How can some people not get why they are overweight?

[Deb in IA]

I see it too, except with children.


Parent wants to know why their child is fat. I reply, "They are eating too much and moving too little." They say they CAN'T be eating too much. OK, so how much are they eating? Oh, 2 bowls of Cinnamon Toast Crunch (cereal is healthy, you know) with milk (2%, so that's good) for breakfast, a PB & J sandwich for snack, cheese pizza with a salad (salad is healthy), but with tons of ranch dressing, M & M's with chips and juice for snack, and chicken nuggets, mac and cheese, corn with butter for dinner.

Excercise? Changing the channel. Putting in a new CD on the computer.

So, I repeat: They are eating too much, and eating too much fat and sugar, and not moving enough.

But NO!! There MUST be something else. They need a brain scan, thyroid tests, tests for diabetes, one of those diet pills. There must be something WRONG, doctor!!!

 

[piglet too]

I'm overweight and I know tons (put intended) of fat people. Not a single one of them would have such a ridiculous conversation as what he posted.

I for one am inclined to believe that this conversation happened. I recall a couple of years ago I got together with friends and our young kids. My one friend was complaining about not being able to lose the "baby fat" she had left from the twins. Of course, while she was doing this, she was eating a Big Mac that she had brought with her for lunch. She also mentioned her concern for the twins weight as she fed them (at age one) each their own cheeseburger happy meal. There really are people out there who are clueless as to why they are overweight and/or why their cholesteral level and/or blood pressure is so high.

 

[BibbidiBobbidiBOO]

I think portions are out of control! People should realize they can eat what they want in moderation. I bring home about half of what I order in a restaurant-the portions are HUGE. Then that is lunch the next day. I see people getting HUGE subs, rather than the halves or smalls, plus chips! If I want a sub, I get the smallest one and have no sides.

I also think the high protein, low carb faze did a number on people. They think they can have all the steak, bacon, and eggs they want!

I also think many people don't get enough exercise. There is often not enough time or they don't make time. I take 30 mins each day to do this. Other things can take a backseat, but health is important! I work hard to stay in the upper 120's, I'm not quite 5'4", so I could do better myself (the thighs for one!)

edited for typos...

 

[snoopy]

Well what about people who are just naturally fat? Surely there must be some naturally fat people who merely have to look at food and gain weight, just as there are some naturally thin people who can eat everything but the kitchen sink and still be rail thin. Don't genetics play at least a part in the equation? Isn't it possible that the person who claimed to only eat tuna fish everyday had some sort of disorder, or was genetically predisposed to being heavy?

Granted, most people are fat because they eat too much, but being thin is easier for some people than it is for others. I'm 5'10", and while a little overweight, I also can eat a heck of a lot more (and do!) than my girlfriend who is 5'0" and built more stocky. She follows a much healthier diet than I do, yet she has a lot more body fat than I do simply because she a) doesn't have a lot of room to store her weight, and b) has obesity in her family history. Therefore for her to be thin it requires great discipline, where for me, it might just mean cutting back a bit.

Although I do have to say your patient seems a bit dimwitted. Who doesn't know that fried foods, cheese and bacon will make you fat?

 

[Rozzie]

DisneySteve, thanks for your post. Some may think you are exaggerating, I know you are not.
As a nurse, I see this denial upfront everyday. The worst are the diabetic patients. A very common scene for me, on a very typical day.

Me: (after accucheck reading of 389) Wow that is high, what have you had to eat today?
Patient: Just what ya'll have brought me on my trays
Me: Well, I'm going to call your Doc, he might need to adjust your meds
Patient: whatever...
Me: (noticing crumbled up candy bar wrappers underneath bed) did you eat those?
Patient: yeah, why?
Me: they are loaded with sugar! no wonder why you are off
Patient: I am not in prison, I will eat what I want to eat. besides, candy bars are not that bad for you.
Me: (staring at the nonhealing chronic wound ulcer on their foot) It is important to control your diabetes, you have a risk of losing your foot, possibly leg, we really would like to help you...
Patient: take the leg off, I am going to eat what I want to eat.

Sorry for the "our town" script, but I get so mad when I see people choose food over a LIMB! or a heart. I am not modeling bathing suits by no means, but I would like to think I would chose a limb over a cookie. Flame away, but it is very hard to be in a profession to help people when it seems very few people want to help themselves. IT IS the patient's decision I know, but it is still frustrating to see it EVERYDAY. (drug users, drunks etc)

okay, thanks for the vent, I needed that.

