How Doctors View Obese Patients

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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.


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72 thoughts on “How Doctors View Obese Patients

  1. Alex

    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.

    Reply
  2. Alex

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

    Reply
  3. Firebird

    “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”.

    Reply
  4. Firebird

    “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”.

    Reply
  5. Galina L.

    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.

    Reply
  6. Galina L.

    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.

    Reply
  7. Cheryl AS

    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.

    Reply
  8. Cheryl AS

    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.

    Reply
  9. desmond

    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.

    Reply
  10. desmond

    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.

    Reply
  11. Bret

    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.

    Reply
  12. Michelle

    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.

    Reply
  13. Bret

    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.

    Reply
  14. Michelle

    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.

    Reply
  15. anon

    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.

    Reply
  16. anon

    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.

    Reply

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