Shouldnt my doctor be healthy too?

[Guest nbmom]

I know this has veered from the OP but I felt compelled to add my 2 cents to the whole obesity debate.

 

I think the main thing missing here....is that for those that are severely overweight (obese) the problem is not about knowledge of nutrition or discipline. Most of these people suffer from disordered eating. Peachy is right they probably know more about nutrition than the average person, but sticking to a diet long enough to lose the amount of weight they need to is hard for anyone especially someone battling with food compulsions. I lived with a binge eater and she would count all her calories every day, order salads at restaurants, and then eat 4 times what she did all day after I went to bed. She actually gained weight when she tried to diet. I'd wake up and my food cupboard was empty. Do you think explaining the concept of dieting or exercise to her or telling her to be more disciplined would help? This is an extreme example but I believe most people who are obese have some sort of negative emotional relationship with food that sabatoges their efforts to lose weight, and that and not their genes or lack of knowledge is their biggest hinderance to lose weight.

As someone who has suffered from other eating disorders I can relate to overeaters, and fixing disordered eating I would wager is harder than quitting any other addiction because you can't go cold turkey off of food, you have to some how learn to work with it not against it. Imagine telling a an alcoholic to have one drink three times a day.

[Guest peachy]

All I said was that 90% of them can lose their extra pounds provided they have enough will power.

Like I said, I don't agree. If it was simply a matter of will power, then there would be lots of people who could successfully lose weight in the long term. And there aren't.

 

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.

But that, the cycle of loss and regain, happens to just about everybody who loses weight. Obviously someone who weighs 1200 lbs is an incredibly extremely example to start with, and not terribly applicable to most people. (The vast majority of people couldn't weigh 1200 lbs even if they dedicated their entire lives to gaining weight!) If it was as simple as diet+exercise, it just wouldn't happen so much.

 

nbmom: the thing is, some (but certainly not all) fat people have eating disorders, just like some (but certainly not all) thin people have eating disorders. Your roommate had an eating disorder, certainly. But that doesn't mean that all or most fat people do.

[Guest Jochi1543]

www.cdc.gov/nchs/data/hus/hus05.pdf#071

 

Some good tables outlining the growth in obesity rates as well as overall caloric intake in the US over the last 30 years. Also shows data that prove that obesity is NOT income-related - if you check the stats, you see that obesity rates are within 2-3% of each other independent of the income status.

[Guest muchdutch]

If it was simply a matter of will power, then there would be lots of people who could successfully lose weight in the long term. And there aren't

 

I don't think so. Food is such a huge and important part of our culture, not to mention the fact that portions sizes are increasing, food is more available, and the time available to spend preparing quality food is diminishing. Perhaps you have incredible will power, but most people don't. Yes, someone may have the will to achieve the most obscure and un-achievable goals, but they can still have issues with food (I don't mean diagnosable disorders either). Heck, I know I have a warped relationship with food. I love it. I LOVE it. I can never say no to a piece of dessert, chocolate, sweets, etc. In most areas of my life I have the will, but not when it comes to food.

Most people (I think) are like me and have little to no will when it comes to refusing food. This is why people have problems in the long term.

 

You're right - I think we have reached an impasse here.

[Guest satsumargirl]

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.

 

Does the walking actually count if you don`t reach a certain target heart rate...say 60--80% max?

Just curious, cause when I hear "aerobic exercise" I tend to think you have to be expending a certain amount of effort.

 

I realize walking can be aerobic if you actually try. But I personally am not breaking a sweat walking to class.

[Guest siobhansiobhan]

"aerobic" - "relating to or denoting exercise which improves or is intended to iprove the efficiency of the body's cardiovascular system in absorbing and transporting oxygen"

 

"aerobics" - "vigorous exercises designed to increase cardiovascular efficiency"

 

That's just a cursory look. More definition could come from reading the document which suggested the "aerobic exercise". Better breathing (i.e. not cutting off breath, keeping it shallow, due to anxiety, etc) could potentially be included in 'aerobic activity'.

