justthestupidparts asked: When you became a doctor, did you not swear an oath to, among other things, try to prevent disease as much as treat it? Refusing to advocate weight loss to obese patients breaks that oath; how do you justify continuing to practice medicine? Serious question.
First of all, I apologize for taking so long to answer your post. When I received it I was still out of town. Second, I wanted to write something thoughtful and I needed time to not write something out of anger. Anger that you would accuse me of doing harm by not mindlessly insisting on weight loss as the ultimate solution to a fat person’s health problems.
To start with I would like to state that I do not refuse to advocate weight loss, where it is appropriate to do so. I assume that you are operating on the false assumption that being fat automatically makes a person unhealthy. I can assure you that it does not.
"But, what about the obesity epidemic? What about the diabetes epidemic? But what about…?" I hear you ask.
There are lots of illnesses that have been statistically correlated with being fat. But the thing to understand is that correlation does not equal causation.
Lets use Type 2 diabetes and fatness as an example. Diabetes type 2 is an illness of insulin resistance. That means the body requires more insulin to produce the same sugar lowering effect than a nondiabetic body would need. Insulin is produced by cells in the pancreas called beta cells.
Contrary to popular belief, people don’t just go from being nondiabetic to diabetic overnight. Rather there is a process that occurs. We have found that there are differences in a person’s beta cells that happen long before a person even begins to show signs of insulin resistance. Many people who go on to become type 2 diabetics will have higher levels of insulin circulating in their bodies for years before they even become prediabetic. One of the other functions of insulin in the body is to promote the storage of excess energy as fat. So, insulin makes people fat, and keeps people fat (makes it harder to lose weight).
Can you see where I’m going with this? The question now becomes, are people diabetic because they are fat? Or are they fat because they are diabetic? This is an extremely important distinction to make.
When I see a diabetic person, fat or not, I tell them to make sure they get plenty of exercise and to watch what they eat to control their carbohydrate intake. What does this sound like? “Diet and exercise.” The difference is that I don’t tell people to lose weight. Many of my patients who follow this advice do in fact lose weight, and that is fine. Many of my patients do not. That is also fine. They all have better control of their sugars, and in most cases, to similar degrees. I fail to see how not insisting on losing weight is “doing harm.”
There are times when a person’s weight turns out to be a factor in their illness and where weight loss may help in treating it. In those cases, I do suggest some weight loss. But in NO case is it ever necessary for someone to get to their “ideal body weight” to help their condition.
Finally, let’s look at the idea of “doing harm.” Did you know that studies (link and link) have shown that the medical profession as a whole is biased against fat people? That there are countless stories about people having serious illnesses going undiagnosed because they are fat and doctors refuse to look beyond that? That fat patients stop going to their doctors after being repeatedly made to feel ashamed for being fat by their doctors? For trying so hard to lose weight but not being “successful?” That, to me is the real harm that is done. The psychological harm. The physical harm that results from not going to the doctor for a serious problem because the doctor will either ignore it or just embarrass them again.
Are you aware that the vast majority of people who lose weight are not able to maintain that weight loss over the long term? And that people can end up far fatter than they would have become otherwise due to the lose-gain cycle. That that cycle can also cause serious harm to a person?
I care about each and every one of my patients whether they are fat or not. Whether they are healthy or not. Fat patients get the same consideration given to their concerns as thin people. I don’t simply dismiss things because a person is fat or tell them that losing weight is the ultimate answer. If my medical work up indicates that losing a small amount of weight may help, then I suggest it. Otherwise, it is not necessary.
Finally, before you try to tell me about all the research that shows being fat is unhealthy, I have a few of links to lots of evidence-based medical research that shows that being fat does not necessarily make one unhealthy.
Serious question? Serious answer.
The doctor is fucking IN
I just read this whole thing and it was worth it
I was told there was good news.
My skin grew too tight.
There was never a choice of two lives. The life inside me was already dead, the question was only if I should die too.
I would have made sure of that.
I still wake up drenched in sweat ready to tear off any part of me he touched. It would not be a stretch to take a knife and carve away what he left inside of me.
