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So they say it’s unhealthy to be fat, but have you considered the role of weight stigma?

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  • HellYeahItsKriss
    HellYeahItsKriss Posts: 906 Member
    edited November 2017
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    @lizery -- Yup, i definitely will never say that i was in any way good at taking care of my diabetes.
    Not even close. But it was always due to the fact that i would see food as a priority over managing my diabetes.

    and yes, I could not achieve any weight loss long term until treatment, mind you the pills are not a cure all, they simply put me at a average state where others would be, where i still need to make a choice, the medication just puts me on the same level as others who while they don't have a binge eating disorder, they too also have to make a choice, so yeah, i do eat what i want within my calories, but that option is made more possible with the vyvanse, where as before, my brain only had one choice and did not listen to any negotiation on the subject. Everything was always "you can start fresh tomorrow".. but tomorrow never came.

    They did dismiss the pain as weight related and it was, however, pain management should still be an offer made regardless, it's not like i could wake up the next day 165 pounds lighter, perhaps some physio or tips from the chronic pain management center would of helped minimize the pain i was having at the time, the same as it would of now with the pain i am having from what seems to be losing weight lol... that is why i said, i can understand not offering me any medications.. outside of advil or tylenol, but even my fat self shouldn't have to wait through an entire weight loss to feel less pain.

    I admitted that their advice was correct, but yeah, the mental aspect did very well influence my ability to effectively take care of my diabetes. The foods i was binge eating on were incredibly carb heavy most of the time, i mean occasionally i would eat entire packages of meats by themselves, but i am a carb girl at heart. I was going through boxes of 1500 units of insulin within a 12 day period.. even with an 80% covered medical plan, it was still $60 for the insulin or more if i needed supplies again, or slow acting since i didn't go through that as quickly. $60 doesn't seem like a lot (Or at least not now, since the vyvanse is $195 a month) but when you are basically eating away every cent you make, my brain really did call the shots on that $60 eventually, which is why i would only stick with my medications for so long before i eventually stopped.

    With doctors, over the years i have learned that you have to ask for what you want. I would of asked for help at the eating disorder clinic specifically however the eating disorder clinic we have here does not actually deal with binge eating disorder, the psychiatrist who works there has many patience who deal with it but if you google the eating disorder clinic here, its for people with anorexia or bulimia. The clinic offers classes and the ability for counseling and seeing a dietitian, but there is no mention of acceptance for binge eating disorder. My 3rd and final family doctor only referred me to the clinic after a final visit made to the emergency department finally had me cross paths with a doctor who agreed that help with my eating was the way to go and faxed off a request to my family doctor for him to send me there. And its not really that he wasn't aware that i was struggling, since he was the one who sent me to the hypnotist, but i circle back to the fact that there is just not enough funding going into our mental health system and maybe he also thought like me that the eating disorder clinic only handled anorexia/bulimia.

    However, i never really expect doctors just to look me up and down and know i needed mental help to lose my weight, i did talk a lot, describe my stories of desperation and feelings of out of control. But as i said, i often felt like these things just weren't taken in as a priority over the basic need to get my sugars under control. The doctor at the emergency who sent my doctor a fax to refer me, after listening to me talk his response to my stories was "No offense but you are seriously messed up mentally" or something along those lines. which wasn't at all offensive to me i just finally felt like someone was listening to me. I was getting great medical advice, I just needed more, if mental health was funded better, maybe doctors would have more information to help know where to send patients that describe the struggling i was to them.

    And i agree with you, it is possible to manage diabetes and be over weight, but i was eating so much that being tight with it wasn't doable for me long term, not with how out of control i was, the difference between me medicated and me without medications is night and day, even now that the effects of it being a new medication have worn off (IE: the extreme suppressed appetite, over kill of extra energy) i thought once those things stopped that it wasn't working anymore and stopped taking it and realized that in fact it really was.

    But i still stand by my point though and it wasn't me directly talking about my own doctors but in general, if there is a doctor out there who is bias when it comes to patients either normal weight or obese, and the effectiveness of their care declines simply because of previous experience with others who are obese, not taking medical advice seriously or what have you, you run the risk of not helping someone who may be the brown egg in a carton of white eggs, they just may need more options

    But i will toss a bone out here too and say that i think both medical professionals and the public really need to make a stand for mental health because it is a big aspect for a lot of people for many disorders and problems.. with more options and more information, doctors would have more knowledge and options to how to help people in a team based therapy plan. Diabetes management always offered a dietitian and a nurse team on your visits as part of my family doctors guidance for my diabetes, it just turns out that i also needed a psychiatrist as well.
  • crackpotbaby
    crackpotbaby Posts: 1,297 Member
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    @lynn_glenmont @YepItsKriss

    I guess my perspective is broad.