 

[Christine]

Steve,
I think it must be very frustrating to deal with this! I think people are just VERY confused about what to eat. I agree with the other poster who said that "it starts at home with the parents." I was lucky that my mom always enjoyed healthy eating--even though she did get overweight at one point. I grew up in my teen years with my mom on Weight Watchers!! Now this is not to say that I don't pick up a few pounds now and again, but I know exactly why that is.

The woman you saw probably thought her bagel was healthy. Wasn't it 20 years ago that a bagel was the healthy breakfast?

My aunt has been VERY overweight for years. Said there was something wrong with her metabolism, etc., even though they could find nothing wrong with her. Then I spent the week with her and saw that she drank a "Coffee Coolatta" every morning from Dunkin Donuts (600 calories maybe?). And then it was a "small hamburger" and a coke for lunch. You get the picture. Yeah, she wasn't eating all day, but what she did it was horrendous.

Don't even get me started on the kids. Many parents are in denial and I'm worried that we've changed our views on how a child should look. Frankly, many of these kids who aren't truly fat these days, look fairly chunky. I was looking at some pictures from my high school days (1980s) and I was shocked in looking back at how thin the kids were then. At the time, I never considered them to be "skinny" but now, with my new "fat glasses" on, they all look like sticks!

 

[piglet too]

I find it distressing that everyone has bought into blaming the "fat" for having high blood pressure and high cholesterol. It's just not true IMHO.

I know several very thin people who eat the most healthy diets you could imagine. They're all plagued by high cholesterol and one recently and suddenly died from a heart attack.
I know several other people who are thin who struggle very much with high blood pressure......in fact when I was at my lowest weight (#112 5'2") I had high bp as well.....

Currently I weigh a full 40 pounds more than the woman you mentioned Steve and my cholesterol is 154.

I've known many fit, rail thin people who have diabetes as well. I'm just not buying that the fat as why people get these illnesses.

I've seen too many variations to blame fat for the ailments human beings suffer with.

I'm glad you care about your patients but personally I stopped going to one of my doctors who's only concern was that my broken ankle hadn't healed because I was fat. Turns out he was wrong and they should have put a pin in the ankle......the healing had nothing to do with my weight but that's all he could focus on. That's an obsession on his part and it wasn't helpful to the patient at all.

Add me to the "thin yet not healthy" group. About 10 years ago, my doctor told me I was too thin (5 foot 7 inches and at that time 115 pounds) so he encourage me to eat fast food, and a lot of it, to try and fatten me up. Well, surprise, surprise, my cholesteral was very high when he did blood test a year later to try and figure out why, despite eating a lot of calories, I had only gained 3 pounds. After switching to another doctor, I was able to get the cholesteral under control by eating better. (BTW ~ I have had three kids and now weigh 25-30 pounds more, yet eat better then I did when I was young. My cholesteral is still a tad high, yet still falls within the normal range.) My DH is about 50 pounds overweight, yet his cholesteral level is low and his blood pressure is "perfect" as his doctor puts it.

 

[DisMN]

To the young lady who says she thinks about her weight 90% of the time......oh honey, please, live your beautiful life! Live, love, play, enjoy the sunshine...

My father died thin but with the concept that he was fat. I grew up with a father who obsessed about his "fat" body......even when it wasn't fat. He hated himself. Yes, hated.

IMHO this obsession about fat has probably caused a lot of people to gain weight. Or more accurately, the obsession that we all have to be thin to be acceptable...has caused people to gain weight.

 

[SunFloridaDisney]

Wow, lots of thought-provoking comments today.

Steve, it must be frustrating from your position, and wanting to help, when people are unwilling and/or unable to help themselves.

I have to agree with Rachie, learning good eating habits is the most important thing, along with the desire to be healthy.

I grew up with not the best education about foods, not the worst either. I was always kind of a chubby kid, but did ok through hs and college. But once I had my 4 kids, I put on (kept on) 10 or 20 with each one.

Finally about 3 years ago, I was motivated to look better, but to feel better as well. I started Weight Watchers, and the most important thing I got was more information about not only portion control, but what to eat, and how to make better food choices.

Now after losing 50 lbs and getting to a place where I look and feel so much better, I never want to lose these good habits.

It certainly isn't easy, though, and I agree that denial is a big part of the failure factor. Food can be as (mentally) addictive as alcohol, which is another thing that can seem impossible to quit, but it can be done. (I've been there too!)

carry on!

