Thank you so much. We're very fortunate to have this technology and so many talented doctors who can help.


I meant to add earlier that he used to be obese when he was younger until a doctor told him that he needed to lose weight. He honestly didn't know that he was obese until the doctor told him. He knew that he was big, but he did not realize he was obese and that his health was at risk. He lost the weight and became an athlete and SCUBA diver.

I have a point of contention with the "be blunt" approach. As someone who was greeted by their doctor with "Someone's gotten fat this year"...being blunt can be detrimental. It made me not want to go back to see that doctor because every time I did, she harped on my weight that was slow to come off, and never commented on how well my Hb1Ac was or my BP or my other readings, it was always weight weight weight weight. She never offered help on how to do it, why it was there, why i had a hard time losing even when on a 1200 calorie diet (yes, her idea). It's that "once bitten twice shy" thing. I know that all she's going to do is yell about my weight and harp on it, so I'm not going to see her, which means the potential for other diseases to go undiagnosed because the doctor is 1) unsupportive 2) unmotivating 3) insensitive to feelings.

just a thought.

I didn't take it as blaming her, but rather pointing out that how he would also be afflicted and its impact on her future.

He did NOT say "you are going to die alone and fat" - he inferred this in some fashion, yes, but the VERY POINT OF TACT is to infer something without saying it explicitly.

He did that.

As a doctor, he should be commenting only from a health standpoint, NOT the social concerns that may come with being over weight, infered or not.

Currently, type 2 diabetes, heart failure and obesity caused by diet is what my main NIH funded research focus is.

I am currently applying for funds from the American Heart Association regarding this issue. And I will also apply for funds from the Ellison Foundation as it relates to aging and diabetes and obesity--because as one gets older, the weight becomes an issue.

There is a problem with bench to bedside research and vice versa. This research is called "Translational Research". I think what this M.D. did wrong was attend a breif session for CME credit on obesity and treating patients. I would say the majority of MD's are smart and well-meaning people, but when you have researchers presenting results with all these biostats to go along with it, I doubt that if you aren't actively DOING research, that you have problems understanding the implications and the outcomes from the research...

Meaning, if I say to MD's to suggest to their patients that our mouse genetic studies show that overproduction of the PAI-1 protein has been correlated to increased inflammatory responses in 75% of samples tested with a P value of 0.001, and how that correlates to the human population, blah, blah, blah the MD's may take that and see what they have in their patient population that they treat... Most of Big Pharma sell their drugs this way...

Even if the MD is also a Ph.D. does not necessarily mean they truly understand the scientific nature of a disease like a PhD, and vice versa--like I cannot go to an MD and tell him or her how to treat a patient. But together, we can work out this patient's issue--more like a patient population's issue... And the way things are, we are going to have to work together--along with DVM's, techs, biostatiscians [sp?], MPH's and other personnel as needed. Especially when we are going from bedside to benchside...

I am currently undergoing a medical issue that I won't go into. I was highly reassured by the MD I was speaking to because he also has a PhD. I could ask him questions about what was going on with me at the molecular level. When MD's do find out I have a PhD in molecular genetics, they start asking me questions and I cannot get them to stop. And don't let my husband who is a veterinarian come with me because we'd be swapping stories left and right. But it does take all of us to work together...

This MD probably is a nice "country doctor" with a small patient population that is trying to make a difference and doing all he can to ensure the best healthcare with the minimum amount of money... However, if I learn anything from my father, who is a dentist and having to spend my whole teenage years in his office working with patients, which made me decide NOT to go into the allied health profession, I think that 1) MD's do not have all the answers; 2) you are your own health advocate and 3) most of the best healthcare that an MD can provide is you trying to enrich your life and your soul--whatever floats your boat to live life...

I've done seent too many of my family members hooked up to things due to their chronic illnesses that made me decide I would NEVER EVER want to live that way... So, I will do whatever it takes to make it happen to be that way. And if I fail--like get cancer or some other lunacy, I will deal with it and strive... MD's love that kind of patient...

