Shouldnt my doctor be healthy too?

[Guest charmingbutterfly]

I had to go to the hospital for something and had to get checked by a few doctors and such and such.... one of the doctors was overweight(by overwieght I dont just mean a little bit on the heavy side - I mean overweight) and I later found out that he smokes! SMOKES!....

well that could just be a rumor but I heard it from someone who is a neighbour of a family friend of the doctor!

I have nothing against people who smoke or are overwieght, but I think doctors should still make an effort to be healthy.

There are so many negative effects of being overweight and how am I to listen to someone who wont take their own advice? If the smoking thing is true - well that just baffles me. For me, a doctor smoking would be like a cop selling weed, but maybe I expect too much...

[Guest moo]

Yes, doctors should be healthy, but unfortunately many are not. Many of my classmates smoke (albeit socially) and I'd say almost everyone drinks--some more than others. (But so does 80% of the population.) Don't be alarmed by fat, smoking doctors. The proportion of doctors who are like that are far fewer than that of the general population.

[Guest Jochi1543]

Smoking is quite addictive and if losing weight or maintaining a healthy weight was as easy as saying "ok, I gotta stay fit," 60% of North Americans wouldn't be overweight.

[Guest debmd]

Obviously doctors play a large role in promoting health. What they do in their non-professional home life is a different ethical kettle of fish... Presumably because you found out about this doctor's habit via the grapevine, he did not counsel you on the benefits of smoking. I also assume it didn't interfere with your treatment (i.e. he didn't leave you in the lurch to go for a smoke). It is important to keep in mind that doctors are HUMAN BEINGS (i.e. subject to vices just like everyone else). It is a slippery slope to travel when deciding who "deserves" to be a doctor based on certain characteristics. Who decides which characteristics are permissible? Where do you draw the line? What about someone who enjoys too much beer on weekends? Or someone who doesn't rigorously apply sunscreen prior to going outside? Those things are also unhealthy. And do those things necessarily preclude an individual from practicing excellent medicine?

[Guest peachy]

First, I personally don't think doctors have any obligation to their patients to lead a "healthy lifestyle" any more than they have an obligation to like a certain kind of music. As long as they do a good job, what they do in their private lives is their own business.

 

Second, with respect to smoking, I think it's ridiculous for people who haven't struggled with it to judge other people who have. Those of us who are not predisposed to addictions are very lucky. Those people who try smoking a few times and find it impossible to stop are less lucky. That doesn't make them any less competent as physicians.

 

Third, obesity is a whole different kettle of fish. Suffice it to say that it is an extremely complex issue, and to date there is no low-risk and effective means for long-term weight loss. (Some interesting reads: Health Care Myths, Big Fat Blog, The Obesity Myth, JAMA: BMI 25-30 has lowest mortality, Health at Every Size)

 

... so I think that you should get off your high horse, and be thankful that you're not predisposed to be addicted or to be fat instead of looking down on those who are, as well as to be thankful that you were treated by a competent doctor whatever he or she might look like or do in his or her private life.

[Guest ComplacentTragedy]

Here's what I dreaded in the interview...

 

"So, you want to be a doctor..."

 

(duh!)

 

"... tell me, what would you say to patients who wanted to be healthier?"

 

"I'd tell them to exercise and lose weight."

 

"HYPOCRITE!! FATTY FAT FAT GO TO THE GYM, YOU FATTY!!!!!!"

 

Luckily, I avoided this question. And now aim to lose ten pounds, in case I need to interview again.

[Guest debmd]

I just wanted to applaud peachy for her comments. I have become intrigued by how social values influence medicine. Last week (or the week before) Maclean's printed an article regarding doctors who refuse to treat patients who smoke and/or are overweight. Yes, we are inundated with information regarding the detrimental health effects of smoking and obesity. But, these are also associated with an increasingly pervasive negative social value. This is an important distinction to make. Would it have been as shocking if the doctor in question had just returned from Cuba with a great tan? Probably not. I recall an interesting anectode relayed to me by one of my tutors. He came across a Soviet medical textbook from the 70s describing a psychiatric condition manifested as rejection of communism. Please note I am not equating smoking/obesity with communism I am simply trying to emphasize that social values and medicine have an "interesting" relationship.

