Oh Altari I totally agree some doctors have terrible attitudes- assuming error isn't cool- I mean if you test twice and it's the same then trust the test!
I have had some horrible doctors in the past tell me DUH things to lose weight that really upset me. I've had the "just drink water"- uh YEAH- that's the ONLY thing I drink... "Don't eat sweets like cake and candy" yeah I don't do that- I don't even like cake!
Before I was diagnosed with PCOS one doctor basically flat out told me I was lying about my diet when I showed her my log. I tried telling her there is something wrong with me (I was counting 1200-1300 cal's a day and STILL gaining- now I realize I ate a lot of carbs) but she refused to listen. Finally I changed doctors and she took ONE look at me and said "I am very sure you have PCOS." *sigh*
ETA: How do you know they are using the wrong cuff size? I feel mine is uncomfortably tight when they do it and my doctor just put me on HBP meds.
The BP cuff will normally be uncomfortably tight when inflated, especially if your blood pressure is high. It has to be inflated high enough to cut off flow - and that being uncomfortable is a good thing
Saying you are overweight but in good health is an untruth. I'm overweight and I can say it isn't healthy although I don't have closterol, bp, issues. Just because they haven't showed up, doesn't mean they aren't looming. Being overweight is hard on the body.
I just wanted to add that I agree, those of us who are morbidley obese are not healthy. How we got here is one story - how we lose it is another - and it's a much harder one, but even if we're comparatively healthy, we're definitely on our way to bigger problems.
I don't object to being told I'm fat, or that I need to do this, this and this to lose the weight. I object to being disregarded and ignored while someone assumes they know better than me. This is MY body and if I feel there's something wrong, I'd like someone to at least look in to it for me. If it is that I'm fat, then fine, thank you for checking.
I don't want to be fat, and I'm working on it, day by day. But I also know that obesity is a factor in the risk for cancer. As a woman who's family is riddled with cancer, I know that my risks are increased exponentially. The weight will come off, eventually, but in the meantime do I ignore possible health issues until the day when my weight magically makes me perfect again?
I think that healthcare providers need to be more sensitive to the needs of the obese. If they think that judging and condemning us will help, they obviously haven't any idea how much we judge and condemn ourselves. Just tell us what's going on..what they think, and why they think it. Tell us why it's difficult to do the testing, make us partners in our health care.
I'm fat....I'm not stupid, or suicidal or masochistic...I'm a work in progress, and if I'm treated as an equal, then I'm much better able to feel confident in my own health and the care provided me.
I think many posters in here have taken what I originally said to a logically conclusion it wasn't meant for. If this comes across as hostile, don't take it that way. I get pretty passionate about certain things (this being one of them) and have been told I come across as aggressive when I'm passionate. I am honestly writing this with a light spirit and cordial tone.
First, I have read more and more studies which come to the conclusion that obesity, in and of itself, is not a condition (in most cases, see note later). It is a side effect of poor diet and exercise, just like high blood pressure, cholesterol, diabetes and liver/kidney problems are usually side effects of the same. A 120 pound woman who eats ho-hos and ding-dongs all day may not gain weight due to a great metabolism, but it will eventually catch up to her.
Unfortunately, my husband is this way. He eats about 5,000 calories a day of not-the-best food but stays thin as a rail. On the rare occasion he goes to the doctor, they never run tests. Why? He's thin and looks to be in general good health. He has no idea what his blood sugar, cholesterol or liver functions are. No one has ever tested him. He's 24, thin, muscular and has a slightly-high BP. They listen to his chest, knock on his knees and send him away. Never once do they discuss his diet!
Now, contrast that to my usual office visit. Disapproving head shake at the scale. Repeated blood pressure testing. Suggestions for unnecessary blood work (unnecessary because I've probably already had it that year!) and comments about what my weight is going to do to my health. If I've lost weight, I get a sigh and a reminder to keep it up!
Again...do we ever discuss diet and lifestyle?
