How can some people not get why they are overweight?

[disneysteve]

I hesitated to start this thread because I didn't want people to think I was criticizing or blaming people for being overweight. That truly wasn't my point. As I've said, I respect and work with folks who are trying to improve their lifestyles and develop healthier habits whether it be diet, exercise or just taking their meds as they should.

I started this thread, rather, to get some input on dealing with people who aren't addressing their weight, people who may not even see their weight as a medical issue. Sometimes I'm just not sure how to attempt to get through to some of these patients.

Despite some flames, I appreciate all of your responses. I think some excellent points have been made. There is no one plan that will work for everyone. Genetics, lifestyle, diet, exercise all play a part as do other diseases like diabetes, thyroid problems, etc.

I definitely agree that portion sizes have gotten ridiculous. Many a time DW and I go out to dinner to a regular sit-down restaurant, not a fast food or chain place. She and I will share one appetizer and one entree and still have enough leftover to bring home for one of us to eat for lunch the next day. There is no reason they need to serve that much food.

I also agree that physical activity, or lack of it, is part of the problem. Schools have cut phys ed as several of you pointed out. It should be a daily class, not once a week. And home ec, or whatever they want to call it now, should be taught including nutrition, shopping, cooking, label reading, etc.

And someone mentioned that there are often emotional issues like depression underlying weight problems. That is also true and something we, as doctors, need to be more aware of and delve into rather than just handing the patient a diet sheet and sending them on their way.

DisDuck - I think seeing a nutritionist is a great idea. When the patient is agreeable AND the insurance company will cover it, I do that. Unfortunately, many plans don't provide that coverage and my patients can't afford to do it on their own.

Shugardrawers - Thanks for your post. You made some great points.

 

[disneysteve]

duplicate post

 

[disneymom3]

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I also find it very interesting to watch a group of children at a party. The skinny kids can take or leave food, but the heavy kids are drawn to the food--they seem to really be drawn into eating. These are young kids, so I know that little secondary gains are gotten from eating, but there is something in their make up that makes them need food more than other children.

I see that too and it worries me. I see it among my own children who have vastly different eating habits and have grown up in the same house. My boys are only 19 months apart and couldn't be more different in the way they eat. DS5 will ask for water with a meal and he prefers it over anything else when he is really thirsty. DS3 on the otherhand would cry and ask for juice every other minute if he thought it would do any good. Today we went to the store and for a "very special treat" I let them each pick out a donut. For lunch, I served them half of their donuts, strawberries and mini pitas with turkey. Also had hummus and celery. First DS3 cried because I gave him half of the donut instead of the whole thing. (I had told them in the store they could have half) then he cried because he thought the water in his glass was going to be juice. (Bummer dude! Never in his LIFE has he had juice at lunch time!) As the meal went on and I noticed that DS5 had finished his strawberries and asked if he would like more. He looked at his donut, more than half of which was still on his plate and said, "Yeah, I think I will just throw that donut away and have strawberries. And can I have more celery please?" When lunch was done, DS3 had eaten a little more than half of his half of a donut. Part of his mini pita sandwich adn two bites of one strawberry. No hummus and no celery. DD8 on the otherhand, ate two strawberies, lots of hummus, one mini pita sandwich and two carrots.

Now, don't worry donuts are not a common lunch item around here, but it would be like that no matter what. The little one loves junk food, the middle one abhors it and the oldest is a pretty decent balance of all of it. However, they are all the same % weight as height on the growth charts.

Personally, I don't get it. DH eats poptarts for breakfast every morning, and an entire frozen pizza for his evening "snack" and is bumming because he has lost 5 lbs recently and thinks he is now too skinny. Yeah, if only I had that problem.

And Steve, I have to say, I think it was a lapse in judgement to post this conversation. I think you shold delete it and just give a general description of the problem.

 

[Storminator]

I don't think there's a fat person alive who would say, "I know I'm fat but it can't be because of the cookies, candy, and chips."

We aren't stupid. I think 99% of us know what we should be eating. I'd also say a good 50% of fat people avoid the doctor because of condescending attitudes and the notion that many doctors have that every issue we face is because of our weight. Sometimes it is, but sometimes it isn't and it would be nice to just once have a cold and not be told that my resistance is lower because of my weight.

I also think it is in very poor taste for a doctor to in effect make fun of a patient on a public forum.

 

[Microcell]

Disney Steve- I understand working in a Dr.'s office that the problems people come in with and some of the things they say are amusing or annoying, but I hope no one in your care sees you venting on this board. I don't ever vent about work here for fear of that very thing. I never give many details about who I work with, etc...

