Here’s one of the studies I’d saved and forgotten until I got organized over the holidays.  The researchers took a survey among doctors to determine their attitudes towards the obese.  Let’s look at the results:

Six hundred twenty physicians responded. They rated physical inactivity as significantly more important than any other cause of obesity. Two other behavioral factors — overeating and a high-fat diet — received the next highest mean ratings. More than 50% of physicians viewed obese patients as awkward, unattractive, ugly, and noncompliant.

So there’s the consensus medical opinion for you:  obese people are obese because they don’t move around enough and eat too much fat.  If you need more evidence that the average doctor doesn’t don’t know diddly about weight loss, there it is.

In his book Fat Politics, Professor Eric Oliver (who appeared in Fat Head) wrote that obese people often avoid doctors – thus allowing treatable conditions to go untreated – because they’re afraid they’ll be criticized for their size.  Given the results of this survey, I’d say that’s a reasonable fear.

“Why aren’t you sticking to the low-fat diet and exercise program I prescribed?!”

“I am, Doctor.”

“No, you’re clearly not.  Just look at you.  You’re awkward, unattractive, ugly and noncompliant.  Now, when should we schedule you for a follow-up visit?”

Unfortunately, much if not most of the general public shares the same belief:  obesity is the result of laziness.  I was reminded of that in two emails I received this week from readers.  Here’s part of the first one:

Having watched Super Size Me I was, as I assume many others were, led to believe what the film intended: the vast majority of Americans are fat, lazy and (for lack of a better term) stupid — a belief I’ve pretty much held my entire life. Being athletic and “skinny,” I have done nothing but look down on those who didn’t match what I saw in the mirror.

I thought all you had to do to be like me is get your ass off the couch and do something. Burn more calories, lose weight, easy enough … or so I thought.  Having grown older and somewhat wiser, I’ve started realizing the faults of that mentality.

Put an M.D. after his name and take away the wisdom that came with maturity, and you’d have your average doctor looking at an obese patient.  Thank goodness he saw the light (and Fat Head.)

Here’s another email from a guy who also believed losing weight was all about being more active – until he gained weight himself:

I was always skinny as a child. I wrestled in high school at a lower weight (130), at 5’9″. The coach was a popular guy, so we often got graduates coming back to practice with the team a few times on their college winter break. Invariably, the graduates would be well over their old weights, leading to joking around about how “fat” they’d become. The coach would always tell us that, in time, we’d all develop paunches and be “fat old men.” We just accepted it, while we downed rice cakes and diet cola at lunch during the season to keep us in our weight class –by senior year, this was already difficult for me, despite the grueling practices.

Years passed (I’ve always wanted to write that)….

When I hit 30, I looked at my weight. Despite never being “fat”, I’d gone up to 170-175lbs (depending on whether I’d pigged out or not the last few days), which is overweight on the BMI scale.

I immediately started working out again like I did on the old squad, and pretty soon had a 2-3 times per week routine of distance running and weight training. I clocked a 7 minute mile in 6 months, and was lifting a substantial amount. Yet, despite all this hard work, I was still tipping the scales at 170lbs!

My diet was “extra healthy”: a glass of orange juice for breakfast, with perhaps some oatmeal; a meal of rice, beans, and cheese for lunch (easy on that fatty cheese, pile on the rice and beans!); and spaghetti for dinner, with 2-3 pieces of wheat bread to mop up the sauce. For a snack, an English muffin, or else three “reduced fat” Oreos. Yet, after months of this “healthy eating,” I still was at 170lbs on my best day! Who’d have thunk it, right?

And then the injuries started up. Plantar fascitis was a huge one—I’d wake up in the morning and feel a ton of pain just standing up. The podiatrist I saw gave me some painkillers and told me I’d need some inserts for my shoes, probably for most of my life. My back and neck ached too.