I went to NAAFA (National Association to Advance Fat Acceptance)'s website to see if they had taken a stance on this story. It wasn't listed anywhere.

My Dr. is stern, but he's not rude. And when he's to the point to where he sounds stern, I know it's because he cares, not because he's trying to hurt my feelings. I'm willing to bet that for her to sue, this is not the first time that he did not use tact in addressing her. She probably got fed up and decided to show him that just because she is fat - he cannot just talk to her any way he chooses.

When I first saw this thread, a picture of Dr. House (from the Fox TV show) popped into my head. House is funny on TV, but I doubt if I would be able to stand him for too long in real life. Hmmmm... maybe her Dr. is a 'House' fan......

:rolleyes: Just lose the weight. I CANNOT believe people out there are so sensitive.

This reminds me of that one Queens of Comedy joke. I'm so bad with names, I won't even try to remember hers.

Anyway, it was making fun of that (I believe) Jenny Craig commercial where the woman says something like, "I'd been thinking I needed to lose weight. Then, one day, my daughter came to me and she said, 'Mommy, you're fat.' I knew right then that something had to be done. So I picked up the phone and called Jenny...and now I feel GREAT!"

The comedienne then said that if that had been her it would have been very similar. Her version goes something like this, "I'd been thinking I needed to lose weight. Then, one day, my daughter came to me and she said, 'Mommy, you're fat.' I knew right then that something had to be done. So I picked up the phone and knocked that little girl upside the head...and now I feel GREAT!"

I LOVED that one!!!

I found this article today, which addresses this case. It gives us a little more information:

- The speech the doctor gave is what he calls "an obesity lecture for women" that he uses to get the attention of obese female patients.
- He tells them that they are likely to outlive their (obese) spouses and then find themselves alone because men don't go for obese women.
- He tells them about some of the health risks of obesity.
- He'd seen this patient "five or six times".
- He had talked to her about her weight before, but she kept gaining. She has also developed diabetes, gastroesophageal reflux, and chest pains.
- He's given this speech to other obese female patients, including one (mentioned in the OP) who is defending his actions.

In this particular case, the doctor did the right thing by giving her a good kick in the @$$. She's obese and now diabetic. More than likely, she is in denial that she even has a problem. The fact that she complained to the state indicates this - she didn't like the message, so she's out to get the messenger.

I would have much more of a problem with the doctor's "obesity lecture" if he used it routinely with women (or men) to whom he had not spoken before about their weight. I'm not obese - but if I were, and I walked in as a new patient, and the first thing I heard from that doctor was that lecture, it would also be the last thing I heard from him. I'd also have a problem if the weight gain were due to extenuating circumstances such as pregnancy - if I'd just had a baby, the last thing I'd need to hear is "You are obese, you need to get on a program." (Although, presumably, the doctor would know about the pregnancy.)

But in this case, the doctor was facing a woman who steadfastly ignored his advice to lose weight, and indeed kept gaining weight. She needed the wake-up call.

:rolleyes: I CANNOT believe people out there are so sensitive about being non-white. </sarcasm & example>

Just because you don't see how overweight people can be sensitive about stuff, doesn't mean that they aren't or can't. People can say the same thing about you with something YOU'RE sensitive with. And how many times does someone have to post that there are people out there who actually CANNOT lose the weight without expensive surgery? (I'm not saying this pertaining to this story) Get off your high horse.


ps. my first comment is not to be used as a racial comment, just an example.

No offense taken here and I understand your point.

However, I'm a big girl myself!! I started out at 350+ and have lost a good 100 pounds, but I'm by no means out of the red. I recognize that I'm fat - yes, fat.

I'm ok with it though because 1) I have the confidence to make it work and 2) I recognize that I need to lose weight (which I'm doing) for my health.

This person is probably both self-conscious and in denial. I'mma need for her to take a good look in the mirror, LOVE herself and get her body in order.

