How can some people not get why they are overweight?

[denisenh]

Do you honestly think that there's no correlation between health and weight?

I am no obesity expert and I didn't say that. I said that my active healthier friends have various "fat related illnesses" and my fat friends don't. I guess time will tell who winds up where healthwise.

 

[donaldsgal]

1. Nothing I stated in my OP violates HIPPA rules because no specific personal data was given. You can't identify the patient based on the info given. However, since many of you felt there was too much info, I did modify the OP to be a little more generic.

While I agree with you as far as the letter of the HIPAA laws go, I disagree in the spirit of how HIPAA laws are intended to work. I have no doubt you know HIPAA like the back of your hand. However, in my training as a counselor, I was told that it is in the best interests of my clients that I divulge absolutely zero information about them to anyone - even to my own sister/roommate. That means, according to the spirit of HIPAA, that I don't go home at the end of the day and say, "Well, I saw a 40 year old woman with major depressive disorder today." It's true what you would say in response to this - that is not identifying information at all. However, it is in my client's best interests that my family not even know that much about her (and, to be clear, this does not describe any of my past or present patients).

HIPAA was adopted to protect our patients/clients, so I think it's dangerous when some say, (which I DO NOT think disneySteve is doing, but others have), "I'm not breaking any laws by saying this because no one knows who he/she is but me." Dr. Phil (take him or leave him) says this about adultery: "If you wouldn't do it with your spouse standing there, don't do it because you know it's wrong." I think the same can be said of disclosing patient information. If you wouldn't say X, Y, or Z about your client to your friend/spouse/coworker/sibling with your client standing right there, don't say it. That's a good rule of thumb in any relationship - personal or professional.

Personally, I find it quite difficult to NOT share what I do all day with my family. To be honest, I've violated this principle by saying something similar to my example above - "I saw a (insert age) (insert gender) today that was feeling (insert emotion) and that was rough." And I do think it's a violation because, at the end of the day, I don't feel right about disclosing even such minimal information. Do I want my doctor talking about me at home to his family, even in glowing terms? That would be preferable to him ragging on me (which I DO NOT think disneySteve was doing), but if he's willing to rag, I think he's more inclined to brag. So, I hope he doesn't do either.

When I pursued this career, these are the standards to which I offered to hold myself and to be held to by others. While it may not be illegal to post what you said because it's not easily identifiable, I think it would be wise and certainly farther away from the "iffy line" to just say, "I realized at work today that some people simply do not understand why they are overweight." The entire thread could have existed without the details, whatever they were.

I don't post this to flame you. I certainly DO NOT believe that you posted the conversation with malicious or hurtful intent. I'm just posting this for the consumption of the general populace. These are my convictions and my personal understandings, but I wanted to address them since others seemed to have been concerned with the thread.

 

[DisneyPhD]

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.

Thank you for that post. As a clinical therapist I think you hit on a very important topic.

BTW I think the OP sounds like a great dr. and I would love to have one like him.

Now for my weight issues. I was always a very thin person growing up. I ate anything I wanted to and when I got married I was 5 feet tall and weighted 93 pounds. (I also weight 16lbs are one year old and weighed 49 poounds in 5th grade.) I didn't weight over 80 pounds until I was in high school. After 2 kids I now weight 128. (and I only gained 13 pounds each times I was pregnant.)

It wasn't until after I got married and started brith control pills that I gained 30 pounds. Try as I might I can't get it off. I know part of it is I never learned to eat healthy since I never had to growing up. Part of it is I am not motovated enough to really work at it. (I have about 15 lbs to lose.) I am however very active and am making strong efforts to cut down on sugar intake (unfortantly at the expense of using fake sugars.)

I know a lot of my problem is what I drink, juice and pop have so much sugar. I can't drink milk, that mostly leaves water. I do drink water, but sometimes you need something with a little taste. Coke is my weakness. I cut it down from one can a day to one a week. (I do drink diet now.)
I also don't drink any alcohal. There is alot of carloires in it. (many people don't realize that.) That isn't why I don't drink though.