    I am a registered nurse that works in a specialist cardiac area, but has worked many years in more generalised health care.

    I also have bipolar disorder (type one) which was misdiagnosed and innapropriately medicated (and poorly managed by myself) for many years.
    The results of that were devastating. Homelessness. Rape. Addiction. Reckless manic behaviour.

    It was *kitten* my symptoms were not addressed sooner, but this was certainly in part due to my presentation in the times I had medical contact.

    ............


    Fast forward to now. I work side by side with cardiac interventionalists who will work to stent an artery in an obese patient. The treat them with dignity. They also might say, it’s hard to see your arteries on the X-ray because you are so fat.
    They absolutely will check if a patient is diabetic. It’s relevant. They might also tell a patient they need to lose weight. It’s appropriate.

    Then to get the obese patient of the table we blow up a hover mat air mattress to zoom them onto the bed. It’s all a little awkward and undignified, but should the nurses try and slide 150kg unassisted? It’s the best we can offer.

    This topic is complex, but as I have stated the doc considers much more than just obesity in the clinical picture.

    ...............

    @YepItsKriss if your doctor is not asking if you are diabetic anymore now you are a healthy weight you should be telling them. The damage to your microvascular and neurovascular system caused from years of poor control doesn’t magically go away once your sugars are stable.
  • HellYeahItsKriss
    HellYeahItsKriss Posts: 906 Member
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    @lizery

    I agree, i think my BPD was what got me into some of the things i went through growing up as well, to a slightly lesser degree of sexual molestation, cutting, homelessness, and destructive relationships, I have burned every bridge i had made growing up, I have absolutely 0 social skills now, I can fake it, but the person i am on the outside is not the person in my head that i have to hog tie and gag when i am at work. It is why i have 0 personal relationships going into my 30's besides my boyfriend who i am pretty sure its only working out with simply due to the fact that his brain is broken from being in a coma for 4 months and my personality and moods don't negatively influence him because he doesn't really grasp emotions and everything rolls right off him.

    One thing i always thought might of helped more often was that when things would get to me, i was so emotional, i only recently started getting meds for the BPD, so when i would slide down the dark tunnel, it was very dark, but that darkness also kept me from leaving the house or sometimes even leaving my own brain.. I don't think doctors ever got to see that part of me, at best i could just describe it, i suppose it was like trying to paint a rainbow with black paint.

    He doesn't ask, we usually just get an a1c check every 3 months.
    But other then that, thats it. Diabetes management center dismissed me after my last visit to them, dietitian looked at my a1c and said there was no need for me to be there anymore, outside of the blood work, the laser treatments on my legs, which is probably the post you were speaking of before, is the only remaining diabetic thing i have been doing. But if i go to emerg, cause i went there a few times trying to get some answers on my chronic pain since my weight loss, they do not ask me anymore if i have diabetes, when usually that would be the first question asked no matter what the reason i was there for.
  • clicketykeys
    clicketykeys Posts: 6,568 Member
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    Aaron_K123 wrote: »
    If a doctor looks at a patient, sees that they are obese and without any effort or attempt to dig deeper declares them to be diabetic and sends them away with insulin even though that diagnosis was in fact wrong then yeah that doctor is being a bad doctor. Conversely if a doctor looks at a patient, sees that they are obese and decides it is inappropriate to take that into account and decides without any effort or attempt to dig deeper declares them artharitic and sends them away with methotrexate even though that diagnosis was in fact wrong then that doctor is equally a bad doctor. Whether or not one takes into account the appearance of the patient isn't the thing that makes a doctor good or bad, it is the level of effort and appropriate actions taken. If anything the first doctor at least applied some sort of criteria.

    Are you claiming that if doctors were blind to race, gender, age, weight and just ordered the exact same lab tests for everyone that that would be ideal? Because if that is the case why even have doctors? Why not just have automated labs that dole out tests based on patient symptoms? The entire point of having a doctor is so they can apply observational biases to a patients symptoms in order to deduce what the most likely cause is. They are detectives and observational assumptions are their main tool. There job is literally to look at you and then jump to conclusions based on what they see coupled with their education and experience. Obesity is part of that, as is race, as is gender, as is age. That isn't automatically prejudice.

