The NYT asks: "Why Do Obese Patients Get Worse Care?" I too would like to know the answer!

KetoGirl_ZC

A very interesting article, part of "The Science of Fat" series.

I once had a doctor that said to me: "There were no fat people in Auschwitz."

I was in my twenties, I'll never forget how inadequate I felt. I tried starving myself for a while (wasn't that what the doctor was recommending?), I ate a very strict diet of brown rice and little else. I did lose weight, together with my energy and sunny disposition. Guess what happened when I couldn't starve any longer? Yes, that was the beginning of the ballooning that brought me to T2D two years ago. Big surprise, I'm sure. That was the first time I stepped in a scale in a decade and I was 315lbs. And I had been low carb for a few weeks already, so I'll never know my real max.

I would like to punch the idiot doctor and all the others through the years. Ignorant and disrespectful.



Full article here:
nytimes.com/2016/09/26/health/obese-patients-health-care.html?_r=0

::flowerforyou::

tcunbeliever

There's a reason they call what they do "practice"...

moonlights

Because doctors are taught to be fatphobic. I have a number of friends whose doctors have missed serious medical issues - and when I say serious as a tumor I mean that literally - because every single symptom is put down to weight. There are a few good doctors out there but the statistics show fat people get worse care, poorer pain management and slower diagnoses. Doctors are under pressure and blaming fat is a simple option. This is why terrible advice is given on things like diabetes too - they just tell you to lose weight and not that eating a ton of low fat junk might make things worse.

There is also almost never any consideration given to a) physiological medical issues that may be causing the person to be overweight or to struggle losing b) mental issues such as depression which are causal or influential in a lot of people's weight gain.

Idk seeing the Doctor is never going to be the funnest thing but when you're fat it can be a nightmare.

KnitOrMiss

I've seen both sides of this, but yes, my obesity is ALWAYS noted in the chart as the primary issue, no matter if it is directly related or not. I kind of felt like a I had a breakthrough with my PCP. My previous visit, she kind of chided me a bit for reading too much into blood labs and such... Then the next visit, she started out with saying something to the effect of, "Before we go into why you're here today, I just really want to say how proud I am of you and your weight loss. You may not have lost as much as you need to long term or for your whole health, but you've lost a good bit (over 60 pounds), and you've kept it off over 4 years so far. That's really rare and nearly every patient I've had who's lost a good bit of weight, they've gained it all back in less time and gained more than their original. Even if you've had a bit of a blip since the holidays, you've stopped it cold, in it's tracks, and I don't know many people who could do that, myself included."

It was a shock, because I'd been feeling horrible and backsliding some at that time. It still resonates with me, and that was what, 6 months ago or longer? I don't consider myself a success, and quite often consider myself a failure. But luckily, I've become enough of an advocate for myself that I address my obesity (still in the morbidly obese category despite my losses) as an ongoing project, and acknowledge that it still impacts my daily life, but I force them to take it off the table as their only concern. If they won't, that doctor(s) will NOT stay my doctor, at least not for long. Even specialists. I've gained the confidence in myself, at least partially due to my age (40), that I will fire anyone who doesn't take me seriously and address me as an educated and knowledgeable person. I don't claim to know everything, by any stretch, but any doctor who treats me as stupid and refuses to explain things? Nope! Not my doc anymore...

In fact, despite having moved 40 miles away now, I'm debating keeping her as my doctor because we have 10 years of history, and she knows what's been going on with me, how far I've come, the struggles I've made. But, I could find someone even better for me here, but there's no way to know...

cstehansen

I have to admit, I was not always fair in my thinking toward those who are significantly overweight. I kept continuing to add to my exercise in an attempt to keep from getting too large. My wife even complained about how much I exercised and it seemed crazy how active I had to be to only add weight slowly. When I got to 223lbs (at 6'1") which put me dangerously close to the obese level on the BMI chart, I thought it was crazy given I was the most active person I knew and I had already cut how much I ate by at least 50% over the previous 10 years or so.