I was in line at the store once and had an eye opening exeprence. This family in frount of me had 2 carts of food. It was all prepacked, sugar, carb, sodas etc.... No produce, no raw meats or egss(to cook for protien). Not even flour and suagr to bake it themsevles. Just empty calories. Every member of that family was at least 50 pounds over weight (more really I am being genrous.) I looked at my own cart and realized that what you take in does really mater. From then on I make an effort to be sure that at least 75% of my grocery cart is healthy, I do allow for some sweets and cravings, but eat healthy 1st. I don't bother with low or no fat versons of most things, just eat reasonably.

 

[Saphire]

I'm not saying being overweight is good at all, but you cannot make a blanket statement like this. My grandmother just turned 76 and is quite overweight. Additionally, I worked for a patient medication assistance program (as part of a pharmacy) for 8 months, and approximately 50 percent of the elderly members of the program were at least 30 pounds overweight. Be careful about dealing in such generalities.

In general, obese people do not make it to old age. I didn't make that up. My work history also supports that. While you can always find exceptions, the truth is that obese people die sooner. This is not a statement of judgement.

 

[donaldsgal]

In general, obese people do not make it to old age. I didn't make that up. My work history also supports that. While you can always find exceptions, the truth is that obese people die sooner. This is not a statement of judgement.

I never said you were being judgmental. I believe your work history supports what you say. I also agree obese people die sooner. I don't argue with that.

In fact, all I DID say was you were making a blanket statement which, as I pointed out originally, is NOT supported across the country in other health care professions. That's all.

 

[Caradana]

I'm 25 and 270. I went to my nurse practioner, who said, "I'll refer you for a gastric bypass if you want." Um, WHAT? You're telling a 25 year old healthy (yes, healthy -tests all concur) that I should just jump in for such an invasive surgery? ... For me, FOR ME, not anyone else, that would be the easy way out. For my NP to advocate this surgery was offensive and inappropriate. I appreciate her concern, but come on.

Wow ... we are all so different. I admire your spirit. At the same time, I'm also 25, and gastric bypass would absolutely be something I'd be begging for under the right conditions ... I'm reasonably sure that she didn't mean to offend you.

 

[Aimeedyan]

I'm sure I'm opening another can of worms in this discussion, but in my defense, it had been mentioned in prior posts! =)

Many have stated reasons why obesity is such an issue in our country, and I agree wholeheartedly that it is an epidemic and needs to be addressed. I do believe that if more physicians would confront their patients that things *might* improve, as many people do take their physicians comments to heart, more than they would someone else in their life.

I also agree that our children are becoming a more and more obese group of people and it pains me to think of the health issues that lie in their future if things keep up. We can name a bajillion things that attribute to this, but one that has been in my mind lately is the foods they are given to eat. Day after day I bite my tongue on the restaurant board right here on Disboards in regards to the NUMEROUS posts regarding kids meals and that "their kids won't eat anything but mac and cheese or chicken nuggets" - it's amazing to me so many kids eat that on a daily basis! IRL, I know a handful of children that are allowed to dine on such junk on a daily basis and one in particular already has health issues (my nephew, age 4). And there will always be parents that state how healthy their child is, how active they are, etc - but we don't know what the longterm effects of that kind of diet and that can't be said in full certainty. Not only that, but what kind of food habits are we instilling when we serve mac and cheese each meal and never expect veggies, meats, and fruits to be eaten? Even if they are a healthy 6 yo, what happens when they are 26 and still eating junk because that's their lifestyle now. We learn SO MUCH from our parents about what to eat, and parents set up a lifetime of eating habits for us. Sure, we can break away from those, but it's a lot harder and often doesn't happen.

It drives me NUTS that Disney only offers processed junk for children to eat - their kids meals are full of chicken nuggets, hot dogs, peanut butter and jelly, and mac and cheese. What the heck? What about children who actually dine on quality, good for you food? I wish more places offered better choices on the kids menu, I think that would be a good first step in helping parents make wiser decisions for their kids.

(disclaimer: I am not referring to those that offer a happy meal on occasion, or eat more junk on vacation then normal - it's the people who never expect their child to eat anything other than processed junk because that is what the child wants.)