    Inappropriate prejudice would be bringing in personal stereotype beliefs that are not epidemiological based at all into it and being dismissive of a patient because you don't like their race/gender/bodytype w/e and assume they are lying or are overly disrespectful. That would be wrong yes, but do we need a study to say that is wrong?

    But prejudice doesn't have to be deliberate to be harmful, or unprofessional. I guess what I'm wondering - and what the article linked at the top of this thread doesn't say - is whether patients who are overweight are misdiagnosed more or less often than patients who are not.
  • rheddmobile
    rheddmobile Posts: 6,840 Member
    edited November 2017
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    I note that it's possible for it to go the other way. When I was very thin in college and had lupus and lupus-caused circulatory issues, it was almost impossible for me to get a doctor to take me seriously because I was normal weight and looked healthy, despite the fact that I could barely walk and my resting heart rate was over 100. Many, many doctors told me to get more sleep and not worry about it, before I finally got a diagnosis.
  • whosshe
    whosshe Posts: 597 Member
    edited November 2017
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    lynn_glenmont wrote: »
    eliciaobrien1 wrote: »
    canadianlbs wrote: »
    i can't speak to the bad attitude about obesity, but this statement about preconceptions of futility mirrors my experience as a person with rheumatoid arthritis. it's like a rug that a lot of things can get shuffled under. so pushing to get the same care and diagnostic attention as a 'normal' person has definitely been a factor since i got diagnosed.

    i've been seeing it lately too, as i try to advocate for my father who is in his nineties. 'la la la mr x, you're just old, too bad. next!' it comes down to not being taken seriously.

    "physicians may over-attribute symptoms and problems to obesity, and fail to refer the patient for diagnostic testing or to consider treatment options beyond advising the patient to lose weight"



    Obesity can cause a variety of health issues. I don't think we can blame a doctor who would chalk up "shortness of breath" to being overweight.

    I would blame any doctor who makes diagnoses based on taking one look at a patient and making an assumption that anyone in the general public would make. Why should we be paying for their supposed expertise if they don't actually take a medical history and administer the appropriate diagnostic tests?

    It used to be that if a woman went to a doctor for anything they couldn't diagnose visually (say, a compound fracture), they just chalked it up to "women troubles" or (worse) assumed it was all in her head ("hysteria" = mental problems caused by having a uterus).
    Even as an asthmatic the only thing the doctors can do for me is prescribe me a puffer that will probably reduce inflammation in my airways.

    So you think someone who is overweight who could benefit from an inhaler to help them breathe should be denied one because they're overweight?
    I don't know about the diagnostic process of rheumatoid arthritis but I can't blame a doctor if he/she says "lose some weight and then we'll see". That seems like the first step in the diagnostic process. I'm sure some doctors are absolutely terrible, but how many doctors get obese patients complaining about all the symptoms of being obese. Must be frustrating.

    So, basically, you think doctors should deny treatment to people if it's possible that their medical problem could in any way be caused by their behavior?

    "Nope, no chemo, radiation, or surgery for your lung cancer until you stop smoking. Maybe the cancer will go away."

    "Nope, we're not going to treat your broken bones until you give up all your dangerous skateboarding, skiing, and mountain biking hobbies."

    "Well, of course you're having balance problems. You're 82. No reason to send you for any diagnostic testing to see if it's an inner ear problem."

    I'm talking about inhaled corticosteroids. A person who has breathing problems BECAUSE they're overweight WOULD NOT benefit from an inhaler. It would actually increase the risk for conditions such as oral candida, osteoporosis and cataracts. No inhaler would be beneficial, unless they have asthma.

    Just in case you missed it:

    "The major criticism of the epidemiological studies has been the basis of diagnosis of asthma. Obesity impairs ventilatory functions i.e. forced expiratory volume in one second (FEV 1), forced vital capacity (FVC), total lung capacity and expiratory reserve volume.5 Besides, it may reduce respiratory muscle strength, decrease thoracic cage compliance and impede diaphragmatic excursion, especially when it is massive and central. The resultant increase in work of breathing may lead to the perception of increased respiratory effort i.e. dyspnoea. The latter may be confused as asthma. Thus, there is a risk of over diagnosing asthma in the obese. Further, it is apprehended that the correlation between obesity and asthma may not be causally related but may be due to existence of common risk factors."

