Sniggering Title
May 2, 2017 2:04 PM Subscribe
For anyone who only read this piece of gruelling great writing and then stopped: I must also recommend you read the rest, she is enormously interesting and real on this and various other subjects and she is an Otago med student.
I had too many friends who were Otago med students, though they were mostly horrid dentists. Godspeed, Izzy
posted by monster truck weekend at 2:40 PM on May 2, 2017 [4 favorites]
I had too many friends who were Otago med students, though they were mostly horrid dentists. Godspeed, Izzy
posted by monster truck weekend at 2:40 PM on May 2, 2017 [4 favorites]
For most people, it's not possible to lose weight long term. It just isn't. As she said, the body has all kinds of clever ways of getting you to be fat.
Someday when they figure it out, Dick Cavett can give me a big (fat) apology.
posted by adam hominem at 3:04 PM on May 2, 2017 [6 favorites]
Someday when they figure it out, Dick Cavett can give me a big (fat) apology.
posted by adam hominem at 3:04 PM on May 2, 2017 [6 favorites]
Note: the medical establishment has no idea how to help people lose weight. For some reason people expect us to do more. We can't. The sooner this is acknowledged, the easier it will be for everyone to actually get the care they deserve.
posted by docpops at 3:07 PM on May 2, 2017 [26 favorites]
posted by docpops at 3:07 PM on May 2, 2017 [26 favorites]
I once went to my GP with anxiety so bad it felt like I was dying. In between writing the prescription, the doctor helpfully suggested my mental health might be better if I lost weight because then I would feel better about myself. He went on to suggest that otherwise I might not be alive in 10 years. I was 22 and otherwise in good health. I went to him with acute anxiety, and he told me I would die in 10 years.
The fundamental lack of empathy should astound me, but it does not. It horrifies me, but I can't say I'm surprised. I volunteer sometimes as a standardized (simulated) patient, mostly for the "bedside manner" teaching scenarios at our local med school, and it has opened my eyes to they ways in which being empathetic do and do not come naturally to different people. Some students I feel were born to be doctors; others, I feel should not approach a live, conscious patient EVER.
Of course I know people are not born with these skills, which is why medical schools must teach them. And I also know that it is larger than that; it is a cultural problem, as in, the culture of medicine has absorbed (and created) the toxic attitudes society in general has towards fat people and women and people who do not fit the so-called ideal in a multitude of ways. All I can hope is that by naming these things and by shining light on the bad assumptions and the bad behaviour (no matter how unintentional or well-meaning it may be) that things will change and future generations of doctors and healthcare professionals will be better equipped to care for more shapes of people.
And thank you jacquilynne for introducing me to this author; she's an excellent writer and I'm enjoying reading some of her other thoughtful posts too.
posted by hurdy gurdy girl at 3:09 PM on May 2, 2017 [27 favorites]
The fundamental lack of empathy should astound me, but it does not. It horrifies me, but I can't say I'm surprised. I volunteer sometimes as a standardized (simulated) patient, mostly for the "bedside manner" teaching scenarios at our local med school, and it has opened my eyes to they ways in which being empathetic do and do not come naturally to different people. Some students I feel were born to be doctors; others, I feel should not approach a live, conscious patient EVER.
Of course I know people are not born with these skills, which is why medical schools must teach them. And I also know that it is larger than that; it is a cultural problem, as in, the culture of medicine has absorbed (and created) the toxic attitudes society in general has towards fat people and women and people who do not fit the so-called ideal in a multitude of ways. All I can hope is that by naming these things and by shining light on the bad assumptions and the bad behaviour (no matter how unintentional or well-meaning it may be) that things will change and future generations of doctors and healthcare professionals will be better equipped to care for more shapes of people.
And thank you jacquilynne for introducing me to this author; she's an excellent writer and I'm enjoying reading some of her other thoughtful posts too.
posted by hurdy gurdy girl at 3:09 PM on May 2, 2017 [27 favorites]
I remember when our child was born. He had the cord around his neck and nearly died. Ended up spending a week in the NICU all told.
My spouse, after having been unexpectedly put under anesthesia and having a Caesarian when we had planned for a "no drugs" birth if possible, didn't get to see him for almost a day. During that time, unbeknownst to me, a nurse apparently took it upon herself to come to my spouse's room and lecture them about how things might have gone better if they weighed less.
People are assholes, is I guess my point.
posted by Scattercat at 3:31 PM on May 2, 2017 [32 favorites]
My spouse, after having been unexpectedly put under anesthesia and having a Caesarian when we had planned for a "no drugs" birth if possible, didn't get to see him for almost a day. During that time, unbeknownst to me, a nurse apparently took it upon herself to come to my spouse's room and lecture them about how things might have gone better if they weighed less.
People are assholes, is I guess my point.
posted by Scattercat at 3:31 PM on May 2, 2017 [32 favorites]
We had to take our baby to the local urgent care place when they were about 12 months old (result: double ear infection, woe). In the middle of assessing our baby, the doctor starts lecturing us on how babies who start out large tend to stay that way, and so to watch out about food intake when $baby hits their teens.
(a) Our baby is a long goddamn Stretch Armstrong baby because Tall Mofos on one side and Dutch ancestry on the other.
(b) We were there for an ear infection. We didn't ask for weight-based input. This was entirely out of nowhere.
(c) Who even cares if they're a large person, now or later? Who? Oh wait the doctors care.
I am prepared to continue disliking the general medical community forever now.
posted by XtinaS at 3:36 PM on May 2, 2017 [7 favorites]
(a) Our baby is a long goddamn Stretch Armstrong baby because Tall Mofos on one side and Dutch ancestry on the other.
(b) We were there for an ear infection. We didn't ask for weight-based input. This was entirely out of nowhere.
(c) Who even cares if they're a large person, now or later? Who? Oh wait the doctors care.
I am prepared to continue disliking the general medical community forever now.
posted by XtinaS at 3:36 PM on May 2, 2017 [7 favorites]
This is a great piece.
My anecdote maybe isn't that relevant because I'm really not "fat," but here it is: I got pregnant, and my BMI was on the overweight/obese line. I was extremely fortunate to go into the pregnancy with really good health indicators -- physically fit, good diet, no major risk factors, supportive partner, healthcare coverage, etc. And on my first appointment, my doctor recommended that I gain no more than 10 POUNDS during the pregnancy. 10 POUNDS! ie approximately the size of the baby and the placenta, without factoring in milk weight, amniotic fluid, the rest of the changes that happen to a body during pregnancy, etc. IE my doctor looked at my healthy blood pressure, blood tests, etc., saw the number on the scale, and essentially told me to lose weight during the course of the pregnancy. When she finally ordered the gestational diabetes test 2 months early (which I subsequently had to attempt to explain to my new doctor), I decided to switch doctors for good.
To have such a common, ingrained, institutionalized bias against heavier patients, nevermind obese patients, is a disgrace. To have to endure that scorn directed at one by a colleague is something I can't even fathom. Good for her to write about it, because god it makes me feel terrible to even think about.
posted by likeatoaster at 3:50 PM on May 2, 2017 [16 favorites]
My anecdote maybe isn't that relevant because I'm really not "fat," but here it is: I got pregnant, and my BMI was on the overweight/obese line. I was extremely fortunate to go into the pregnancy with really good health indicators -- physically fit, good diet, no major risk factors, supportive partner, healthcare coverage, etc. And on my first appointment, my doctor recommended that I gain no more than 10 POUNDS during the pregnancy. 10 POUNDS! ie approximately the size of the baby and the placenta, without factoring in milk weight, amniotic fluid, the rest of the changes that happen to a body during pregnancy, etc. IE my doctor looked at my healthy blood pressure, blood tests, etc., saw the number on the scale, and essentially told me to lose weight during the course of the pregnancy. When she finally ordered the gestational diabetes test 2 months early (which I subsequently had to attempt to explain to my new doctor), I decided to switch doctors for good.
To have such a common, ingrained, institutionalized bias against heavier patients, nevermind obese patients, is a disgrace. To have to endure that scorn directed at one by a colleague is something I can't even fathom. Good for her to write about it, because god it makes me feel terrible to even think about.
posted by likeatoaster at 3:50 PM on May 2, 2017 [16 favorites]
*offers hugs to all the other fat people in the thread*
posted by Deoridhe at 4:13 PM on May 2, 2017 [23 favorites]
posted by Deoridhe at 4:13 PM on May 2, 2017 [23 favorites]
Ok guys, the point of the article was the doctor-patient relationship for fat patients is as follows:
I came to my doctor with something unrelated to my weight and they didn't take my health issue seriously or listen to me, because they were too busy worrying about my weight to treat my presenting symptoms.
So, how you get from that pretty basic and easy to understand point to "your doctor should definitely tell you you're fat" is like, obtuse on a level that makes me think you either didnt rtfa or else you did and just reacted as though the article said "being fat is totes awesome and no one can tell me otherwise! Lololol eating ice cream forever!" Which, to be clear, it did not.
And given that it was written by someone who is both 1. Overweight and 2. A medical student, maybe trust that she has a unique perspective into how therapeutic relationships can be inproved to enhance patient care?
posted by supercrayon at 5:02 PM on May 2, 2017 [20 favorites]
I came to my doctor with something unrelated to my weight and they didn't take my health issue seriously or listen to me, because they were too busy worrying about my weight to treat my presenting symptoms.
So, how you get from that pretty basic and easy to understand point to "your doctor should definitely tell you you're fat" is like, obtuse on a level that makes me think you either didnt rtfa or else you did and just reacted as though the article said "being fat is totes awesome and no one can tell me otherwise! Lololol eating ice cream forever!" Which, to be clear, it did not.