I could survive with him being a part of my life; I could not survive with him being all of it.
The alternative was never baby-showers, the pitter patter of little feet or even simply nine months of growing fat before never seeing it again.
The alternative was knitting-needles, coathangers and bleach.
It’s strange how the people that tell us men are animals with no control over their own sex-drive, are the same people who tell us men are more logical and rational that women.
“I just want someone to see me.” She says, I don’t reply.
“I watched this movie yesterday, it was a compilation of people saving other people’s lives at the risk of their own, it really moved me, but…”
“It made me think…If I was to die, right here, right now, not in public, but in this apartment that no one visits uninvited, would anyone come to save me?”
She’s not talking about killing herself, I know, because we’ve had this conversation before. She’s just feeling lonely.
“Probably not.” I respond, because I’m cruel like that. I can’t bring myself pay lipservice to someone who knows me this well.
She looks down, scratches her elbow. I know she’s fighting with herself, trying to keep all that pent up despair in check. She just wants someone to see her. Someone who isn’t me.
“I’m sorry.” I say, and I mean it, with every part of me I wish I could make things better with that sentiment alone.
“I know you are.” And for a moment we’re almost friends again, my reflection and I.
Stuck between seconds
“Are we there yet?” I ask my brain, impatient, time does not move fast enough. “Not yet, not yet.” It replies, and the lump in my chest grows. I want to be anywhere but here, anywhere but anywhere. I want things to happen, the situation to change, I want surprises and adventures and new beginnings. “Are we there yet?” no time has passed, but it feels like forever. Forever caught between the seconds, forever waiting, but waiting for what? For you of course, I’m waiting for you. Do something, anything, make the seconds go by, take away the distance between tick and tock. But you don’t, you can’t, you don’t know that it’s you. That it’s you who puts me between the seconds and makes it impossible to move. Everything is standing still, and it’s all because of you.
But you don’t know. And I can’t tell you. Cause that would be AwkwardTM, and we can’t have that. I can’t have that, I can’t deal with it, I already feel too awkward, too wrong. Unable to say the right things, unable to speak at all, stuck between seconds with a weird expression on my face and a lump in my chest. I’ve made up my mind, to not tell you, to not let you know of the AwkwardTM you cause. It’s my secret, me and the friends I’ve told. Because I can’t keep this inside, I can’t let it build up without release, I’d explode! And we can’t have that. I fidget and look at the clock again, still stuck between the seconds, still waiting. It will end, I know. Sooner or later I’ll break free of the space between the seconds, forget about you and move on. You will no longer make me waver, no longer make me smile when I think of you, no longer make me gush into incoherent rambles at my friends just because you are. But not right now, right now I’m stuck between the seconds. “Are we there yet?”
Impatience builds. I decided not to say anything, decided not to act, but sitting still is painful. I catch myself staring at my phone, staring at my facebook messages, wishing you’d say something. You won’t though, you don’t know, and I know that you don’t know and that is how I chose for it to be.
“Are we there yet?” my brain finally loses it at my endless nagging. Moving the lump from my chest to my stomach, makes me feel like I’m sinking. “Why isn’t the tock coming!?” my brain is as impatient as I am. “Cause I chose not to say anything.” “Well, why did you do a silly thing like that?” “Because…” And I stop, I know the reasons, no matter how many excuses I make up and how much I pretty up the words I use, I know the reason all too well. “Because I’m scared…” I don’t want to admit it; I want to pretend it’s because of the AwkwardTM, because of ReasonsTM, because it’s not logical, because I chose to take control over my emotions. But the truth is I’m terrified, and that’s what’s really keeping me stuck between the seconds. Terrified of you and your wonderfully horrible ability to tear my chest open and put a lump in my gut. Terrified that I won’t be able to do the same. Terrified of being mocked, ridiculed, stomped on by your giant feet, terrified that you’ll be just like him and use those emotions you provoked as a weapon that keeps me locked up forever.
I like you.
But I’m too scared to tell you.