It's about time! I've always been amazed by how unknowledgeable most doctors are about weight loss. Now they are being told to get serious about it. The only thing is I hope they approach it with common sense. They are being asked to use the BMI scale as a guideline, which is fine, as long as it is used only as a guideline and not as definitive answer for everybody. A muscular person might be told they are overweight when they aren't, based on the BMI scale, unless common sense is used. On the flip side, a person who has extremely little muscle mass might be told they are healthy when they aren't, based on the BMI scale, unless common sense is used. The question I have is, are doctors really going to put that much effort into it? Or are they going to do the bare minimum? If insurance companies are getting involved, you can bet it's going to matter, so I hope they begin to show a real interest, get some real training, and get it right.
I agree that this is long overdue! But I've only had one doctor who seemed to have had any training in nutrition and most of them just pass on a comment of "you need to lose weight" without any other guidance, assistance, direction etc. If I had cancer, they would be committing malpractice to just say, you need to fight this and send me home. Hope this helps with forcing doctors to acknowledge that this is an area where for some significant training is needed.
11-15-2013, 12:51 PM
The question I have is, are doctors really going to put that much effort into it? Or are they going to do the bare minimum? If insurance companies are getting involved, you can bet it's going to matter, so I hope they begin to show a real interest, get some real training, and get it right.
I think the answer is, it depends on the doctor. When it comes down to it, doctors are people just like everyone else. Some are good at their jobs, some aren't. Some are good at parts of their jobs and not others -- they may be good at diagnosing but not have good people skills, or vice versa. Some love their jobs and put in 110% effort, and others dislike their jobs and do the least they can do to get through the day.
In the US, medical schools have not taught much at all about nutrition -- this may be changing, but it has been true historically. If an individual doc is interested in nutrition, she can take the time outside of her regular day to educate herself about it and bring her knowledge to her patients. If she's not interested, she won't. If she loves to exercise, she may share that with her patients and try to inspire them. If she herself is sedentary, she will probably not be as enthusiastic.
(I once had a doctor who always reeked of cigarette smoke. Freaked me out. Like going to an accountant whose checkbook is a mess, or a bankrupt investment advisor.)
I think a lot of doctors become jaded and cynical about their overweight patients and lose faith that they can and will lose weight, and that's part of why they don't talk constructively with their patients about weight loss. It's a shame, because they are not helping the ones who are ready, willing, and able.
11-15-2013, 02:54 PM
Its also very discouraging for doctors to give patients info about weight loss and have them ignore it and come back even heavier. We have all been given information about being a healthy weight and how to get there, but just take a look around when you are out and about - more and more people are obese and couldn't care less.
11-15-2013, 03:15 PM
We have all been given information about being a healthy weight and how to get there....
Not quite all of us have. I was thin for much of my life and when I moved into the overweight range (which I was never told was officially "overweight") and expressed concern about the extra pounds to my doctor, I was simply told I should try to exercise more. That was it. When I was later put on meds that caused me to gain 50 lbs in 6 months and expressed my upset about it, I was told that the positive consequences of the meds outweighed the negative consequences (which they didn't by the way). I've never been given any advice on losing weight by a doctor. Everything I learned about weight loss, I learned through my own research.
11-15-2013, 04:13 PM
We have all been given information about being a healthy weight and how to get there...
I had a doctor when I was a kid (like, 12 or 13 years old) who told me I should lose weight for my health. I asked how. She said to exercise and eat better foods, and then nodded like that was that. I was so, so confused and worried. My health was bad? Lose weight? What exercise? What was "better" food? I didn't eat good food? How much should I weigh?
And my parents knew what I did about nutrition (not much). I'm now totally self-taught in what I know nutritionally. I had to find literally all of it on my own. The only "information" I was given was on sugar cereal boxes claiming to be healthy because they had half a gram of whole grains or something.
Doctors aren't great at advice most of the time. They need to keep caring and trying because eventually someone WILL want help. And if they can't be bothered (or don't have a clue), that's contributing to the issue.