Who's talking?? Let me know and I'll take care of it! There are certain people (some of whom may be reading this right now - you know who you are!) who think I'm luscious. But really they love me for my personality, intelligence, openness, acceptance and, most important, the work of God in my life. The fact that my tummy feels like velvet is just a perk!

I would tell you the same thing I'd tell the subject of this thread - LOVE yourself! Either people are not talking smack about me or I'm just not hearing it. Whichever way it is, they can't change the fact that God loves me so much that I could never fully grasp it. So, who am I not to love His creation?

PM_Mama - On a very serious note, I have made lifestyle changes that have brought me to this point. I can honestly say that the most important thing I've done for my health was to see a naturopathic doctor (not a nutritionist) who monitors my health and is helping to bring my body back to equilibrium. Weight loss is a side effect of working toward optimum health. You kinda don't even have to try to lose weight if you just let your body do what it knows to do already!

Maybe you're an exception, but you can't always assume the healthiness or unhealthiness of anyone, overweight or not. The fact is that being obese can still lead to a whole host of problems (clogged arteries, vascular disease, high cholesterol, high blood pressure, joint problems, etc.). I feel like it's in any doctor's realm to warn their patients against gaining too much weight, and to get that point across clearly.

Any doctor who wouldn't do anything in his or her power to help a patient in that situation would be negligent, in my opinion.

I saw an interesting guest on CNN last night discussing this case. What she pointed out was this: If a doctor thinks his patient should stop smoking, he should suggest that they change their behavior AND give them ways to help them change their behavior, not say "You smell like an ashtray and men don't like that so quit smoking". But rather, "Smoking is very dangerous, leads to COPD, lung cancer, etc" and "There is a medication on the market that can help you quit, or there are numerous nicotine replacement methods you can try. Would you like a prescription for them or a referral to a stop smoking support group?". They address the actual problem, not the secondary effects.

So, when addressing someone who is overweight, a doctor could say "Your weight is at the point where it is unhealthy for you and I would like you get some nutritional counseling and exercise assistance. Here are names of people you can contact for this type of help" The doctor should address the behaviors, eating right and exercising, and offer solutions/treatment for them.

Ultimately, it is always the patient's choice whether they follow the doctor's advice or not. And, patients have choices about which doctors they choose to see again, in most cases. You are the doctor's customer and should be treated as such. Would you go to a doctor who tells you that you have a terminal illness by saying "Well, I hope you have life insurance" or "You do have a cemetary plot, don't you? Because you have to start digging your grave."

I wasn't making any assumptions about you - I don't know you and I'm not in the business of making assumptions about people I don't know.

I was just adding more of my opinion about the case in question.

I actually do think that people can benefit from people being blunt with them. So many people want doctors to walk on eggshells around them and try to "nicely" and without saying fat or obese tell them that they need to lose weight.

I know this isn't the exact same situation, but my dog has gained about 5 pounds in the past year for some reason. I'm assuming it's the handouts from the table that everyone gives her, but I wasn't really worried about it. I took my dog to get shots a couple weeks ago and the vet told me "you are going to kill your dog if you don't put her on a diet. She's fat and needs to lose about 8 pounds" (which is alot for a dog!). He basically was a complete ass and I was annoyed after the fact because I felt he could have said it in a nicer way. But, it prompted me to put her on a strict diet and monitor anything she eats...including milkbones-she only gets one in the morning now instead of one whenever she wants one...:) She has lost 3 pounds and is looking very trim...:p

So the point is, I think that sometimes bluntness can be annoying and (especially if it's about YOU and not your dog) offensive, but sometimes people need an asshole doctor to make them get the picture about the effects of their lifestyle.

I think being blunt only works in some situations. Just as being nice and tactful and pleasant only works in some situations. it depends on the person.
One person may have their doctor call them fat and that person may say, "hey, you know what? I am fat. I really should do something about it". Another person may be called fat and and that just might make them feel horrible and then depressed, which might make them turn to food, and then they get caught up in that vicious cycle. Obviously, one can't tell who's more sensitive and who's not, but I think one should always start off being tactful before being blunt.
Now this woman, has been told numerous times her health is bad and she hasn't done anything about it. At the end of the day, you can't help someone who doesn't want to help themselves.