 

In medicine it is important to continually check one's biases (and yes, we all have them). Our role is not to judge.

[Guest muchdutch]

to date there is no low-risk and effective means for long-term weight loss.

 

Except for that whole diet-exercise thing. you know? watch your portions, everything in moderation, an hour a day for 5-6 days a week - that one. Not easy by any means but not much that's worth it in life is easy, is it?

 

Though I'm sure you meant quick-fixes, peachy, not this one.

[Guest Jochi1543]

Right on, muchdutch.

[Guest peachy]

Except for that whole diet-exercise thing. you know? watch your portions, everything in moderation, an hour a day for 5-6 days a week - that one. Not easy by any means but not much that's worth it in life is easy, is it?

 

Though I'm sure you meant quick-fixes, peachy, not this one.

Actually, I meant exactly that. Eating healthy and exercising are both important, and both have significant effects on health. I certainly agree that they are good things to do. But are they going to make everybody thin? No, they aren't. Many, many people are still going to be fat even if they do that, because that is the size that their bodies were meant to be. The concept that all fat people are fat because they are eating far too much and moving far too little is not true.

 

If it was as simple as you think, then there would be some research showing that. But there isn't. Like I said, it's far too big an issue to debate here, and you can read those sources that I posted and disagree with them as you like. But it is a complex issue, and not as simple as "fat people eat too much and exercise too little".

 

One study that has stuck with me that I don't have the citation for offhand, sorry, looked at women who had successfully lost weight and compared them to women who had always been thin, that were the same size. They found that the always-thin women were eating ~1950 calories a day, and the formerly-fat women were eating ~1300 calories a day. It is not as simple as you think.

[Guest Lurkergonepublic]

Clearly there are different body types, and some are going to be naturally different sizes and shapes than others, so no, you can't judge how healthy a lifestyle someone is living simply from their appearance. Having said that, eating well and exercising is still going to have a healthy effect on all body types, and each person can probably tell when their own body is in better or worse shape because of such lifestyle factors. Whether or not that healthy effect translates into a noticable weight loss is, as Peachy said, dependent on a large number of factors unique to the person.

 

You might reasonably expect your doctor to try and recognize that in their own life - although as mentioned before they are people like any others struggling with their own set of predisposed weaknesses. Greater knowledge of a health problem is not necessarily going to equate with greater motivation to act on it - that depends on the person.

[Guest Jochi1543]

I don't know what kind of study this is, but does it take activity level into account? Does it take bodyfat into account? Does it take people's size into account? What about psychological effects of having your food intake evaluated by someone else? Does it measure their resting metabolism? Of course if you are 5 foot tall and sit on your ass all day you can't eat 2000 calories without gaining weight. I know some people who have been thin all their lives and eat some 1200 calories on a daily basis and maintain their weight without any issues - they are just small and don't need 3000 calories a day.

 

Also, people tend to underestimate their serving sizes and calories to a great extent. Your typical restaurant dish is 1000+ calories. People will eat a salad with bacon, cheese, and ranch dressing for lunch and then wonder why they can't lose weight - well, hello, all the fixin's alone are like 800 calories.

 

Then the other extent people go to is eat like 2 hardboiled eggs a day and nothing else and then the second they start eating normally, they blow up, because their metabolism is shot. They might have been able to maintain their weight on 2000 calories before they started fad-dieting, but then after killing their metabolism by starvation, they will begin to gain weight if they eat that much.

 

Then it also helps to define what "healthy" is. Some people think that a 1,400 calorie Chipotle burrito is "healthy" - yeah, it has vegetables in it, loads of fiber, fairly lean protein, etc, everything is organic - but then the damn thing provides enough calories to feed a small town.

[Guest RoseSmurfette]

I guess this whole discussion is getting a little off track. But I just wanted to add that eating well (regularly, balanced, appropriate portions, etc.) and exercising is healthy (I'm mostly thinking of Type II diabetes studies, but I'm sure this applies to lots of different levels of health) REGARDLESS of whether the person loses weight or not.

[Guest leviathan]

One study that has stuck with me that I don't have the citation for offhand, sorry, looked at women who had successfully lost weight and compared them to women who had always been thin, that were the same size. They found that the always-thin women were eating ~1950 calories a day, and the formerly-fat women were eating ~1300 calories a day. It is not as simple as you think.

