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Old 10-16-2009, 10:43 AM   #1
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Default Medical Assumptions

Out of curiosity, how many of us "Fat Chicks" are overweight but in good health? And, how often do our health care providers make assumptions based on the weight?

My OB knows that, despite the extra pounds, I'm in excellent health. BP is low, blood sugar is perfect, cholesterol is perfect, etc. However, new nurses, or other docs when I was in the hospital giving birth, didn't just suggest screenings due to the weight. They refused to believe the results.

For example, one nurse took my blood pressure four times citing it wasn't possible for someone with "extra weight" to have such low blood pressure. At the time, I believe it was somewhere around my norm of 70-80/60, maybe even lower.

Another suggested we redo the blood work, because my blood sugar was "so low" considering "other factors."

Then, there are just the little comments. The new nurse at my OB's practice made a comment about my pulse being "surprisingly slow" when she was prepping my chart. "I expected it to be a lot higher!" Now, this may have been meant as a compliment, but..

Now, not only is this rude, it's highly unprofessional. Suggesting tests be redone, simply because the results don't stack up with your version of reality, should be a huge no-no in the medical field.

Just curious if anyone else have ever experienced this in one form or another. How do you handle it? I'm not sure there is a "good" way to handle it!
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Old 10-16-2009, 10:53 AM   #2
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I had this happen to me...twice, in fact. I had the slurry of blood work done about 4 years ago... I was overweight then (probably 175 lbs?) and the doctor couldn't believe that everything came back normal. She sounded shocked.

The second time happened earlier this year - I was 205 lbs then. The doctor assumed I would be pre-diabetic, or had PCOS, or at least insulin resistant because I was obese. She wanted to start me on Metformin before the blood test results even came back. Turns out I was, again, perfectly healthy - cholesterol was low, good cholesterol was high, blood pressure low, fasting blood glucose not even CLOSE to pre-diabetes levels. I hesitated to fill the Metformin prescription until I got the test results back, and now I'm glad I waited since there was no need for me to be on it.
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Old 10-16-2009, 11:03 AM   #3
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But most people who are overweight aren't in perfect health. I know I have high blood pressure- my doctor is still worried despite my loss that I could get diabetes, and I do have PCOS but obesity is usually a symptom of PCOS- not the other way around.

I think for doctors and nurses, generally they see overweight people who do have HBP, diabetes, and other weight related issues- and I bet there are a good number who think "well I am healthy" so for the doctors and nurses they prefer to check vs. just believe you. It's probably also a liability issue for them to check. I am sure they don't mean to be rude. Though I have met some doctors who are DEFINITELY rude IMO.

THOUGH I think prescribing a medication without knowing 100% isn't the best idea.
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Old 10-16-2009, 11:10 AM   #4
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beerab, don't get me wrong. I don't mind when a doc says, "We have to check just to make sure has changed since your last lab. Your weight gives you X, Y or Z risk factor."

I hate hate hate when medical professionals get the results and assume an error. I'm 24. Aside from losing my gallbladder-which was attributed to pregnancy-I'm in perfect health for a 24 year old woman. It just so happens that I'm 50 or so pounds overweight.

However, I've also noticed this on the smoking side. Everyone in my family smokes [myself included]. My 84 y/o grandmother has been smoking forever. When she got sick and developed a cough, her doctor couldn't believe her chest x-ray (and then he couldn't believe the second!). No spots, no signs of any damage from the smoking. It does defy the "norm" of medical science, but that doesn't mean it isn't possible. People miraculously recover from cancer-anything's possible.

But, I understand more with smoking. It's commonly known that losing weight will reverse most, if not all, of the bad side effects of gaining the weight. It's also possible to reverse those effects without losing weight. Many people follow a healthy diet and are in excellent cardiovascular condition, but just can't drop the pounds. I read an article covering a study on this phenomena, and it basically said that extra weight was not a condition but a side effect [of a poor diet and sedentary lifestyle] and shouldn't be treated as a condition.
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Old 10-16-2009, 11:33 AM   #5
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Yes, it is possible to be overweight or even obese but healthy according to those tests. But it usually doesn't last forever--which is why it's better to lose excess weight.

I was very healthy for years, but then one day my blood sugar was borderline diabetic at 109 and my cholesterol was 209. My BP had always been normal to low, so 120/80 was fine.