About your post, I for one feel that I am very un educated on how to diet. I understand the basics, but wonder if I need to have different diets for me with high cholesterol and DH with his high blood pressure. I think it would be nice for a doc to give brochures with resources of where I can get answers.

 

[Wishing on a star]

edited to add: WOW! DisneySteve, I was typing this as you posted your last response... and, how similar could they be!!!

I agree that to some people, they truly do have a skewed perception of what 'normal' and 'healthy' is. Our perception is based on what we see every day. And, I know what I see every day. McDonalds, huge servings of food, etc...

But what I REALLY want to throw in here is that, I truly do not believe that we have skimmed the surface when it comes to the knowledge and science of eating, body weight, etc... Just think of all the factors that are out there, like Genetics, Thyroid, Diabetes, Insulin Resistance, Low Carb, High Fat, and throw in the Psychological/Emotional issues, etc..... And, we are just skimming the surface of these kinds of things.

Just this morning, on GMA, I saw the update story on the girl who was actually taken from her parents as a toddler due to excessive obesity. This girl was returned to her parents. He parents are acutely aware of the health risks that she faces, and are trying to see that she eats healthy. Yet, this girl continues to become even more excessively obese. It was mentioned on this story that this girl has Native American heritage. And these problems plague this ethnic group, and nobody seems to have an answer.

I would hope that a Doctor would show more respect and to help to find answers, instead of thowing out negative pre-judgements. I would be tempted to blow-off a person who I felt may have this attitude. A doctor is not God. I mean, taking a "You are a moron, stop eating" approach is just not the way to go.

Also, a busy physician, in my opinion, simply does not have time to adequately address this area. I mean, when somebody is sitting there with a broken ankle, or strep throat, or even diabetes or high blood pressure and cholesterol, there is just not enough time to adequately cover diet-excercise-emotional/psychological issues, etc..... I am thinking that in this situation, I would run some rudimentary tests, and if needed, refer this patient to a specialized clinic for nutrition/weight/etc.... In other words, there is no quick pill to address this issue. Unfortunately, there simply is not! This type of problem requires a lengthy and coordinated effort. If I suspected that I had a patient with Parkinson's, Leukemia, or any other serious problem that required ongoing treatment and therapy, the first thing I would do is hand them some basic information and refer them to a specialist.

 

[disneysteve]

Just this morning, on GMA, I saw the update story on the girl who was actually taken from her parents as a toddler due to excessive obesity. This girl was returned to her parents. He parents are acutely aware of the health risks that she faces, and are trying to see that she eats healthy. Yet, this girl continues to become even more excessively obese. It was mentioned on this story that this girl has Native American heritage. And these problems plague this ethnic group, and nobody seems to have an answer.

I saw that and thought it was very interesting. It is true that Latinos and Native Americans are much more prone to obesity and no one knows why.

The other thing the doctor said this AM was that this girl would be overweight even if she was born 2 decades ago but is much more obese today due to societal changes, processed foods, lower activity levels, etc. So there are definitely genetic issues but there are modifiable lifestyle issues too.

 

[C.Ann]

I think at least some of the problems are learned behavior, as well as the way society views food in general..

I know of a lovely couple who have two adorable grandchildren.. The grandparents are quite obese - and have been for all the years I've known them.. Everything they do in their lives somehow centers around food - every trip they take; every meeting they attend; every church function; every get together at their home; etc.. When they take a trip anywhere and you ask how it was, they immediately proceed to tell you every restaurant they went to, every bit of food they ate, and whether the portions were large or small.. It almost seems like an obsession - the continual discussion of food.. Sad to say, due to family problems, they have practically raised the two granddaughters on their own and the kids are now obese too.. (One is 9 and the other is 5..) The grandfather recently had a stent inserted in his heart, has a serious kidney problem that needs futher testing but can't be performed due to his body mass, is diabetic now, and had a cut on his leg that nearly required amputation last winter because it wouldn't heal.. The grandmother is diabetic now too - and neither of them are even 60 years old yet..

Another couple that occasionally comes up here to the lake to visit (they live about 50 minutes away) can not make the trip up here without packing sandwiches, snacks and beverages to have on the way.. Oddly enough, even if they're running to Walmart - about ten minutes from their home - they'll grab something to eat on their way out of the house..

I was thinking about these weight issues on my last two trips to Florida and was amazed at how many people were eating on a two and a half-hour flight and how much they were eating.. Of course I don't know their stories - maybe they were making connecting flights and hadn't eaten lunch or dinner yet - but it just seemed that no matter where I looked, people were eating..

