Comments on Today in Obesity

There is definitely something to this.

I have VERY RARELY seen a physician, certainly one under the age of 50, who was not really really fit.

I'm convinced that medical schools actually use this as one of their selection criteria. This is creating a culture of fatty-haters.

Plus, of course, physicians are frustrated by people who won't lift anything (except a fork and knife) to help themselves.

Maybe this will be incentive for fattyies to get their phat asses off the sofa and get in shape, lest they get shitty care.

If I was a physician, I would have no tolerance for fatties. Having to deal with their morbid obesity is not why doctors get into the medical profession. I once considered a career in medicine, but realized I'd have to deal with fatties and their excuses, and preferred not to get involved going down a career path that would set me up to have to deal with them on a daily basis.

Something to think about fatties...

A few friends of mine who are nurses (not doctors, but they probably deal with patients a lot more) find obese patients difficult to deal with simply because of their girth. It takes a few people to move a patient of normal size from a bed to a gurney, and many more to move someone of "exceptional size". Everyone has a part of their job that they hate doing and will half-ass if given the opportunity, unfortunately, because doctor's work usually involves human beings, it is more hazardous to do so.

As for Arschbomber's comment, I feel like part of the mentality that a patient shouldn't "have to lift anything but a knife and fork" is the fault of the pharmaceutical industry and doctors who won't let you leave the office without a prescription.

I can see the sign now:

Dan Savage, MD

"No Fatties"

From the last "fat" post:

Street-Porter's tone creeps me out for a couple reasons. First, as several commenters have already pointed out, you put medicine on a slippery slope when you begin linking the right to medical care or coverage to the deservingness of the individual patient. Deservingness is a really subjective category, and what strikes one person as an incurred fault (it's your fault you contracted HIV because you had unprotected sex/the wrong kind of sex/sex at all) may strike another person as not in the least worthy of blame (the risk of STIs is part of being sexually active, which is a standard part of being human; you can take steps to limit the risk but you can't erase it entirely). Once you begin dispensing care or payment for care based on deservingness, you must make some individual or group responsible for making the decision to dispense or not. Seems like a way either to give free rein to the tyranny of the majority. It may all sound reasonable when your own ideas about what behaviors incur medical fault match the majority's, but what about when they don't match? Since the majority tends to define itself as normal and to identify the behaviors of other groups as not-normal, the very behaviors that are central to some groups' identities could be labeled as fault-incurring.

My other objection is more philosophical. I think it's important to accept that people are what they are, even though what they often are isn't all that great: most people are short-sighted, uninformed, and occasionally make really dumb decisions. Accepting these traits and being willing to work with them rather than harp against them derives from empathy -- the recognition that one has one's share of these traits oneself. However dumb other people sometimes act, you yourself have sometimes been dumb too. Working with the reality of who people are and who they identify themselves to be is central to my politics. Using incentives to try to encourage what is generally agreed to be positive behavior is great, but if those incentives don't work, and people do dumb things anyway -- which, being what people are, they often will -- you just help them anyway. The idea that all people deserve certain basic kinds of help, without regard to the roll they may have played in getting themselves into whatever mess they're in, seems to me foundational of the political left. I think health care is one of those kinds of help.

Posted by A in NC | January 27, 2008 12:50 PM

I hate doctors and think they generally suck. It's such poetic justice that high insurance rates are cutting into their incomes.

I agree with Anna, however that is not the case among the "fat acceptance" crowd. I don't appreciate being accused of having an eating disorder because I am thin and I also don't appreciate not being able to find clothes that fit in a typical American store. I will accept them for being fat...but they need to accept themselves first - then maybe it won't matter if anyone else accepts them. But, we step in when people are alcoholics or drug addicts because it is a health risk, right? People eat themselves to death all the time. We should just accept that, right?
I am the only thin member of my family. My parents and sisters are all obese. They all have health problems. They all are miserable. Fat and happy is an illusion.

Can we conclude that the "health problems" being addressed where physical in nature? If so, I would think the first suggestion for a solution would address the physical person. Something along the lines of, "you should lose some weight". That hurts when being directed at someone that as tried and tried. Of course it does not negate the need to do so, regardless of how painful the suggestion.

I have a lot of friends who are doctors. They drink, they smoke, they go to titty bars. They love a good slab of red meat as much as the rest of us. They're pretty much just normal people. Nothing wrong with that.

I'm with #5 here. God how insurance companies would LOVE permission to go denying coverage for everybody who doesn't spend an hour a day at the gym.

My doctor is hot. Hot, I tell you.