11-18-2013, 09:45 AM
It is such a tough balance sometimes. I try to address weight with my patients at each visit, and use my own struggles to humanize it. However, I do not want to make the patient feel "attacked" and avoid seeking health care. I have had numerous patients say things like, "I kept putting off coming in because I did not want to hear it about my weight". I have done that myself, out of embarrassment with my weight.
I really try to make my patients feel like I am their advocate, and partner in becoming healthier, but there are always patients who are not ready for a change in lifestyle, and do not want to hear any discussion, even in a non-judgmental tone. I have many patients who say, "I try to avoid going to a doctor because they always find something I need to change", whether it be quit smoking, lose weight, increase activity, or decrease alcohol intake. It does not stop me from mentioning those things, but I know that until a patient is receptive and wanting to make a change, I may not get anywhere.
11-18-2013, 10:41 AM
I saw my doctor on Friday, and I brought up weight loss. It was a good discussion of options and risks, but he admitted he had "no answers, obviously" gesturing towards his own overweight frame (much less overweight than hubby and I, but still significantly overweight). I also noticed that he seems to have gained some weight recently, but I know his wife has some severe health issues, so the stress is probably taking its toll.
Sadly, weight loss "science" isn't very advanced and mostly amounts to trial and error, resulting in (at best) the only slightly less blind leading the slightly more blind.
I didn't get much in the way of practical advice from our conversation, getting the impression that I had a lot more knowledge and experience with weight loss and nutrition (and even exercise) theory and practice than my doctor.
Where our doctor succeeds tremendously, though is in compassion. He doesn't criticise or give stern or judgemental advice, and he shares his own personal struggles, which I think makes all the difference.
Feeling lectured or scolded by your doctor doesn't help.
11-18-2013, 11:44 AM
I've only ever been to one doctor that seemed to give a rip that I was obese. The rest are in such a hurry to get me out of their office, they don't bother to do much aside from, "Uh huh, looks good, lose weight." The one that cared naturally moved away. The one I have now is into the HCG thing and keeps trying to push that on me. That proves to me right there that he knows nothing about nutrition.
In fact, I really wish I could find a decent general practitioner around here that wasn't completely booked all the time and too busy every visit to take any time with me. I get more help from the nursing staff most visits than I do the doctor. We do have a really good nurse practitioner at the HD that is really nice, and aside from chewing me out about my blood sugar, has been really helpful and knowledgeable. I get the feeling she keeps up with nutrition. The problem is, the HD is ALWAYS full and is hard to get in. They also don't prescribe narcotics, and while I'm not a druggie by any means, when you're in hellish pain like when my husband was when he had a root canal, they help. :) They sent him home with prescription strength Advil.
I haven't been back to her since my sugar is under control and I've lost weight. I think next year I might just schedule a follow up since my current Dr. is more interested in prescribing meds than trying to get to the root of the problem.
Honestly, medical guidelines or not, I don't really see my local physicians changing much. They are old and set in their ways.
Care to move to Florida, Kendah? :D
11-18-2013, 03:03 PM
I went to a doctor about a severe gout attack after finally getting insurance. I hadn't been to a doctor for close to 10 years before that. True to form he said "You are overweight and you probably have diabetes because we see a lot of that in women who haven't seen the doctor in years." In retrospect I wanted to ask him why he thought the reason was I hadn't been to a doctor in years. Could it be that, I didn't go to medical school and could diagnose myself as obese? Could it be that I'd been shamed before but not helped? Could it be that I didn't have insurance? Could it be that every experience with the medical professional I've had has left me feeling like I could have saved the copay?
11-18-2013, 03:14 PM
I think another issue may be how complex the whole issue of losing weight is. What works well for one person may not work for another. It all boils down to how an individual metabolism works.
What they learned in med school will not work for everyone even if carefully followed.