Somewhere along the line, people were brainwashed into thinking that they have to eat all of the time and the more food at a social gathering, the more successful it will be.. Ask any hostess what her biggest fear is and 9 times out of ten she will say, "I'm afraid I didn't make enough food.."

My biggest concern though is the children.. I see SO many overweight and obese children these days, it scares the wits out of me.. If we don't get a handle on this, we're going to have a whole bunch of twenty-somethings dropping dead left and right from weight related health issues.. I think a good place to start would be in the schools.. Get the darn candy/soda/junk machines out of there - scrap the popular "junk" food menus - and serve the kids REAL food.. (I worked in a school cafeteria and basically what was served to these kids was junk - no getting around it..) The schools claim that they use these menus and make these offerings because if they don't, "the kids won't eat.." Well - good.. They would be better off not eating that meal.. They're not going to drop dead from skipping lunch..

Then get the kids outside playing in the fresh air (away from the t.v., computers & video games).. Get them walking - everywhere that is within walking distance and safe for them to walk to.. And for gosh sakes, don't pack them a "snack" to take on the walk with them.. I really, really fear for these kids..

As for the adults, only they can decide what they do or don't want to do - and it's not up to you or me to make that decision for them.. But please - let's keep the kids healthy and fit so they can live long, happy lives...

 

[Sandy22]

For those of you wishing you had a doctor like Steve, would you feel the same if you recognized him from his photo as your doctor, and the patient whose information he was freely sharing on a public message board was you?

Wow - people are cranky today!

He's probably paraphrasing a conversation and might have substituted certain things to protect his patient's anonimaty. I guess some people just rather assume the worst all the time.

Great topic Steve! My doctor knows nothing about nutrition and never talks about it. I think many obsese persons are addicted to food. Part of their treatment should include addiction counselling.

 

[Christine]

Wow - people are cranky today!

He's probably paraphrasing a conversation and might have substituted certain things to protect his patient's anonimaty. I guess some people just rather assume the worst all the time.

Great topic Steve! My doctor knows nothing about nutrition and never talks about it. I think many obsese persons are addicted to food. Part of their treatment should include addiction counselling.

Sandy22, ITA!!! I was thinking the same thing. I just assumed that disneysteve as probably had many conversations like this and we got a "sample."

 

[Sandy22]

My biggest concern though is the children.. I see SO many overweight and obese children these days, it scares the wits out of me.. If we don't get a handle on this, we're going to have a whole bunch of twenty-somethings dropping dead left and right from weight related health issues..

I heard a report the other day that this next generation may be the first ever to live shorter lives than their parents due to obesity.

 

[Lachesis00]

This could be me. I was told I don't eat enough and at some point went into a starvation like mode but what happened is the fat started storing up. I try and eat 3x+ a day and I am just not hungry. Over the years my body has been fooled into thinking water "fills me up" and my stomache shrunk.

I am lucky if I eat a granola bar for breakfast and thats it for the day. I will try and eat at night but I always feel sick to my stomache like I am over full.

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.

 

[poohandwendy]

Wow - people are cranky today!

He's probably paraphrasing a conversation and might have substituted certain things to protect his patient's anonimaty. I guess some people just rather assume the worst all the time.

Actually he is the one who gave the impression that he is not paraphrasing a conversation (see below quote). It seems odd to me that he doesn't just delete that info, just in case he does have patients who may read here. Even if I didn't recognize myself in the OP, if I were one of his patients i would be put off by his seemingly divulging personal info of any of his patients. I think it is a valid point.

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.

 

[JVL1018]

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.

Meet my FIL. He is about 5'7" and weighs about 240 lbs and is 78 years old.

That said, he has sleep apnea and sleeps with the mask thingy, he has diabetes, he has high blood pressure and he says ohhh I have to lose weight, I know everything that is wrong with me is the result of my weight..but does he do it? Nope.
He'll compalin about his blood sugar being high and when I ask him what he's eaten, I say well no wonder!

I have a couple of friends who are obese, and they know exactly why and don;t make any excuses.

As for me, I was overweight during my childbearing times there for a while and when my son was 9 months old, I went on WW and lost all that weight.
I think about my weight constantly, weigh myself every single morning and night and exercise at least 5 times a week.
I will never let myself get that heavy again. I was 40 lbs heavier than I am right now.
My diet however is not usually that good. I eat more junk than I should(sweets), I avoid fast food for the most part.

I teach my kids about exercising and good foods, but I never say it's to be thin, I say it's so we are strong and healthy, which is true.