But apart from this: my health insurance (Regence) won't cover anything related to weight loss. In fact, if I or my doctor mention it during an appointment, then the health insurance company will not pay for ANYTHING from that visit--prescriptions, etc. The minute I ask a question about weight loss, boom, $400. It's not a joke; this really happened to me (twice).

Hey Chi Type...I agree but what if you got an insurance credit for going to the gym an hour a day, or giving up smoking, or riding a bike to work. People shouldn't be punished for being heavy, but rewarded for being proactive about their health. Kind of like the good-student discount for car insurance, you could get the healthy-lifestyle discount.

Just to clarify, I'm not "A in NC". His/Her comment was eloquent and compassionate, I felt it bears repeating.

@1: Medical residency requires
a year of 80-110 hour weeks, with 36 hour shifts. Damn straight they're fit!

Re #5, one big difference between overweight people and people who have contracted HIV is that HIV is irreversible (thus far). Being morbidly obese is not. Being fat does not CAUSE illness, in the same way that smoking tobacco does not CAUSE illness, but both are very strongly correlated with health problems. Remaining morbidly obese and/or continuing to smoke despite the health risks should have to cost 'ya. I believe that if someone makes the choice to be morbidly obese or to smoke, that person should have to pay a larger premium for health insurance. I also believe that insurance companies should pay for treatment for obesity and other addictions.

I heard that over time fat can develop its own vascular system and become like an organ, which makes it very hard to loose once the fatty Rubicon has been crossed.

First of all, if that's true - ewww.

Secondly, it would suggest those who are obese need to basically check out for a while and focus almost exclusively on weight loss. But given day to day demands of life/work, etc, how realistic is that?

Of course, it also probably doesn't help that a twinkie is cheaper than fruits and veggies.

These posts were redundant long ago, but I do wonder if Dan is in the habit of browsing the University of Michigan Health System Department of Public Relations and Marketing Communications Newsroom Web site over his morning coffee. Does he just google the news for "obesity" every day or can you sign up for a google alert or something? I think knowing how he stumbles on all these ground-breaking, paradigm-shifting news items would give some insight into his obsession, which I am beginning is not with fat people, but with his personal grudge match with that fat acceptance chick. If one of them surrenders do you think we can move on to, I don't know, fucking around with shit in your car while you're driving is likely to kill other people? I'm sure there will be frequent interesting news stories on that theme. And it will save us all money on our health care. Yay!

Someone -- a magical fairy -- sent me the links, Skweetis. And I didn't post the second link, to the story about doctors mistreating (in every sense of the word) their obese patients, to be mean to obese people. It actually backs up some of the fat activists' complaints, namely that the medical establishment treats them poorly and that they get inadequate care due to anti-fat bias.

You're right, Sargon. It's completely reasonable for a doctor to suggest weight loss when a fat patient comes in complaining of a likely pneumonia infection.

And actions by the giant health maintenance organization Kaiser Permanente show the medical establishment is beginning to respond.

Do you suppose the double entendre was intentional?

Second part of this is terribly true. It's good we are fabulously healthy because we quit going to the doctor decades ago when the doctor(s) refused to pay attention to any part of us aside from our flabby belly. Didn't matter if we were there with a runny nose or runny anything else, first thing they do is weigh you, second thing they do is tell you sanctimoniously that you should lose weight. Soon as somebody figures out how to do that without it coming back plus 10 pounds, or without having to mutilate your body surgically to do it, great, I'll listen to their advice. For now, I hope to live to 95 without ever setting my big fat feet in another doctor's office.

@18 - Got it. Bio-google-alerts. And I didn't say you were being mean to fat people, I kind of said the opposite. I used to get defensive at your fat posts, because they felt like an attack, but you know that they feel like an attack. It's the blogger equivalent of your brother holding his finger an inch from your face and yelling, "I'm not touching you! I'm not touching you!" Anyway, I'm over it and am not taking it personally anymore. But really, the only thing more obvious than "obesity can cause medical problems" and "it's hard for some people to lose weight" is "fat people get shitty treatment at the doctor, restaurants, the playground, etc." They also make less money and are less likely to be promoted. I think you can see by the diminishing comment count in these threads that it's not exactly exciting information. Unless you're having an awesome passive-aggressive pissing contest with someone. I'm not kidding, enjoy that!