First off, I agree with all the points Jochi raised.

 

Secondly, there is a problem with weight loss that when you starve your body, your basal metabolic rate drops to compensate for the calorie deficit. Sooo these people may have been artificially low at 1300 kcal to obtain their body weight.

 

Even if their calorie requirement was only 1300 a day, perhaps they are indeed genetically different and require less calorie consumption. That in no way prevents them from eating less and exercising more to create a balance between calories in:calories out.

 

These hypothetical people with a 1300kcal/day requirement were once thin in their ancestral environments, and it is the easy access to cheap high calorie foods and an environment that reduces physical activity that has been biggest contributor (IMO) to the obesity problem.

 

Edit: I'm not saying it's easy for some people to lose weight, or that some of us don't have an easier time to keep the pounds off, but it definitely can be done if they have more discipline and learn to eat less calories and exercise more. Person A may eat the same and exercise the same as person B, but person A unfortunately might have to exercise more and eat less than person B to maintain a healthy weight. That's life.

[Guest ssc427]

Suffice it to say that it is an extremely complex issue, and to date there is no low-risk and effective means for long-term weight loss. (Some interesting reads: Health Care Myths, Big Fat Blog, The Obesity Myth, JAMA: BMI 25-30 has lowest mortality, Health at Every Size)

 

As you are noting it is very complicated. Alot of strange things have been published over the years. Weren’t there papers which showed that smoking was ok? The incidence of type 2 diabetes has skyrocketed in recent years and you can contrast this to WWII when Britain was under rations and type 2 dropped dramatically. You can always find publishable stats to argue one side of the coin or another. As a physician I will never ever discriminate, judge or not treat a smoker, alcoholic, overeater et… but I will try to work with my patients in helping them understand why certain lifestyles are beneficial.

 

However, Leviathan and Jochi: there are also other socioeconomic factors in addition to genetics and diet management. These days the rich are thin and lower income groups tend to be heavier. This is because bad food is cheap and more convenient. And gym memberships are expensive. Try finding the time to work out even 30 minutes/day and wip up some healthy meal when you are raising kids without the benefit of outside help (ie can’t afford child care/nanny). I only have one child at the moment and I assure you it’s not easy. So basically when you are a doc making 100K+/year the things which allow you to maintain a healthy lifestyle will not be realistic for family making 20K/year.

 

But that’s not the OP’s point. I guess, like it or not, doctors are perceived to be roll models of health. In the same way that if a police woman or man speeds, jaywalks or smokes a joint they are unduly chastised. I think the system perpetuates the expectations placed on doctors. I don’t remember seeing 1 single overweight med student at 11 different interviews (though I wasn’t looking). I don’t know why that is.

[Guest peachy]

Jochi: yes, some people are misinformed. But the idea that fat people, in general, just don't "understand" portion size and calorie counts as well as thin people is, as far as I'm concerned, both wrong and offensive. Try talking to someone fat who has dieted extensively: they will know calorie counts a million times better than the average person. Maybe some are putting themselves on starvation diets but lots of them know a hell of a lot more than the average person, or are doing exactly what their doctor told them to. This attitude feeds into the whole myth that fat people are "stupid" -- something I heard several medical students in my class say during our Metabolism and Nutrition unit. Fat people are not fat because they are stupid.

 

Person A may eat the same and exercise the same as person B, but person A unfortunately might have to exercise more and eat less than person B to maintain a healthy weight.

To maintain the same weight, sure. To maintain a "healthy weight"? Hard to say, since everybody has a different "healthy weight". The BMI ranges that are used to define "healthy weight" in medicine are incredibly arbitrary, hence numerous studies showing that the "overweight" range has the lowest mortality of all, including lower than the so-called "healthy weight" range.

 

it definitely can be done if they have more discipline and learn to eat less calories and exercise more.

Ah, right. Fat people don't have the same amount of "discipline" as thin people. Funny how fat people can be successful in every aspect of their life, but they are still seen as lazy or "undisciplined" because of their weight. If it was as simple as this, then there wouldn't be very many fat people. There would be studies showing that people can successfully lose weight non-surgically. But ... there aren't.