After losing weight, my blood sugar is 84, cholesterol 194, and BP 106/56. Most of this change, I believe, is due to increasing my exercise while losing weight. I am more fit now that I probably was 20 years ago.

So, rejoice if you still have good numbers, and be glad if you have good genetics! But don't think that that makes you immune as time goes by.

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Old 10-16-2009, 11:35 AM   #6
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This is a recurring nightmare for me! Last year I contracted pyelonephritis (sp?), which is a 'severe and complicated kidney infection'. Rushed to hospital in pain, with a fever of 104-105. The ambulance guys were 'chatting' about how if I just started doing a little walking, I'd drop some weight. Then the doctors sent me for all kinds of tests, assuming appendicitis - while having discussions on the phones with other doctors over the 'morbidly obese woman, like 300lb, with what's obviously appi, but we can't see clearly because of the weight'. I kept telling them my appi was fine, but the pain was in my kidney. I was ignored in emerg for hours, till finally a nurse realised just how high my fever was, and they started iv antibiotics.

My own gp routinely tells me that if I lost weight I'd cure everything from my torn Achilles to my chronic, treatment resistant depression. She suggests every time that I reduce my anti-depressants (which my psychiatrist absolutely won't do as it's just waiting for a relapse) and just start walking....then I remind her that SHE told me not to walk or run for fear of fully rupturing my achilles. She blithely says things like, 'eat more fiber, no fat, no junk, drink only water'....like that's so easy only an idiot couldn't follow it. She's skinny and Croatian - she believes all North American's are spoilt slobs and she needs to educate us about how we should live. She can't understand why anyone would choose to drink caffeine drinks - tells me how half a can of pop will have her bouncing off walls. This is all stuff I know - if it were easy to drop weight, I'd not be fat in the first place.

My bp is constantly in the lower end of the healthy range, even a little low. My heart rate is fine. I tend towards low blood sugar but it's always been taht way, and it's under control with diet.

When I had my last child (he's ten now) I gained 14lbs. My dr kept telling me I'd have a tiny baby (my first was 10lb 10oz) and I'd be fine. I kept saying it was bigger and I needed a c-section. Turns out, just by eating small and often (and totally unintentionally) I'd actually lost weight - my post delivery weight was 50lbs less than my pre-pregnancy weight. My son was 11lb 03oz, and nearly died because he was too big for them to deliver normally. If, instead of just assuming because I was fat, my pregnancy weight was correct, and if he'd listened to me, my son and I would both have had a lot better time of birth.

I get extremely fed up with people telling me all the wrongs would be right if I just lost weight. I'm breathless going upstairs because I'm fat - I know that. Being constantly nagged about everything and having everthing dismissed because I'm fat, drives me insane!

Sorry - that's a bit of a soap box for me - I'll climb down now!
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Old 10-16-2009, 11:47 AM   #7
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I'm well beyond "over weight" and my blood pressure is perfect, blood sugar is perfect, but my cholesterol is to LOW, my doctor ordered me to eat more good fat to get my HDL well above 23. I have other medical issues, allergies, intolerances, and I have a skin disease, but the rest of me is in good health. Even my blood tests showed my nutrients were great for me being a vegan lol. I still need some improvements though.

I've had one nurse take my blood pressure a few times because she didn't think it would be "perfect" as she said lol. Both of my doctors were pleasantly surprised and I got my blood tests done when I was around 285 pounds. I'll probably get a second round when I go back for my yearly checkup, but my blood pressure was on target a few weeks ago when I went to the OBGYN (that is where the nurse was who took it a few times lol, I didn't mind though.).

I don't consider myself "healthy" because if I stay at the weight I am now I run the risk of future problems and I even have problems now because of my weight, mostly the skin stuff. However, I do think people tend to look at us big people and assume we are going to keel over any moment, when in fact I'm stable. I think the lesson I learned, as I thought my stats and things would be horrible, is that just because I'm obese doesn't mean that I'm going to automatically have high blood pressure and yadda yadda. Saying that, being thin doesn't mean that you aren't going to have those problems either.