 

This conversation could go a lot further with more "I" statements, and less "they" statements. After all, what would happen if we did take seriously the statement, 'healer, heal thyself'. I have more understanding of struggles i have gone through than struggles i think i have easy answers for. so when i see the 'easy'/'simple' opinions i get angry that i may never be able to communicate with colleagues I feel don't listen.

[Guest nbmom]

Peachy Morbidly Obese people certainly suffer from disordered eating if not a DSM eating disorder, and I am sure the vast majority of them will describe using food as a comfort, which all of us do to an extent but in the case of people suffering with obesity this is a viscous cycle. However certainly everyone who is moderate obese may or may not have an eating disorder and their extra thiry or so pounds could be due to a combination of lifestyle and genetic factors.

I just wanted to point out that in the case of morbid obesity, to describe the problem as either genetic or will, is an extreme oversimplifcation.

I also did not use the term Eating Disorder (although my roommate certainly had Binge Eating Disorder) I used disordered eating (or EDNOS) which can be extreme restrictive dieting, binge eating, purging, but these may only occur occasionally. With disordered eating the key is that the unhealthy eating stems from some emotional turmoil. And for someone who is morbidly obese they didn't get that way because they like food, are lazy, or they have fat genes (although these may be all true), is is much more complicated than that.

[Guest Jochi1543]

65% of college-aged women have disordered eating habits, which may include spitting out food, exercising obsessively after overeating (whether actual or imagined overeating), self-induced vomiting, binge-starve cycles, extreme caloric restriction, refusal to consume food in front of others, etc.

[Guest satsumargirl]

so when i see the 'easy'/'simple' opinions i get angry that i may never be able to communicate with colleagues I feel don't listen.

 

I don`t mean to sound rude, but Siobhansiobhan, before you accuse people posting on this thread as being bad listeners you should at least post your opinion ... so everyone at least has the chance to listen to you.

[Guest siobhansiobhan]

o.k, so my opinions:

 

1) listening is about encouraging a person to talk, creating an atmosphere where it is safe to talk. if you're not hearing what you want to hear, change your listening style.

 

2) doctors who are overweight or smoking are more credible to me, if i'm going through the amazingly difficult process of changing my behaviour. I know that they know what is actually involved in the struggle. they can talk from experience - and in my opinion, they'd better be ready to do just that, not hiding their own experiences, but willing to work from that place. patients know when a doc is just not getting it. when a doc is in touch with their own process, when they have worked on their abilities to be self-aware, then they may be available when truly needed. not as a dispenser of advice, but as an ally in some hard work.

 

3) satsumagirl, i said i'm *angry*when i see easy/simple opinons, that i feel I may never be able to communicate with colleagues i feel don't listen. you've got that to go on - that's where my *heart* is. Your request is now for my *thoughts*. My point is: can you actually deal with *heart*? Not because you somehow have the right to get the opportunity to listen to me, but because you are interested in the two of us understanding each other. For instance, I'm interested in how you're *feeling* right now. I know something's going on, because you're telling me what I *should* do, rather than working with where I and you are at.

[Guest Jochi1543]

On a sidenote: I was on campus at the library today. There's an employee there who's always been morbidly obese, I'm gonna bet probably as much as 500 lbs. The guy always looked like death (he had this dark grey color in his face) and I've never seen him in any position other than sitting down - he was glued to his chair seemingly 24/7, and any time I'd come up to him and ask questions about some computer problem I was having, he would NEVER get up. Instead he'd tell me "go there, and then there, and then click this," etc, and you could just tell that getting up and walking a few steps was a daunting task to him, so he had to resort to a long list of verbal instruction.