And given that it was written by someone who is both 1. Overweight and 2. A medical student, maybe trust that she has a unique perspective into how therapeutic relationships can be inproved to enhance patient care?
posted by supercrayon at 5:02 PM on May 2, 2017 [20 favorites]
Mod note: Folks, both the "it's easy to lose weight, just use willpower!" and the "definitely yell at fat people about being fat, it's super helpful!" arguments are very much played out and you can just take them as read. We don't need to go around that pair of arguments again.
posted by restless_nomad (staff) at 5:07 PM on May 2, 2017 [17 favorites]
posted by restless_nomad (staff) at 5:07 PM on May 2, 2017 [17 favorites]
If I seem kind of pissed off it's because I am actually. When someone shows up to you for help, and they're scared and vulnerable and might even be in quite severe discomfort, what on earth would possess a health professional to bypass all that in favor of "btw lose weight yo." Like are you fucking kidding me? If you help people, make sure you've established trust and rapport, treat them respectfully and as full partners in their healthcare, and triage them correctly - after all that then maybe you can talk about their weight if it's germane. Like sorry, speaking as someone who works in a hospital, do primary care practitioners lose all their entire fucking skillset for how to interact with patients appropriately?
posted by supercrayon at 5:08 PM on May 2, 2017 [20 favorites]
posted by supercrayon at 5:08 PM on May 2, 2017 [20 favorites]
My mom spent a good chunk of a year limping around on a broken foot because a doctor would test her cholesterol and marvel at how low it was then lecture her on needing to lose weight. It was only when she collapsed and was literally unable to walk that they thought to X-Ray her foot. Part of the reason she couldn't "just exercise" was she could barely walk because her foot was broken.
posted by Ghostride The Whip at 5:10 PM on May 2, 2017 [13 favorites]
posted by Ghostride The Whip at 5:10 PM on May 2, 2017 [13 favorites]
This is basically the same problem people with addiction face from doctors: just quit! You are lazy scum with no willpower if you don't. It's not really a medical problem, just go to AA (confession, prayer, restitution— not at all moralistic).
The reality is that appetites of all sorts are regulated in complex ways that are not meant to be under total conscious control because otherwise we'd starve and/or fail to reproduce successfully.
Another part of it is that humans are incredibly varied in terms of the childhood stress we've been exposed to, our underlying temperaments and our genetics (including risk for various mental illnesses). Anything that makes you more stressed and less happy and less able to connect with others can set you up for obesity and/or addictions. And then obesity and/or addiction will reduce your ability to get the social support you need to change. While blaming you.
Anyone who says "it's just a matter of discipline" does not have the underlying neurochemistry to understand why this advice is pointless for people with actual weight problems most of the time. Discipline can only work in the context of complete control over biological drives, which is often an illusion. It might work for you right now— but let's see how easy it is for you to control your eating if, say, I give you certain antipsychotic medications.
This was a brave, well written piece.
posted by Maias at 5:10 PM on May 2, 2017 [36 favorites]
The reality is that appetites of all sorts are regulated in complex ways that are not meant to be under total conscious control because otherwise we'd starve and/or fail to reproduce successfully.
Another part of it is that humans are incredibly varied in terms of the childhood stress we've been exposed to, our underlying temperaments and our genetics (including risk for various mental illnesses). Anything that makes you more stressed and less happy and less able to connect with others can set you up for obesity and/or addictions. And then obesity and/or addiction will reduce your ability to get the social support you need to change. While blaming you.
Anyone who says "it's just a matter of discipline" does not have the underlying neurochemistry to understand why this advice is pointless for people with actual weight problems most of the time. Discipline can only work in the context of complete control over biological drives, which is often an illusion. It might work for you right now— but let's see how easy it is for you to control your eating if, say, I give you certain antipsychotic medications.
This was a brave, well written piece.
posted by Maias at 5:10 PM on May 2, 2017 [36 favorites]
> the doctor starts lecturing us on how babies who start out large tend to stay that way, and so to watch out about food intake when $baby hits their teens
I brought my daughter in for a check when she was nine years old or so, and the doctor spent 10 minutes telling me how healthy my daughter was, then five minutes lecturing me for buying whole milk instead of skim.
posted by The corpse in the library at 5:38 PM on May 2, 2017 [2 favorites]
I brought my daughter in for a check when she was nine years old or so, and the doctor spent 10 minutes telling me how healthy my daughter was, then five minutes lecturing me for buying whole milk instead of skim.
posted by The corpse in the library at 5:38 PM on May 2, 2017 [2 favorites]
US medical schools self-select for students who:
--take for granted that goals are reached through punishing self-discipline (grueling workloads and schedules in medical school, residencies, classes designed to make half the class drop out, sleep deprivation)
--have lifestyles allow them to do those things (generally young, middle class, without significant familial responsibilities)
--thrive in an environment based largely on individual mastery of facts (as opposed to collaboration and theorizing)
And then it trains doctors in triage thinking via decision tree — ie: is there something urgent that must be addressed? if yes then address, if no then dismiss
This is may well be a fine way to train certain specialists (surgeons) and researchers. But it turns out the exact opposite of what you need most doctors to be: empathetic, collaborative, whole-picture thinkers.
posted by mrmurbles at 5:42 PM on May 2, 2017 [20 favorites]
--take for granted that goals are reached through punishing self-discipline (grueling workloads and schedules in medical school, residencies, classes designed to make half the class drop out, sleep deprivation)
--have lifestyles allow them to do those things (generally young, middle class, without significant familial responsibilities)
--thrive in an environment based largely on individual mastery of facts (as opposed to collaboration and theorizing)
And then it trains doctors in triage thinking via decision tree — ie: is there something urgent that must be addressed? if yes then address, if no then dismiss
This is may well be a fine way to train certain specialists (surgeons) and researchers. But it turns out the exact opposite of what you need most doctors to be: empathetic, collaborative, whole-picture thinkers.
posted by mrmurbles at 5:42 PM on May 2, 2017 [20 favorites]
This was a great read.
As an overweight woman, I was amazed when I went to the doctor for back pain and wasn't told to lose weight to fix it. I got a referral to a physical therapist who flat out told me that it was NOT because of my weight. This should not be an amazing thing.
posted by WowLookStars at 5:54 PM on May 2, 2017 [15 favorites]
As an overweight woman, I was amazed when I went to the doctor for back pain and wasn't told to lose weight to fix it. I got a referral to a physical therapist who flat out told me that it was NOT because of my weight. This should not be an amazing thing.
posted by WowLookStars at 5:54 PM on May 2, 2017 [15 favorites]
A friend of mine tweeted this morning that she went to the doctor and all the staff were fat ladies and I would seriously pay cash for office visits to any doctor that advertised this. Then I cried because I really ought to go get my perimenopause looked at but probably I will just die of something treatable instead.
posted by Lyn Never at 6:30 PM on May 2, 2017 [10 favorites]
posted by Lyn Never at 6:30 PM on May 2, 2017 [10 favorites]
A few years ago I had to have my thyroid removed because I was diagnosed with thyroid cancer. The particular hospital where I was having the surgery happened to be the same hospital where I attended eating disorder clinic when I was a teenager. It was a terrible time; I weighed 82 lbs. and ultimately ended up in a psychiatric hospital. Apparently my saga was still available in my chart, because when the anesthesiologist came in for the consult prior to surgery he took one look at me and said, "I guess the eating disorder isn't a problem anymore, hah ha."
Fuck you, anesthesiologist. I was there for thyroid cancer and weighed 146 lbs. Maybe a bit fat, sure, but it's not like the fire dept. had to cut me out of my house to get me there for surgery. The surgery was over a decade ago and I still think of that asshole doctor making fun of my weight at least once a month.
posted by xyzzy at 6:41 PM on May 2, 2017 [65 favorites]
Fuck you, anesthesiologist. I was there for thyroid cancer and weighed 146 lbs. Maybe a bit fat, sure, but it's not like the fire dept. had to cut me out of my house to get me there for surgery. The surgery was over a decade ago and I still think of that asshole doctor making fun of my weight at least once a month.
posted by xyzzy at 6:41 PM on May 2, 2017 [65 favorites]
The description of the doctor visit for anxiety/depression made me think of a really difficult question (maybe there's an obvious good answer here that people in the field know).
The author states "I am always aware of my fatness", "On bad days I feel like a huge inconvenience" and the hard hitting paragraph "I have been fat all my life to a greater or lesser extent and I don’t believe there has been a day when I have not been aware of it. I dread eating in public and squeezing into the backseat of full cars. I plead claustrophobia and refuse to get into elevators when they are anywhere close to capacity. I always know when I am the fattest person in the room."
That is clearly a huge factor in their mental health, not the weight itself but the knowledge of everyone's gaze and likely judgement.
How the hell, as a doctor, do you help with this without being yet another example of the unhelpful doctors in the essay? How do you recommend actions the patient can take that will be helpful when the ethical recommendation has to include losing weight?
Sure, internet comments can be all childish with the "well everyone should just ..." fantasies, but what should real people do in that situation?
posted by Infracanophile at 7:00 PM on May 2, 2017 [1 favorite]
The author states "I am always aware of my fatness", "On bad days I feel like a huge inconvenience" and the hard hitting paragraph "I have been fat all my life to a greater or lesser extent and I don’t believe there has been a day when I have not been aware of it. I dread eating in public and squeezing into the backseat of full cars. I plead claustrophobia and refuse to get into elevators when they are anywhere close to capacity. I always know when I am the fattest person in the room."
That is clearly a huge factor in their mental health, not the weight itself but the knowledge of everyone's gaze and likely judgement.
How the hell, as a doctor, do you help with this without being yet another example of the unhelpful doctors in the essay? How do you recommend actions the patient can take that will be helpful when the ethical recommendation has to include losing weight?
Sure, internet comments can be all childish with the "well everyone should just ..." fantasies, but what should real people do in that situation?
posted by Infracanophile at 7:00 PM on May 2, 2017 [1 favorite]
Worry about the anxiety/dread first?
Lots of people are fat and not depressed about it. It's not automatic.
posted by Lyn Never at 7:24 PM on May 2, 2017 [8 favorites]
Lots of people are fat and not depressed about it. It's not automatic.
posted by Lyn Never at 7:24 PM on May 2, 2017 [8 favorites]
How the hell, as a doctor, do you help with this without being yet another example of the unhelpful doctors in the essay?
One good option is to recommend healthy behaviors that are a good idea for anyone. Doctors shouldn't only discuss exercise and dietary habits if obesity is an issue; these are important for everyone. They do need to make sure they're not making assumptions about a person's behavior based on their appearance, just like we all should.
posted by asperity at 7:41 PM on May 2, 2017 [4 favorites]
One good option is to recommend healthy behaviors that are a good idea for anyone. Doctors shouldn't only discuss exercise and dietary habits if obesity is an issue; these are important for everyone. They do need to make sure they're not making assumptions about a person's behavior based on their appearance, just like we all should.
posted by asperity at 7:41 PM on May 2, 2017 [4 favorites]
On a slightly less serious note, though, I was appalled to learn from this that it's apparently possible to feel a person's liver through their skin and can I have a robotic exoskeleton now? Because that is creepy.
posted by asperity at 7:48 PM on May 2, 2017 [1 favorite]
posted by asperity at 7:48 PM on May 2, 2017 [1 favorite]
My friend just went to the doctor with shingles and was told to lose weight (I'm guessing he's about 20 lbs over; nothing dramatic).
posted by AFABulous at 7:49 PM on May 2, 2017
posted by AFABulous at 7:49 PM on May 2, 2017
How the hell, as a doctor, do you help with this without being yet another example of the unhelpful doctors in the essay? How do you recommend actions the patient can take that will be helpful when the ethical recommendation has to include losing weight?