At first I just thought I was getting old. So I continued to work out. I hit 10 pullups, 100 situps, and 50 pushups, with my running at a 7 minute mile clip and lifting weights. But … more pain, no weight loss!

The reader saw Fat Head and decided to try a low-carb diet based on meats, eggs and vegetables with some full-dairy.  He hoped to lose 3-4 pounds in the first month.  He lost 10 instead.  He continues:

I nearly flipped out! As one person wrote on another website, low-carb dieting was like playing a video game with a God-mode-cheat-code. So easy! I didn’t count calories, never skimped on a meal, was always full and happy. And I hadn’t seen 160 since…well, I don’t know when I passed it to begin with, but certainly not since I passed 30.

Full, happy, no counting calories … that’s my life now.  I didn’t make a New Year’s resolution to lose weight this year and haven’t in three years. I don’t even own a scale.  My only diet resolution this year was to return to what I know works after indulging a bit over the holidays.

The “fluffy” picture (as one reader kindly put it) I posted earlier in the week was of me on a low-fat diet – and I was a regular jogger in those days.  (I once found a videotape of me jogging, looking quite fat in my jogging outfit.)  I also worked out at a Nautilus club two or three times per week.  An athletic, naturally-lean buddy of mine (who also believed people are fat because they eat too much and don’t move around enough) once joined me for a workout and admitted later he was surprised by how much I could out-lift him.

Despite the low-fat diet and all that physical effort (doctor approved!), I was fat.  I wasn’t morbidly obese, but I do remember a doctor pointedly telling me I should focus on losing some weight.  He likely thought I was lazy and sat around all the time.  Hardly.  I probably could have beaten him in either an arm-wrestling match or a 5k race.

It’s January, so millions of fat Americans are hitting the gyms and health clubs, hoping to sweat their way into leaner physiques.  Their doctors would approve.

Around April or so, many of them will become frustrated and give up — at least that’s the annual pattern Chareva and I have noticed at the rec center where we work out.  Their doctors will disapprove, labeling them as lazy and non-compliant.

Their doctors don’t know squat.

36 Responses to “How Doctors View Obese Patients”
  1. Greta Kirkland says:

    I read a survey once where doctors said they would rather treat a homeless drug addict than me.

    Probably because the advice they give to homeless drug addicts has a chance of working.

  2. Milla says:

    “Obese people are obese because they don’t move around enough and eat too much fat.” Yeah I tried that once. I gave up bread and pasta, low-fat dairy and other health foods and instead sat around on the couch and consumed very manly quantities of bacon, fatty cheeses and other goodies. Ended up losing around 70lbs in a year and change, got rid of pains and aches and a sizeable stomach and 3 of my chins.
    Speaking of doctors: My mother went to a doctor once, she started telling him “I keep having these pains….” and before she could finish her sentence, her doctor said “Well you should try to lose some weight!”. My mother continued “….in my wrist…”. Ergo: If you have pains or aches or something going on, it’s because you’re fat and lazy. But hey, we all knew that. She started low carb a few years ago, she got rid of her type 2 diabetes, among other things. My grandfather, who is in his 70’s, got rid of gout and diabetes and whatnot, and is now med-free. A man in his 70’s without meds is rare nowadays!
    Well, that’s all I had to say for now. Great blog, Tom, and Fat Head rocks!

    Something like 90% of seniors are on at least one prescription medication, with most being on more than one. So kudos to your grandfather and the rest of your family for adopting a diet that works.

  3. I’m down from 215 to 177 since August, following the simplest of rules I could discern from your movie. I look forward to shaking your hand on the Low Carb Cruise, because your down-to-earth simple explanation of what my body does with calories is the only thing in decades that has made a difference. And I’m lazy. I could never be on a “low fat” diet for more than a few months, because I got tired of salads. 🙂 As a fellow programmer and professional stand-up comedian, I salute you. (And yeah, I’m *that* Randal Schwartz, with the wikipedia page, etc.)