If he had said this to a man we wouldn't blink an eye about it. In fact we would think the guy just needed to suck it up and lose the weight . . . why? Because we know the doctor was right.

So why the ridiculous double standard?

Because, James, women are delicate little (er, maybe not so little) flowers who will spend hours crying after their fragile little egos are crushed by the cruel words of such an evil man who does not understand that every woman is beautiful just the way she is, even if she's likely to drop dead of a heart attack tomorrow.

Although I'm not as big as the woman in the article, weight's a battle for me too. The things that have been the most helpful have been concrete suggestions about how to change behavior, and positive feedback for even small improvements. It can also be good to set modest goals. The idea of losing 80-100 pounds might have been overwhelming to the woman, but starting with 5 could have been more attainable. Feeling shamed or rejected can backfire, because it can make it harder to get out and be active. Some of the women I exercise with are smaller than me, but they're very supportive, so it's still a good experience. What guys think seems like a non-issue - do I really want an SO who'll love me only if I look a certain way?

The medical reasons for quiting often aren't very motivating. Many people have an invincibility complex and when they're told about cancer, heart disease, etc. they just hear "blah blah blah". Telling someone they're not going to score b/c of their smokers' breath might be more effective on some people.

You expect a doctor to be accurate.

I am not sure that tactful in the way that its being used here is what they are supposed to be.

Tactful, the way its being used in this thread, means offering information in a sugar coated form that lessens the emotional impact of it.

Therefore lessening the overall impact of the effect and making it less likely the information will be acted on.

I am not sure thats even rational to want that.

But if you don't like a Docs bedside manner you don't have to go to him. Also, if he is "mean" to a lot of his patients he won't have much of a practice.

Exactly, I want a doctor to be honest and blunt with me. If something's wrong, tell me how I can change my behavior to fix it. Am I making too much out of something, or not enough? Just give me the straight answer.

I don't think it's their job to sugarcoat things, especially since they're dealing with people's health.

I saw the CNN interview too...
 

My take...

Dr. dude totally attended a 1-day CME course about obesity.

His level of understanding stats is limited.

He may know his patient population and their behaviors, but he's no psychologist or psychiatrist. And it doesn't sound like he's board certified to be a psychiatrist, but just a family practioner or GP--which is cool, for some patients, but without much information on the patient and no feedback, and the fact that some MD's are arrogant for whatever reason, I do think the patient was not empowered to be her own health advocate.

I have not done any searching on communication with patients from a psychological level--what do the research articles say, bluntness vs. sugar-coating, etc.

Yes, the chick who was from the Acceptance of Fat People was very defensive and activisty, however, I myself have been inappropriately judged by many an MD for other health issues and I know what it feels like when you do not get the best of care.

But either way the Dr. did have some assumptions that were inaccurate.

Obesity in and of itself does not kill the patient directly. The heart attacks and type 2 diabetes vascular complications (i.e. stroke) do. There is a huge flurry of reports that discuss lean fat and white adipose tissue--it's where your fat is placed that causes the problem to organs. How it does it, is under intense research.

The Dr. misunderstood how obesity affects longevity. Longevity may have nothing to do with the levels of fat you have. However, there are genes that are involved with metabolism that also shorten or extend lifespan in mice. The gene products directly affect insulin levels that are the main culprit in obesity. If you have too much insulin, you have problems, if you have no insulin, you have problems. Why this yin and yang? Who knows...

Then NOBODY COMPREHENDS how obesity causes cancer. That is just a correlation in rats and some humans... Most cancer patients are thin, with the exception of colon cancer patients and that research I do not even have an answer... In fact, I study a gene when mutated causes mesenchymal cancers, however, I feed a nasty diet to the mice, they little guys get fat as hayle, sugar levels jump up and so do insulin resistance levels. There may be issues with the insulin response mechanism. But, when I looked at the mice, there were no cancers anywhere. These guys are chillin'...

