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.

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.

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.

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.

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
Zone™-type diet
Lacto-avo-vegetarian style
Low-Calorie
Low-Carb
Low-Fat vegan style
Low-Fat
Low-Glycemic load
Lower-Fat, high dairy plus low-glycemic index load foods
Macronutrient targeted diets
Mediterranean-style diets
Moderate-Protein
Provision of high-glycemic or low-glycemic load
AHA-style Step 1 diet

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.

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.

"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?"

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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.

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.

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.


Helena