 

[denisenh]

Before you get out the flamethrowers, let me say that I understand many people battle with their weight. Losing weight and keeping it off requires an ongoing effort and isn't a simple task. But you can't turn on the news or open a magazine without seeing stories about the obesity epidemic in this country and what people can change to address their own weight problems. I'd like to think that folks who are obese have at least a general idea of what they are doing wrong, but that simply isn't the case in my experience.

Here is an actual conversation I had just yesterday with a woman who is 5'2", 188 pounds and has high blood pressure and high cholesterol as well as pre-diabetes.

Me: Your weight is probably a factor in the health problems you have. Tell me about your diet. What do you eat for breakfast?
Her: I don't know why I'm so heavy. I really don't eat much. All I have for breakfast every day is a bacon, egg and cheese bagel sandwich and coffee.
Me: Well, that's a very high fat, high calorie meal. What about lunch?
Her: We usually order out. I'll get an Italian hoagie or a cheesesteak or something like that.
Me: Well, how about dinner?
Her: We'll have steak and potato or fried chicken or fried fish.
Me: What about snacks or desserts during the day?
Her: I like chips or cookies or ice cream.

This woman seemed shocked when I explained how poor her diet was. As far as she was concerned, she wasn't doing anything wrong and was just unexplainably getting fat. So is this just plain old denial or is the message really not getting out? What can we, as a society, do better to teach the public about proper diet and nutrition? Many times, I've told a parent that her child is significantly overweight - 30 or 50 or 100 pounds so - only to have mom laugh at me. How can I get through to someone who finds that so amusing?

Sorry if I sound frustrated, but it just upsets me to see people suffering from so many medical problems that are all attributable to their weight but, at the same time, making no effort to do anything about it and sometimes even denying that a problem exists.

Curious to hear your thoughts, whether weight is an issue for you or not.

I think it is time for you to hang up the black bag and look for a new occupation. (That's my thought)

 

[Christine]

I think it is time for you to hang up the black bag and look for a new occupation. (That's my thought)

Really?? I think Disneysteve sounds like a wonderful doctor and very concerned about his patients. I wish I could find a doctor that was actually moved/disturbed by some of their patient's lifestyles. Sometimes, I think mine doesn't give a hoot!

 

[denisenh]

Really?? I think Disneysteve sounds like a wonderful doctor and very concerned about his patients. I wish I could find a doctor that was actually moved/disturbed by some of their patient's lifestyles. Sometimes, I think mine doesn't give a hoot!

Yes, really. That's what I really think.

 

[Saphire]

I find it distressing that everyone has bought into blaming the "fat" for having high blood pressure and high cholesterol. It's just not true IMHO.

While there are always exceptions, it is generally true that being fat puts you at great risk for high blood pressure and cholesterol, diabetes, joint problems (especially arthritic knees), problems with breathing, sleeping, heartburn, acid reflux and more. New studies have shown that being overweight increases your risk of cancer. In all the thousands of people I have treated, I have never, ever treated an elderly person (over 75) who was obese. They just don't make it to old age.
I do think that schools are doing a better job at educating about nutrition, and I know that doctors being trained now will be advising their overweight patients with a much more aggressive approach.

 

[CEDmom]

I think it is time for you to hang up the black bag and look for a new occupation. (That's my thought)

I don't think he needs a new occupation and I do think for the majority of people being extremely overweight is mostly of their own doing. I'm not talking about someone who could stand to lose 10 lbs but is overwise healthy. I'm talking about the people who medically can classified as obese. I do have to agree with other posters who pointed out that excess weight is not the sole cause of high blood pressure, high cholesterol or diabetes. These conditions have genetic links and some people are just predisposed to them regardless of weight. However, weight causes muscular and skeletal problems even if all other markers are w/i normal range. I also agree that some people are naturally larger than others no matter how healthy they eat or how much they exercise. However, even taking this factor into consideration it doesn't account for the high rate of obesity in our country.

 

[disneysteve]

I didn't understand what good eating habits were until I joined Weight Watchers for the first time.

This is a good point. I often recommend Weight Watchers to my patients. I think WW is a very good program and is the only commercial program that actually teaches people how to eat properly.

 

[Rachie0507]

Really?? I think Disneysteve sounds like a wonderful doctor and very concerned about his patients. I wish I could find a doctor that was actually moved/disturbed by some of their patient's lifestyles. Sometimes, I think mine doesn't give a hoot!