I think generally people assume, but a lot of the reaction I have gotten was more of "YAY" and "GOOD NEWS" not rudeness. That is too bad that you've had experiences, or people have, with rude behavior.
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Old 10-16-2009, 11:53 AM   #8
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Personally, I think habits including diet and exercise are a better determining factor than your weight. There are a lot of obesity related issues but I think it is more or correlation than causation. A poor diet is a major cause of obesity (although not the only cause) and I also believe it is a major cause of obesity related diseases.

So I think your blood tests and what not can be perfectly fine and you can be obese. It is either 'good' genetics or a good diet that would result in that. Of course excess weight can be hard on the body as your heart and cardiovascular system does have to work harder and your joints/ligaments/etc are under more stress.
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Old 10-16-2009, 11:57 AM   #9
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I should have added what Jay said in her post - I have a family history of diabetes and heart disease so I knew in the back of my mind that, while at 26 I was in very good health, it was probably only a matter of time before my obesity started catching up with me.

I would be hard pressed to find someone who is healthy and obese and could make a good argument for staying obese.
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Old 10-16-2009, 12:23 PM   #10
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Quote:
Originally Posted by Altari View Post
For example, one nurse took my blood pressure four times citing it wasn't possible for someone with "extra weight" to have such low blood pressure. At the time, I believe it was somewhere around my norm of 70-80/60, maybe even lower.
Well, at least in the case of the blood pressure, it was entirely appropriate to re-check a number that low. But her comments were certainly not appropriate or even logical.
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Old 10-16-2009, 12:28 PM   #11
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I read an article covering a study on this phenomena, and it basically said that extra weight was not a condition but a side effect [of a poor diet and sedentary lifestyle] and shouldn't be treated as a condition.
I think that might be true for some. I think different people are healthy at different weights. But it turns out fat is not inert. It's metabolically active and some would call it an endocrine organ
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Old 10-16-2009, 12:45 PM   #12
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To me, it seemed that I was healthy and obese, until I suddenly wasn't (healthy), but in truth, it was a slow cascade.

Every attempt at dieting only ended with me fatter, so for a few years, I did choose obesity over crash dieting. The endless weight gain stopped - it seemed to prove what I'd encountered in the "Fat Acceptance" literature. Their main theories at the time, were that eating did not make you fat, dieting did, and that fat did not make you sick - dieting did. It was rather difficult to find a fat person who had never attempted to lose weight through dieting, so theories difficult to prove either way. However, my weight gain stopping did seem to support the equation dieting = fatter. I do believe it wasn't dieting, but dieting as it is usually done, which means for the most part, crash dieting.

People with no health problems often don't go to the doctor - so the numbers of healthy thin and healthy fat people may be difficult to count. Our assumption may be that fat healthy people do not exist, where it's simply a matter that healthy fat people (like many healthy thin people) just don't go to the doctor, so are never "counted." Fat people who are healthy (or think they are) and even those who aren't, often have doctor phobia, afraid the doctor will rag them about their weight. Medical treatment avoidance, is not good for long term health. So are fat people unhealthy because they are fat, or because they avoid early medical treatment? Social ostracism is also known to be extremely bad for your health, it can even kill, often by impairing the immune system. Are fat people sick because they're fat, or because they have been mistreated or ignored by people?

Personally, I believe that obesity can cause several health problems. I think though that many of the health-effects aren't from obesity itself, but other factors. Some independent of the obesity, and some a cause of both obesity and the specific health problem.

I think the problem of medical staff being unable to treat "the individual" is a problem that sadly isn't unique to obesity. My sisters' husband is African American, and while he would never suggest that he received inadequate medical care because he is black, I will say it for him. I have witnessed some of the horrific medical care for myself, and I can't believe it was anything else. In one of the best cardiac hospitals in Illinois, he went in for surgery to "repair" his heart defect as best they could, and was discharged with medications that he would be on for life. We all went to see him, we all talked to the doctors. Two years later, we found out that the surgery repaired absolutely nothing - it had been a diagnostic test, nothing more.

To me, that's medical malpractice, but my BIL would not sue. I wish I could sue FOR him, because I am outraged on his behalf. Looking over the course of his life, his medical care improved dramatically when he got good medical insurance (unfortunately, not a huge surprise there) and even more dramatically when he became a store manager. To me, that says NOW they see him as an educated, professional black man (who can only now understand the medical treatment he needs?)