    And here I thought I was the only programmer/comedian in the world. Looking forward to meeting you on the cruise.

  4. Jo says:

    Yeah, I had some unexplained weight gain recently (despite being low carb). Took 10 minutes explaining to the doctor that I had spent 20 years failing to lose weight through calorie control and exercise, and that low carb was the only way I had managed to do it in the past. His advice? Eat less and do more exercise than I was already doing (told him that I was going to the gym 3 days a week – I’m obviously lazy then).

    Can’t say I’m surprised.

  5. Tracey says:

    My husband came up with a brilliant business plan this New Year…he reckons we should open a facility called “Resolutions” that opens Jan 1st as a gym, and by March it’s a pub.

    Love it. Sign me up.

    • Walter Bushell says:

      Would work, start in January as a health club with a juice bar, encourage social interaction and bonding between members and gradually introduce alcohol while increasing the bar size. Use very upscale beers with lots of hops to induce obesity. [1] Have to keep some exercise space and activities and trainers so people come thinking they are going to exercise.

      [1] In addition to the carbs and beer there is an estrogenic effect from the hops.

      Damn, why can’t I come up with a high profit idea that isn’t evil?

  6. Mike Poisson says:

    Great stuff as always.

    Got into a row with my Dr. last night. He stated that soon the insurance companies are going to want all type 1 and type 2 diabetics to be put on statins regardless of the cholesterol numbers. I find this blanket prescription dangerous. Supposed to be based on a University of Michigan research.

    Head. Bang. On. Desk. Are they ignoring the evidence (observational only so far) that statins may induce diabetes?

  7. Sean says:

    I saw a BBC doc where a doctor was spouting the party line that she presumably followed. They did an immersion BF% test and she was classic thin/fat, quite thin but with 25% BF or something. Eating a very restricted and boring diet combined with treadmilling every day can keep one thin but the results aren’t great. I suspect a lot of these people who manage to stay thin following an ascetic food pyramid and doing aerobics, such as the doctors who follow their own advice, are thin/fat.

  8. Wow. The results of this study really do match up with my experiences with most doctors. A summary of all my weight consultations:

    “Doc, I’m on your diet but I’m not losing weight! I gained three pounds!”
    “Well, you must be cheating.”
    “I’m NOT. Here’s my food log! See? I’m following the rules to the letter!”
    “You’re eating the minimum on grains [6 servings] and the maximum on meat and fat [6oz and 2 Tbsp, respectively]. You need to cut that in half! Eat more hearthealthywholegrains!”
    Two weeks later
    “Doc, I’ve gained more weight, and I’m tired and depressed!”
    “You cheated!”
    “NO, I DID NOT!”
    “You must have, because you’ve gained weight. Come back when you can be honest with me about your eating habits.”

    I’m sure that same scene plays out thousands of times per day.

  9. Tammy says:

    I have had my own doctor disappointment. A few years back I started seeing my current doctor. She’s fairly young (late 30’s – early 40’s) very smart and (I thought) open minded. We had discussed nutrition and she was perfectly open to my thoughts/ideas. About a year and a half ago I gave her my copy of Taubes Good Calories Bad Calories since she said she was interested in reading it. But this past holiday, I was at her house for a party and commented on the skim milk she was giving the kids. I mentioned whole milk as a better option and her response was “leave us alone we’re skinny”. Now I know it was hectic and probably not the time/place to talk nutrition but it opened my eyes to her probably just giving lip service in the office. I mean we’re friends outside of the doctor office so I’m not holding anything personally against her, I just realized that she’s stuck in CW like everyone else. Disappointing since I thought I had a Doctor’s ear, someone who really could make a difference.

    It’s difficult to let go of an established paradigm, even as evidence mounts that the paradigm is wrong.

  10. Walter B says:

    RE: Greta Kirkland : Also the homeless drug addict is much less likely to tell the doctor he’s full of fecal matter.

