**** hath no fury like a woman scorned.

I'm not a doctor and nor do I play one on TV, BUT...

I agree with PhotoChick -- if a doctor has an obese patient and DOESN'T mention the weight problem, that dr is doing a disservice to her patient. But, I think there is a definitely a point at which mentioning the weight issue goes from being part of a dr's responsibility to just harping on something the patient already is aware of. I'm not precisely sure how to define when that line is crossed, but I think if you're in a medical exam, you definitely can feel when the comments ab the weight have gone into the "All right, all right, I know I'm fat and need to lose weight, shut up already!" catagory. I once sprained my ankle and had to go to the emergency room (I was around 260lbs at this point) and the ER dr kept changing the subject from my throbbing sprained ankle to my weight and how I need to lose weight and how it's terrible I'm so fat, etc. THAT, imo, is entering the realm of "shut up about the weight and fix my damn ankle." I didn't go to the ER to be lectured about my fatness.

I have a primary care dr who is a relatively young woman, attractive and very fit. She has never really commented on my weight, bc, I guess, I'm not SO huge that she feels the need to make a huge issue of it, but during my first appointment with her *I* brought up my weight problem and we talked ab it a bit and she offered me some personal advice, saying, "this is the kind of exercise I do..." I actually LIKED that she was able to talk from experience and not just offer me the same old "eat less and exercise more" line. I don't think she's ever been overweight or obese, but knowing that she has to take the same steps to maintain her own health and weight made me trust her more and be more open to what she has to say.

Yeah, exactly.

I think it's a slippery slope here: At what point does the risk of "driving off" someone who can't deal with the truth counterbalance the responsibility of the doctor to talk to her patients about potential problems?

In my life I have dealt with this personally: My mom didn't go to the doctor for nearly 20 years because she didn't want to be lectured about her smoking. I cannot express very determined she was to not see a doctor, ever. She suffered through horrible arthritis and back pain that she self-medicated for, to avoid going to the doctor. When she was 62 she died of a heart attack - suddenly. Thursday night she was fine. Friday at noon she was dead. It was incredibly hard on all of us because had she been going to the doctor regularly, even with her smoking, this heart attack didn't have to kill her. It didn't even have to happen. I was really angry with her for a VERY long time after she died - that her SELFISHNESS about not wanting to hear a lecture about smoking deprived me of my mom way too young. I've since worked through most of my anger about it, but it is still something that I'm very aware of and that does nag at me, especially when I'm really missing her or wish I could share something with her.

Perhaps that clouds my views on the subject.

I just think that every doctor has the responsibility to talk about potential health issues to every patient.

.

My mother is the same way re: smoking. One of her friends has recently been able to conjole her into FINALLY seeing a doctor, but I still worry because of how badly she neglects her health so she can keep on smoking without any "annoying" dr warnings. My biggest fear is that she will die of something preventable way too early in life all because she hadn't seen a dr in a decade.

But she's sworn to me that after my wedding, in early October, she will make a real and concerted effort to quit at last. I guess we'll see.

Photo - IMO, it isn't a matter of "should" or not. It's a matter of what IS, in a world of imperfect, sometimes irrational people who still need to get the message about health and weight from their health professionals.

You're absolutely right...if one is overweight, and goes to the doctor and is given a "talk" about weight, it should not matter ONE IOTA who is doing the talking...skinny, fat, muscular, etc. The facts are the facts are the facts, and if all people were totally logical, and had no emotions, this issue would never come into play.

People are more complex than that, however, and the fact of the matter is, to some people (again, logical or not), it does matter. For that reason and that reason alone, I think it might help the doctor get her message across if she shared her weight loss history with patients. After all, if that gets just one person to think "hey, she did it, so can I! Maybe I should give this weight loss thing a shot" rather than "that doctor just has NO idea how HARD this is and where I'm coming from, its just HOPELESS for people of my size and she couldn't possibly understand that", isn't that a good thing, whether or not it makes logical sense?

No, I get that. And sure it makes sense that a doctor who has lost weight would use that as a point of reference with her patients. I don't necessarily have a problem with that.

But then if that logic follows, then the doctor who has never had a weight problem should not be allowed to say anything about weight to her patients, because she has no experience to fall back on and therefore would seem like she was lecturing on something where she had no experience.

.

I think... it depends on how it's said. A lot of thin people, drs included, who try to discuss weight problems, whether they intend to or not, often come off either with an air of superiority for not having a weight problem or just feeding the person a meaningless line about diet and exercise, offering no real advice. You can lecture a person forever about how they need to eat less and exercise more, but if you don't suggest meaningful ways HOW to do this, it's pointless and annoying. Most of the time, when I was heavier and a dr brought up my weight, it was never done in a helpful way.

But I agree with you that ANY doctor should act in the patient's best interest and bring up the weight problem, whether that dr has been in that position or not. But I once read that doctors are taught more about obscure illnesses in med school than they are about obesity. Whether or not that's true, I think it raises a good point about how well-suited doctors really are o advise a patient about weightloss. But I definitely agree that the weight issue can't be ignored for discretion's sake.