Yes, the extra weight can cause complications down the road. If I'd needed a c-section, it would have been tricky with the extra flub. Ultrasounds were harder. Over the long term, the extra weight will cause knee, back and hip problems, and may even contribute to breast cancer with the extra estrogen. In all of these, being "fat" is the reason. You can be overweight and in otherwise good health, but have terrible knees from carrying around even just 20 extra pounds.
But, that wasn't my point. My point was that, at this moment, I'm in good health. It isn't denial to say that it's rude and unprofessional for health care providers to insist the test "must be wrong" because I'm carrying extra weight. They haven't looked at my diet and my lifestyle. It's ridiculous. Just as ridiculous as assuming my thin husband has good cholesterol because he's young and...what?...THIN. IMO, it's bad medicine. The body operates on what you put in it. My 140 pound husband is operating on on-the-go Chicago food - refined carbs, sugary drinks and caffeine. Health care providers should also look at that factor before making sweeping statements, since we now know health is more than just a numbers-from-the-lab game.
In regards to diabetes, I'm hypoinsulenic hypoglycemic (sp?). I am in constant fear that, if I don't control it with diet, I'll burn out my pancreas and become insulin-dependent. I also know that excess fat excretes hormones which affect metabolism, but, once again, the fact that I'm overweight is not the cause. Contributing factor? Yes. Root cause? No. I'd be in the position even if I didn't have an ounce of fat on my body. Genetics, diet and exercise play an equal role.
Anyway, if that made any sense, that was my point.
((Oh, and I'm happy to announce that I have 1 less pound of estrogen releasing fat on my body today. Huzzah!))
Yes, but on the flip side when I was merely overweight but not obese and under 40...
I have had borderline high cholesterol since I was 21(work screening, not in my medical charts), I have a family history of VERY high cholesterol. But since I was NOT obese, I couldnt get insurance to pay for routine cholesterol screenings without a fight.
I have a high family history of diabetes. My blood sugar tests were always borderline but.....again, too young, too "thin" to be tested regularly. I had gestational diabetes which makes my likelihood of developing diabetes MUCH higher. Still had to argue to get screened EVEN when I was borderline obese. Still do.
Family history of hypothyroidism. Struggling with weight regain but since I am trying to deal withit at 140 lbs instead of 180....you guessed it had to argue a bit to get my thyroid checked. (guess what!)
In someways it is a blessing to be nearing 40 since these tests will be "allowable". As long as my numbers remained borderline, no one thought I needed to check to make sure they remained borderline.
Insulin resistant, but until i fall off the cliff to diabetes no referral for nutritional counseling or to an endocrinologist. Heavy friend got that referral with much lower numbers as a preventative measure.
and to further the OP feelings. My friend who is obese was having bad sudden onset of joint pain, body aches etc. They just told her to lose weight and wouldnt run any tests. She has Rheumatoid arthritis and had ALL the risk factors but was ignored because she was obese. She missed a year of treatment and with RA treatment time lost is joint degeneration that can never be recaptured.
The BP cuff will normally be uncomfortably tight when inflated, especially if your blood pressure is high. It has to be inflated high enough to cut off flow - and that being uncomfortable is a good thing
Yep, uncomfortable is normal, pain is not. My arm circumference is off the chart - 22" (and that's currently, at my highest weight, it was 23.5") - far too large for a standard cuff, yet that's all that was available in most offices even 10 years ago. I still run into it occasionally.
and to further the OP feelings. My friend who is obese was having bad sudden onset of joint pain, body aches etc. They just told her to lose weight and wouldnt run any tests. She has Rheumatoid arthritis and had ALL the risk factors but was ignored because she was obese. She missed a year of treatment and with RA treatment time lost is joint degeneration that can never be recaptured.
This is what I faced, when I started having mystery symptoms that I knew were abnormal, but every doctor I saw (in Illinois) attributed the symptoms to obesity, and dismissed my concerns. They would refused to do any tests or provide any treatment, just advise "lose weight." Others would prescribe drugs (but again, no diagnostic tests).