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2853040/

  • lynn_glenmont
    lynn_glenmont Posts: 9,988 Member
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    eliciaobrien1 wrote: »
    lynn_glenmont wrote: »
    eliciaobrien1 wrote: »
    canadianlbs wrote: »
    i can't speak to the bad attitude about obesity, but this statement about preconceptions of futility mirrors my experience as a person with rheumatoid arthritis. it's like a rug that a lot of things can get shuffled under. so pushing to get the same care and diagnostic attention as a 'normal' person has definitely been a factor since i got diagnosed.

    i've been seeing it lately too, as i try to advocate for my father who is in his nineties. 'la la la mr x, you're just old, too bad. next!' it comes down to not being taken seriously.

    "physicians may over-attribute symptoms and problems to obesity, and fail to refer the patient for diagnostic testing or to consider treatment options beyond advising the patient to lose weight"



    Obesity can cause a variety of health issues. I don't think we can blame a doctor who would chalk up "shortness of breath" to being overweight.

    I would blame any doctor who makes diagnoses based on taking one look at a patient and making an assumption that anyone in the general public would make. Why should we be paying for their supposed expertise if they don't actually take a medical history and administer the appropriate diagnostic tests?

    It used to be that if a woman went to a doctor for anything they couldn't diagnose visually (say, a compound fracture), they just chalked it up to "women troubles" or (worse) assumed it was all in her head ("hysteria" = mental problems caused by having a uterus).
    Even as an asthmatic the only thing the doctors can do for me is prescribe me a puffer that will probably reduce inflammation in my airways.

    So you think someone who is overweight who could benefit from an inhaler to help them breathe should be denied one because they're overweight?
    I don't know about the diagnostic process of rheumatoid arthritis but I can't blame a doctor if he/she says "lose some weight and then we'll see". That seems like the first step in the diagnostic process. I'm sure some doctors are absolutely terrible, but how many doctors get obese patients complaining about all the symptoms of being obese. Must be frustrating.

    So, basically, you think doctors should deny treatment to people if it's possible that their medical problem could in any way be caused by their behavior?

    "Nope, no chemo, radiation, or surgery for your lung cancer until you stop smoking. Maybe the cancer will go away."

    "Nope, we're not going to treat your broken bones until you give up all your dangerous skateboarding, skiing, and mountain biking hobbies."

    "Well, of course you're having balance problems. You're 82. No reason to send you for any diagnostic testing to see if it's an inner ear problem."

    I'm talking about inhaled corticosteroids. A person who has breathing problems BECAUSE they're overweight WOULD NOT benefit from an inhaler. It would actually increase the risk for conditions such as oral candida, osteoporosis and cataracts. No inhaler would be beneficial, unless they have asthma.

    Just in case you missed it:

    "The major criticism of the epidemiological studies has been the basis of diagnosis of asthma. Obesity impairs ventilatory functions i.e. forced expiratory volume in one second (FEV 1), forced vital capacity (FVC), total lung capacity and expiratory reserve volume.5 Besides, it may reduce respiratory muscle strength, decrease thoracic cage compliance and impede diaphragmatic excursion, especially when it is massive and central. The resultant increase in work of breathing may lead to the perception of increased respiratory effort i.e. dyspnoea. The latter may be confused as asthma. Thus, there is a risk of over diagnosing asthma in the obese. Further, it is apprehended that the correlation between obesity and asthma may not be causally related but may be due to existence of common risk factors."

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2853040/

    But in the study in the OP, the obese patients do not get the benefit of testing to see why [in your example] they are having trouble breathing. They are simply sent on their way with advice to lose weight, without any attempt to discover whether in fact their problems are due to their weight and whether there is any kind of intervention or additional education/information that could be provided that would help them.

    No one on here except the people defending the doctors is saying treat people for conditions they don't have, or even to ignore obesity as part of the medical used to make an initial diagnosis. The criticism is that for the doctors in the study, all attempt at diagnosis or treatment stopped at, "Oh, you're obese. The problem must be caused by that. Go lose weight. Next patient."
  • crackpotbaby
    crackpotbaby Posts: 1,297 Member
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    lynn_glenmont wrote: »
    eliciaobrien1 wrote: »
    lynn_glenmont wrote: »
    eliciaobrien1 wrote: »
    canadianlbs wrote: »
    i can't speak to the bad attitude about obesity, but this statement about preconceptions of futility mirrors my experience as a person with rheumatoid arthritis. it's like a rug that a lot of things can get shuffled under. so pushing to get the same care and diagnostic attention as a 'normal' person has definitely been a factor since i got diagnosed.

    i've been seeing it lately too, as i try to advocate for my father who is in his nineties. 'la la la mr x, you're just old, too bad. next!' it comes down to not being taken seriously.

