This winter she started baking again, and the weight is creeping back on. Why?

Because I didn't change my behavior. Weight gain and loss is a change in behavior, and it's not easy to change after 50odd years on this Planet.

I do love deviled eggs, though. And sausage, so I'm primed for Inga's diet if ONLY I could stop eating cookies and danishes. :) Oh, and Kringle. And crullers.

SGT Ted said...

mmmm devilled eggs.

Inga said...

MM,

Splendid Low Carbing, by Jennifer Eloff

Cookies, muffins, breads, scones, chocolate desserts, low carb gluten free.

She has written several lowcarb cookbooks, I think she the bet on the net. I'm having a chocolate chip scone as we speak with my coffee with half and half.

Aridog said...

How did the human race get to the point where the very foods that sustained us and enabled our survival are now considered *bad*?

It appears we've so changed our average activity lifestyle that you can get fat just thinking about it...almost.

Inga said...

That should be the best on the net, fingers chocolaty.

jr565 said...

Sgt Ted wrote:
I don't buy all the "gluten is bad" stuff tho. I think that is a metabular thing and dependant on the individual.

actually gluten is bad even if you aren't allergic to it.
I actually agree with Inga on this. She's on the right track with her diet tips (I think. I just started eating that way and have yet to see any weight loss but am noticing some physical benefits.
But the reason it's bad is because wheat converts to sugar in you body and raises insulin even more than sugar. And insulin in turn drives fat .

GRW3 said...

The fundamental truth is you have to eat...

You do not have to smoke cigarettes but you have to eat...

You do not have to drink alcohol but you have to eat...

You do not have to have unprotected sex with strangers but you have to eat...

The issue becomes matching your particular chemistry to an appropriate diet. Maybe not everybody is over reactive to carbs but some are. Maybe not everybody blows up with dietary fat by some do. Maybe wheat is just another carb but not for everybody.

If you have never had a weight problem you should just be prepared to help those who struggle but otherwise STFU.

dbp said...

Synova said...
"...I got a factory job back in 2002. But it took zero mental discipline. I *couldn't* sit, and I *couldn't* eat..."

This agrees with what I have observed at my work. I work in an office and there are a fair number of overweight people here. Every so often I have the chance to go to one of our production facilities and you hardly ever see anyone there who is fat. The workers can't eat in production areas and are pretty much on their feet all day. They look a lot better than us office workers.


jr565 said...

Madison Man wrote:
This winter she started baking again, and the weight is creeping back on. Why?

Try having her bake with Almond flour or Coconut Flour. (I'm not a baker, but I hear they are good substitutes, especially when you are worried about gluten).

jr565 said...

INga wrote:
Diet science may be wrong, but I'm talking about the science of metabolism.

I'm agreeing with you about the Atkins style diet being the best. But you have to realize that it's still one expert pedaling his version of the best diet.
All diets will say theirs works.

hazelmae89 said...

I do agree with the latter's comment that dieting maybe wrong, however, there is always an exception.

dental hygienist salary