Does your doctor comment on your weight?

DebbsSeattle wrote: »

It does not benefit doctors to have their patience healthy. It is sick care not health care. They get paid more money to prescribe rX, which means the fatter and less healthy you become the more they make. The healthier you become the less your shopping supports big food. The healthier you become the less you support big pharma. The insurance companies pull a 15% profit no matter what (as per federal regulation/law on insurance industry) so they don’t care if you are healthy or sick. The healthier you become, the longer the social security will have to support you…they want you dead. You are the only one who will benefit by your being healthy. The individual must take control of their own being.

Since I'm seeing those from other countries saying this is not true where they are, but I haven't seen an obvious US person speak up yet:

There are many things wrong with the US health care system, but in my experience it is not the case that doctors or the system at large are universally cynical profiteers who want us to be unhealthy.

Even my for-profit insurer does some stuff that is clearly and reasonably formulated to try to make me healthier and keep me healthier - things that cost them money to do. (Example: They pay for and push home visits to alllllll seniors they insure to improve home safety and medication compliance. That has to cost a bunch. They have reward programs for exercise compliance.)

My doctors, generally, have been delighted when I make changes that improve my health, and often have done things that limit how much they get to bill my insurer (like, cure me of things via quicker, less expensive routes; or send me to other health care sources (unaffiliated with them financially) whom they feel can do a better job for me). I'd observe that in the case of weight loss specifically, my GP (and his med assistant) was utterly gobsmacked - in a good way - when I lost weight. I inferred that that was because it's super rare in real life that someone who says they'll try weight loss to avoid statins actually follows through.

Are there some bad actors here and there in the US system? Sure. But it's not the predominant pattern in my experience, not even close. If someone else has had uniformly bad experiences across the system, that makes me sad for them, of course. But it doesn't entitle those people to assert (unchallenged) that the entire system is corrupt, in the face of others with dramatically different experiences within the same system.

"Big food" exists to give us what we vote with our dollars to say we want to eat, and they compete to make it cheaper, more convenient, and more ubiquitously available. Probably due to long pressures of natural selection, we want things that are high in fat and sugar and salt, not very filling so we can eat MoreMoreMore, and fatty meaty cheesey things. That's what Big Food delivers: The stuff we repeatedly show we want to buy.

Products are formulated with heavy input from focus groups and taste tests. The components of those foods become cheap in part because there's huge competitive pressure to produce them more cheaply, in support of price competition. We get what we collectively ask for, cheaply made and marketed intensely.

Big pharma for sure has some perverse incentives in the US, and it's had its share of bad actors in recent years. I won't try to defend any of that. Yes, they do try to influence doctors, but countervailing forces - including legal strictures - continue to be implemented to limit scope of that influence, and the damage from it. To say otherwise is inaccurate. Further, my observation in my social context - which may not be representative - is that quite a few people just want - actively want - to visit the doc and get another pill for (whatever) rather than make even minimal changes in how they live their lives.

In the quoted post, there's lots of "they" language, not very specific: "They" want us ill, "they" don't want to pay us social security, etc. The implication is that there's a conspiracy of "theys" against the "us-es". Generally, no. IMO, that's denial. (Plus, the bigger the imputed conspiracy, the less likely it's real as an actual collaboration amongst some cabal.) The one thing I agree with the previous post about: We ought to take responsibility.

Cartoonist Walt Kelly's Pogo made the main point best: "We have met the enemy, and he is us."

Where does all this redirection and blame come from? I’ve read page after page of blame directed towards doctors for their obesity, or not telling them how to lose weight. It is your responsibility to get on a scale, learn what weight range is typically healthy for the amount of muscle you have, and make sure your blood work is fine. It is your responsibility to research your TDEE. You’ve been given the foundation for moderation since you started school- you just chose to ignore it. Why does everyone act like they didn’t know they were fat, obese, morbidly obese, and then blame everyone but themselves? I’ve been every size at this point, but I know every decision I made was because of me.

However, I’ve read comments stating they are happy their doctor told them the truth and they did something about it. I think that’s fantastic. Though, I think if you rely on your doctor to tell you that you’re fat, you’re living on autopilot and there’s a lot more wrong than just your weight.

I hate that my tax dollars are responsible for people that don’t take care of themselves when I work hard to not be a burden to myself and others. Health care support should be there for those who are in circumstances that their body or mind can’t control, and not for those who can. You should pay for your personal issues if you created them when you have all the tools to do so.

ETA This does not mean you are not lovable or that you are expendable. It just means you need to take responsibility for yourself and quit expecting others to fix you.