Just after I managed to get under 200 is when I got diagnosed with T2D. This led me on a research binge. Understanding insulin resistance and how it leads to fat storage even when there is no over-eating involved as well as all the other stuff I have learned has really helped me understand this so much better.

The biggest realization is that it seems obvious to me that being overweight does not lead to diabetes. It seems far more likely that being insulin resistant leads to both diabetes and weight gain.

I think the fact that I was not as high carb as the average person (but no where near LC), is probably why I was able to avoid the more significant weight gain.

I went LC with good results - currently about 180lbs and down into pre-diabetic levels now. I am right about what I think is my ideal weight now and continuing to try to drive my BG down to levels below pre-diabetic.

CICO does have some merit, but hormones - particularly insulin and cortisol - are much larger factors for a significant portion of the population. Until we can get this to be the common understanding in the general public in the same way the "dietary fat is bad for you" lie is there now, too many people are going to continue to blame the victim.

T1DCarnivoreRunner

I see an endocrinologist a few times each year for T1D and Hashimoto's and I see my PCP maybe once per year (or if I have a specific illness that will require antibiotics or an injury or something)... so my endocrinologist knows my medical history best. I've always struggled with weight, in part because of T1D. I was under-weight for my height when diagnosed at age 9, but treatment wasn't great and I ended up doubling by weight within a year of diagnosis and tripling it within a few years.

So when I asked my current endocrinologist about losing weight a few years ago, his answer was "just burn more than you eat." As though it is that simple... and for many, it probably is. But for me, that didn't work like is does for most. I was never losing as quickly as CICO calculations would suggest despite extremely meticulous logging of both CI and CO. I even experienced unusual plateaus that almost nobody else seems to experience. Meticulous logging proved that I was eating at a deficit, and I still wouldn't lose. During a particular plateau, I even ate at an enormous deficit for 6 weeks to see if I would gain (I didn't, because that is how real plateaus work... no sustained weight change no matter what you do, just fluctuations). Fortunately, I always had a "whoosh" at the end of the plateau of several lbs., but the anxiety is terrible in the meantime. And there is no help with that either... no help from doctors, no help from others trying to lose weight (everyone else seems to find it just as simple as my endo initially suggested)... nobody has a real answer, so they just accused of not logging properly, which adds to my frustration.

So when I originally started low carb, the intent was to stabilize BG. I didn't have any expectations that it would help with weight loss. The results, though, are that it helped my logging match my weight loss based on the 3,500 calories = 1 lb. formula. This is the first time that CICO has actually worked as everyone says it should.

MyriiStorm

This is one of my favorite videos about a doctor changing his view of obese patients and T2D: https://www.youtube.com/watch?v=UMhLBPPtlrY

I wish more doctors had his current attitude.

KetoGirl_ZC

@MyriiStorm thank you so much for sharing! I love Peter Attia and had never seen this talk.

So inspiring. I kept thinking of my grandmother who died after losing first a foot and then a leg, due to diabetic complications. She followed her doctor's recommendations religiously. That's one of the main reasons I don't. I wish there was a Peter Attia around here!

::flowerforyou::

KnitOrMiss

MyriiStorm wrote: »

This is one of my favorite videos about a doctor changing his view of obese patients and T2D: https://www.youtube.com/watch?v=UMhLBPPtlrY

I wish more doctors had his current attitude.

@MyrilStorm - I have never watched any talks from Peter Attia before, and this literally brought me to tears. What if my getting to the point of being Severely Morbidly Obese by the age of 33, at just under 5'4", and 319 pounds as the highest recorded weight...what if that horror I lived through actually protected me so far? I have insulin resistance, but I hadn't yet tipped the balance over to have problems in my glucose levels. This makes me wonder how much of that weight is my body being protective and trying to save me from that underlying metabolic issue. Goodness, I think this might be the feather in my cap I needed to finally be more motivated to fight back against my IR...


Thank you. I've no other words.