11-18-2013, 03:28 PM
I find that quite a few of the people that excel at science based professions such as medicine are very concrete thinkers. A+B=C. If a condition is exacerbated by obesity, remove the obesity and the problem is solved. The thing is, getting them to see the obesity as a problem in and of it's self is difficult, because doctors are like everyone else; many of them have been taught throughout their lives that obesity is a weakness and not a health problem.
I had a fantastic doctor from the time I was about 7 until last year. He treated me and my dad, and went out of his way to find answers for both of us, and never assumed my problems were related to my weight (For the record, the only health problem I've had that could be weight related is kidney stones, other than that I've had perfect bloodwork even well up into the 400 lb range).
My new doctor has never commented negatively on my size, and I go see him about every 6 months for blood panels and I had him refer me to an obgyn just to make sure that PCOS wasn't part of my problem. He's never made me uncomfortable, but he insisted on testing me again for diabetes this past month during my kidney stone struggles, based on one symptom - that also appears when you have stones. I didn't kick up a fuss. I let him run the panels, and when he said "you don't have diabetes" I simply said "I know, I didn't have it in April when you ran my blood work last either".
He wasn't being mean - he just did the math in his head based on the symptom and my weight. Really, that's what he's taught to do.
11-19-2013, 01:00 AM
I went for a basic checkup a couple of years ago. My bloodwork ended up being fine, but I broached the subject of my obesity with the doctor anyway. This was the very very early inklings I started to have on my own to maybe possibly consider probably trying to lose weight in some fashion; I thought I was being very brave to broach the subject. Anyway, I was expecting some in depth response, and what I got was a shrug, and, "It's really hard to make lifestyle changes. We'll keep an eye on your blood pressure, and if it goes up, don't worry, we have a pill for that." That was the sum total of my obesity lecture :rollseyes: I live in a town/part of the country where many people are obese.
The new Obesity Treatment guidelines are a rather huge document. I did start to skim through it. I'm simplifying for brevity, but it recommends doctors discuss BMI as well as take waist measurements at regular patient visits. FYI, women should be under a 35" waist. It also tells doctors to bring to the obese patient's attention all manner of help regarding weight loss, from support groups to over-the-phone help, etc. They specify that a possibility could be recommending a 1200-1400 calorie a day diet for women. Patients with a BMI over 40%, or patients with a BMI from 35-40% with at least one co-morbidity, who are unable to lose weight should be referred for a bariatric consult. These are pretty specific action recommendations for physicians. I have only read a small percentage of the publication so far. If anyone is interested, here is a link http://onlinelibrary.wiley.com/doi/10.1002/oby.20660/pdf
11-19-2013, 10:25 AM
It makes me really nervous to see the push for bariatric consults, even with a co morbidity. I don't think we've looked far enough into the long term consequences of the surgeries. I hope a good dose of common sense is used in conjunction with the BMI. I will never have a 35 inch waist, and I'll always be overweight according to the index.
11-20-2013, 06:05 AM
I guess my doctor read that document, because I know that the paperwork he gave me after the first visit with him said, "refused bariatric surgery." He didn't suggest anything else.
I'm not getting a lot of lectures, but everything that I have wrong with me, blood pressure, blood sugar (pre diabetic), plantar fasciatis, is all attributed to my weight. I've joined weight watchers, which my new podiatrist is happy about. I just wish that doctors were given some actual training in weightloss and food issues. I think that will be a long time coming.
Plus, there are so many issues with processed foods that are just now emerging. I just finished reading "The End of Overeating". If you haven't read it, please do! It is a fantastic book.
11-21-2013, 07:19 PM
This is a huge topic. No easy answers. But given the prevelance and consequences of obesity any medical school now not training GP and internal docs on this issue extensively is not doing its job. And any doctors not training if out of med school I think is a big oversight.
I personally never took any umbrage at a doc or anyone saying I needed to loose weight. Ultimate dah for me.
