This is just . . . weird

[pegkerr]

Doctor in trouble for calling woman obese.

The story doesn't say exactly how he phrased what he said to her. I gotta think there is more to the story here.

It makes me think of that term Berke Breathed coined: "Offensensitivity."

Comments

[megd.livejournal.com]

It's not he thought she was obese. It's not a judgement, it's a medical formula. And she was an exeisting patient.

Also, her BMI was (based on the 5'7" and 250) 39.2. She has diabetes, borderline hyper tension, esophageal reflux. And had been told by other doctors she's obese. She just didn't want to listen.

[skylarker.livejournal.com]

And, as several people have pointed out below, there can be other physical conditions that contribute to weight, aside from and in addition to emotional issues.

It's all too easy to dismiss any compulsive behavior as an issue of character or will power; if it were a simple matter to just 'put down the fork' there'd be far fewer people with weight issues, and if it were simple to quit, there'd be far fewer smokers. I think part of the problem is in thinking of ourselves as if body and mind weren't integral to one another, setting ourselves up to believe that our conscious minds are not only responsible for, but capable of being 'in control' of the whole complex dance of physical and emotional processes that make up our lives.

[pameladean]

Why the hell should she listen? Dieting doesn't work. Jenny Craig, Weight Watchers (the programs he recommended, with the comfortable comment that there were "lots" of them out there) -- they don't work in the long run. And they're horrible for one's frame of mind. I personally would rather die than ever go through another one of those stupid useless programs with their adherence to the ickiest ideas about bodies and femininity that our culture affords, which is saying a lot.

P.

[ex-radparker580.livejournal.com]

And yet some people manage to lose weight.

[faeryguinevere.livejournal.com]

I'm really of two minds about this (and I didn't see the news story on TV, only the article linked above, so I can't speak to the doctor's "bedside manner" so to speak).

Several years ago, I was overweight. I kind of was aware of it, but I wasn't paying much attention. I was carrying much too much weight for my height, genetics, and frame. I was 21 and was going to the doctor because I had high blood pressure. At 21, I shouldn't have had high blood pressure. There were no real causes for my blood pressure to be high. The doctor asked me to reduce my salt, change my birth control pills, etc. all of which I did, and still saw no results. He said that the problem might be weight related, but he didn't push it. I rather ignored him on that front. I tried the other solutions and didn't have any good results in reducing my blood pressure.

Not long after that, I independently decided I should (and could) lose weight. After about 2 years of very hard work, careful eating and consistant exercise, I had lost about 60 lbs and was much healthier. Guess what else was better? Of course, my blood pressure. It was well within the normal range for someone in her early 20s with no other health conditions.

So even though I didn't go to the doctor to talk about weight, it really was the source of my problem. It was well within the scope of his professional obligations to talk with me about it. It impacted many areas of my life and health, not just my blood pressure.

I guess that the doctor featured in the story above may not have had the best delivery (some doctors aren't good at that sort of thing, sadly), but may have been doing his best as a health care professional to help his patient increase her health levels and quality of life.

Was he right to talk with her about it? Or should have have addressed her other health concerns without talking about the weight, since she didn't bring it up, even though it may have impacted the other problems she was having? It's really hard to say what the 'right' answer is in this case.

[faeryguinevere.livejournal.com]

I think that's terrible, and not appropriate. The broken ankle was likely not *caused* by the weight. Not a good idea on the doctor's part.

[faeryguinevere.livejournal.com]

"Dieting" doesn't work, but changing one's diet and lifestyle permanently to a healthy one often does. If nothing else, it at least improves one's health, if not changing one's weight.

[callunav.livejournal.com]

Yeah, and the sad thing is (as illustrated by several of the other comments here) weight isn't even primarily - let alone entirely - about *eating* (or fitness), let alone about emotional issues, compulsive eating, etc.

There have been all sorts of studies done indicating that eating habits (and exercise habits) are quite a small part of the determining factors in weight/size. There are medical conditions and disorders (discussed below) and there's just plain heredity.

I'm not saying this very well. What I'm /trying/ to say is that 'not being thin' is not necessarily pathological, according to a majority of the reputable research out there. There is a huge range of what can be a healthy, normal weight/size/shape for people. Unfortunately, in the past century especially, Americans (and, I suspect, many Europeans, but I don't really know) have become so invested in thinness as an aesthetic and moral issue that they're not prepared to accept that it might not be attainable and therefor these findings are ignored. They're not, by and large, from what I know, refuted - they're just disappeared.