    "physicians may over-attribute symptoms and problems to obesity, and fail to refer the patient for diagnostic testing or to consider treatment options beyond advising the patient to lose weight"



    Obesity can cause a variety of health issues. I don't think we can blame a doctor who would chalk up "shortness of breath" to being overweight.

    I would blame any doctor who makes diagnoses based on taking one look at a patient and making an assumption that anyone in the general public would make. Why should we be paying for their supposed expertise if they don't actually take a medical history and administer the appropriate diagnostic tests?

    It used to be that if a woman went to a doctor for anything they couldn't diagnose visually (say, a compound fracture), they just chalked it up to "women troubles" or (worse) assumed it was all in her head ("hysteria" = mental problems caused by having a uterus).
    Even as an asthmatic the only thing the doctors can do for me is prescribe me a puffer that will probably reduce inflammation in my airways.

    So you think someone who is overweight who could benefit from an inhaler to help them breathe should be denied one because they're overweight?
    I don't know about the diagnostic process of rheumatoid arthritis but I can't blame a doctor if he/she says "lose some weight and then we'll see". That seems like the first step in the diagnostic process. I'm sure some doctors are absolutely terrible, but how many doctors get obese patients complaining about all the symptoms of being obese. Must be frustrating.

    So, basically, you think doctors should deny treatment to people if it's possible that their medical problem could in any way be caused by their behavior?

    "Nope, no chemo, radiation, or surgery for your lung cancer until you stop smoking. Maybe the cancer will go away."

    "Nope, we're not going to treat your broken bones until you give up all your dangerous skateboarding, skiing, and mountain biking hobbies."

    "Well, of course you're having balance problems. You're 82. No reason to send you for any diagnostic testing to see if it's an inner ear problem."

    I'm talking about inhaled corticosteroids. A person who has breathing problems BECAUSE they're overweight WOULD NOT benefit from an inhaler. It would actually increase the risk for conditions such as oral candida, osteoporosis and cataracts. No inhaler would be beneficial, unless they have asthma.

    Just in case you missed it:

    "The major criticism of the epidemiological studies has been the basis of diagnosis of asthma. Obesity impairs ventilatory functions i.e. forced expiratory volume in one second (FEV 1), forced vital capacity (FVC), total lung capacity and expiratory reserve volume.5 Besides, it may reduce respiratory muscle strength, decrease thoracic cage compliance and impede diaphragmatic excursion, especially when it is massive and central. The resultant increase in work of breathing may lead to the perception of increased respiratory effort i.e. dyspnoea. The latter may be confused as asthma. Thus, there is a risk of over diagnosing asthma in the obese. Further, it is apprehended that the correlation between obesity and asthma may not be causally related but may be due to existence of common risk factors."

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2853040/


    No one on here except the people defending the doctors is saying treat people for conditions they don't have, or even to ignore obesity as part of the medical used to make an initial diagnosis.


    In my own comments which could be described as ‘defending doctors’ (personally I would consider it exploring the topic from both perspectives), I am quite certain I have not said treat people for conditions they don’t have. Quite the opposite.

    I have however seen a post saying people with obesity related dyspneoa/shortness of breath should be entitled to ‘puffers’ - a medical treatment which would not be clinically indicated!

    Early on in this thread I listed several other causes of ‘shortness of breath’ and the most basic investigations/considerations a doctor might take.

    In many - and certainly acute - presentations of ‘shortness of breath’ a diagnoses or exclusion of asthma can be made by listening to a person’s chest with a stethoscope.

    I’m pretty sure a person obese or not going to the doc saying I’m short of breath has their chest auscaltated. If there is no wheeze, riles, crackles, dullness, rub, abnormal heart sounds etc that warant further investigation and the person is obese, it’s actaully a reasonable clinical judgement to suggest they need to lose weight rather than refer for unnecessary, costly and inconvenient and (in some cases carrying a risk of radiation) etc testing.

    I think we all agree stigmatising a population is bad.

    Giving appropriate medical advice based on presentation, probably not so much.

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