I would caution people who overweight to think they are the exception to the rule. Vast majority will suffer consequences even if blood work fine. It might be more prone to cancer, or less energy, or more depressed, or joint problems. It isnt always heart disease and diabetes. For me it was sleep apnea, borderline blood work, and probably heading to all kinds of stuff.
11-21-2013, 08:57 PM
I guess I have mixed feelings about this. So many doctors are just appallingly ignorant about weight loss. I remember years ago having one hand me a diet plan which, looking back on it, was very restrictive and not that great foodwise (think cottage cheese and hamburger patties).
A few months ago I had a visit at my allergist's and I noticed on the sheet they gave me after the visit that had what I was supposed to do (all allergy related) at the end it said to see physician for weight management (I was at about a 32 BMI so not heavy enough for WLS). I really felt it was a little strange since this was an allergist. Also, I thought about just how that would work. That is, since when do most physician's give you any real help on weight management? This just seems to support the fiction that people get weight loss help from physicians when that is mostly not the case.
My actual regular family practice doc did mention weight loss to me. I told him I was doing WW and he was approving of that. He didn't really push me so it was OK.
I did get annoyed when every time I went to the allergist that was at the bottom of every sheet they gave me! I finally told them I knew I needed to lose weight, I was on WW and they could give it a rest and not remind me every freaking time I went there. It was starting to make me not even want to come in.
11-21-2013, 09:07 PM
I will also say that the medical establishment is, sadly, either willfully or not a big part of the obesity problem. The American Heart Association for goodness sake ENDORSES SUBWAY for diabetics.
That is insane. They have lost all credibility to me. A subway sandwich would cause a huge spike in a diabetic. HUGE. It is the height of irresponsibility. But then again Americans followed the food pyramid and mainstream advice...cut fat...cut fat. Carbs, no worries.
And bam...look at where we are. Doctors have to question conventional wisdom first to be of any good. 3FC probably has more good advice than all American medical doctors put together.
11-21-2013, 09:14 PM
I can't see doctors measuring your waist when you go in to see them. It seems far too intrusive and humiliating.
I can only remember one doctor commenting on my weight. It was a new cardiologist I saw a year ago. He had never met me before and immediately told me that I was 10 pounds into the "overweight" category and that I needed to do something about it. The assistant told him that I had just lost 40 pounds since I was in there a year ago, and the cardiologist was totally dismissive. He then told me it was likely I had high cholesterol and ordered up a panel, despite me telling him that I have always had excellent levels, which proved to be the case yet again.
Needless to say, I never went back to him.
11-21-2013, 10:00 PM
Still slogging through this report.
Regarding the waist measurement - the report says it's not helpful to measure waist if bmi is greater than 35, because at that point the bmi alone tells them enough about health risks that the waist measurement adds no new info about risks. So the waist measurement is applicable in the up to 35 bmi crowd.
In addition it says that people that are in the overweight range bmi, but have not other uh health issues (I assume this also means the max waist measurement is not breached,) need to be counseled to not gain any more weight.
It recommends physicians keep checking with their obese patients for "readiness" at each visit for willingness to make a lifestyle change to address their obesity.
Also mentioned are viable diets, deemed reasonably healthy/effective in helping with weight loss IF combined with an energy deficit which I guess means a calorie deficit? I'm not knowledgeable at all about various diets. Here are the names of the recommended diets:
Higher Protein diet
Low-Fat vegan style
Lower-Fat, high dairy plus low-glycemic index load foods
Macronutrient targeted diets
Provision of high-glycemic or low-glycemic load
AHA-style Step 1 diet
11-22-2013, 09:02 PM
I've been working my way through the report, too. and some of the points that stuck out are that just about any diet works - and it's about finding what somene can and will stick to. Also the discussion about providing ongoing support. the report made it clear that nursing and dietician input is really important. Of course, the report also didn't mention a word about whether these services would be covered by insurance or if patiets would have to pay out of pocket.
it's also worth remembering that this 'sudden' interest in BMI at every visit is being driven by the fact that docs have to show that they're meeting certain quality measures if they want to get the full Medicare/Medicaid reimbursement. these measures have been in the works for several years, but compliance has been voluntary and recommended. but the reimbursement motive kicked in this year.