  11. Janknitz says:

    When confronted with an obese patient, a physician hands out the same, tired advice, “eat less, move more”. (Even worse is a referral to a dietician who will advise at least six servings of carbs daily and forbid fat. ). When the patient returns no thinner, it’s obviously the patient’s fault for failing to comply with that brilliant advice, therefore the patient is a lazy glutton who can’t overcome his or her own inherent sloth. After all, the physician believes that CICO has a scientific basis (the fact that it does not escapes them),

    It is a vicious cycle and a rare physician who can look beyond his or her own nose to perhaps question the advice and see that there may be another path.

  12. Craig says:

    I’ve worked doing parts sales in the collision repair industry for nearly a decade. Most body repair techs eat a terrible starch and sugar-heavy fast food diet. Body work is definitely hard work and I used to tell friends it was obvious how much exercise body techs were getting because all the old techs were super skinny despite the piles of garbage they ate.

    However, over the years I’ve seen plenty of young body techs get steadily fatter year-after-year until they have to find another career because they can’t do the work anymore. It slowly became obvious that even grueling body work doesn’t keep you skinny regardless of what you eat. Instead, those random guys who are able to stay skinny no matter what they eat are the ones who are able to keep doing the job up into their 60s despite having terrible diets.

    I thought about that while watching the crew move us from California to Tennessee. These guys hauled 15,000 pounds of our belongings downstairs in California, then upstairs in Tennessee. They were strong as gorillas. Two of them were also fat.

  13. Firebird says:

    I’ve been reading a lot lately about replenishing glycogen as it pertains to weight lifting…eat carbs once every 5 days. Doctors like Greg Ellis deem this unnecessary, but I’ve considered it. I began to think of what carb heavy foods to eat…a couple of slices of pizza? Oatmeal? (an old favorite)…maybe a calzone…burrito? pasta? None of it appeals to me…not at all. I just don’t want it, and it has nothing to do with gaining a pound or two for doing it, it is simply that it is no longer appealing to me.

    The research conducted by Volek and Phinney shows that ketones can fuel workouts just fine, once you’ve become keto-adapted. I don’t carb-load before workouts, but if you go that route, I wouldn’t do it with grains.

  14. Baron Von Cruzer says:

    “Why aren’t you sticking to the low-fat diet and exercise program I prescribed?!”

    “I am, Doctor.”

    I describe the above as “doing an Ornish.”

    Good description.

  15. Lori says:

    Move more to lose weight? I just saw a bunch of paunchy football players on TV.

    Eat less? My mom barely eats (no appetite). She can’t drop a pound. (She’s always cold, too, so I urge her to get her thyroid checked.)

    Anyone who thinks those big-bellied linemen don’t exercise enough should go watch a training camp.

  16. Ellen says:

    My husband is a mailman and of course he walks miles every day, yet has been gaining weight steadily over the last several years. He has started eating eggs for breakfast every day (instead of eggo waffles), gave up soda and sweet tea, and started losing weight immediately. He’s amazed how long he stays full each day. I guess my year and a half of explaining this to him has finally sunk in.

    I admire your persistence. That’s good news about your husband.

  17. Cameron Baum says:

    I just shared this with a friend who is currently super obese, and is having a pig of a time trying to get the doctors to sign off for him to have the Cambridge Diet on the NHS. He was very down and hacked off earlier this week, because he has had quite an uphill struggle with it.

    I wish your friend well.