First, recognize that there is a huge amount of scientific evidence that for many people, any attempt to lose weight will result in them gaining weight. So suggesting that someone lose weight is not the slam dunk "ethical" recommendation that you think it is.
After medical science has mastered step one, we can work out what step two is.
It probably involves doing all the usual testing and diagnosis steps you'd do on someone who wasn't obese, instead of treating every symptom like it has only one cause.
posted by jacquilynne at 7:56 PM on May 2, 2017 [13 favorites]
First, recognize that there is a huge amount of scientific evidence that for many people, any attempt to lose weight will result in them gaining weight. So suggesting that someone lose weight is not the slam dunk "ethical" recommendation that you think it is.
After medical science has mastered step one, we can work out what step two is.
It probably involves doing all the usual testing and diagnosis steps you'd do on someone who wasn't obese, instead of treating every symptom like it has only one cause.
posted by jacquilynne at 7:56 PM on May 2, 2017 [13 favorites]
"How the hell, as a doctor, do you help with this without being yet another example of the unhelpful doctors in the essay? How do you recommend actions the patient can take that will be helpful when the ethical recommendation has to include losing weight?"
Start by assuming they know they're overweight and are probably aware of possible health consequences. Secondly, be up to fuckin' date on literature about obesity and don't assume obesity causes everything, or that it's easy to solve. Third, understand that overweight and obesity are social issues, which don't have easy individual solutions -- although you have an individual patient in front of you.
My last doctor (who I had for ten years before she moved *sob*) and my new doctor have both been really helpful. Since I started having kids, my weight has been higher than I'd like. Some of this is baby weight; some of this is that breastfeeding is pretty miserable for me and I'm hungry all the time and have weird autoimmune reactions; some of it is trauma and damage from the pregnancy and deliveries. For example, I had such bad plantar fasciitis I couldn't walk with my second pregnancy. And twice I've had Pubis Symphysis Dysfunction, where the ligaments holding your pubic bones together loosen up and the bones go out of alignment and it HURTS LIKE MOTHERFUCKING HELL to walk ("the most common symptom is wrenching pain, as if your pelvis is tearing apart" -- actual quote). It takes for fucking ever to heal, and if you breastfeed and have the right hormone cocktail (I do!), may persist throughout much of breastfeeding. It is totally clear to me that I need to exercise more. AND YET all of my joints ache from breastfeeding and walking or climbing stairs feels like being stabbed repeatedly in the pelvis. It's very hard to strengthen the abused back and abdominal muscles from pregnancy when you have pubis symphysis because everything is so painful.
Anyway, coming to a point, my new doctor asked me what my concerns were and when I told her weight was one of them, she started with blood tests to see how my metabolism is doing and if there's anything of concern like thyroid problems. And she asked me about my lifestyle and diet, she didn't just lecture. I eat a pretty healthy diet (because I cook for my kids and I'm super-serious about them getting healthy diets), but, as noted, I have some serious impediments to exercise right now, and my appetite is all out of whack from the breastfeeding. So she started with helping with the immune reactions and joint pain, so I will not be in pain all the time; said not to worry about my calorie intake until I'm done breastfeeding as long as I'm mostly eating healthy calories, because there are just too many moving hormonal parts (and indeed, both of the last times I breastfed, I dropped a bunch of weight as soon as I stopped); and referred me for physical therapy to work on strengthening my back and ab muscles and controlling the pubis symphysis pain/keeping that shit in alignment, so that I can move around more and enjoy my kids more and get more exercise. She said she'd refer me to a nutritionist if and when I wanted that help, but she thought my diet sounded okay.
There are a lot of doctors in the world who would be like, "Lose the baby weight, your joints will hurt less." Seems true! But also unhelpful. By contrast, her whole orientation is, "What are your barriers to better health and how can we address them together?" And she acts like I'm the expert on my own life. In my case, I have some physical aftereffects of pregnancy and childbirth, and some ongoing stuff with breastfeeding, so she is -- revolutionary, I know -- helping me deal with those with goals and a plan we crafted as a team, so that I can have a happier, healthier life whether or not I lose weight, and to get me in a position to tackle the next step w/r/t weight loss.
"The surgery was over a decade ago and I still think of that asshole doctor making fun of my weight at least once a month."
When I get my superpower, which will be punching people through the internet, this dude will be first in line.
posted by Eyebrows McGee at 9:02 PM on May 2, 2017 [52 favorites]
Start by assuming they know they're overweight and are probably aware of possible health consequences. Secondly, be up to fuckin' date on literature about obesity and don't assume obesity causes everything, or that it's easy to solve. Third, understand that overweight and obesity are social issues, which don't have easy individual solutions -- although you have an individual patient in front of you.
My last doctor (who I had for ten years before she moved *sob*) and my new doctor have both been really helpful. Since I started having kids, my weight has been higher than I'd like. Some of this is baby weight; some of this is that breastfeeding is pretty miserable for me and I'm hungry all the time and have weird autoimmune reactions; some of it is trauma and damage from the pregnancy and deliveries. For example, I had such bad plantar fasciitis I couldn't walk with my second pregnancy. And twice I've had Pubis Symphysis Dysfunction, where the ligaments holding your pubic bones together loosen up and the bones go out of alignment and it HURTS LIKE MOTHERFUCKING HELL to walk ("the most common symptom is wrenching pain, as if your pelvis is tearing apart" -- actual quote). It takes for fucking ever to heal, and if you breastfeed and have the right hormone cocktail (I do!), may persist throughout much of breastfeeding. It is totally clear to me that I need to exercise more. AND YET all of my joints ache from breastfeeding and walking or climbing stairs feels like being stabbed repeatedly in the pelvis. It's very hard to strengthen the abused back and abdominal muscles from pregnancy when you have pubis symphysis because everything is so painful.
Anyway, coming to a point, my new doctor asked me what my concerns were and when I told her weight was one of them, she started with blood tests to see how my metabolism is doing and if there's anything of concern like thyroid problems. And she asked me about my lifestyle and diet, she didn't just lecture. I eat a pretty healthy diet (because I cook for my kids and I'm super-serious about them getting healthy diets), but, as noted, I have some serious impediments to exercise right now, and my appetite is all out of whack from the breastfeeding. So she started with helping with the immune reactions and joint pain, so I will not be in pain all the time; said not to worry about my calorie intake until I'm done breastfeeding as long as I'm mostly eating healthy calories, because there are just too many moving hormonal parts (and indeed, both of the last times I breastfed, I dropped a bunch of weight as soon as I stopped); and referred me for physical therapy to work on strengthening my back and ab muscles and controlling the pubis symphysis pain/keeping that shit in alignment, so that I can move around more and enjoy my kids more and get more exercise. She said she'd refer me to a nutritionist if and when I wanted that help, but she thought my diet sounded okay.
There are a lot of doctors in the world who would be like, "Lose the baby weight, your joints will hurt less." Seems true! But also unhelpful. By contrast, her whole orientation is, "What are your barriers to better health and how can we address them together?" And she acts like I'm the expert on my own life. In my case, I have some physical aftereffects of pregnancy and childbirth, and some ongoing stuff with breastfeeding, so she is -- revolutionary, I know -- helping me deal with those with goals and a plan we crafted as a team, so that I can have a happier, healthier life whether or not I lose weight, and to get me in a position to tackle the next step w/r/t weight loss.
"The surgery was over a decade ago and I still think of that asshole doctor making fun of my weight at least once a month."
When I get my superpower, which will be punching people through the internet, this dude will be first in line.
posted by Eyebrows McGee at 9:02 PM on May 2, 2017 [52 favorites]
My current doctor is incredible. We don't discuss my weight except in the most general terms. The nurse will have me jump on the scale. "Hm. Up a little since last visit. How are you feeling?" "Down a bit since last visit! Did you pick up extra dance classes?"
Then doc will remark similarly. My cholesterol and glucose are great, you can drive a bus through my arteries, and I'm pretty limber for an old broad with RA and MDD. We focus on the RA and the MDD, and he occasionally suggests I maybe cut back a little on the wine. It makes a huge difference.
posted by MissySedai at 9:12 PM on May 2, 2017 [5 favorites]
Then doc will remark similarly. My cholesterol and glucose are great, you can drive a bus through my arteries, and I'm pretty limber for an old broad with RA and MDD. We focus on the RA and the MDD, and he occasionally suggests I maybe cut back a little on the wine. It makes a huge difference.
posted by MissySedai at 9:12 PM on May 2, 2017 [5 favorites]
Also, I find myself continually aggravated by doctors who feel the burning urge to tell off individual patients for being fat, but who can't be arsed to come to local public meetings and say, "Soda machines in elementary schools are literally killing our children. Cancelling recess is literally killing our children. Putting in a riverfront walking trail will save lives. Increasing public transit availability so people don't have to drive everyhere will save lives. Increased urban density will save lives. These jobs that require people to sit all day and don't allow people breaks are killing people. Cheap, subsidized fast food is killing people. Long hours at low wages so people don't get enough sleep is killing people."