It's sad. Women who are "too thin" are treated horribly by other women. And women and men who are "too fat" are treated terribly by the medical establishment, the media, well-meaning friends, families, acquaintances, strangers, and often themselves. Being fat is considered a sign of laziness, overindulgence, lack of willpower (again, also mentioned below), low self-esteem. It's gotten tied into class perceptions. And so often the best we seem to be able to say is, "Oh, it's not their/our fault--there's a medical disorder that's the reason I'm/they're/we're 'like this.'".... It's better to be excused than to be blamed, but the implication is that size NEEDS an excuse.

I was thinking about it when I got started on the replacement thyroid hormones. My very likeable (and very thin) doctor said laughingly, "Now, I don't think you should be expecting to become a size 5 overnight..." and I said, "Oh, no. Heck, size 5 would *not* be healthy for my body." And there was a little silence. I realized that my very intelligent, supportive, understanding doctor was not really sure that there was a size that would be 'too small,' except maybe down to size 0. But I remember when I was 13. I was active, I had started getting my figure maybe a year and a half before. I had that kind of thinness only younger adolescent girls have, the kind you know doesn't last, even though it's what our standards of beauty are based on. I was a size 14.

You'd have to fracture my pelvis and remove my ribs before I'd be a size five, no matter how much fat came off my body. That ain't healthy.

So--yeah. What you said, just - from my point of view - more so.

[pameladean]

Oh, sure, I've managed to lose weight myself. Repeatedly. Almost any crazy regimen will work in the short run. But very little works in the long run on most people.

P.

[pameladean]

Sure. If that doctor had recommended the Health at Any Size program instead of Weight Watchers or Jenny Craig, I'd be having a different response.

P.

[nellorat.livejournal.com]

What struck me about the article is that the doctor baldly said her weight would "kill" her, which is really bad medical practice. Most fo the time, when your life is at stake, you can't get a straight answer from a doctor about whether the cancer, say, will certainly kill you, or when. And there's a good reason for that: the doctor can't know such things with any certainty, and it is both unscientific and unethical to pretend to certainty they don't have. When you think about that, a doctor saying, "your weight will kill you" is almost hard to believe--except I know how many people feel that any kind of unethical treatment, including outright abuse, is justified if it might make a fat person lose weight. So I believe it, but I think the woman was right to report him to the medical board. Not for saying she's obese, but for making a pronouncement of death that could not possibly have been medically justified.

[nellorat.livejournal.com]

Wonderful final comment. My sister has a chronic disease, and one thing we've found is that any evidence that the body can be stronger than the conscious mind frightens people. And that too often leads to bad behavior towards the people who appear in public even though they may be fat, or in a wheelchair, or whatever. We're constant reminders of what could happen. And being fat isn't even really that bad, but some people sure think it is!

[nellorat.livejournal.com]

I bet you were still taught to say something like "you are at risk for diabetes" instead of "your obesity will kill you."

Also, I wish more doctors were more informed about the whole picture, especially the high rate of regaining the weight and the health consequences of yo-yoing weight. Or that better nutrition an exercise can have health benefits apart from whether or not any weight is lost. And we're not even going into true but weird stuff like how fat people have a better survival rate with cancers and less osteoporosis. Just a realistic picture of how weight-loss dieting does and doesn't work.

[megd.livejournal.com]

Nope, I was taught "your obesity will kill you", which considering I am the fat kid, was the yo yo dieter, etc, stung me to say, but its true.

[nellorat.livejournal.com]

How long have you kept the weight off, and how did you do it? I ask because the majority regain the weight, but some do keep it off, and I'm interested in whether there's a pattern of what makes a difference.

[nellorat.livejournal.com]

For those who have never fought their weight in any real sense (I'm not talking about 10-15 vanity pounds) the issue is often equated with a lack of moral character.

Yes! Sadly, even people who have been through it can accept that line and find themselves at fault. It took me three major diets--regaining the weight and more each time--to wise up and realize that if I had to be hungry all the time to stay a certain weight, maybe that wasn't the right weight for me.

You may be interested in this post and my reply, in fat_feminists.

[pegkerr.livejournal.com]

Of course, none of us are going to get out of this life alive anyway . . .

[megd.livejournal.com]

Next you're going to tell me I can't take it with me.

I weep!

[faeryguinevere.livejournal.com]

I've kept the weight off for about 4 years, with good success. I stress that I changed my lifestyle when I lost it. I went with a much healthier, lower calorie, low fat, and in my case vegetarian diet. (The vegetarian part isn't key, but it worked really well for me).