Doctors don't have personal experience with most of the diseases and treatments they recommend. It's based on evidence, as much as possible. A great deal of diet & exercise information falls within those bounds. But the mental / emotional / psychological side is often more challenging when losing weight. And while some doctors may be excellent with that, most don't have the training, and compensation is difficult. I think it's kinda an unfair expectation. Maybe not in an ideal world ...

What made me frustrated with doctors talking about the weight issue, is that mostly I've had either the doctors that don't say a word about weight, or the doctors who attribute everything to weight (if you came into their office with a dagger in your eye, they'd find a way to blame it on weight and tell you to go home and lose weight before they'd treat you).

What I do, that I would advise ANYONE to do, is if there's something you dread hearing from your doctor - you bring it up first.

Whenever I see a new doctor, even it's in the emergency room for a sprained ankle, I bring up my weight before they have a chance to. "I've been fat all my life, and trying to lose it most of it, and if you have any helpful suggestions, I'd be happy to hear them."

The thing is most doctors know their patients (and sometimes themselves) need to lose weight, but don't have any more information than we do on how to succeed. "Keep trying," has been about the best any doctor ever had recommended until my present doctor (a little pudgy himself, but I doubt clinically obese, he just looks like the "average" grandpa) said that I might have luck with low carb, because of my insulin resistance, but he warned "not too low carb," and I asked for clarification (how low is too low), and he admitted he didn't know.

I'd heard so much bad about the low carb diet, and have had so little helpful advice from doctors in the past, that I didn't really give the low carb idea much weight, I'll admit until months later when I met the woman doctor running our weight management clinic (excellent reputation, but insurance rarely covers). During the consultations, she also recommended a modified Atkins or South Beach, and talked about she and her husband losing about 100 lbs each on a modified Atkins. Knowing that she had succeeded herself, very much did influence my decision to try reducing carbs. I also brought up my severe PMS and cravings/hunger and asked about using the bc to skip periods. Unlike all the (male) doctors I had asked about it, she was all for it, telling me why it was safe, and why it might (and might not) help.

WOW, if I had seen her in my twenties instead of my forties, it would have changed the whole course of my life. As those two things have completely transformed my experience with weight loss.

She was also the first doctor I'd ever had who suggested that I meet with a dietician (in fact, it was part of the consultation, and if I'd been able to join the program, it's the dietician I would meet with most often, and the doctor just once a month).

I'm surprised at how little doctors know about weight loss. In the past, and with my current family doctor, I've had several doctors anxious to know what works. When I've lost significant weight in the past, my doctors at the time were anxious to know how I was succeeding. One I was doing Nutrisystem (and the doctor asked me if I had a contact number), and once it was after a herniated disk and I was going to TOPS and swimming at the YMCA 3 times a day (well, more like treading water at first, but being in the water was the only thing that took away the pain that the Vicodin couldn't touch).

My doctor now is the same way. When I have success, he's anxious to know how I'm doing it. He is constantly telling me not to get discouraged, which is a breath of fresh air, as I've had many doctors who no matter what I lost between appointments, they acted disappointed and reminded me of how far I still had to go (not very motivating).

I'm at a point in my life now, that if a doctor acted that way to me, I would tell him that his patient communication skills stink, and that if he really wants to motivate patients to lose weight, that isn't the way to do it.

I was raised in a "doctor knows best" era when you did what your doctor recommended, no matter what he recommended. My mother didn't blink, let alone question when my pediatrician prescribed amphetemine diet pills for me at 13. In this day and age, the patient has to be an informed consumer. Some doctors hate that (and they're the doctors to avoid in my opinion).

I've found that most obese pts know that they are obese. Usually they mention it first.
The most common response I get is that I'm dismissed because I'm 'not that big'.

I believe it was Taurie who said "If it's an issue" .... this is a definitely a grey area. So many health problems are either directly or indirectly effected by obesity ... more and counting as research developes. And denial is a huge factor. There are still folks who deny that what and how they eat has anything to do with their health.

I disagree with this. I think that people who have motivation to help other people change should use whatever tools they have in their arsenal to acheive that...for someone that has lost weight previously, they have an additional tool in that they can use that experience as a frame of reference. Other doctors might have other tools (additional nutrition training, for example, or patients they have helped previously that they can get information from or have new patients talk to) that would help their patients in their own weight loss.

The idea that one doctor might have an extra tool that could help some of that doctor's patients lose weight doesn't necessarily mean that doctors without that tool have no right to talk to their patients about weight at all. It just means that, if the doctor WITH that extra tool uses it, he or she might be more successful at acheiving the end goal.

I guess my feeling is that if it is a doctor you see regularly, they should mention your weight once, either when you first see them or when your weight crosses the limit into being dangerous to your health, and depending on your response they should either never mention it again or give you as much info as possible.