 

Anyways, I don't expect to convince anyone in this thread! (Though, I do think it is worthwhile to read through some of the links I posted). But you do not know what someone's health habits are by looking at them. Lots of thin people eat badly, and lots of thin people don't exercise, and you don't judge them the way that the original poster judged the overweight physician. That is a double standard.

 

And, because weight loss is a very complicated issue, and not nearly as simple as "fat people eat too much and don't exercise enough", you shouldn't be judging someone's suitability as a physician (or a "role model" or, frankly, anything else) by their size.

[Guest satsumargirl]

I have nothing against people who smoke or are overwieght, but I think doctors should still make an effort to be healthy.

 

This is an interesting comment....aside from the fact that overweight people are not necessarily at higher risk of non-overweight people based on their weight alone...not really going to debate that now.

 

What I wanted to discuss was how the public/patients etc. view doctors as role models. A few months ago I had been talking to one of my best friends about exercise and how hard it actually is to be motivated to work it in (it was winter...in the summer this doesn`t seem to be a problem!). And then I said that now it is even harder since the recommendation is to fit in aerobic exercise 6 days a week! And I admitted that I certainly did not meet that recommendation!

 

She replied "and you're the one who's going to be the doctor". That comment surprised me. And it was my first glimpse at how somehow doctors are seen a little differently than others.

 

Just thought I would share that. Like it or not we are going to be looked upon as role models.

[Guest muchdutch]

The concept that all fat people are fat because they are eating far too much and moving far too little is not true

 

That's certainly now how I think and not what I meant by this comment (don't worry, I'm not offended and I don't think your comment is accusatory in that way either, I just want to clarify).

I do realize that it's more complex than 'calories in, calories out' (I learned about a study that said that 'fidgeters' expended hundreds more calories than non-fidgeters!) and some people will still never be 'thin' by watching what they eat and exercising regularly, but there's nothing wrong with being a little on the heavy side, contrary to the initial poster's doc who was apparently quite overweight - this is a problem (for their own sake). But one can maintain their weight to the 'healthy' side of heavy through diet and exercise - that is a fact (before you skewer me, this does not include the VERY small portion of the population that have metabolic diseases such as momo and others). I have no problem with one of my docs who is a bit heavy, but he talks all the time about the hiking he does, and he even ruptured his achilles at his weekly tennis game! It's obvious he is healthy, and his weight is just fine - still within 'healthy' levels.

I think it is important for docs to maintain a somewhat healthy lifestyle that includes lots of activity (and hopefully only a bit of fast food) as a good example for their patients - you think dentists don't floss? (wait, maybe they don't, but they sure have nice teeth!) you think fitness trainers don't work out? It's all part and parcel with the job I think, but that doesn't mean you have to abstain from booze and other vices - just try to be healthy overall. But I probably live in an idealistic world where people are generally 'good'. :eek

It's much better to be 'fit and fat' than 'not fit and not fat' anyway!

[Guest Jochi1543]

Yup. Not everybody can be shredded, but you don't just get to 300+ lbs out of nowhere. As someone who's had weight problems herself and have paid lots of attention to other people's eating and exercise habits in an effort to find some excuses for myself, I eventually had to admit to myself that people who are in good shape DO eat less food and healthier food and DO exercise more than people who are overweight. Yeah, there are variations, but unless you have some major health issue that makes you put on loads of weight, which 90% of overweight people don't, in the end it's you who is in control. Nobody said it's easy to exercise instead of watching TV on the couch, cook your own food and bring it to work instead of eating out, or commute on foot or by bicycle instead of driving, but then if you don't make the effort, you don't get the reward. Yes, you don't have control over what your parents fed you when you were a child, which can certainly predispose you to unhealthy habits; but you do have control over what goes in your mouth as an adult.

 

As far as being healthy while being overweight, it's really more of an exception than a rule. First of all, just common sense - no matter how healthy was the food that got you fat, your weight is still taxing your joints. Second, most of the food that makes you gain weight also happens to be full of saturated fat, trans fats, funny chemicals, and what not. Just once, try to compare how much food you need to take in 3000 calories in one day (which will be too much for most people) if all you eat is unprocessed food and you avoid animal fats. You'd be surprised, but you'd have to eat non-stop all day to reach that goal. But if you eat 3 meals at a restaurant that day, you'll probably be actually over 3,000 calories and you won't feel nowhere as stuffed. So getting fat on natural and healthy foods would actually quite time-consuming.