So, I can see if the patient was shocked and pissed off...

Moreover, size for women is a cultural issue. What some cultures call fat, others call "big boned" or "healthy". What some cultures call skinny, other call "sickly".

However for the morbidly obese--i.e. those who are well over their weight by 100lbs, men and women, the best that can be done without exercise is bariatric surgery--an NOT liposuction, because lipo-ing causes the fat to come back with a vengence... And bariatric and gastric bypass are extremely dangerous surgeries compared to ultra workout that takes years to get going...

There is something wrong with folks metabolism in the US... No one is really discussing this issue alone... I think it's a conspiracy of the processed food companies covering some chit up... But that's my psychosis for today....

And, I have a gastroenterologist who celebrates every pound I gain because to him, that means my Crohn's isn't active and I'm absorbing calories. He'll say "You've gained weight, that's great!" and I tell him "I've gained enough already, thanks". But, he did point out that if I'd been at my ideal weight when I originally got sick and lost 65 pounds as fast as I did, that I'd have been dead. He has FORBIDDEN me from intentionally losing too much weight. He wants me at 40 pounds above my ideal weight because that's about how much a Crohn's patient will lose from an acute bowel obstruction or emergency re-section. I tell him I love him for that...lol.

Interesting that colon cancer patients are not usually thin. Crohn's and UC make you high risk for colon cancer and generally make you thin too. Although, perhaps all the prednisone we take alters that some.

I find this no different than a doctor telling a man who's been in for several STDs and is in danger of permanently wrecking his fertility (or worse!) to either start practicing safe sex or stop sleeping with partners who haven't been tested. People just don't want to be reminded when they should be taking better care of themselves.

Yeah, and a lot of people can't stop eating, and they pitch a hissy when someone tells them to be more responsible about their bodies. It's the same thing in my mind.

The majority of morbidly obese people could very well help it. If someone is honestly and truly overweight due to hormonal imbalances and thyroid issues, then that's a different story. But, if that was the case with this woman, her doctor probably would not have warned her on how her obesity could eventually kill her.

This isn't always the case. Obesity can be genetic, and in those cases it can be very hard for people to lose weight.

The thing is, I don't think anybody is saying it's not hard for people to lose weight. BUT IT CAN BE DONE.

I don't mean this to sound rude at all (:)), but have you consulted a nutritionist or dietician? If you really have decreased your caloric intake and started working out consistently you should have lost weight or seen some results within a few weeks. Sometimes people think they're eating healthier by modifying their eating, but really they are just replacing calories with other calories and aren't going to lose weight. You should talk to your doctor and maybe he/she can recommend someone who can design an eating and exercise plan for you!

Obesity is only genetic in a very very tiny fraction of those who are obese -- we're speaking of probably less than a percent. (Note that I am not speaking of a genetic predisposition towards being overweight -- but there is a difference being overweight and obese.) The indisputable fact is that the vast majority of people who are obese are obese because of the choices they make. Studies have been done on people who claim that they "just can't lose weight" no matter how little they eat. The outcome of these studies? These people were underestimating the calories they consumed -- sometimes by as much as 2000 a day. And until you've been put into a situation where you're being monitored 24/7 for an extended period of time by doctors/scientists/nutritionists, I don't think you can accurately claim that your weight problem is genetic.

I find it interesting that no matter what the statistics say, a good 1/3rd-one half of all obese people I've ever come into contact with claim that they fall into that fraction of a percent for whom obesity is genetic.

Exactly - the doctor is going to try to find what is causing the issue, whether it's diet or genetics. He's not going to drive the nutrition issue if it has to do with more than nutrition.

The fact is that a doctor (and anyone for that matter) can't simply assume that something like weight is out of a person's control. For some people, yes, there can be other issues, but for the majority it's a matter of nutrition, exercise and taking better care of one's self. I know (from personal experience) that in those cases, while it's not easy, it can be done.