I ASKED for a CT scan of my sinuses (based on the suggestion of an ER doctor), and was actually LAUGHED at by my gp. About 2.5 years later after moving to Wisconsin, my ENT ordered an MRI of my sinuses - one I did not ask for, but he felt the symptoms warranted - and found a large fungal mass growing in my sinuses. He said it had been there at least two years, probably much longer. He wasn't able to culture the fungal ball, so that tended to rule out the really nasties (he said though that it was consistent with autoimmune disease, the body is so busy fighting itself, it misses invaders like fungi).
It took years of complaining before doctors found an autoimmune disease destroying my sinuses and connective tissue (probably by attacking small blood vessels). I understand that autoimmune disease symptoms are even difficult to detect in slim patients, because the early symptoms are so generic and nondescript until damage is being done - but the frustration in KNOWING that something is seriously wrong and doctors are dismissing you as a hypochondriac is beyond frustrating.
So while I can appreciate that my obesity can obscure test results, and make diagnosis more difficult - the dismissiveness and oversights of doctors I trusted makes me insanely angry. For example, I was told that I developed asthma because of my weight, only to find out it was an NSAID sensitivity (a fairly common reaction). Instead of suggesting I go off the NSAIDs and see it if relieved the asthma symptoms, I was just given stronger and stronger asthma meds over the ten years I was on NSAIDs. Only being unable to afford even OTC ibuprofen, and having to go off NSAIDS until payday, did I discover the interaction. I suddenly and dramatically found myself able to breath - when I told my doctor, he said it was not an uncommon problem (so why wasn't I told).
In general, my medical care in North Central Wisconsin has been astonishingly better. I've received more respect and open communication with my doctors here. And it's not because they keep their mouth shut about my weight. The opposite is true - it's discussed, but not ignored or dismissed as a cause to all my problems. I've had some doctors, I swear who would find a way to blame my weight if I walked in with a dagger in my eye.
I always bring up my weight FIRST in any appointment with any new doctor. I tell him/her what I'm doing to lose weight, and if they have any better ideas I'd be glad to hear them. I also say "I know losing weight will likely help, but we've got to treat the body I have today, not the one I may have in two years, or even six months."
I have three doctors now, My GP, my ENT, and my neurologist. I trust them, but I don't trust them to know everything. With autoimmune disease, most doctors aren't very knowledgeable. Patients often have to educate themselves first and then their doctor (and finding a doctor willing to BE educated by a patient, is a very rare thing), but I still have some lingering resentment over the years I went undiagnosed because doctors only saw the fat and not the patient underneath it.
Oh, kaplods, that's terrible! Apparently, docs here in Illinois suck. I'm very happy you found better treatment behind the Cheddar Curtain.
I went through a similar, but much less severe, thing with my gallbladder. Doctor after doctor chalked my severe abdominal pain up to IBS - something "common in someone your size" - and put me on all sorts of medications to handle it. It wasn't until I was in the ER, with yellow skin, eyes and gums that someone thought, "Hey, let's check her liver!"
Had the docs listened in the first place and accepted that the pain was my only symptom of IBS, that I wasn't under-reporting other symptoms, maybe they could have caught the gallbladder before my liver began shutting down. Or, even, before I spent three weeks with nothing but water and plain soda crackers, writhing in pain every night with no sleep. Or, better yet, before I lost the first 2 months of my daughter's life because I was too preoccupied with the consistent, burning pain in my gut.
This is MY body and if I feel there's something wrong, I'd like someone to at least look in to it for me. If it is that I'm fat, then fine, thank you for checking..
Havisham, your story is very interesting and instructive and there is a lot of truth in it.
You might find it interesting to learn that there is good scientific data indicating that women's estimate of their own baby's size during pregnancy is MORE accurate that getting an ultrasound done.
In other words, if a health care provider doesn't listen when a pregnant mom says "I think my baby is really big" then that health care provider isn't just failing to listen, he or she is also not following the best available scientific evidence.
I think many health care providers are not as good listeners as they should be, and I think they are lazy and short-sighted if they provide less thorough care to obese people on the principle that weight causes every ill.
I think a lot of the failure stems from their feeling of helplessness. Obesity causes many health problems, but they don't feel like they have good tools available to help them help their patients fight obesity.