We KNOW a lot of the social causes of obesity -- car-centric urban planning, subsidized low-quality calories, advertising crappy food to children, forcing both children and adults to sit all day and never move -- but most doctors are a lot happier berating individual patients for being trapped in a society determined to make them fat to the profit of our corporate overlords, instead of standing up against the social problems and social conditions that cause obesity, both locally and nationally. In five years on school board not one doctor or nurse or public health professional bothered to come to one of our meetings and say "STOP. FUCKING. CUTTING. RECESS." Not one bothered to come and complain about chocolate milk! Which is 60 extra empty calories a day, every day. We got a couple of hippie parents over soda machines, but no local health professionals. They don't seem to actually care about the conditions in the community that are making their patients fat, just berating the ones who get fat.
posted by Eyebrows McGee at 9:16 PM on May 2, 2017 [62 favorites]
We KNOW a lot of the social causes of obesity -- car-centric urban planning, subsidized low-quality calories, advertising crappy food to children, forcing both children and adults to sit all day and never move -- but most doctors are a lot happier berating individual patients for being trapped in a society determined to make them fat to the profit of our corporate overlords, instead of standing up against the social problems and social conditions that cause obesity, both locally and nationally. In five years on school board not one doctor or nurse or public health professional bothered to come to one of our meetings and say "STOP. FUCKING. CUTTING. RECESS." Not one bothered to come and complain about chocolate milk! Which is 60 extra empty calories a day, every day. We got a couple of hippie parents over soda machines, but no local health professionals. They don't seem to actually care about the conditions in the community that are making their patients fat, just berating the ones who get fat.
posted by Eyebrows McGee at 9:16 PM on May 2, 2017 [62 favorites]
How the hell, as a doctor, do you help with this without being yet another example of the unhelpful doctors in the essay?
One, don't treat me like an idiot. Oh, you're fat? I'll assume you're ignorant, uneducated, undisciplined and lazy, not a national leader in your very disciplined field who's doing amazingly well in every single facet of your life and career except your weight, which you've struggled with since you were three years old.
Two, accept that you're pretty much powerless to make me not fat. You just are. You've got nothing. I know everything you know about losing weight. I also know everything you know - which is precisely one hundred percent of fucking zero - about how to sustain even small levels of weight loss in the medium to long term without surgery. If you had something, everybody would be doing it and nobody would be fat. I think part of you knows that but you're used to being an all powerful doctor and so it's just easier to believe that half the population is just ignorant, uneducated, undisciplined and lazy.
Three, I'm not fodder for Friday drinks stories or god help me your blog. There was a case here in Canberra of a nurse blogging with pretty open contempt about what a drama his fat patients were, and Christ they're disgusting, and oh noes what a burden they are on the health system. And when people pointed out that maybe that wasn't professional, they got shouted down because it's all anonymous, and you can't tell which fat person he's talking about. Except everybody knew who he was and what he looked like, and what's a fat person going to think when they score him in the wards and he's all smiling and polite but he's going to write about you on his blog because you're some sort of inconvenient subhuman? He got rightfully shitcanned but the outcry about what a loss this represented for the medical community was deafening. There were claims that this was all about frank and free speech but it was mostly thinly-veiled 'well, fat people are useless and disgusting, so why shouldn't I be able to blog about that from a position of trust and power?' Fuck those guys.
posted by obiwanwasabi at 9:29 PM on May 2, 2017 [20 favorites]
One, don't treat me like an idiot. Oh, you're fat? I'll assume you're ignorant, uneducated, undisciplined and lazy, not a national leader in your very disciplined field who's doing amazingly well in every single facet of your life and career except your weight, which you've struggled with since you were three years old.
Two, accept that you're pretty much powerless to make me not fat. You just are. You've got nothing. I know everything you know about losing weight. I also know everything you know - which is precisely one hundred percent of fucking zero - about how to sustain even small levels of weight loss in the medium to long term without surgery. If you had something, everybody would be doing it and nobody would be fat. I think part of you knows that but you're used to being an all powerful doctor and so it's just easier to believe that half the population is just ignorant, uneducated, undisciplined and lazy.
Three, I'm not fodder for Friday drinks stories or god help me your blog. There was a case here in Canberra of a nurse blogging with pretty open contempt about what a drama his fat patients were, and Christ they're disgusting, and oh noes what a burden they are on the health system. And when people pointed out that maybe that wasn't professional, they got shouted down because it's all anonymous, and you can't tell which fat person he's talking about. Except everybody knew who he was and what he looked like, and what's a fat person going to think when they score him in the wards and he's all smiling and polite but he's going to write about you on his blog because you're some sort of inconvenient subhuman? He got rightfully shitcanned but the outcry about what a loss this represented for the medical community was deafening. There were claims that this was all about frank and free speech but it was mostly thinly-veiled 'well, fat people are useless and disgusting, so why shouldn't I be able to blog about that from a position of trust and power?' Fuck those guys.
posted by obiwanwasabi at 9:29 PM on May 2, 2017 [20 favorites]
I swear I read on here a few months ago about how like 30% of obesity is likely caused by a virus. And that we've known that for 30 years or something. I'm still stunned that this is *never* talked about. It's always shitty willpower, laziness, and bad diets.
posted by greermahoney at 10:18 PM on May 2, 2017 [3 favorites]
posted by greermahoney at 10:18 PM on May 2, 2017 [3 favorites]
Man, I would be thrilled to have a fat doctor.
My most recent story: I am in recovery from an eating disorder but still struggle with restricting and purging. 10 years ago I was underweight and very unhealthy, but now I'm overweight and Christ, apparently almost obese (deep breaths) in spite of eating a healthy diet. I'm in great therapy, and my therapists sent me for a check up with a doctor that was supposed to kind of "get" eating disorders. The doctor (1) assumed I am an overeater, which I'm not, and (2) told me I really should work hard on getting my eating disorder under control so I can then get to work on losing weight.
All in all, not a great experience, and took me a lot of work to deal with my feelings after that. It just makes me wonder, how the hell are there people in our society who *don't* have eating disorders, given how messed up we are about food and weight?
posted by imalaowai at 11:11 PM on May 2, 2017 [5 favorites]
My most recent story: I am in recovery from an eating disorder but still struggle with restricting and purging. 10 years ago I was underweight and very unhealthy, but now I'm overweight and Christ, apparently almost obese (deep breaths) in spite of eating a healthy diet. I'm in great therapy, and my therapists sent me for a check up with a doctor that was supposed to kind of "get" eating disorders. The doctor (1) assumed I am an overeater, which I'm not, and (2) told me I really should work hard on getting my eating disorder under control so I can then get to work on losing weight.
All in all, not a great experience, and took me a lot of work to deal with my feelings after that. It just makes me wonder, how the hell are there people in our society who *don't* have eating disorders, given how messed up we are about food and weight?
posted by imalaowai at 11:11 PM on May 2, 2017 [5 favorites]
As a naturally fat person, I found The Hacker's Diet to be an enormously empowering read. It has helped me get my own weight mostly-under-control for the last 5 years.
posted by beniamino at 12:42 AM on May 3, 2017 [1 favorite]
posted by beniamino at 12:42 AM on May 3, 2017 [1 favorite]
It’s very, very hard to consciously regulate the amount you eat vs your energy expenditure Piter. A tiny daily excess leads to significant weight gain if maintained year after year. In order for calorie counting to be effective you need to a) know your energy expenditure precisely, b) know the energy content of your food precisely and c) know how much of that energy is absorbed by your own particular gut. None of these things can be measured accurately enough for an individual without heroic effort. At best calorie counting gives you a rough guesstimate & subconscious changes in behaviour can counteract dietary measures very easily.
(nb, does someone have a solid reference to this virus story? Particularly the infection rates if it actually exists. Because otherwise I’m going to put it down as “yet another vague claim people throw into arguments over this wildly controversial topic because it supports the side of the argument they like the most”.)
Very apropos this discussion, Scott Alexander reviewed Stephan Guyenet’s “The Hungry Brain” recently. Worth reading.
posted by pharm at 1:49 AM on May 3, 2017
(nb, does someone have a solid reference to this virus story? Particularly the infection rates if it actually exists. Because otherwise I’m going to put it down as “yet another vague claim people throw into arguments over this wildly controversial topic because it supports the side of the argument they like the most”.)
Very apropos this discussion, Scott Alexander reviewed Stephan Guyenet’s “The Hungry Brain” recently. Worth reading.
posted by pharm at 1:49 AM on May 3, 2017
It's also worth remembering that the concept of obesity-as-medical-crisis-responsible-for-endless-deaths was largely manufactured by the diet pill industry in the 90s using absolutely lousy, unsupportable statistics.
The fact that we live in a society that loves to ascribe morality to bodies, especially negative morality to atypical or perceived-as-less-ideal bodies, doesn't mean we have to swallow "fat is inherently bad for your health and will definitely make you die" without question.
posted by terretu at 3:20 AM on May 3, 2017 [10 favorites]
The fact that we live in a society that loves to ascribe morality to bodies, especially negative morality to atypical or perceived-as-less-ideal bodies, doesn't mean we have to swallow "fat is inherently bad for your health and will definitely make you die" without question.
posted by terretu at 3:20 AM on May 3, 2017 [10 favorites]
My understanding is that Type II diabetes is responsible for a huge amount of the rise in health care costs in the west (the later consequences of Type II Diabetes are extremely expensive to manage because they are so catastrophic for the patient) & obesity is a primary cause (alongside genetics & age) of Type II diabetes.
Just because bad outcomes are not an inevitable consequence of obesity doesn’t mean that the consequences for society as a whole of the obesity epidemic are not very serious.
posted by pharm at 3:32 AM on May 3, 2017 [1 favorite]
Just because bad outcomes are not an inevitable consequence of obesity doesn’t mean that the consequences for society as a whole of the obesity epidemic are not very serious.
posted by pharm at 3:32 AM on May 3, 2017 [1 favorite]
I have chronic pain. I was put on a non opiod medication that was like a magic pill. For 10 or so years prior I'd maintenaned the same weight in recovery from an eating disorder with pretty little thought. My body had a set point. I truced, my doctor agreed it was normal weight and I ate when I was hungry and stopped when I was full and worked and did a tiny bit of excersize but not really because I hurt all the time.
Well, this magic pill made all the pain go away. I went from sleeping 12 to14 hours a day to 8. It did wonders for my mental health. I was able to do more around my house. My therapist, psychiatrist we're baffledbut thrilled and my PCP was beyond impressed with the results.
However I was goddamn hungry all the time. I just didn't get full like I used to. It didn't feel satisfying. I would dream about specific foods like I did in my anorexic days but I was gaining a pound a week. I knew there was food I shouldn't just eat but like I'd literally think about the sonic shake for days until I bought the sonic shake. It would not leave my head. It was terrible. I gained 50 lbs in a year before I gave it up; because there was no reason to stay on a medication to treat chronic pain when weight gain would cause more problems longer term. My medical team and wife we're against my decision . I could not handle it.
Off the medication the weight gain immediately stopped followed by minor weight loss. After some discussions adjustments were made and topomax was added with the original med which allowed me to then loose weight without much thought.
I'm still plus some weight, but I'm happier.