 

[inaminute]

I guess some people just rather assume the worst all the time.

I assumed nothing. I based my response on the information provided. The good doctor stated it was an ACTUAL conversation with one of his patients. Here is a quote of the orginal statement:

Here is an <b>actual conversation</b> 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.

Note the words "actual conversation." He then proceeds to describe his patient including her medical problems.

Discussing patients in this manner on a public message board is certainly unprofessional if not unethical.

I'm just glad he's not my doctor.

 

[Caradana]

I've seen two posts here which really resonated with me: Crankyshank and DisneyMom3. Crankyshank brought up self-esteem and emotional issues. YES. That is at the core of the obesity epidemic for women, I truly feel that way. Disneysteve, when you were watching this woman in your office, and she was telling you these things, what was the look on her face? What could you see in her eyes? The eating is a symptom, the denial is a symptom, the real issue is emotions and self-esteem, and the prospect of facing those issues is paralyzing to many. And then DisneyMom3: your descriptions of your children: YES. Some kids are just more drawn to food, to "bad" food, some children have stronger sweet teeth, some use food to assuage nerves and anxiety, and some of them are going to rebel against their parents and use food as the mechanism. And these children become adults, and they don't change those behaviors. I certainly didn't.

I weighed around 180 at one point - I'm 5'3" - and I felt literally awful about it. Literally awful, it was like a pain and self-doubt that I re-fed every day, in a vicious cycle that didn't seem breakable.

I remember being a chubby 8- or 9-year-old and chastising myself in front of the mirror. I thought I had a tummy bulge and thick thighs - I thought that I was ugly - and I thought of those skinny, pretty girls in my class and wondered, "what did I do to deserve this?" I carried those feelings with me for a long time. I never felt like it was "my eating," although any objective analysis of my eating showed that it was obviously too much. I was heavy because I ate, and I ate because I felt like food made me feel better and made negative feelings go away, and because it was something to do when I was nervous or scared or sad. Shaking off the weight came along with shaking off those feelings. And I'm another who can vouch for Weight Watchers, about 35 pounds and two years later ...

I see obese women on this thread who post as though they retain their dignity and don't feel in the least "bad" about their weight. I'm sure that's true of some, but I also know that I would've said exactly the same things when I was at my top weight, and I would've been lying. And I would've known I was lying, even at the time. Even today, at 143, I'll tell you - I'm too heavy. I want to drop about 10 more pounds but I eat too much food, I go out too much, and I use food as comfort and distraction, and as long as I do that, I'm never going to drop these last 10. I have to assign WW a higher priority than my fun and my impulses to drop the last 10, and I'm just not willing to do it right now. There it is.

I think about what motivated me to change - it wasn't my health. Amusingly, it was two things: the fact that I am so darned competitive - I wanted to be able to compete with any girl in the room on pure looks, because as shallow as that sounds, it's a powerful asset in our world, and I wanted to get promoted, and it's a horrible truth that being thin is associated with being held in high regard. It's awful, but it's true, I can see it. I see it in our darned secretarial pool. The thin, pretty, outgoing girls become senior admins in six months; the heavier, less "model-looking," more reserved girls never do. This is not to say that there aren't heavy, pretty people, or thin, reserved people in our sec pool - obviously there are - but I'm describing the two ends of the continuum, the ones who seem to do "best" and "worst." The others land in between somewhere. It has so little to do with merit. And this is true all over the place. The other thing that helped was that my doctor told me the naked, awful truth. He said "you're fat, it's impacting your health and happiness, you're punishing yourself with your overeating, and you're on the verge of making this a problem that you have to deal with forever." I cried. I was angry at him. But he was right and his words were the straw that broke my back; I couldn't deny it anymore.

Maybe - maybe - for some people - a confrontation akin to the one disneysteve is tempted to have helps matters, similar to an intervention.

 

[laurie31]

(Laurie tentatively sticks cyber-foot into the water of this thread...isn't too hot...yet

Okay, here I go.

First, I took the conversation Steve posted to be the spirit of what was said, not a word for word recap.

Second, I didn't take it as "making fun" but rather a "wow, is this really what people think" kind of frustrated astonishment. I had a very similar conversation with DH back before we married. He was not at all overweight (waist size 32) but had high cholesterol. He couldn't understand it as he "didn't eat that much," he didn't really snack, and he never ate "junk food." Well, no he didn't sit around with a spoon and a quart of Ben and Jerry's, but he had a sausage biscuit for breakfast EVERY DAY. Helllooooo -those have 70+ grams of fat! He had no clue! He thought it was just a little meat and a little bread - and since he *only* had one, he was starved by lunch, when he went out to a meat and three kind of place (no fast food "junk" for him) where he ordered stuff like fried okra, green bean casserole, meat loaf, friend chicken, etc. Yikes! He's already eaten enough fat at breakfast for 3 days, then he has southern fried heart attack on a plate for lunch.