Sometimes an honest voice is all it takes to get started, and it seems like this woman doesn't want to hear that honesty.

High fat vs. High carbs...
 

Currently, there are 2 genetic mouse models for obesity that many researchers study:

The ob/ob mouse that is leptin (a protein secreted from adipose tissue which affects the arcuate nucleus of the brain indicating some level of satiation) deficient and there are VERY LOW numbers of humans that actually have a leptin deficiency because it causes a birth defect (I think) only in humans...

And the db/db mouse that is a leptin receptor-deficient mouse--meaning the leptin must use a "key to unlock the door to get into the brain"--a receptor... I don't think any human has been found with a leptin receptor deficiency--but I could be wrong...

What we are discussing is diet-induced obesity that indirectly affects leptin levels. But leptin levels alone cannot account for the massive increases in WAT in morbidly obese people. To induce obesity in animals, one has to feed a high-fat and high carbohydrate diet with essential vitamins and nutrients... But only a select number of mouse strains are obesity susceptible--most never get fat, ever... Either they don't eat the diet, or the rapidly metabolize the diet.

There is a "convention" of thought that something in WAT suppresses metabolism in the liver and the gut. Something is secreted by the WAT that goes to the brain that shuts off the metabolism in the liver and gut--something to do with POMC and melanocortin levels... What the WAT cranks out is not really understood. But my guess is that it they are free fatty acids which can be strong ligands for many a receptor... It has been shown that fatty acid structured sterols in the liver with the orphan nuclear receptors--such as LXR and RXR regulating cholesterol levels... So, I have no reason why this would not occur in other parts of the body...

Which says, that the genetic pathways to regulated appetite and metabolism is not all just with will-power, it may be truly genetic. It may not be because of straight out mutation in one's genes, but by differences in the genetic structure of the protein--like my protein just works better than yours kinna thing... The single nucleotide polymorphism issue...

Moreover, women are structured in the child-bearing years to maintain a certain weight... Why? Because you don't want the lack of "insulation" and "nutrients" if a woman were to ever become pregnant... I.e. there is no such thing as a cholesterol-free fertilized chicken egg... There IS a reason for that and YES, it is evolutionarily conserved...

Scoop the Poop...
 

PM--

If you can see a bonafide nutritionist/dietician recommended to you by a physician, then I would do that too...

You need to make sure you have a BALANCED diet... Low in fat AND low in carbs... And you need to eat the correct things for your body. Find out what your body craves--sweets or fats... Based on that info, you can adjust your diet accordingly to correct for your workouts... Moreover, cardio is not the only way to correct for weight, you must also do it with weight toning. And muscle weighs more than fat. You will first build muscle before you lose fat. Once you build enough muscle, then the fat starts to come off.

And depending on the length of time you've been overweight, it will take you a lot of time--like years--to get that weight off... The sad part about gaining weight that it is quick to gain, but slow to come off...

And alot can be said about eating HEALTHY foods--the veggies like leafy green lettuces with mixed greens, cucumbers, peppers, broccoli if you can handle it along with fiber...

And some folks think that your "poops" need to be "frequent"--not diarrhetic--but like 2 per day... That is "roughly" ONE sign of how you can tell you are beginning to lose the fat... If you are all clogged up, that stuff stays in your bowel and bloats you out... That is why ab exercises are VERY useful in "relief"...

I say if you are consistent with your exercises and your eating habits and you haven't lost weight--and I mean you aren't aiming for a size 1 and anorexia--then that suggests your body has reach its "rheostat" for just about as much weight it can lose without going into "haywire" mode--where you'd get sick all the time for whatever...

However, if you are gobbling food up and cannot control yourself, you have other issues that need the help from your physician. A satiation problem is a whole nother issue that is realistically addressed by researchers... You cannot stop mice from eating kinna thing--you can only manipulate their caloric intake of their feed...