I never had a doctor complain about my weight. They have always told me what I weighed when I went in, but never commented on it. On the other hand, at my high weight I was only barely into the "obese" category, I was usually just "overweight." I guess it should be the same for doctors as for parents. Like, if my parents told me once that they were concerned for my health because of my weight, fine. But when they told me repeatedly that I was fat, it just made me not want to talk to them anymore. It's like, okay, I know I'm fat, you already told me, so just shut up now. I feel like doctors should be the same -- tell you it's a problem, but then leave it until you bring it up.

Something funny about how doctors can blame it all on your weight if you're obese . . . I actually had doctors blame my health issues on having LOST weight! :rolleyes: They said I felt cold all the time because I had lost my fat layer, and that my knees hurt as an after-effect of being fat (ignoring the fact that they never hurt when I WAS fat). If I had a hard time losing weight or I gained, it was because I was relapsing. Eventually they figured out it was hypothyroidism! (Well okay, *I* figured it out and demanded a blood test, but same idea.)

I will post in response to midwife's question:

As a healthcare provider of women and as a woman who has recently gotten fit and healthy with weight loss as a factor, I have struggled with many of the same issues as midwife.

In my practice... years ago, I would often not mention the weight issue... what was the point? she knows she is overweight...why make her uncomfortable... Now, however, with what we all know, proven by countless studies, about how extra weight can so markedly impact so many different aspects of health and well being I find I would be remiss if I do not mention weight and potential weight loss as a means to avoid or mitigate many health concerns.

As an overweight provider I felt hypocritical but also less threatening in giving counsel, "I know the battle of the bulge, listen, I live it... but it is my job to inform you of the importance..." Some would hear, some not. And now as a non-overweight provider, I worry about sounding judgemental or flip or glib regarding the benefits of healthy diet and exercise and a normal BMI. I am totally aware of not wanting to tick my patients off. For those who know me, they have witnessed my weight gains and losses over the years. For those who don't, I remind them that weight control and health is a never ending mindfulness. That for most, it is not easy and does indeed take much work. Then I hope they don't turn off.

One last thing. It is surprising how many people are hearing this counsel for the very first time. And their eyes open wide and I know I've been heard. Then we talk about very small changes to start.
:)

I think people and even societies tend to change opinions in a "pendulum" fashion. There was a time when it seemed to me that many if not most doctors "harped" on weight, mostly in a judgemental "lecture" fashion. It didn't work and it alienated patients. Instead of toning down the discussions, they eliminated them. Not really a great strategy either.

I had a boss once tell me that it was refreshing to meet a person (meaning me) that had no "ego." What he meant is that I took criticism extremely well, without any defensiveness or anger (sometimes there was a little anger, I judt didn't show it), and that I was very open about discussing my strengths, weaknesses, and ways to improve my performance.

I don't easily offend easily, if a person is respectful they can tell me just about anything they think I should change, and I will listen and consider the advice seriously. I have never gotten angry with a doctor for bringing up my weight, so long as the didn't do it with a sneer on their face, and an attitude of contempt. You know when a person is disgusted by you, and everyone deserves a doctor that treats them courteously and with respect. When I feel the respect, I can discuss anything with that doctor without taking offense. However, if a doctor lectures me without ever making eyecontact, that draws my attention and colors my judgement more than anything he/she says.

One of my doctors when I was in Illinois, who was trying to be sympathetic and attempting to be knowledgable, gave me the very unhelpful advice, "you could lose a lot of weight just by giving up sweets and desserts. If you want icecream, go and buy a cone, but don't keep icecream in the house."

Sound advice - if I frequently ate sweets or ever kept icecream in the house. I told the doctor that sweets weren't my problem, that I ate a very balanced diet, just way too much of it. I didn't have a problem with eating what I shouldn't, I had a problem stopping when I should.

Apparently his "sweets" advice, was his one trick pony, because he gave me a bit of a blank stare, and had no further advice, and I don't think he believed me. As usual, I brought up my theory that much of my weight issues were hormonal, and I'd like to try stacking the bc to avoid the periods. He advised against it, and as always I dropped the matter.

I think it's ridiculous that doctors, at least those headed for general practice, internal medicine, and ob/gyn, aren't given more education in nutrition, diet therapy, exercise physiology, and bariatric medicine. It seems that ignoring a condition that is becoming more common than not, leaves a very big hole in their education.

Kaplods, your doctor must know my gyn! She has brought up my weight many times, and her advice is always the same, "just eat one or two less slices of bread a day" - huh? How does she know what I eat? I keep going to her for gyn stuff, because I'm more comfortable with a woman, but I've gotten a new pcp who's great. He has much more of a handle on what it takes and better yet - he notices when I've lost!

I agree that your doctor has a responsibility to talk to you about the things being overweight can do to your health, but it should be down with respect, with support, and in a conversation not a lecture. Many many doctors know very little about weight loss/nutrition.