I guess I have a special interest in this topic because I see it from both sides-- provider and obese patient.
You might find it interesting to learn that there is good scientific data indicating that women's estimate of their own baby's size during pregnancy is MORE accurate that getting an ultrasound done.
I can say from anecdotal experience, this is so true! I guessed my son would be 8 pounds 10 ounces, the ultrasound said he would just barely break 7 pounds. He was 8 pounds 15 ounces at birth.
Women are very very good at saying "this kid is huge!" or "eh, he's just floatin' around in there."
Havisham, your story is very interesting and instructive and there is a lot of truth in it.
You might find it interesting to learn that there is good scientific data indicating that women's estimate of their own baby's size during pregnancy is MORE accurate that getting an ultrasound done.
In other words, if a health care provider doesn't listen when a pregnant mom says "I think my baby is really big" then that health care provider isn't just failing to listen, he or she is also not following the best available scientific evidence.
I think many health care providers are not as good listeners as they should be, and I think they are lazy and short-sighted if they provide less thorough care to obese people on the principle that weight causes every ill.
I think a lot of the failure stems from their feeling of helplessness. Obesity causes many health problems, but they don't feel like they have good tools available to help them help their patients fight obesity.
I guess I have a special interest in this topic because I see it from both sides-- provider and obese patient.
Thanks, Ubergirl, it's something I found out the hard way. For the last six weeks or so of the pregnancy I couldn't move with pelvic separation and my GP (who was shortly thereafter made head of Ob in our local hospital) just kept telling me it was normal and telling me to take tylenol 3....which I wasn't about to do. I couldn't turn over in bed, couldn't get out of the bath, out of a chair, in the end my husband rolled my pj pants down to the floor - you know like you do for little kids - and I couldn't lift my leg high enough to step in to them.
This same doctor then came in for the delivery - when it was apparent that my son was stuck in the birth canal (huge shoulders - neither of my boys was fat, just really long) they had nurses pushing and pulling....and ultimately broke his collar bone to get him out. Almost 14 hours later I stopped a nurse and said that something was wrong - he was looking at me desperately. God bless her - she told the trainee with her, if a mom says there's something wrong, there's probably something wrong. Turns out they'd punctured his lung during the delivery and hadn't realised. If I hadn't found a nurse willing to listen - like my dr wouldn't - he'd have died.
My doctor (who complained that he had to stitch in the middle of the night when he thought it would be an easy birth) said that with babies that big, they often don't make it because they get stuck and suffocate.
All long and boring - but ultimately, he dismissed my feelings and concerns because I was obese. Because he messed up the measurements and told me I was over reacting, and after a 10 10 baby, I could do 11lbs 'easily', he nearly cost me my son.
I know I'm not healthy - and I want to lose the weight. But there needs to be more education for health care providers - and I know they're only human...but there needs to be at least a willingness to remain open minded. Sounds like you have a unique perspective, and I'm sure your patients benefit from that.
As Americans get fatter, so do American doctors, and I think sadly that may actually be a lifesaver in the long run. When doctors don't suffer from the same complaints they treat, they often lack compassion. Before women doctors, women's doctors often ignored or dismissed "female complaints," as primarily "hysterical." I truly believe that because men didn't suffer from PMS, and menstrual cramps, many of them believed those conditions only
existed in the minds of women with nothing better to occupy their time.
My family physician is slightly overweight - not obese, but he has some health issues for which weight loss would benefit. He's tried - and failed to lose weight repeatedly, and "huh, what do you know?" he's the most sympathetic, encouraging, yet realistic physician I've ever met. He admits it's hard, and he admits he doesn't have all of the answers.
Two doctors can give the exact same advice, but it's alot easier to hear from someone who says "I know it's hard, I'm trying too and not always successfully," than a doctor who treats you like an imbecile when you find putting his advice into practice isn't as easily as HE had hoped, and treats you like an inconvenience. If a doctor acts OFFENDED to see a patient (and I have had that experience), there are a lot of patients who won't come back - and not only may not return to that particular doctor, but may refuse to seek medical treatment in the future.