I tell this story because it's a great example how chemicals and not conscious diet change can play a huge role.
posted by AlexiaSky at 3:33 AM on May 3, 2017 [5 favorites]
My current impression is that the way medical professionals treat overweight patients is a combination of two things. One is the huge contempt and negative associations that most societies have with respect to the condition. The other is what's also responsible for phenomena like going to a doctor and being told your problem is certainly psychosomatic, even though, while psychosomatic effects are definitely real, there's virtually no understanding of how they work or manifest, and even though that diagnosis is often given after a bare minimum of actual investigation; or phenomena like going to a doctor and having your problems dismissed because you're female or young or you sure seem healthy or whatever; or like having a doctor insist on lumping every condition you might develop over the course of a few decades under the umbrella of the same, often vague, condition (fibromyalgia's a hot one at the moment, and did you know that depressed people will never develop any issues unrelated to their depression, aside (possibly) from broken bones?)
It's a kind of unscientific sloppiness in thinking, combined with overconfidence, lack of patience/time, and a strong, almost definitely unconscious desire for things to be easy. And, to be fair, probably some repeated experiences with hypochondria. But you'd think good medical training would produce doctors who both recognize their biases and consider it vital to put them aside, who are capable of holding multiple alternative possibilities in their heads at a time, who are deeply aware of the current limitations and constantly changing nature of medical knowledge and of the high rates of misdiagnosis that exist, and who take seriously the consequences of failure to diagnose correctly or notice new issues. You have to possess a lot of knowledge to be certified as a doctor, but it's not clear you are required to become an egoless, objective, humble, observant, and creative thinker of complex thoughts.*
One of the arguments against "alternative" medicine is that a person might, say, go to a homeopath for their cancer not in addition to but instead of a doctor, and that by the time they make it to a source of real medical care it's too late. I wish doctors (as a whole) would be considerably more aware of their own capacity to mete out simplistic "woo" rather than the objective, self-doubting, and constantly evaluating and reevaluating treatment that science-based medicine is all about - and of the enormous opportunity cost for the patient when that happens.
* Or to have deeply ingrained respect for and goodwill towards one's patients, and some understanding of human psychology and communication skills, and...
posted by trig at 4:41 AM on May 3, 2017 [5 favorites]
It's a kind of unscientific sloppiness in thinking, combined with overconfidence, lack of patience/time, and a strong, almost definitely unconscious desire for things to be easy. And, to be fair, probably some repeated experiences with hypochondria. But you'd think good medical training would produce doctors who both recognize their biases and consider it vital to put them aside, who are capable of holding multiple alternative possibilities in their heads at a time, who are deeply aware of the current limitations and constantly changing nature of medical knowledge and of the high rates of misdiagnosis that exist, and who take seriously the consequences of failure to diagnose correctly or notice new issues. You have to possess a lot of knowledge to be certified as a doctor, but it's not clear you are required to become an egoless, objective, humble, observant, and creative thinker of complex thoughts.*
One of the arguments against "alternative" medicine is that a person might, say, go to a homeopath for their cancer not in addition to but instead of a doctor, and that by the time they make it to a source of real medical care it's too late. I wish doctors (as a whole) would be considerably more aware of their own capacity to mete out simplistic "woo" rather than the objective, self-doubting, and constantly evaluating and reevaluating treatment that science-based medicine is all about - and of the enormous opportunity cost for the patient when that happens.
* Or to have deeply ingrained respect for and goodwill towards one's patients, and some understanding of human psychology and communication skills, and...
posted by trig at 4:41 AM on May 3, 2017 [5 favorites]
I applaud this woman, and she should applaud herself for her courage, both in sticking it out in med school AND for writing about it from her perspective.
And I don’t know how to even begin to fix it.
Oh, but you ARE taking a step to fix it, just by being visible and frank within the community that most needs your honesty and reality.
As someone who very deeply loves an overweight person, and myself being overweight but much less so, it has been a roller coaster of on/off diets together and separately to tackle the problem.
However, we started doing a low carb diet in earnest right before Thanksgiving (!!!) last year, and have both been on it since, with very little "cheating".
I gotta say it feels good, preparing all our meals at home, with non processed ingredients that taste better & make us feel better. It's been an unexpected mental & emotional transformation also: knowing we are treating our physical systems with respect, thinking about where everything we eat comes from & appreciating its lifetime & existence (whether plant or animal). Enjoying physically preparing the meal, the aromas, and textures, has become a joy. We have become our own positive feedback loops.
The farmers market is such a highlight now: we only buy what we'll use within a few days, & rarely waste food now. Such is the beauty of the vanished corner market: if only we had them again, and ironically, the more of them, the less waste we might have.
The spiritual change has been as important as the 20+ lbs and 12+ lbs we have lost together, and is now a permanent habit we've grown attached to. Love and compassion does help.
posted by yoga at 5:37 AM on May 3, 2017 [2 favorites]
And I don’t know how to even begin to fix it.
Oh, but you ARE taking a step to fix it, just by being visible and frank within the community that most needs your honesty and reality.
As someone who very deeply loves an overweight person, and myself being overweight but much less so, it has been a roller coaster of on/off diets together and separately to tackle the problem.
However, we started doing a low carb diet in earnest right before Thanksgiving (!!!) last year, and have both been on it since, with very little "cheating".
I gotta say it feels good, preparing all our meals at home, with non processed ingredients that taste better & make us feel better. It's been an unexpected mental & emotional transformation also: knowing we are treating our physical systems with respect, thinking about where everything we eat comes from & appreciating its lifetime & existence (whether plant or animal). Enjoying physically preparing the meal, the aromas, and textures, has become a joy. We have become our own positive feedback loops.
The farmers market is such a highlight now: we only buy what we'll use within a few days, & rarely waste food now. Such is the beauty of the vanished corner market: if only we had them again, and ironically, the more of them, the less waste we might have.
The spiritual change has been as important as the 20+ lbs and 12+ lbs we have lost together, and is now a permanent habit we've grown attached to. Love and compassion does help.
posted by yoga at 5:37 AM on May 3, 2017 [2 favorites]
The fat virus study on AD-36 has been posted at least 3 times here on the Blue, and here's the actual study, Pharm.
As someone who has hypothyroidism, this topic is always hard. Working out 2-3 hours per day or vomiting 20 times per day kept my weight normal. Both are as likely to kill me as being 15 lbs overweight.
That said, a newish Danish study says that a BMI of 27 has the lowest mortality rate, which was previously 24 in the 1970s when the original study made a BMI of 24 the global standard for "normal" weight and health.
Alternate link for those who don't want to create a MedPage Today account.
posted by Unicorn on the cob at 6:00 AM on May 3, 2017 [6 favorites]
As someone who has hypothyroidism, this topic is always hard. Working out 2-3 hours per day or vomiting 20 times per day kept my weight normal. Both are as likely to kill me as being 15 lbs overweight.
That said, a newish Danish study says that a BMI of 27 has the lowest mortality rate, which was previously 24 in the 1970s when the original study made a BMI of 24 the global standard for "normal" weight and health.
Alternate link for those who don't want to create a MedPage Today account.
posted by Unicorn on the cob at 6:00 AM on May 3, 2017 [6 favorites]
I mentioned this story before.
The psychiatrist I was seeing after leaving my abusive marriage left the clinic I went to and I was assigned a new doctor. Before each visit, they weigh us and check our blood pressure using a machine like those you see in Walmart by the pharmacy. I walked into the room and before I had even sat down fully, I was told, "Your blood pressure is high and you're obese. Your anxiety and insomnia is probably from sleep apnea caused by obesity. I want you to see your doctor about your weight before you come back here."
Apparently my years of emotional and verbal abuse, history of sexual abuse, and my marital rape were totally not to blame for my anxiety, depression, and insomnia. I was just fat all along!
Needless to say, I didn't go back to that clinic.
posted by 80 Cats in a Dog Suit at 7:09 AM on May 3, 2017 [12 favorites]
The psychiatrist I was seeing after leaving my abusive marriage left the clinic I went to and I was assigned a new doctor. Before each visit, they weigh us and check our blood pressure using a machine like those you see in Walmart by the pharmacy. I walked into the room and before I had even sat down fully, I was told, "Your blood pressure is high and you're obese. Your anxiety and insomnia is probably from sleep apnea caused by obesity. I want you to see your doctor about your weight before you come back here."
Apparently my years of emotional and verbal abuse, history of sexual abuse, and my marital rape were totally not to blame for my anxiety, depression, and insomnia. I was just fat all along!
Needless to say, I didn't go back to that clinic.
posted by 80 Cats in a Dog Suit at 7:09 AM on May 3, 2017 [12 favorites]
Man, I would be thrilled to have a fat doctor.
I had to go to the high risk obstetrician because I had an excess of amniotic fluid and a large fetus (I'd been tested by my regular OB for gestational diabetes in three different ways so we knew that wasn't the issue). The high risk obstetrician was shaped like me! I was so excited! She was helpful and told me to eat vegetables in a way that was very non-judgemental and when she came into the room I just felt SO RELIEVED to be talking to a medical professional of my general shape and size. It made a stressful situation feel much easier!
posted by Mrs. Pterodactyl at 7:11 AM on May 3, 2017 [13 favorites]
I had to go to the high risk obstetrician because I had an excess of amniotic fluid and a large fetus (I'd been tested by my regular OB for gestational diabetes in three different ways so we knew that wasn't the issue). The high risk obstetrician was shaped like me! I was so excited! She was helpful and told me to eat vegetables in a way that was very non-judgemental and when she came into the room I just felt SO RELIEVED to be talking to a medical professional of my general shape and size. It made a stressful situation feel much easier!
posted by Mrs. Pterodactyl at 7:11 AM on May 3, 2017 [13 favorites]
Mrs. Pterodactyl: Yes! My primary doctor is my general shape and size, and suddenly I don't have nearly as much anxiety about going to the doctor as I'd had previously.
posted by XtinaS at 8:10 AM on May 3, 2017 [4 favorites]
posted by XtinaS at 8:10 AM on May 3, 2017 [4 favorites]
I've struggled with weight all my life, so I've heard it all, multiple times, especially from medical professionals who one would think should really know better. It was still super shocking when I recently heard the victim blamey "you're fat because you're ignorant, uneducated, undisciplined and lazy" assumption from trained therapists and members of the clergy. It reminded me a lot of President Obama's quote about the empathy deficit being a more pressing problem than the federal deficit.
posted by jazzbaby at 8:18 AM on May 3, 2017 [3 favorites]
posted by jazzbaby at 8:18 AM on May 3, 2017 [3 favorites]
So I followed up the AD36 study. As ever, things are a little less clearcut than the original quote upthread. “hey did you know that 30% of obese people are obese because they’ve been infected by a virus!” is an oversimplification unfortunately.