 

Then today I was editing my senior thesis, and saw him WALK around with some papers, come up to the printer, then the front desk, and wow, he has lost at least 100 lbs in the last 6 months!!! It was unbelievable how much more *alive* he looked - he actually had some color in his face, and he was alert and active. I went up and congratulated him on taking control of his health, and he was really flattered that people noticed his positive changes and encouraged him. I don't know him personally, so I didn't feel right asking whether he's been losing weight due to diet/exercise or bariatric surgery (he was certainly at the stage where his surgery would've been covered by insurance). But either way, I can't imagine how hard it is to embark on a weightloss journey when your weight has long spun out of control and being fit seems unattainable. I found him extremely inspiring!:eek

[Guest charmingbutterfly]

well I see that the topic has gone a little off topic, however I hear what ya'll are saying but I still think doctors should make an effort to be healthy - I said effort.

The one thing that annoyed me was the implictation that certain ppl seem tohave made -that just because this doctor was was overeweight I shouldnt be using that as a factor towards his compentency, err I never said that.

From what I hear he is one of the best, just because he smokes and is overwieght doesnt make him a bad doctor , just not an exemplary doctor. For example , say some precher of whatever belief is telling me to keep strong in my faith in a God, while I know at times he doesnt do that but that doesnt make him bad , however it would be comforting to know that he literaly practices what he preaches.

Whether it is just trying to squeeze in a few hours of excerice or not eating from the greesy caf, a little bit of work will make a little difference. I know doctors are stressed, some of them started smoking way before they were even in medschool and others are just so darn tired the last thing they want to do is go home and whip up a nice healthy supper.

I love my doc these past days I have found him to be quite funny, makes you feel at ease and shows a true passion for what does, but I still think he should make an effort to be healthy for his patients (yes, peachy - his patients) and ofcourse himself...

[Guest marbledust]

I will probably take some flack for this, but oh well...

 

I am coming to this thread late. However it always annoys me when people argue that doctors have an obligation to not be overweight or smoke.

 

Ideally it would be nice if everybody could practice what they preach and all doctors were model examples of healthy living for their patients. However we all know that isn't always possible--even for doctors. It's always easier to say what a person should be doing (exercising more, eating less, not smoking, whatever) from the other side of the fence.

 

I guess I am slightly wandering off the topic myself, but I have never understood why the profession of medicine has a cult mentality--among doctors and the public. The reality is that it is a job, that's all. I am sure there will be complaints about this statement. But it is just a job. And considering it just a job doesn't make one an any less competent or credible physician.

 

An MD doesn't grant one immunity from the same vices, addictions, bad habits, and questionable choices that others fall prey to. A big part of your job is to often educate your patients about healthy lifestyle choices. I don't think an obligation to act as a role model for your patients is a job requirement. Just my opinion...

[Guest JewelLeigh]

Butterfly...do you know for a fact that this doctor isn't "practicing what he preaches?" Who are you to comment on his personal life? Perhaps the cigarette you saw him smoking was one of only 1/2 pack per day, having cut down from 2 packs per day? Can you truly say from your minimal knowledge of this person's private life that he eats terribly and doesn't exercise enough? I somehow doubt it. As peachy has pointed out, losing weight is not a simple matter for everyone. As such, I think it would be best if one didn't make comments regarding an individual's efforts to live in a healthy manner based on a lot less than the whole story.

 

If a doctor saw an overweight, smoking patient and wrote him or her off as someone who doesn't make "effort" to live in a healthy manner (as you have similarly judged the physician you mentioned), I can imagine this patient would not be likely to trust or respect this physician. As such, since most patients expect a non-judging attitude from their doctor, I do not think it is ridiculous for doctors to expect the same from those around them.

[Guest Jochi1543]

I don't think it's that shocking that some people expect doctors to be role models. After all, teachers are expected to provide good examples to their students, and we expect soldiers and policemen to display exceptional character. (jeez, lots of alliteration in that sentence 8o ) Also, I think it's a personal issue - how far you can go telling a patient to do something you yourself won't do until you begin feeling like a hypocrite.