11-23-2013, 08:32 AM
Good that doctors have to do this now. If you don't think gov policy matters for the first time in decades obesity in youngest kids went down. Why? Changes in WIC, women, infants, children. Healthy foods were covered and lots of junk fell off.
People thought there would never be healthy food in like inner city convience stores. But when the regs changed healthy food showed up.
So why I am saying good is that better regs and requirements can effect good change IF they are good and implemented well.
Govt going along with big AG has failed us. But maybe it can do better.
11-23-2013, 11:48 PM
"I went to a doctor about a severe gout attack after finally getting insurance. I hadn't been to a doctor for close to 10 years before that. True to form he said "You are overweight and you probably have diabetes because we see a lot of that in women who haven't seen the doctor in years." In retrospect I wanted to ask him why he thought the reason was I hadn't been to a doctor in years. Could it be that, I didn't go to medical school and could diagnose myself as obese? Could it be that I'd been shamed before but not helped? Could it be that I didn't have insurance? Could it be that every experience with the medical professional I've had has left me feeling like I could have saved the copay?"
Amen to that! I have diagnosed the last few health problems I have had myself...just Google the symptoms. I go to the doctor for medication, and they are so busy typing on their laptops their records and observations that they are not looking at you and treating you like a human. You are a list of symptoms to record. Then they tell you to lose weight in a flippant manner-not acknowledging the suffering you have already done in repeated attempts to lose weight. Our health care system is broken on so many levels.
Why should I trust it to care about anything other than the bottom line, and avoiding malpractice suits? It is an industry, and doctors are industrial workers.
Overweight and obese people have got to be empowered to find help in new ways, and given support for their efforts. I have very little faith in an industry that works hand-in-hand with the insurance industry, both for profit industries that have created spiraling cost for care, while not preventing illness and disease comprehensively. It is akin to the industrialized prison system in this country-create tougher and longer sentences to have a ready made prison population. Obama Care is the tip of the iceberg so far as a needed overhaul of the medical/insurance company industrial complex goes. However, the health insurance lobby is one of the heaviest funded lobbies in the nation.
11-24-2013, 06:04 AM
For many years, I only ever had one doctor who even mentioned weight, and because no doctor ever had said anything about it, I was shocked when he did.
I was at an appt and said something about being "big boned" and he said, "you're not big boned, you're overweight" and he proceeded to show me my little wrists and ankles (little for someone over 5'9 that is) and then talk about muscle mass and body fat. I almost fell off the table in surprise. He was so awesome, though, he talked about strategies for losing weight, including low carb (and this was before the Atkins craze hit). Turns out he had a big interest in nutrition. So helpful.
My gyn is the only other doc who ever mentions weight, and only notes it and encourages me to lose when I'm heavy.
02-13-2014, 02:51 AM
The senior doctor in the practice at which I have been a patient is obese. He looks to me at least 280lb. He has six doctors and a few nurses in the practice, yet the combined training of all of them can't make him lose weight.
About two years ago he told me to go and lose weight. When I asked him how, he said "I don't know, but if you ever find a diet that works, is palatable and sustainable, let me know."
I then lost 31lb low carbing and wrote him a letter setting out exactly what he should eat to get the same results. However, I imagine he is unable to bring himself to follow the diet, because it flies in the face of the UK govt official warnings against fat and meat.
Every bit of diet literature available in the practice preaches high carb eating. They gave me some new booklets just a few weeks ago, all funded by the British Heart Foundation, and they were full of the same old same old ... eat lots of pasta, potatoes, fruit, juices, rice, bread... but eliminate fat, which clogs your arteries.
Interestingly, when I last went to the practice I was seen by a woman doctor from Hungary who was exactly the same size as me, that is, about 350lbs.