Yes, infection with AD36 is strongly correlated with increased obesity (odds ratio between 1.6 and 2.0 depending on age group) & pathways for these effect to occur have been reasonably well established - it’s known that the virus infects the stem cells that generate adipose cells in the body & stimulates their activity, as well as affecting both fat & glucose metabolism elsewhere in the body. At the same time population studies also find that a sizeable proportion of their non-obese control group has also been infected with the virus, so infection by itself is not strongly predictive at the individual level.
Adenovirus 36 and Obesity: An Overview is the most recent review paper I could find. It quotes a couple of meta-analyses if people want to go look them up. Also, this meta-analysis contains a nice forest plot.
I look forward to a putative future CRISPR treatment that eliminates AD36 - it sounds like it might help a lot of people.
posted by pharm at 9:22 AM on May 3, 2017 [2 favorites]
Yes, infection with AD36 is strongly correlated with increased obesity (odds ratio between 1.6 and 2.0 depending on age group) & pathways for these effect to occur have been reasonably well established - it’s known that the virus infects the stem cells that generate adipose cells in the body & stimulates their activity, as well as affecting both fat & glucose metabolism elsewhere in the body. At the same time population studies also find that a sizeable proportion of their non-obese control group has also been infected with the virus, so infection by itself is not strongly predictive at the individual level.
Adenovirus 36 and Obesity: An Overview is the most recent review paper I could find. It quotes a couple of meta-analyses if people want to go look them up. Also, this meta-analysis contains a nice forest plot.
I look forward to a putative future CRISPR treatment that eliminates AD36 - it sounds like it might help a lot of people.
posted by pharm at 9:22 AM on May 3, 2017 [2 favorites]
> Just because bad outcomes are not an inevitable consequence of obesity doesn’t mean that the consequences for society as a whole of the obesity epidemic are not very serious
U.S. emergency rooms treated 123,355 high-heel-related injuries between 2002 and 2012, but do doctors lecture women on their footwear every time they go in with sinus infections? (I have no idea, maybe they do, I always wear sneakers.)
posted by The corpse in the library at 12:02 PM on May 3, 2017 [11 favorites]
U.S. emergency rooms treated 123,355 high-heel-related injuries between 2002 and 2012, but do doctors lecture women on their footwear every time they go in with sinus infections? (I have no idea, maybe they do, I always wear sneakers.)
posted by The corpse in the library at 12:02 PM on May 3, 2017 [11 favorites]
Yeah, until people come running into insomnia threads, AskMes about incredibly stressful work/personal situations, and work exploitation articles on the blue to start shaming about the "consequences for society" (which seem to be that it costs money for people to be fat?), I'm not buying this shining altruism as an excuse.
posted by Lyn Never at 12:50 PM on May 3, 2017 [7 favorites]
posted by Lyn Never at 12:50 PM on May 3, 2017 [7 favorites]
pharm, I don't know how to say it politely, so I won't: don't spout off a remark like "obesity is a primary cause (alongside genetics & age) of Type II diabetes" without doing some research.
And I'll bold it here so it's real obvious: correlation is not causation.
If you're so concerned about healthcare costs, maybe you can go into a thread about running because running is basically guaranteed to cause injuries at some point.
Professional athletes' healthcare costs are are sky high, why aren't people sure to bring that up every time we discuss sports?
Being tall is a marker for an earlier death compared to being short, do you make sure to let every tall person you know that you don't appreciate their extra healthcare costs due to their lifestyle choices of being well-nourished enough to grow tall?
If you want to scapegoat fat people for healthcare costs because it's easier than considering the complexity of fatness and health, go ahead, but don't be disingenuous and pretend it's about diabetes and not anything other than hatred of fat bodies.
posted by the thorn bushes have roses at 1:24 PM on May 3, 2017 [15 favorites]
And I'll bold it here so it's real obvious: correlation is not causation.
If you're so concerned about healthcare costs, maybe you can go into a thread about running because running is basically guaranteed to cause injuries at some point.
Professional athletes' healthcare costs are are sky high, why aren't people sure to bring that up every time we discuss sports?
Being tall is a marker for an earlier death compared to being short, do you make sure to let every tall person you know that you don't appreciate their extra healthcare costs due to their lifestyle choices of being well-nourished enough to grow tall?
If you want to scapegoat fat people for healthcare costs because it's easier than considering the complexity of fatness and health, go ahead, but don't be disingenuous and pretend it's about diabetes and not anything other than hatred of fat bodies.
posted by the thorn bushes have roses at 1:24 PM on May 3, 2017 [15 favorites]
it isn't fair or productive to say that trying to bring some clarity to the costs of obesity is the same as a hatred of fat people. There are particular frustrations and impossibilities that arise when caring for an obese person that simply do not exist in almost any other type of situation, and these are inescapable and real and would take many hours to detail. But at their core there is a simple consistent truth - many of the health problems that show up in our office, because they are tied to body weight, become insoluble because the fix - weight loss - is as yet an unknown as far as how to accomplish it. A smoker can stop smoking more successfully than an obese person can lose weight. A runner can alter their activity or get PT. Etc Etc Etc.
The author of this piece will see this soon enough, and I expect will be much more circumspect and empathetic in how she treats her patients. At a minimum, when I see a problem that I know is clearly tied to a person's weight (and to be fair this is really not very often, which is a point many are making), I acknowledge it at the same time I state that I know weight loss may not be within reach. I know of no more honest way to practice medicine.
Also remember that the government and private insurers now mandate that every pt with a BMI over 20 gets counselled about their weight. It's fucking ridiculous.
posted by docpops at 1:37 PM on May 3, 2017 [1 favorite]
The author of this piece will see this soon enough, and I expect will be much more circumspect and empathetic in how she treats her patients. At a minimum, when I see a problem that I know is clearly tied to a person's weight (and to be fair this is really not very often, which is a point many are making), I acknowledge it at the same time I state that I know weight loss may not be within reach. I know of no more honest way to practice medicine.
Also remember that the government and private insurers now mandate that every pt with a BMI over 20 gets counselled about their weight. It's fucking ridiculous.
posted by docpops at 1:37 PM on May 3, 2017 [1 favorite]
Stating that obesity causes Type II diabetes as though it is a fact, when it is not, is not bringing clarity to a discussion about healthcare costs. It's doing the direct opposite and it's pretty clear that reducing fat people to healthcare burdens has nothing to do with health and everything to do with hatred of fat bodies.
Is being fat a risk factor for Type II diabetes? Yes, but we only know that there's a correlation and we also don't understand why some people are fat and how to make them not fat, and 'risk factor' also doesn't cover any of the complexities of income, mental health, healthcare access — not to mention racial and gender disparities therein— that may tie into the link between weight and Type II diabetes. As I said, it's complicated, and whenever people want to make a reductive statement about fat = unhealthy = burden on society we must speak up against it, especially those in the healthcare profession.
posted by the thorn bushes have roses at 2:02 PM on May 3, 2017 [8 favorites]
Is being fat a risk factor for Type II diabetes? Yes, but we only know that there's a correlation and we also don't understand why some people are fat and how to make them not fat, and 'risk factor' also doesn't cover any of the complexities of income, mental health, healthcare access — not to mention racial and gender disparities therein— that may tie into the link between weight and Type II diabetes. As I said, it's complicated, and whenever people want to make a reductive statement about fat = unhealthy = burden on society we must speak up against it, especially those in the healthcare profession.
posted by the thorn bushes have roses at 2:02 PM on May 3, 2017 [8 favorites]
Also, you missed my point by a mile about lecturing athletes or tall people about their health. It wasn't that we should lecture them, it's that people should not be judged as worthy by whether they contribute to healthcare costs. If anyone here wants to do it to fat people, I want to ask them to think about why they don't lecture tall people or professional athletes or marathon runners. Again, it's about our collective disgust for fat bodies and not about healthcare costs or health.
Yesterday I saw a doctor about issues I've had with sleep my entire life that I've avoided taking care of because of many terrible fat shaming experiences in my past. She mentioned that weight loss can help with sleep problems like sleep apnea (which I have not been diagnosed with yet but do assume is causing my issues), the way she did it was extremely non judgmental and it was great. She was stating a fact: people who lose weight often find their sleep apnea is improved, but it's not a guarantee and losing weight is not something that works for everyone for a variety of reasons, including that it's hard to do the things that cause weight loss when you're not getting quality sleep. She was not implying or outright stating "so you did this to yourself, fat lady, and you're lucky I'm even bothering to help you" which is what 99.9% of healthcare professionals who have ever spoken to me about weight have done.
She also said that everyone's anatomy is different and that weight isn't always the cause of sleep apnea, and even if it is, poor sleep health causes all sorts of issues and it might be that includes causing weight gain. Basically, she did what I wish every single healthcare professional would do when talking about weight — avoid weight loss as a panacea and acknowledge what we do and don't know about fatness and health.
posted by the thorn bushes have roses at 2:13 PM on May 3, 2017 [7 favorites]
Yesterday I saw a doctor about issues I've had with sleep my entire life that I've avoided taking care of because of many terrible fat shaming experiences in my past. She mentioned that weight loss can help with sleep problems like sleep apnea (which I have not been diagnosed with yet but do assume is causing my issues), the way she did it was extremely non judgmental and it was great. She was stating a fact: people who lose weight often find their sleep apnea is improved, but it's not a guarantee and losing weight is not something that works for everyone for a variety of reasons, including that it's hard to do the things that cause weight loss when you're not getting quality sleep. She was not implying or outright stating "so you did this to yourself, fat lady, and you're lucky I'm even bothering to help you" which is what 99.9% of healthcare professionals who have ever spoken to me about weight have done.
She also said that everyone's anatomy is different and that weight isn't always the cause of sleep apnea, and even if it is, poor sleep health causes all sorts of issues and it might be that includes causing weight gain. Basically, she did what I wish every single healthcare professional would do when talking about weight — avoid weight loss as a panacea and acknowledge what we do and don't know about fatness and health.
posted by the thorn bushes have roses at 2:13 PM on May 3, 2017 [7 favorites]
and did you know that depressed people will never develop any issues unrelated to their depression, aside (possibly) from broken bones?)