Just my two cents, as worthless as they are Not meaning to step on toes, just offering observations =)

 

[Judy from Boise]

I am very intuned to professionalism,boundries and confidentiality issues. Nothing that Steve has posted in my opinion has crossed any of these lines. Health care professional need the occasional "safe" place to rant and or engage in some theraputic "black humor". As long as he avoids patient identifiers why wouldn't the DIS be a good place to accomplish this?

 

[MouseClubMom]

I think you are right, Steve. We live in a society that makes it okay for us to lay blame on situations or others.

Personally I have about 35 extra pounds on me that I would love to lose. I gained 25lbs of that since December when my doctor prescribed a medicine for me to control some female issues that is also a medicine given to cancer patients to gain weight. I ballooned. I have stopped the meds but the weight is not going anywhere until I adjust my diet and exercise. To me that is common sense.

 

[PryncessChrysty]

Steve, I understand where you're coming from and see how that could be quite frustrating. My point of view is a little bit different, and even though this is a long post, I just felt compelled to post it for some reason:

I am someone who could stand to lose quite a bit of weight. I'm 26, almost 27, and am realizing that if I don't do it now, it's only going to get harder. I've used Weight Watchers in the past, which I find to be a great program for me and I lose weight very quickly (luckily). So right there, you'd think that I'd just get on the ball and go with it. But after about two months, I tend to go back to my old ways. I'm trying to understand why I do this, and have come to the realization that my food addiction (yes, addiction) is emotional. Stemming from a very early age. I have always been a little bit on the chubby side, but nothing like I am now. I always find myself looking at pics from when I was younger and saying to myself "If I only knew then..." When I was in high school, I needed to lose about 40 lbs, but my mental image was so distorted from years of my family constantly focusing on my weight (since the age of 6), that that 40lbs felt like 400lbs. I couldn't handle the pressure, and food became a comfort for me. So here I am today, with a LOT more than just 40lbs to lose, and because I'm so self conscience (I can't believe I'm admitting this to the world) to do almost anything in public situations, eating is one of the few forms of satisfaction for me. DH2B and I will order in from one of our favorite restaurants and watch movies, and that is a 'date night' for us. And because no one's around but me & him, I'm not ashamed by what I'm eating. Thankfully, DH2B is SO supportive, but I almost wonder if that works against me. Because I know it's okay with him, I'm not in any rush to change it (but that's such a double edged sword, because if he were pushing me to lose it, I'd want to rebel ). So now, I'm trying to learn to let go and realize that if I just stick it out for a little bit, I'll soon be able to get out there and do those things I wish I could do (even just walk around a park, or go for a hike), and those things will replace the "high" that I get from food. Real life experiences. Because of my weight, I have high blood pressure and sciatica. It is hard for me to walk and it's such an embarassment. I also suffer from panic attacks in certain social situations, and have lost contact with many of my friends because I am too embarassed to go out with them. When it comes down to it, I KNOW what I need to do; 1) Eat healthier 2) Practice portion control 3) get moving!! I refuse to take any of the "shortcut" pills, or slimfast or anything like that because it doesn't TEACH you anything. And what do all of the pills say? "These pills work with proper diet & exericse" Well, gee, what do you think is making you lose the weight??? The diet & exercise, or the magic pills?? That drives me crazy!! I'm also not in favor of gastric bypass unless you've tried every possible avenue and your body just doesn't want to let go of the extra weight. I think too many people are going for the surgery, not realizing that it's not the easy way out. People think that they're going to get the surgery and it will solve everything. But that's just not the case.

Sorry for such a long post.

 

[Bobbles]

There really are no simple answers to the human being. Not everybody is perfect. Some are (just ask them!) but most of us are not.

I guess it would be best just to clone the best and leave the rest.

(I am a smoker (considerate) and 20 lbs over my ideal weight. Not perfect eh?)

 

[panfan]

Okay...I'll chime in on this one !

First off ....I'd like to say while not obese...I do struggle with my weight daily and I do attribute my not being able to "stay on track" with emotional issues, past experiences and the like. Without going into details....did have eating disorder as a teen etc.