  18. KD says:

    Our pediatrician discussed diet with my 2 ultra-fit teenage boys over the summer. They play a very demanding sport and sometimes workout as much as 5-6 hours a day, even with that they are bursting with energy and sometimes just “need” to go shoot some hoops or go for a run. They are strong, healthy and have great muscle tone, she only sees them for their annual sports physical or if there is an injury because they don’t seem to catch every little bug that goes around. Even with their extreme workouts there are boys on their team that are heavy. One of them is a vegetarian, the others have parents that push very low fat foods. They are all doing the same workouts and at least a few of the heavier boys are eating far fewer calories because their parents are restricting what they are eating. (as much as possible with a HS kid anyway)

    So, you would think she would want to suggest other patients eat the way they do, not tell them to eat less fat and fewer calories. (to be fair, they take in ALOT of calories even for the amount of exercise they get. We’ve tracked calories before and a “light” day would be 6-8,00, a heavy (in season) day would be 10,000-12,000 calories. They just eat until they are full.
    They would both like to gain some weight, so maybe that was what she was trying to help them with/NOT-yes, sometimes I want to bang my forehead on my desk too)

    You would think, but that would require the doctor to think about the advice she’s offering instead of just parroting what she was told in med school.

  19. Troy Wynn says:

    What’s the date of that study Tom?

    That one was published in 2003. It would be nice to think a lot of doctors have changed their attitudes since then, but I wouldn’t bet on it. After all, one of our big national anti-obesity campaigns is called Let’s Move.

  20. Mirva says:

    You know that feeling fat person gets when he/she must go to doctor…..what ever is reason/illness is, doc says that to lose weight is the answer….so….fat people get rid of flu if they only lose some weight, right?.

    One doc told me I must have good genes because I have such good bloodfats…..He knows I am on LCHF WOE, it can not be the food…..

    The sadness with all of doctors is, that big pharma owns them, where to find a doc who does not listen to money ?

    I’ve heard from so many readers now … they go high-fat/low-carb, their lab numbers improve, and their doctors declare them freaks of nature. We sure have a lot of freaks these days.

  21. Peggy Holloway says:

    I had a Facebook conversation with a former student who is now 30-ish. She posted that she had lost 6 pounds since starting Weight Watchers Jan. 1, but was hoping it wasn’t just because she had the flu. A friend of hers suggested that she should consider it a lucky “jumpstart” on her weight loss. I posted the experience my sister had with going on Weight Watchers and gaining 10 pounds and her “diabetes” diagnosis and advised the young woman to be sure and watch her carb consumption. She replied that she appreciated my advice concerning the carbs and does not intend to eat all of her points in carbohydrates, but that she was doing Weight Watchers because she had done it in the past and was very successful. I resisted the desire to ask”if you have to go back on Weight Watchers again, doesn’t that imply that it was not successful?” It is so sad to see the 20 and 30-somethings I work with buy into the “calories in, calories out” paradigm. I did the same thing at their age, destroyed my metabolism, and really paid for it in my 40s. Wish they would read all of my low-carb info Facebook posts and not have to go through what I did. Oh well….what they say about leading horses….

    Yes, I’ve heard the “I’m going to try Weight Watchers again” line in my own extended family more than once.

    • Walter Bushell says:

      Weight loss by flu.

      I remember reading of someone who was complemented on losing weight,
      and said, “I’m in therapy for cancer.”

      “But you look marvelous.”

  22. Bruce says:

    Head. Bang. On. Desk. Are they ignoring the evidence (observational only so far) that statins may induce diabetes?

    Don’t worry. They have a pill for that.

    LOL. Too true.

  23. Marilyn says:

    @Mike Poisson: “He stated that soon the insurance companies are going to want all type 1 and type 2 diabetics to be put on statins regardless of the cholesterol numbers.”

    Chummy! A win-win situation for everyone but the patient.

  24. soren says:

    If that guy had Plantar fascitis then he was doing way too much running and the time he spent weight lifting was a complete waste for weight management purposes.

    We want to believe our reward for all that effort will be losing weight, but unfortunately that’s just not the case. I suspect my jogging days didn’t do much for the knee I had repaired last year.

  25. Alex says:

    Obesity is clearly a hormonal imbalance and should be treated as such. If it were just a matter of laziness, I’d be obese a long time ago. But my hormones won’t allow me to keep eating and eating because my brain get the “I’m satisfied” signal. Obese people are literally starving.