To his credit when I explained (on paper - he studied mechanical engineering and has to SEE it to belive it) how much fat he was eating, he was even more shocked that I was, and has made permanent changes. BReakfast is now cheerios in skim milk with a 6oz glass of OJ and he gets a 6" low fat sub for lunch most days.

However, after 12 years, he can still be fooled by food that looks innocent but is FULL of fat. Most frozen convenience foods, for example. SOmeone posted on a thread a few weeks ago about a Boston Market entree that had over 50 grams of fat. DH recently stopped buying the Little Charles pizzas from Sam's (that made such an easy dinner for the kids while I'm at work) when I pointed out they have 20 grams of fat EACH! And he was adding extra cheese to make it taste better He also thought those incredibly delicious chicken pies (Marie Cavender's) were a good late night snack. Um...no honey, they have enough fat for an entire 3rd world country. I love them too, but if you don't buy them, you can't give in to the temptation. We haven't bought them in over a year.

It is SO hard to make good choices when high fat, overprocessed convenience foods are everywhere! I went on a field trip with DD where the kids had to bring a sack lunch. Most kids had those lunchables. I'm sure the moms had no idea how bad most of those are. I think they're the nutritional equivalent of sending a tub of Crisco and a salt shaker. I have showed my DDs the nutrition label on them and told them what all they could eat instead, to get the same amount of fat and calories. They decided they didn't want them after all.

And Disneymom3, you have described my kids. DD1 would eat nothing but sweets if I let her. DD2 will sit down her ice cream cone and let it melt while she goes back for more broccoli. At birthday parties she eats a few bites of cake and throws the rest away. DD1 will go back for seconds, plus eat the icing that kids like DD2 have scraped off their serving. I don't want to be the food police, but it's so hard to tell her she CAN'T do that, it's bad for her when her sister can eat whatever she wants. btw, we are seeing a pediatric nutritionist who suggests any dietary changes involve the entire family and not single her out. (and no our insurance won't pay )

Sorry, this is long. I just wanted to point out that it is extrememly likely that a person can have a very high fat, high calorie diet and be totally unaware. Also, I have always been overweight - I'm just like DD1 about food - and have lost 85 pounds over the last two years. I have 20 more to go to reach my goal, and it's just as hard now as it was 2 years ago. But it's worth it! Nothing tastes as good as being thin feels I weigh less now that I did when I was 16. I love being about to shop in "regular" stores, not just Lane Bryant. Also, before I changed my diet (not "went on a diet" ) I had no idea how many calories I consumed from snacking and eating the leftovers off my kids' plates. It was really hard for me to convince myself that I was NOT helping any starving children on the other side of the planet by eating that last tablespoon of mac and cheese on dd's plate...

So yes, we need MUCH better nutrition education as well as physical education!

Laurie

 

[Christine]

Dana--great post!!

I wanted to add that I am one of those people who was rail thin *most* of my life. Note I said "was." I am still not overweight by any means although I've got some flab on me. And I eat WAY too much. I can go on a diet (WW or just cutting back) and I can get it off if I try. I am a true carb addict. It's awful. I also have some other health conditions that I've seen mentioned on this thread that people blame for their weight. I cannot blame my lack of thyroid for my weight condition. I JUST EAT TOO MUCH.

Anyway, I just wanted to chime in that about 10 years ago when I was on my weight "upswing" I was at my doctor for a checkup. He said to me "you know, you're not horribly overweight by any means but you are starting to edge up in that direction. You might want to think about dropping a few pounds." Honestly, I was shocked when he said that. No one has EVER said that to me in my life. I was a bit embarrassed and a little preterbed (sp?). But, after I thought about for a few days I realized that he was right and I did need to start looking at my eating habits. I really respected him for having the guts to say that to me.

 

[7thdwarf/dopey]

..................edited by 7.....................

 

[momof2inPA]

Can doctors still prescribe appetitie suppressants? I know there is no magic pill for losing weight, but is there a prescription that helps or do doctors just give you a diet and exercise plan to follow? Has there been any medical advancement in this area besides stomach staples and gastric bypass?

Maybe Steve's patient was looking for more than advice.