 

I'm also sure that most people here would have a friend or a relative who's overweight, but claims that he or she is unable to control the weight no matter what. You might even wonder yourself, because you never see them eat anything "bad" in your presence. Then in reality it often turns out that they hardly eat anything all day, and then go on a binge at night which more than compensates for whatever calories they "saved" during the day. Some people don't even realize they are overeating in that manner. Or you know someone who exercises regularly with little results, but then it turns out that they reward themselves with a hefty meal after every workout.

 

Bottom line, if people adopt lifestyle changes, it will always improve their weight and body composition. 1) Get in the habit of going for a walk every evening (even easier if you get a dog), 2) prepare the bulk of your food for the week over the weekend and store it so that you don't find yourself ordering takeout when you are busy with homework on a Thursday 3) brown-bag your lunches 4) when you eat out, don't touch the bread basket and get a doggie bag for half of your portion right away 5) when you would like to meet up with a friend, go for a walk in the park instead of eating out 6) take your coworkers to a dance class or a racquetball game instead of sitting at a bar for happy hour; etc, etc. If you incorporate all of these changes and stick to them, I guarantee that you either lose weight/improve your body composition or that you are some sort of medical miracle.

[Guest Jochi1543]

Oh yeah, and just to comment on some other things said earlier:

1) there's nothing illogical about fidgeters burning more calories than non-fidgeters - fidgeting is still a form of moving, and thus burns more calories than being completely motionless would.

2) the recommendation about 6 days of aerobic activity a week is actually not that hard, because it's 30 minutes, and walking counts. If you walk the last 3 bus stops of your commute in the morning and evening, you'll meet the requirement.

[Guest leviathan]

Ah, right. Fat people don't have the same amount of "discipline" as thin people. Funny how fat people can be successful in every aspect of their life, but they are still seen as lazy or "undisciplined" because of their weight. If it was as simple as this, then there wouldn't be very many fat people. There would be studies showing that people can successfully lose weight non-surgically. But ... there aren't.

Peachy, I said they need MORE discipline than person B with a higher metabolic rate. I didn't say they were less disciplined than thin people. Please don't put words into my mouth.

[Guest peachy]

Jochi, Lev: I don't agree with you, but I think we've reached an impasse, and I'm not capable of being nearly as eloquent as the sources that I listed. Suffice it to say ... I strongly believe that it's a hell of a lot more complicated than you are making it sound. And that people should not be judged (or assumed to be lying, or lacking motivation, etc) based on how they look.

[Guest siobhansiobhan]

forget it -

[Guest leviathan]

Again, peachy, where did I say we should judge people based on their weight? All I said was that 90% of them can lose their extra pounds provided they have enough will power. You keep interpreting this as me saying they don't have enough will power as thin people. I already said that they may eat the same as the next person, but unfortunately they have to work harder than the next person and have more will power than some thin people.

 

I just watched a documentary of a guy who weighed 1200 pounds and dropped down to 190, then gained it all back over the next few years when he relapsed into his old habit of overeating and underexercising.

[Guest Jochi1543]

Alright, I'll make sure to one day conduct a study showing that controlling your food intake and increasing your physical activity will make you lose weight. If it weren't the case, anorexics wouldn't be emaciated and 60% of professional athletes would be obese, same as the general population. I'm willing to say that the only reason such a study yet has not been conducted is because it's complete and utter common sense.

 

 

There are lots of fat people in America because people would rather die than walk a mile, and they drive everywhere, and then they eat 1000-calorie portions at restaurants and watch TV 6 hours a day. SIX hours a day is how much time an average American spends in front of the TV? But no, of course they are obese because of genetics. And if it really were "that complicated," how come obesity has become such a grotesque problem only in the last 60 or so years? The roots of this "complex" problem are in the modern lifestyle which is marked by nearly complete lack of physical activity and obsession with whatever tastes good. Whatever happened to responsibility? I think that it's just another element of the culture that produced frivolous lawsuits, not to mention North America's obsession with energy - the gasoline, the huge engines, the heating/cooling your homes all year round, when most of us have enough fat in our love handles to generate sufficient energy to melt the polar ice caps - does anyone else think it's extremely ironic?