Now ...with that being said.....I DO KNOW WHAT I AM SUPPOSED TO EAT ! I just don't always do the right thing.

I do agree with DisneySteve that many people HONESTLY dont really know what they are doing to their bodies. I think this is a great thread and wish there were more doctors like him. He didn't start this thread to blame "fat" people for emotional eating etc. His point was that he couldn't believe how so many just don't REALIZE what they are eating isn't so great. I have a few family members/friends that are the same way and it is atonishing.

Case in point. A few years ago a co-worker and I were pregnant at the same time/ due around the same time. She developed gestational diabetes and has to modify her diet etc. After one week following the new "diet" ....basically less sugar her numbers actually went UP ! She was so upset. We sat down together and went over everything she was eating. She tried so hard to eat exactally what was expected and did a wonderful job...........
...............
What she didn't factor in t0 the equation was the GALLONS of sugared up ICE TEA and LEMONADE she was consuming daily !!!! She didn't even think about it AT ALL!!!! So there you go.

I could go on with some more stories like this also.

So.....I don't think DisneySTeve is lying or has bad intentions at all. I think that YES some people honestly don't really know the harm they are doing to themselves. And that was the intention of the OP's post ....not to flame the overweight.....I would think that most people that do have emotional weight issues ( myself included) really do KNOW what they are supposed to be doing . It's just sad that many Americans don't know!

I strive every day to "feed my body good food" and keep the emotional eating at bay. And am teaching my children that good foods==feeling good....not sluggish etc. And my older DS is starting to realize the relationship between better sports performance and good foods vs. Junk!

Oh....and just one observation about Low Carb Diet......Let me just say that being in the rest. buisness I have seen all kinds of things. I think that Atkins probably really works....but I have seen too many people think they have the liscense to eat all the meat, butter, cheese, eggs they want as long as they don't eat the bread.....okay that is all fine and good...but guess what ??? They have continued to eat the "ATKINS WAY" ....but now they have also added back the pancakes, french toast , rolls and haven't cut back on the protein/fat! And wonder why the scale is going up ???

Just some thoughts for a Wed morning

 

[Mskanga]

Boy , we just had this discussion last week at my husband's doctor's office during a visit. My husband is one of those people who has sort of a sedentary life , he does not exercise and eats what he likes because he wants it.
He doesn't feel comfortable with his weight, he smokes almost two packs a day, has had high cholesterol for the longest time ( he got it down with medications ). He recently told me that he didn't want to take sandwiches from home for lunch anymore ( believe me he's a very picky eater and it's not easy to cook for him ), so now he takes one bottle of Boost for lunch everyday to try to lose weight but the food intake at home it's still the same.
He asked the doctor the other day if there was any kind of pill or diet plan he could put him on and the doctor said that there are pills out there that he could put him on , however pills only work as long as you take them and when you stop taking them , the weight comes on again. He adviced him that he has to make some lifestyle changes first , meaning more exercise, significant reduction on smoking and eating within the amount of calories that he would tell him , he gave him a good informational packet to look over.
He has not done a darn thing about it , and I know he won't because he has told me flat to my face that he enjoys what he does, so there's a total lack of willpower on his part. He tells me to stop buying things he shouldn't eat , oh so I am supposed to punish my kids to not have a cookie or ice cream every now and then ? My kids don't have any health issues and eventhough they eat quite well , doesn't mean I have to keep them on a diet too.
I am a bit overweight myself and I know what my weekness is , but at the same time I am very active and have no health issues. Most of my weight came from two pregnancies and having c-sections ( most of the extra weight is around my hip ) . I go on bike rides with my kids, I go swimming and walking everyday in the summer , that's aside from my job and all my family / house duties.
What I am trying to say is that my husband wants the miracle answer from someone without him doing a darn thing about it , I have tried to somewhat change his eating habits and make him healthier meals , he refuses to eat. I can't do it for him and neither can the doctor, HE has to do it , and he doesn't want to.
I tell him to then not whine about it , if you are uncomfortable , do something about it, don't expect someone else to do it for you.