I'm totally convinced that in a ton of cases where there is comorbidity of depression and fatigue or depression and physical pain, the cause of the fatigue/ pain is the primary problem and depression is a very predictable effect.
I think in the 1800s people used to acknowledge depression was a very common symptom or aftereffect of many illnesses and even now you'll sometimes get "malaise" listed as a symptom of some virus.
But I think that in the same way doctors see fatness and stop looking for anything else, some doctors hear anxiety or depression and stop hearing anything else.
posted by mrmurbles at 6:19 PM on May 3, 2017 [7 favorites]
I'm totally convinced that in a ton of cases where there is comorbidity of depression and fatigue or depression and physical pain, the cause of the fatigue/ pain is the primary problem and depression is a very predictable effect.
I think in the 1800s people used to acknowledge depression was a very common symptom or aftereffect of many illnesses and even now you'll sometimes get "malaise" listed as a symptom of some virus.
But I think that in the same way doctors see fatness and stop looking for anything else, some doctors hear anxiety or depression and stop hearing anything else.
posted by mrmurbles at 6:19 PM on May 3, 2017 [7 favorites]
The corpse in the library / the thorn bushes have roses: If treating diabetes was on the same level as treating injuries from slips and falls, or professional sports, or running we wouldn’t even be having this conversation: These things are all trivialities compared to diabetes. There are almost 4 million people in the UK with the disease & nearly 30 million in the US. Treatment of diabetes (which means overwhelmingly treatment of type ii diabetes) is taking 10% of the entire NHS budget in the UK, and is only projected to grow in the forthcoming years. US healthcare costs must be horrendous. (One estimate I found suggested around $180 billion in direct healthcare costs alone in 2012) The growth in diabetes is a public health crisis that’s only predicted to get worse. Since US healthcare spending is so skewed towards the rich (90% of healthcare spending goes on the top 30% of the population) this means that the bottom 70% are simply left to deal with their disease as best they can.
Naturally these costs horrify healthcare administrators. But they should horrify all of us because of the tide of human misery they represent. Diabetes is the single largest cause of blindness, amputations, stroke and kidney failure in the UK. None of these are likely outcomes, & if your diabetes is well managed you can reduce the likelihood, but they are all devastating if you are unfortunate enough to have them happen to you. Effectively managing diabetes requires active monitoring - you can imagine what this means for those without regular access to healthcare in the US.
the thorn bushes have roses: That page you link to is misleading, because it doesn’t want to give people the impression that they are immune from the risk of developing diabetes if they aren’t obese. Yes there are other risk factors for developing diabetes (We know that Hispanic people in the US are more likely to develop diabetes then other ethic groups for instance) & I agree: correlation is absolutely not always causation. But at the same time obesity is the most significant risk factor at the population level by a wide margin, whilst the likelihood of developing diabetes increases the more overweight a person is (this looks like a decent study, but I’m open to any objections), which is indicative of a causal relation.
This is why there is such pressure on GPs to try and turn this around at the patient level: the combination of the huge numbers of people affected & huge cost of treating them & awful outcomes for many with the reality that the only thing we know to be correlated with diabetes incidence that we have any hope of changing is how fat people are. It’s crass and insensitive and unfair, but the people who are looking at the long term outcomes (both for individuals and for the healthcare system as a whole) are horrified and anything that might help probably seems like it’s worth doing from their POV, no matter how ineffective. Unfortunately, this campaign against obesity runs headfirst into the reality that weight loss appears to be very hard for most people & we just don’t have an effective intervention that enables people to lose weight & stay at their new target weight - nothing that has been tried seems to work in the medium to long term. Yet the people within the healthcare system feel that they have to do something & so the end result is the patients at the bottom being harried for being fat.
(NB. If you read The Hungry Brain by Stephen Guyenet you’ll see that he puts sleep quality as an important factor in fat regulation in the body. The fat -> sleep apnea -> poor quality sleep -> get even fatter is a particularly nasty vicious cycle to get trapped in. Plus fixing the sleep apnea sounds like it would make a huge QoL difference regardless. Good luck!)
posted by pharm at 2:34 AM on May 4, 2017 [2 favorites]
Naturally these costs horrify healthcare administrators. But they should horrify all of us because of the tide of human misery they represent. Diabetes is the single largest cause of blindness, amputations, stroke and kidney failure in the UK. None of these are likely outcomes, & if your diabetes is well managed you can reduce the likelihood, but they are all devastating if you are unfortunate enough to have them happen to you. Effectively managing diabetes requires active monitoring - you can imagine what this means for those without regular access to healthcare in the US.
the thorn bushes have roses: That page you link to is misleading, because it doesn’t want to give people the impression that they are immune from the risk of developing diabetes if they aren’t obese. Yes there are other risk factors for developing diabetes (We know that Hispanic people in the US are more likely to develop diabetes then other ethic groups for instance) & I agree: correlation is absolutely not always causation. But at the same time obesity is the most significant risk factor at the population level by a wide margin, whilst the likelihood of developing diabetes increases the more overweight a person is (this looks like a decent study, but I’m open to any objections), which is indicative of a causal relation.
This is why there is such pressure on GPs to try and turn this around at the patient level: the combination of the huge numbers of people affected & huge cost of treating them & awful outcomes for many with the reality that the only thing we know to be correlated with diabetes incidence that we have any hope of changing is how fat people are. It’s crass and insensitive and unfair, but the people who are looking at the long term outcomes (both for individuals and for the healthcare system as a whole) are horrified and anything that might help probably seems like it’s worth doing from their POV, no matter how ineffective. Unfortunately, this campaign against obesity runs headfirst into the reality that weight loss appears to be very hard for most people & we just don’t have an effective intervention that enables people to lose weight & stay at their new target weight - nothing that has been tried seems to work in the medium to long term. Yet the people within the healthcare system feel that they have to do something & so the end result is the patients at the bottom being harried for being fat.
(NB. If you read The Hungry Brain by Stephen Guyenet you’ll see that he puts sleep quality as an important factor in fat regulation in the body. The fat -> sleep apnea -> poor quality sleep -> get even fatter is a particularly nasty vicious cycle to get trapped in. Plus fixing the sleep apnea sounds like it would make a huge QoL difference regardless. Good luck!)
posted by pharm at 2:34 AM on May 4, 2017 [2 favorites]
NB. I’m not saying that GPs are right to be going round haranguing their overweight patients, but that the pressures on them to "do something" are significant. It’s the "We must do something, this is something, therefore we must do it" syllogism in action.
Also, physical activity helps (in all sorts of ways, not just against diabetes) even if it doesn’t lead to weight loss, so holding up weight as some kind of magic totem of health is wildly unhelpful, if not actively injurious. (My understanding is that physical activity mitigates a lot of the risk of being overweight, yet it seems to be that the way things are being communicated to patients is going to inevitably lead to them giving up altogether: "my doctor says being fat will lead to be getting diabetes, I can’t stop being fat even though I’ve tried, so I may as well not bother" is an obvious mental path to follow.)
We shouldn’t be taking measures used at the population level and applying them to individual patients, but the temptation to do so is unfortunately very high :(
posted by pharm at 2:50 AM on May 4, 2017
Also, physical activity helps (in all sorts of ways, not just against diabetes) even if it doesn’t lead to weight loss, so holding up weight as some kind of magic totem of health is wildly unhelpful, if not actively injurious. (My understanding is that physical activity mitigates a lot of the risk of being overweight, yet it seems to be that the way things are being communicated to patients is going to inevitably lead to them giving up altogether: "my doctor says being fat will lead to be getting diabetes, I can’t stop being fat even though I’ve tried, so I may as well not bother" is an obvious mental path to follow.)
We shouldn’t be taking measures used at the population level and applying them to individual patients, but the temptation to do so is unfortunately very high :(
posted by pharm at 2:50 AM on May 4, 2017
Relevant is this comic by someone struggling with weight and social issues. :(
posted by XtinaS at 6:52 AM on May 4, 2017 [5 favorites]
posted by XtinaS at 6:52 AM on May 4, 2017 [5 favorites]
How the hell, as a doctor, do you help with this without being yet another example of the unhelpful doctors in the essay?
Here's how you help with it: you deal with the problem at hand. You TREAT the blood pressure and sore knee and asthma - instead of saying "you're a fatty and you have [X], come back when you're thin."
Then one day they might come back for a pap smear, and you can do that without mentioning their weight while they're up on the table.
Then one day they might come in because of anxiety or depression, and you can help them with THAT without mentioning their weight.
And then one day - one day - they might trust you enough to ask you how they can lose some weight. So you'd better get ready for that day. You'd better have more to say than 'eat less and exercise more'.
posted by superfish at 3:48 AM on May 5, 2017 [4 favorites]
Here's how you help with it: you deal with the problem at hand. You TREAT the blood pressure and sore knee and asthma - instead of saying "you're a fatty and you have [X], come back when you're thin."
Then one day they might come back for a pap smear, and you can do that without mentioning their weight while they're up on the table.
Then one day they might come in because of anxiety or depression, and you can help them with THAT without mentioning their weight.
And then one day - one day - they might trust you enough to ask you how they can lose some weight. So you'd better get ready for that day. You'd better have more to say than 'eat less and exercise more'.
posted by superfish at 3:48 AM on May 5, 2017 [4 favorites]
Also remember that the government and private insurers now mandate that every pt with a BMI over 20 gets counselled about their weight.
This is a typo, right? I am 110 lbs with a 28" waist and my BMI is 21.5. How much am I supposed to weigh??
posted by AFABulous at 9:28 AM on May 5, 2017 [1 favorite]
This is a typo, right? I am 110 lbs with a 28" waist and my BMI is 21.5. How much am I supposed to weigh??
posted by AFABulous at 9:28 AM on May 5, 2017 [1 favorite]
Not a medical professional, but someone on Facebook just recommended that I get more exercise (which coming from that person means 'lose weight') in order to cure various ailments I had complained about, including gingivitis and having my hand smashed in a car door.
posted by jacquilynne at 10:50 AM on May 5, 2017 [5 favorites]
posted by jacquilynne at 10:50 AM on May 5, 2017 [5 favorites]
What I "love" about getting older: I eat and move the same as I did pre-pregnancy. I weigh ~50lb more now than I did then (3 years ago). Where's your GIGO now?