Many doctors and nursed also don't know how to deal with obese patients adequately or with respect. Yelling doesn't work. Ignoring problems doesn't work. Contempt doesn't work.


It's amazing how many doctors and nurses don't know how to take an obese person's blood pressure. That has gotten MUCH better over the years, but even 10 years ago, I had to tell doctors and nurses that I needed a larger cuff, or my bp reading would be high. I told them if they used the right cuff it would be normal (at the time, it was).

I'm starting to rant and ramble, so I'll try to calm down. There's no way to get around medical assumptions. Doctors and other medical professionals are flawed human-beings like the rest of us, and they tend to act according to their own assumptions and biases. We all make thousands of assumptions every day about the people we encounter. In medical situations, it's very important that those assumptions don't get in the way of appropriate treatment, but the reality is that sometimes it does. I think it only makes it everyone's job to decrease the odds. That means medical staff being aware, educated, and open to feedback - but also patients speaking up, asking questions, giving feedback and even criticism, not just on the medical issues but on the socal ones as well - "bedside manner" is often just as important as medical knowledge.
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Old 10-16-2009, 01:55 PM   #13
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Like a lot of other posters here, I am perfectly fine with doctors or other medical professionals being concerned about issues that are correlated with being fat. What I am absolutely never okay with is being talked to like I'm subhuman, having medical professionals express disbelief that a fattie could NOT have diabetes, high blood pressure, or high cholesterol (to the point of, like other posters, having tests repeated), and being denied things because of my weight with no other reason given (when I was 19 I was told I could no longer have birth control pills because I was fat - not because of high blood pressure, I've never had that - the doctor just said "you are fat, and fat women can't have birth control pills, find another method").
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Old 10-16-2009, 02:20 PM   #14
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This happens to me alot too. I have very very very strong legs and I know that I carry most of my weight there. I mean, I can leg press 2 sets of 5 reps @ 700lbs. I may be 207 but I can wear a medium shirt and I just bought a size 11 pair of corduroy pants- but when they see my charts and they see that over 200 weight and they start getting all these ideas in their head about what is wrong with me. Even when they see me they take my pulse (resting pulse is around 50) and they give me this shocked look.

Its very aggravating.

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Old 10-16-2009, 02:20 PM   #15
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I can put on my health care provider hat here and weigh in with the doctor/nurse perspective....

This is a hard thing.

I can personally vouch for the fact that in general it is much harder to care for the obese patient. It is harder to do a good physical exam, it is harder to use medical technology appropriately, it is harder to manage complications.

The poster above who mentioned the possible appendicitis is a good example. Ultrasound can be helpful to rule out appendicitis, but ultrasound is a MUCH LESS USEFUL TOOL when dealing with obese patients. Why? Simple... the excess adipose tissue (fat) makes the images of the internal organs less clear. The ultrasound's waves don't bounce as well through a thick wall of fat.

Who does that put at risk? YOU.

If you are obese and you have a health problem, the tools that doctors and nurses use to treat you may be less effective-- it will be harder to get a diagnosis and harder to get a good treatment.

That stresses out doctors and nurses, whose job it is to try to help you.

It's especially hard because obesity is a medical problem that is associated with lifestyle.

Like it or not, the smoker who has emphysema, the alcoholic with cirrhosis, and the obese person with diabetes or hypertension or heart disease are considered to be contributing to the very problem for which they are coming and asking for help.

Ok. But of course, a good health care provider understands that people do want help, and they DON'T want to cause problems for themselves, and they WOULD fix the problem if they knew how, but usually they don't feel successful at fixing the problem.

So, I think that compassionate understanding on the part of the health care provider is key. You DO have to watch what you say. You DO have to be sensitive to the needs of your patients, and you DO have to care for obese patients with compassion and skill and NOT blame them for them for their problems, which obviously, are causing them problems that they don't want.

On the other hand, I'm hearing quite a bit of denial on this thread. You might be a young healthy person right now, but that does not make you immune to the health problems associated with obesity. The problems accumulate and become more and more severe with age. A healthy obese thirty year old may turn into a fifty year old with heart disease, or such severe arthritis that she is unable to walk.

I think it is ENTIRELY appropriate to mention it to a health care provider if you feel that his or her comment was insensitive about your weight.
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