 

[golfgal]

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.

When we were in Cancun a few years ago, I commented to DH about how fit and trim the staff was at the hotel. We have a fairly large hispanic population in town and on average, most of them are overweight. This wasn't the case when we were in Mexico. I have to wonder if their bodies have evolved in such a way that the food they eat here isn't processed the same way or some other physical reason for the high obesity rate (something along the lines of the American Indian population and the high alchoholism rate-not having the natural tolarance to alchohol way back when the Europeans came to North America?).

Another observation, when I was at the Mayo Clinic undergoing testing for my sudden hearing loss, I noticed that 90% or more of the patients there were either overweight or underweight. The thing about Mayo is there are patients from all over the world, from all walks of life and the common denominator there was weight. I thought it was interesting.

 

[Christine]

I'm sure I'm opening another can of worms in this discussion, but in my defense, it had been mentioned in prior posts! =)

Many have stated reasons why obesity is such an issue in our country, and I agree wholeheartedly that it is an epidemic and needs to be addressed. I do believe that if more physicians would confront their patients that things *might* improve, as many people do take their physicians comments to heart, more than they would someone else in their life.

I also agree that our children are becoming a more and more obese group of people and it pains me to think of the health issues that lie in their future if things keep up. We can name a bajillion things that attribute to this, but one that has been in my mind lately is the foods they are given to eat. Day after day I bite my tongue on the restaurant board right here on Disboards in regards to the NUMEROUS posts regarding kids meals and that "their kids won't eat anything but mac and cheese or chicken nuggets" - it's amazing to me so many kids eat that on a daily basis! IRL, I know a handful of children that are allowed to dine on such junk on a daily basis and one in particular already has health issues (my nephew, age 4). And there will always be parents that state how healthy their child is, how active they are, etc - but we don't know what the longterm effects of that kind of diet and that can't be said in full certainty. Not only that, but what kind of food habits are we instilling when we serve mac and cheese each meal and never expect veggies, meats, and fruits to be eaten? Even if they are a healthy 6 yo, what happens when they are 26 and still eating junk because that's their lifestyle now. We learn SO MUCH from our parents about what to eat, and parents set up a lifetime of eating habits for us. Sure, we can break away from those, but it's a lot harder and often doesn't happen.

It drives me NUTS that Disney only offers processed junk for children to eat - their kids meals are full of chicken nuggets, hot dogs, peanut butter and jelly, and mac and cheese. What the heck? What about children who actually dine on quality, good for you food? I wish more places offered better choices on the kids menu, I think that would be a good first step in helping parents make wiser decisions for their kids.

(disclaimer: I am not referring to those that offer a happy meal on occasion, or eat more junk on vacation then normal - it's the people who never expect their child to eat anything other than processed junk because that is what the child wants.)

Just my two cents, as worthless as they are Not meaning to step on toes, just offering observations =)

That Hoop Dee Doo thread on the Restaurant Board *got* to you too, didn't it?

I agree with everything you said. Just wanted to add that one of the reasons we do a lot of the buffets at Disney is for the kids. They can actually try all kinds of "real" food. My kids will go to the buffets and get salads, eat some of the veggies and get some of the better meats or shrimp. Much better fare than the typical chicken strips meal. Also, some of the nicer restaurants in Disney (Artist Point for one), have a very good kid's menu.

 

[Galahad]

I am very intuned to professionalism,boundries and confidentiality issues. Nothing that Steve has posted in my opinion has crossed any of these lines. Health care professional need the occasional "safe" place to rant and or engage in some theraputic "black humor". As long as he avoids patient identifiers why wouldn't the DIS be a good place to accomplish this?

As long as it is an anonymous patient it should be OK. DW would go absolutely batty if she couldn't come home an unload about her anonymous difficult patients.

 

[pw2pp]

I haven't read this ENTIRE thread..... I have just seen it now for the first time and it is too long.

However, I would like to say this....