I agree. I talked with my doctor at my check up over a year ago about my desire to lose weight. At that point I had about 90 lbs to lose. She had NO ADVICE. She kind of laughed it off. This year, she was so happy about the fact that I had lost 10 pounds. What about the other 80lbs!! I was just looking for some advice and motivation. I think if she had even acknowledged that this was a medical concern for me I would have been more motivated. I have lost another 30 lbs since then, so I am on my way, but with no help from her. I wish I had a doctor like Steve.

 

[DawnCt1]

Sadly, it isn't exaggerated at all. And yes, I am a physician and could tell you dozens of stories just like this. I had a patient a few years ago who insisted that all she ate every day was a can of tuna fish, plain right from the can, at lunchtime. She denied eating breakfast or dinner or any other snacks during the day. Her husband even was in the room and agreed with her. I tried to explain that she couldn't possibly be surviving and continuing to gain weight if she was only consuming 500 calories per day and there was really no helpful advice I could give her. Denial is an incredibly powerful thing.

It's like the tree falling in the woods. If no one see it, it didn't happen or didn't get eaten.

 

[Wish I lived in Fl]

IF food advertisers spend 2 billion a year to advertise processed and fast foods and the FDA spends 500 k to advertise portion control and nutrition, whose message is getting across to the public? The patient really thinks her eating is normal and anything less is abnormal.
Center for Science in the Public Interest (CSPI) publishes a great "Nutrition Action" nesletter. It would be great reading for the waiting room.
It exposes the tricks on the package. A quick glance might tell you the calories,fat and protein per serving. But a second look might reveal 2 1/2 servings per small bag of chips that will be purchased and eaten by one.
Nutrition Action tells you what you should be eating. Last issue said limit sweets to less than 5 servings a week. That was a surprise to me. We grew up with dessert everynight.
I used to eat a bagel with cream cheese for a breakfast i could eat while commuting. Then food labeling was increased and I found out it was only 2 grams of protein in the cream cheese.
I never took up drinking soda (even though the waiters sneer at me) because i had read that each can contained 12 teaspoons of sugar. The idea of putting that much sugar in a glass of water was gagmaking.
SO the patients need better info, they don't even know what they don't know about nutrition and portion control.

As for the kids, if they have a xbox or playstation they can add Dance Dance Revolution game and dancepad and get some exercise.

Good luck with helping lead your patients to healthier lives.

 

[Lisa loves Pooh]

I think a lot of people could control their weight if they wanted to. But I also think that some people try their hardest and people still say that they are fat or whatever. I used to have an eating disorder in high school. I went 2 1/2 weeks without eating once. I only drank water. I never have weighed under 130 lbs. Now I'm on a lot of different medications for depression and anxiety as well as thyroid disease, birth control and others and it has made me gain a lot of weight.

I will ask my doctors what is wrong with me and they tell me to cut my portions. Well I don't drink soft drinks, I only eat two small meals a day that are low fat or low calorie, I count both and no snacks. But of course no one will beleive me. Worrying about my weight is something that I am totally obsessed with and probably spend 90% of my days thinking about it.

But I don't fit into what is "pretty". I must look like I've really "let myself go". I must "not try" Even though I work out at the gym 4-5 days a week. Why don't
"I get" why I am fat? Wow what I loser I must be.

Alright go ahead tell me what is wrong with me, or think that I am lying or whatever. Everyone else does. It's so easy to criticize when you aren't living in this body.

In your case--dare I say it...you probably aren't eating enough. Even if they were 500 calorie meals (pretty big meal)--1000 calories is toooo low. In your case--I would say your body thinks it is starving and has made accomodations for that.

 

[Crankyshank]

It's not just laziness or medical issues that causes people to gain or have difficulty losing weight. I know very few people with weight issues, myself included, that don't have a lot of emotional and self esteem issues that go hand in hand with weight gain.

Sure I have a large frame, gained weight due to medication, and have difficulty losing due to hypothyroidism, but a big reason why I gained was due to lack of education about proper nutrition (I was told what and when to eat - I wasn't allowed to make the decision for myself) and because food was the rope in a psychological tug of war between me and my Mother. Psychological issues associated with food are extremely hard to deal with. Even worse than quitting smoking because you need to eat.

For those of you that are Dr's that are seeing patients that are overweight. I hope you're not berating your patients because of their weight because I can tell you from personal experience that it has the negative effect. I also hope you're looking further than the veneer because there's a very good possibility your patient is depressed and those chips and ice cream he/she is eating is because of emotional eating and not just laziness.