Rhetorical.
posted by XtinaS at 4:01 PM on May 5, 2017
Rhetorical.
posted by XtinaS at 4:01 PM on May 5, 2017
Exactly where it always was: What is this, some kind of reverse dieting myth game of gotcha?
The fact that CI=CO is completely irrelevant & totally unhelpful in every possible way as a dietary stick to beat people with (for all the reasons outlined here & elsewhere) doesn’t mean that it’s false.
posted by pharm at 3:31 AM on May 6, 2017
The fact that CI=CO is completely irrelevant & totally unhelpful in every possible way as a dietary stick to beat people with (for all the reasons outlined here & elsewhere) doesn’t mean that it’s false.
posted by pharm at 3:31 AM on May 6, 2017
My fat doctor breezed past all my other numbers (Cholesterol: Under control because I'm compliant with my medication, and even improving a bit because I've been exercising more. Blood pressure: under control because I'm compliant with my medication. Thyroid Stimulating Hormone: Under control because I'm compliant with my medication) and said, "I'll see you in 12 months. Let's hope you do a little better between now and then." Because my weight was six pounds higher than my last weigh-in.
posted by BrashTech at 8:11 AM on May 6, 2017 [1 favorite]
posted by BrashTech at 8:11 AM on May 6, 2017 [1 favorite]
The fact that CI=CO is completely irrelevant & totally unhelpful in every possible way as a dietary stick to beat people with (for all the reasons outlined here & elsewhere) doesn’t mean that it’s false.
Calorie in equal calories out is a lie. A person who once weighed 240lbs and now weighs 140lbs needs to eat less to maintain it than someone who always weighed 140lbs. If ci=co was actually true, that wouldn't be the case.
posted by Deoridhe at 2:51 PM on May 6, 2017 [3 favorites]
Calorie in equal calories out is a lie. A person who once weighed 240lbs and now weighs 140lbs needs to eat less to maintain it than someone who always weighed 140lbs. If ci=co was actually true, that wouldn't be the case.
posted by Deoridhe at 2:51 PM on May 6, 2017 [3 favorites]
You’re going to have to unpack that one for me, because from where I’m sitting it makes no sense whatsoever.
posted by pharm at 6:38 AM on May 7, 2017
posted by pharm at 6:38 AM on May 7, 2017
Calories in = calories out assumes that either nothing happens to the calories in the meantime, or the same thing happens to them every time in a given person. Neither of those are true. (This is also assuming we actually know what a calorie is, which is a whole other ball of inaccurate-science wax.)
posted by restless_nomad at 7:11 AM on May 7, 2017
posted by restless_nomad at 7:11 AM on May 7, 2017
And I said those things where exactly? If your energy expenditure drops (because you’ve lost weight in Deoreidhe’s example) then the CO portion drops & you’d need to drop CI to maintain the new weight. I’m completely failing to see the contradiction here.
I stand by the statement: the core element of CI=CO is both true & irrelevant simultaneously.
Again, the problem with CI=CO is that using it as a stick to beat overweight people with completely ignores that both sides of the equality are impossible to measure with any kind of accuracy & simultaneously subject to all sorts of feedback loops through which both can be radically altered without the individual even being consciously aware. (A classic example is the observation that many anorexic people twitch and fidget *all* the time - I’ve seen one estimate that such activity burns up to 700 calories over the base TDEE. The difference between someone who fidgets and a relaxed is potentially large, yet both might claim to be sedentary people!) That’s on top of the obvious fact that different people absorb different amount of nutrition from the same food & therefore the CI you care about is the CI absorbed through the gut & not what goes into the mouth.
posted by pharm at 7:44 AM on May 7, 2017
I stand by the statement: the core element of CI=CO is both true & irrelevant simultaneously.
Again, the problem with CI=CO is that using it as a stick to beat overweight people with completely ignores that both sides of the equality are impossible to measure with any kind of accuracy & simultaneously subject to all sorts of feedback loops through which both can be radically altered without the individual even being consciously aware. (A classic example is the observation that many anorexic people twitch and fidget *all* the time - I’ve seen one estimate that such activity burns up to 700 calories over the base TDEE. The difference between someone who fidgets and a relaxed is potentially large, yet both might claim to be sedentary people!) That’s on top of the obvious fact that different people absorb different amount of nutrition from the same food & therefore the CI you care about is the CI absorbed through the gut & not what goes into the mouth.
posted by pharm at 7:44 AM on May 7, 2017
What I mean is, it's functionally false, because what little data we even have about CO is both highly individual and highly suspect, and CI is also a confusing and inaccurate number at best. It's pointless to trot out even as a truism.
posted by restless_nomad at 7:53 AM on May 7, 2017
posted by restless_nomad at 7:53 AM on May 7, 2017
You seem to know all the ways that CI=CO is complete bullshit, but I promise that most of the meatheads on the internet and far too many doctors in their offices lecturing fat women about it think that the human body works exactly the same as an internal combustion engine. Since you know that CI=CO is complete bullshit, why bother arguing in support of it, especially when doing so aligns you with assholes who don't know that it is bullshit?
(or you know what restless_nomad said)
posted by hydropsyche at 7:54 AM on May 7, 2017
(or you know what restless_nomad said)
posted by hydropsyche at 7:54 AM on May 7, 2017
You’re going to have to unpack that one for me, because from where I’m sitting it makes no sense whatsoever.
posted
You take ten people whose adult weight has always been about 140. Find a diet that on average maintains their weight.
Feed that same diet to ten people weighing 140 pounds who spent an extended period at 240 pounds. Most of those people will gain weight quickly, even though it's the same diet that only maintained the weight of the first 140 pound group, and even though both groups weigh 140 pounds.
You can even insist that both groups have similar exercise levels and the ex-heavy group will put on fat on a diet that only maintains the first group.
posted by ROU_Xenophobe at 7:56 AM on May 7, 2017 [2 favorites]
posted
You take ten people whose adult weight has always been about 140. Find a diet that on average maintains their weight.
Feed that same diet to ten people weighing 140 pounds who spent an extended period at 240 pounds. Most of those people will gain weight quickly, even though it's the same diet that only maintained the weight of the first 140 pound group, and even though both groups weigh 140 pounds.
You can even insist that both groups have similar exercise levels and the ex-heavy group will put on fat on a diet that only maintains the first group.
posted by ROU_Xenophobe at 7:56 AM on May 7, 2017 [2 favorites]
You’re going to have to unpack that one for me, because from where I’m sitting it makes no sense whatsoever.
Yes, it makes no sense. Based on the ci=co nonsense you're defending, it shouldn't work that way. However, it does. People who lose weight down to 140 have to eat less to maintain it than people who have always been 140. Forever.
And if they slip they will gain back the weight they lost plus a little more. It's called the yo-yo effect and it's documented in something like 90% of weight loss cases five years out from the initial weight loss.
Turns out human bodies aren't simple math.
posted by Deoridhe at 1:06 PM on May 7, 2017 [4 favorites]
Yes, it makes no sense. Based on the ci=co nonsense you're defending, it shouldn't work that way. However, it does. People who lose weight down to 140 have to eat less to maintain it than people who have always been 140. Forever.
And if they slip they will gain back the weight they lost plus a little more. It's called the yo-yo effect and it's documented in something like 90% of weight loss cases five years out from the initial weight loss.
Turns out human bodies aren't simple math.
posted by Deoridhe at 1:06 PM on May 7, 2017 [4 favorites]
I honestly think you're having a straw man argument with someone else. Do you think I don't know that people with the same weight but with different histories can have completely different metabolic rates? It's as if you're ignoring every word I write & substituting something else in its place. Feel free to keep on having arguments with your straw opponent: I'm done.
posted by pharm at 3:17 PM on May 7, 2017
posted by pharm at 3:17 PM on May 7, 2017
I'm late to the party Pharm, but I think a lot of people are talking about the results from this previously on metafilter. TLDR: people who successfully lost a large amount of weight must consume fewer calories to maintain that weight than someone always at that weight. Bonus, you have more hunger hormones.
So, a doctor hoping to help someone lose weight shouldn't be saying "you just need to eat less." They should say, "You need to eat a lot less. You'll need to eat a lot less than people you know at your target weight even when/if you hit your goal weight. Oh, and your body is going to be telling you that your more hungry than those other people. Oh, this continued state of feeling more hungry and needing to eat less might be forever. Have fun!"
Things I'd be curious about similar to the article, is if perhaps a slower weight loss (perhaps alternating 3-4 months of loss, with maintaining for 3-4 months) of a more healthy 1lb per week might have different results. Perhaps it's the large weight loss over a non-trivial time period which flips something in one's epigentics.
I'd also be curious if someone who's undergone the successful rapid weight loss and somehow maintained that for 2, 4, 8, 16 years might eventually have their base metabolism approach that of someone who's adult weight was always that goal weight. I.E. maybe it's not forever, but "only" a decade of relatively under-eating while feeling over-hungry.
At anyrate, I think people are trying to say that a doctor who's hoping to help but doesn't know any of this ... well, I did say that the doctor is hoping to help, and not actually helping, right ?
posted by nobeagle at 11:26 AM on May 9, 2017 [1 favorite]
So, a doctor hoping to help someone lose weight shouldn't be saying "you just need to eat less." They should say, "You need to eat a lot less. You'll need to eat a lot less than people you know at your target weight even when/if you hit your goal weight. Oh, and your body is going to be telling you that your more hungry than those other people. Oh, this continued state of feeling more hungry and needing to eat less might be forever. Have fun!"
Things I'd be curious about similar to the article, is if perhaps a slower weight loss (perhaps alternating 3-4 months of loss, with maintaining for 3-4 months) of a more healthy 1lb per week might have different results. Perhaps it's the large weight loss over a non-trivial time period which flips something in one's epigentics.
I'd also be curious if someone who's undergone the successful rapid weight loss and somehow maintained that for 2, 4, 8, 16 years might eventually have their base metabolism approach that of someone who's adult weight was always that goal weight. I.E. maybe it's not forever, but "only" a decade of relatively under-eating while feeling over-hungry.
At anyrate, I think people are trying to say that a doctor who's hoping to help but doesn't know any of this ... well, I did say that the doctor is hoping to help, and not actually helping, right ?
posted by nobeagle at 11:26 AM on May 9, 2017 [1 favorite]
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Damn, I need a hug and that's just from thinking about it without ever having to have it be my life.
posted by drewbage1847 at 2:29 PM on May 2, 2017 [11 favorites]