@8-
It's not that these docs are addressing the issue of weight loss, because you are right they should be discussing it with their patients. It's that they are prejudging their patients to such an extent that not only are they alienating their patients, but they are actually making basic diagnosis mistakes! Yes, doctors need to address things like unhealthy eating habits, just like they need to address issues like smoking, excessive alcohol consumption and unsafe sexual practices. But a doctor should approach their patient as a partner for change when the patient is ready and a source of information on how to reduce their risks for those activities they are not willing to entirely give up, not as a force of condemnation. Those who think providing their patients with what I'm sure they think of as "tough love" rather than presenting what they have to say in a nonjudgmental fashion risk their patients simply lying to them about their habits when it comes to alcohol or sex. An obese who obviously can't hide their weight is more likely to not talk to them at all. And you can't help your patients with what they aren't willing to tell you.

Could it be that doctors disregard obese people because they realize they are dealing with an addict?

Being obese doesn't happen overnight, like an HIV infection. The person has to make the decision to overeat, and then keep making that poor decision repeatedly until the point that they completely give up any vestige of self control. (Addiction = Inability to voluntarily discontiune a self-destructive behaviour.) Since the addict's life revolves around feeding that addiction, the doctor knows that telling the heroin junkie to eat more bran is pointless. Telling the food junkie to follow an exercise program is equally foolish. The doctor knows that the source of the obese person's health issues is their food addiction. Telling them otherwise is deriliction of duty.

The doctor also knows that the obese person is well aware of their obesity: it's a matter of overcoming the addiction, and there isn't much an MD can do about that. They know the person should be seeing a shrink to find out why they overeat.

@9.. Word. My brother is a doctor and his fruit & vegetable drawers in his refrigerator are filled with candy bars.

I think he is not overweight for the simple reason that he has no time to actually eat anything.

@24,

Doctors don't disregard obese patients obesity. What they do is assume that every health complaint is related to obesity, to the point that they don't bother conducting a real exam. A fat person can go to see the doctor complaining of shortness of breath and the doc will never consider the possibility that the shortness of breath has any other cause than obesity. That is the dereliction of duty that negatively affects fat people's health and makes them leery of ever going to the doctor.

I'm going to have a tray of brownies....

@26 - Exactly. I've had a number of doctors who pulled that on me. Any health issue I've had has been attributed to my weight. Some were treated, some were not - because the answer I got was, "lose weight and it'll go away." And the thing is, I have, either before or after they say something, said "So, I understand my weight is a health issue - what kind of resources do you have available to help me lose weight and manange health risks?"

There aren't any. They don't even have an idea of what might be helpful. The closest I got to helpful was "um, well, we've got a pamphlet on nutrition in the lobby."

At what point are the massive costs of obese people going to be managed by doing things like providing nutritionists or other specialists? I keep hearing complaints about fat people driving up health care costs... so where's the plan? The current one sure isn't helping, as the article shows.

Thank God all my extra fat is on my thighs.

No, wait... Goddamn it.

I have this one friend who is overweight. And she has recently been complaining about some symptoms that have us worried that she may be diabetic. (Which runs in her family.) So we try to encourage her to visit a doctor, and she won't -- because she says the doctor will just give her crap about her weight.

So this is counterproductive. And yet, her weight is probably the main thing that is causing this possible diabetes. So the doctor needs to tell her to lose weight. But I guess they aren't very helpful with "how." Maybe if they provided some support instead of just "you need to lose weight" she'd be more willing to listen.

It's seriously frustrating. She may lose years from her life because she doesn't want to hear another lecture.

It probably doesn't help their health that as a group that fat people tend to be poorer and have less access to health care. I wonder how much of poorer health correlations relate to that rather than the fat?

Plus, I recall a study a while ago that said a few pounds extra was healthier than normal weight. Not obese, but an extra ten pounds or so.

Hell, if I was a doctor and kept seeing the same fat fuckers with the same obesity -related health issues day in, day out, I think I'd find it increasingly difficult to give a shit about their self-inflicted problems, too.

I guess that's one reason I'm not a doctor.

Poor people in food starved countries probably wish they had all their Care packages stuffed with twinkies and candy bars and soda cans. If the doctor got into the HEALTH field to help people, he should suggest exactly what the patient should be ingesting. If the health field workers realize that healthy foods are too expensive for their "clinics for poor people" patients, then they might either lay off the lecturing or bring up the subject to the CDC that a country like ours has fat poor people who can not afford to eat all those foods that are in the Food Pyramid EVERY day. People would eat whatever is given to them at the food banks, even if it was strictly healthy food. But is it doing any good at stopping the poor from becoming obese? Doesn't look like it.

Give peas a chance.
.
Carrots are aiight too.
^_^

@34 That is *awesome* to yell at fat hippies :D
If you ever see one that is.