I don't care if a dr. tells me to lose weight, but sometimes they assume you need to lose weight so that's probably all that's wrong with you. Sometimes, weight gain causes health problems; and sometimes, other health problems cause weight gain. I think some doctors forget that sometimes.

Okay, long story follows but this is why it's so important to advocate for yourself with doctors when they dismiss everything else because you're overweight:

I lost 10 yrs of my life with my health going downhill. When it started I was overweight-- chubby mom who didn't take off all the baby weight-- but I had always been very active, playing basketball or freeze tag with my kids, dancing for hours on a night out, camping and hiking trips. Until I started getting more and more tired, more and more achy. Drs say "just lose weight."

Fast forward 5 yrs. I can still work and do chores and stuff, but I have no where near the energy I did have. Now, I trudge along and get through things, and I'm exhausted at the end of the day and stop doing stuff that used to be fun. My joint aches are making it difficult to be active and it's starting to depress me. I gain weight, and am diagnosed with Type 2 diabetes. I'm getting occasional heart palpitations, but dr. gives me EKG and it doesn't happen then, so she just tells me women sometimes get heart palpitations and it's normal, but my heart is fine. Drs say: "just lose weight."

Fast forward 2 more years, I rarely go out. I don't play with my kids anymore, it's a chore just to get through a day doing the minimum I need to take care of them. I have itchy rashes all over my skin. My joints hurt so bad sometimes I can't sleep. I get night sweats. I have what I called "heart flutters" a lot, like daily on and off. I'm always tired and having anxiety attacks and out of breath. I'm hating myself for failing at everything. I switch to working at home because my job as a photographer was too physical for me. I'm eating mostly junk because I haven't the strength to shop or cook, and I'm comfort eating due to the depression. Beg dr's for help, they run some tests and say "Just lose weight."

Time goes by, it's getting worse, and worse. I developed a cough that comes with the "heart flutters." I get to the point when I'm hardly leaving the house anymore. Just walking from one room to the next leaves me achy and winded. Showering knocks me out. I need to sleep with no blankets and two fans on me. I'm neglecting my kids, they learn to fend for themselves for a lot of things or my husband or mother have to help.

By year 8 or 9, I'm so discouraged by Drs I barely wanna go to them anymore, and when I do I don't try to get them to look deeper anymore. I've gained more than 100 lbs since all this started. They still say "just lose weight." And I hate myself more and more for failing every time I try to follow their advice.

Year 10, I can't barely walk to the bathroom and back. I've gained like 150 lbs since this started. I need help bathing. I'm getting my "heart flutters" and cough every 30 to 60 seconds, nonstop night and day. Every few minutes I wait to see if I'm just having a heart attack and wonder if I'm gonna die. I'm sleeping 18-20 hours per day and still tired the rest of the time. I realize I haven't left the house to even step out on the porch in a year. I'm still working at home but only part time. I'm always mad achey and always shoveling in Tylenol and Ibuprofen or I can't get thru the day. My marriage is affected terribly from the stress. I hate going to drs. Last dr visit like this and I'm told I've got chronic bronchitis without further tests, I'm put on a cough syrup, and told "just lose weight."

Finally I'm taken to the ER against my will. They do some tests and tell me I probably have non-Hodgkin lymphoma. They admit me and spend 10 days doing batteries of tests. Nurses are always like "you're still sleeping?" It finally comes down to exploratory lung surgery, because I've got no other signs of cancer.

Turns out I had a rare auto-immune disease. A treatable one that is rarely fatal, even though it came close to killing me. It's mainly attacking my lungs, joints, and skin. And the "heart flutters' are actually heart arrythmia due to low blood oxygen levels.

I was treated with steroids, which got the auto-immune disease out of control but sent my diabetes out of control. I still got winded easily and my muscles were so weak I was in a wheelchair for a couple of years doing PT till I got back enough strength to walk. The depression and frustration of it all unfortunately took quite a bit more time and effort to heal. My marriage never healed, and I ended up divorced. He got sick of being responsible for everything, and started cheating.

But I'm down 80 lbs. now, and my diabetes is not only under control but almost reversed, my auto-immune disease flare-ups are rare, and I can walk and do things again; still low on energy and stamina and strength in comparison to what I was before it all started, but I'm still working on it. And I'm finally finding peace of mind and depressive episodes are rare. Recovery has been slow but steady.

So yeah, I wasn't just this fat, lazy chick who didn't wanna exercise or eat right after all. Turns out that "just lose weight' meant my doctors weren't doing their job. Had they just listened to me and looked past my weight, they might have caught it years earlier and prevented the spiral downward.

Dr's should mention people's weight, sure, but when you're overweight you have to be careful and forceful in advocating for yourself when your doctor chalks all your problems up to weight.