Although I am certainly not as strict about the diet now as I was when I was losing the weight, I am careful about my consumption, and I do try to stick with healthy, low-fat, nutritious food options (while still enjoying the occasional ice cream cone).

I've also kept my activity level up. I don't work out 5 days week for an hour or more each day like I did when in the weight-loss cycle, but I do get moving for about 45 min 3 days a week or more.

It was something I had to decide was really important to me and commit to it. When I was actually actively losing weight, it was really my full-time hobby outside of work. Now that I am just maintaining, it was just a matter of incorporating healthy choices and activity into my day to day life.

Thanks for asking. :)

[jbru.livejournal.com]

Nothing in the article Peg linked to has that information. Information about her health history cannot, as I understand HIPPA, be released without her consent.

As for "medical forula" and BMI, these objective measurements are totally arbitrary. I plugged my measurements into the CDC's BMI calculator (http://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm) and got 29.7 meaning I'm "overweight" and nearly "obese." If I were to gain five pounds I'd be nicely in "obese" territory (30.3). I'm a skinny guy with a bit of a beer belly. If someone told me I needed to lose weight, I'd laugh in their face.

She just didn't want to listen.

I suspect that she'd heard that same information more than enough. From doctors, family members, even well-meaning strangers. Not to mention the cruel ones who laugh or give her dirty looks because she dares to pick up a carton of sugar-free ice cream or whatever. Or the constant barrage of advertising and other media that says you're worthless if you don't fit into some narrowly defined vision of what a woman should look like. If anyone didn't want to listen, it was probably the doctor who didn't want to listen to her.

[megd.livejournal.com]

Actually, Peg's article linked to the interview he gave today.

[dreamcoat-mom.livejournal.com]

Was he right to talk with her about it? Or should have have addressed her other health concerns without talking about the weight, since she didn't bring it up, even though it may have impacted the other problems she was having?

Oh, absolutely he should have talked to her about it! He would be sadly remiss in his duty if he didn't - but his approach was reprehensible, and he lost any hope of actually helping his patient when he chose his unkind and unprofessional words.

My issue with the medical community in terms of obesity has never been one of "don't you dare tell me I'm fat." I KNOW I'm fat - hello! My issue stems from actually NOT treating symptoms until the patient loses weight. Some people can and do - others can't and don't. Many of us are living healthily, but are stuck with a certain setpoint to which our bodies always return once we've finished starving them. Healthy eating habits and regular exercise often result in - guess what? A healthy fat person.

When a physician refuses to address a set of symptoms until the patient loses weight, he or she is not being wholly realistic. If it was merely a matter of moral character, many of us would be pencil thin.

If Doctor Not-so-nice (I don't recall his name) REALLY feels that losing a great deal of body weight is as simple as a moral character change, perhaps he can start by changing his OWN moral character. He could begin by taking the class the board suggested he take that will teach him to talk to his patients at a higher level of skill. Learning to not talk like jerk must be at least as easy as dropping 100 pounds then living the rest of one's life on a limited caloric intake.

[copperwise.livejournal.com]

I can't view the live interview but if he publicly discussed her medical history without her permission, he's opened the HIPPA can of worms all over the place.

[dreamcoat-mom.livejournal.com]

Well said! I do find it interesting that many thin people (my sister-in-law is one of them) hold us to a double standard in terms of lifestyle. She is able and does eat things I can only dream of on a regular basis, yet remains a svelte size 9. She loves her sugared soda, eats gallons of ice cream, won't touch green leafy vegetables, etc. In the arena of dietary self-control I've got her beat hands down - but in society's and the medical establishment's eyes, I'm the one with the self-discipline problem, though my diet is made up of largely low-fat food items.

[em-h.livejournal.com]

"if you saw your doctor about a sinus infection and, after describing your symptoms, his first comment was, "You know, you could stand to gain 20 pounds." I'm suggesting that would be seen as odd and inappropriate."

Well, when I was in my twenties, I was in a minor bike accident, and went to a doctor to make sure the bruises and cuts weren't serious. They weren't, but she _immediately_ called me on my very low weight. She was right. I was anorexic. She dealt with this with a lot of sensitivity, and I ended up seeing her regularly as part of the recovery process. So yeah, it does happen, and it can be a good thing.

I don't know the details of this particular case, but sometimes a doctor does need to address a manifest problem that isn't what the patient came in about.