  26. Alex says:

    Ellen – at a certain point everyone gets sick & tired of feeling sick & tired and they will try a diet they would have ridiculed earlier.

  27. Firebird says:

    “I don’t carb-load before workouts, but if you go that route, I wouldn’t do it with grains.”

    I don’t either. I train on an empty stomach, but I take a drink to the gym that consists of BCAA’s, creatine and Vitamin C.

    The carb loading that bodybuilders do isn’t part of a pre-workout routine. Rather, they low carb for 5 days then carb out for one day, keeping protein intake to a minimum. The low fat people in the community like to call that a cheat day. Dr. Ellis prefers the word “sabotage”.

  28. Galina L. says:

    My family physician just stopped recommending people to go to a weight-loss diet because he read a lot of research that people are unable to keep the lost weight. He is very supportive of my LCarbing and put it in my med.records.

  29. Cheryl AS says:

    Yes, once upon a time we thought Dr’s where god liek and knew it all – well we have since found out they are human and guess what they do not know everything after all. Weight is one issue they generally do not have much information on that or Nutrition thats because in their Medical trainin they are given around 40mins on the subject – so how in hell can we take what they say as truly professional. Fortunately more and more Dr’s are seeing that they need to learn more – although some wont be convinced. I have a condition called Lipedema which affects over 3 million in the UK 6.5 millin in the USA, dont have the figures for Australasia. This is inherited rare fat disease – and yes hardly ANY Dr’s know anything about it or how to treat it with frustrated patients. The suffers have large fat deposits in the legs and arms sometimes. So we go to a Dr who tells us to go on a diet…well if they knew anything about this disease it does not respond to ordinary dieting, people look down on us that we must be glutons etc and lazy. We are in fact victims of many external and internal issues and there is no known cure. So much for help or understanding from the Medical Community.

    I’m sorry to hear about your condition and wish you well.

  30. desmond says:

    Today a coworker and I were joking about a recent “gift” of doughnuts and fruit juice at my office. I discovered that he is at risk of Type 2 diabetes. His doctor actually advised him to go on a low-carb (particularly avoiding wheat/gluten) low-sugar diet, and he has been following it. Maybe things are changing.

    Word is getting around and more doctors are waking up on the issue. It’s slow progress, but progress.

  31. Bret says:

    The current state of the medical profession is tragic. All these chronic problems are being treated with prohibitively expensive medications and procedures that are totally unnecessary and horribly ineffective compared to eliminating carbs and switching to quality food. And since our spineless politicians will “pay” for people to get just about any of these medicines/procedures, the cost of health care in general is inflating out of control.

    I’ve heard some experts in the low carb community predict that these problems will work themselves out in a decade or two through greater general awareness of how to eat properly. I’m not quite so optimistic, but I sure hope they’re right and I’m wrong. I don’t think we can afford too much more of things the way they are now.

    Look on the bright side: when our politicians finally spend the country into bankruptcy, they won’t be able to subsidize grains anymore, much less the medical procedures required to treat the result of eating all those grains.

  32. Michelle says:

    I had that happen with my bloodwork. I had my lipid profile done and my HDL was very low (was never “ideal” but had dropped well into the danger zone!), and the nurse gave me a mini-lecture about eating beans, fruits, vegetables, and whole grains. I just glared at her, because that was at the end of a month of eating SUPER “CLEAN” in which I had a detailed food journal specifically listing everything that had passed my lips, and those things were EXACTLY what I had been eating! I wanted to pull out my journal and demand she explain herself!

    She just would have accused you of lying.

  33. anon says:

    In response to tammy’s post, perhaps you dont realize how rude you came off telling this woman how to parent. Most people dont. want advice they didnt ask for at the best of times. Getting advice on nutrition off of fat people is a little bit like getting financial advice from someone with gambling addiction.

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