Steve, surely do don't believe that YOU are going to change people's habits, now do you?
I work with Dialysis patients and believe me, there CAN BE alot of non-compliance with this group especially regarding diet, fluid intake, meds, showing up for dialysis as scheduled, etc ....
All you can do is educate.... what a person does with the info is completely up to them. They are adults and how they choose to live their lives is ultimately up to them. I don't begin to think that I can save them all. All I can do is give them the info. that they need to be an educated consumer. However I don't believe that I have the power to control what they do with the info. It can be frustrating, sure, but I must say I don't lose sleep over it. They are living their lives and dealing with their illness as best they can and maybe "cheating" a little helps give them the sanity that they need to go on.

 

[disneysteve]

And what do all of the pills say? "These pills work with proper diet & exericse" Well, gee, what do you think is making you lose the weight??? The diet & exercise, or the magic pills?? That drives me crazy!!

Thanks for your post. You really made some great points about issues that may underlie weight problems.

Regarding the statement I quoted, have you ever watched any of the commercials for Metabolife or TrimSpa or Jenny Craig or any other weight loss product. They show before and after photos of "real people" who have used the product and how much weight they lost. But there is always a disclaimer on the screen that says "Results not typical." It doesn't matter if the person they are showing lost 100 pounds or 10 pounds, it always says that. So what is typical for users of the product? I suspect the typical loss is probably little if any weight loss. The ones who successfully lost the weight and kept it off were doing something besides just taking a pill every morning.

For the record, and I'm kind of surprised nobody has asked this yet, I do prescribe weight loss medications when I feel it is appropriate for the patient. When is it appropriate? The patient needs to be significantly overweight or obese (BMI>27). They need to be in generally good health otherwise (no uncontrolled high blood pressure or heart issues, etc.). And they need to be making a reasonable effort already to modify their diet and activity levels. I think a short course (3-6 months) of a diet pill can sometimes be a good motivating aid to help get people going in the right direction.

Thanks for all the other comments during the nite while I was snoozing.

 

[disneysteve]

Steve, surely do don't believe that YOU are going to change people's habits, now do you?
All you can do is educate.... what a person does with the info is completely up to them.

My goal is to give them info that makes sense for them as an individual to teach them a way to live healthier without feeling deprived. I will often discuss a patient's eating habits in a fair amount of detail and make specific recommendations for things they could change, even to the point of recommending specific brands or products to substitute for the ones they are currently using. I think that kind of info is much more likely to produce change than just handing out the same generic diet sheet to every patient. Honestly, I don't always have the time to do this nearly as much as I would like, but every little bit helps. If I ever get to the point in my career where I just don't care enough to make the effort, that's when it will be time to hang up the stethoscope.

 

[DMRick]

I thought I would chime in on this. I'm overweight by by about 40-45 pounds, but so far with no health problems. My cholesterol, blood pressure, sugar are all within normal range. I do get some exercise, although not enough. I walk a lot in the warm months, do some skiing in the winter. I love food, and many of our days are made up with people over for dinner, camping and sharing meals at camp, pot luck dinners at church. We are very social, and eating together is one of the ways we express that. I thing I eat faily heathy food most times, but my portions are usually more than I should have. I had no problem staying a skinny mini (when I could subsititute a cig for food, I was actually underweight..about 105-110 for 5'1" after three kids) when I smoked, since I substituted a cigarette whenever I felt hungry. Once I stopped almost 20 years ago, I realized how good food tasted LOL! I also realized that I feel much better with too much food, than I did with smoking, so I guess I picked my "poison"..food over cigarettes. I have only "dieted" once, and that was weight watchers. As soon as I quit going, the weight came back (but I didn't like my food choices when I was going, so I was happy not going). I like to eat, I like to eat with friends, and I dislike most "diet" foods. While I seldom have foods such as french fries, or big mac's, I'm very happy at a Chinese Buffet (although I still avoid the fried foods) with all those veggie's in sauces, all the crab legs you can eat, etc.I realize I won't be stopping the eating, so for me, it's walk, walk, and more walk, which allows me to eat more, without gaining too much more weight. Do I wish I was a smaller size? Sure, but for me, the extra work of watching everything I eat, and being very careful (yep, I know Oprah says she is very satisfied with her menu..but I wouldn't be) isn't worth it.