[Guest Jochi1543]

Also, kind of a spin-off question, I guess. Imagine that you are a doctor struggling with some sort of health issue and you see a patient in a similar situation - maybe both of you are smokers or are diabetic. Should you tell the patient that you share his or her problems? Do you think it would encourage the patient to confront the issue in a better manner than if he/she didn't have a sympathetic ear? What if sharing your own experience is actually going to harm the patient by making his or her concerns feel insignificant to thim/her personally or make them feel as if you are focused on yourself instead of them?

 

Edit: at the clinic where I volunteered as a patient educator for 3 years (just had my last shift ever on Monday!), we were trained not to share our personal experience concerning a drug/treatment with the patient.

[Guest satsumargirl]

doctors who are overweight or smoking are more credible to me, if i'm going through the amazingly difficult process of changing my behaviour. I know that they know what is actually involved in the struggle. they can talk from experience - and in my opinion, they'd better be ready to do just that, not hiding their own experiences, but willing to work from that place.

 

I am not sure I agree with this. I person is still capable of empathizing and encouraging and listening to someone having not gone through the same experiences.

 

I have run support groups for people who's spouses have had strokes. Most of the people in these groups were over 60 and married for 40 years. I have never been married, let alone been married for 40 years!! I have not had a stroke and have not had to take care of someone who has (on a personal level). Did that make me less effective in leading the group? I don't think so. I may have no idea how I personally would react to my spouse of 40 years having a stroke. But I am aware of how others have reacted and what helps them based on my professional experiences and what information is available in the literature. Same goes for any other counselling I have done whether it be for dementia, Parkinson's, brain injury, whatever.

 

Should women expect sub-standard care from a male OBGYN or a female OBGYN who has never given birth? I suspect not.

 

And besides even if you did struggle with similar issues as your patient. The way you experienced it would be different than how your patient is probably experiencing it. You would still have to rely on the literature.

 

I agree that a doctor must be more than just a provider of information but it is possible to be able to provide the "extras" like empathy, support and encouragement having not had a direct personal experience with whatever the problem is.

 

I know something's going on, because you're telling me what I *should* do, rather than working with where I and you are at.

 

I am really not sure where you think you are going with this. But just to be clear you and I are nowhere. This is a place where you can post your opinions and read the opinions of others. That is it.

[Guest siobhansiobhan]

satsuma girl -For someone who is nowhere with me, you're getting a lot of excitement from cut-and-pasting my remarks and responding. That *is* something, and if you can't see that, that's a dangerous place to be - you have impact on me, you are enaging and dialoguing with me, and you are unwilling to acknowledge that you may have an impact. Yes, we have responsibility towards each other. As humans.

 

Now, I do come from a background of feminist studies and counsellor training - humanist counselling where it is important for the counsellor to be present and able to share themselves - and it is a clinical decision what to share and when and for what purpose. medicine, as i see it, goes beyond 'educating' , as does 'educating' according to feminist pedagogy! Medicine is about healing. healing does not always come through the model of providing info. and, in terms of emotional healing, it has long been considered a given that a high-quality professional healer will have undergone their own healing process. that shows, not in telling the patient - 'oh i've been there too', not even in having had the same experiences, but being able to access experiences that were similar enough - any grief, not just grief of a partner dying from a stroke - and be able to be comfortable enough with the grieving process (or addiction process, as per my first example) to be able to hang in there with a person. When we have not done our personal work, we are more likely to hide behind giving out 'education' or even run out of the room - 'studies show' that many doctors are phobic towards death and are often not around for the patients who are actually dying. it the personal work of being less likely to tune out, run away, or get judgemental in the face of addiction, grief, and dying, is done, then the quality of the the health-care improves. empathy is not just 'caring' it's also about figuring out what are our own blocks towards caring - we all have places we get phobic.

[Guest siobhansiobhan]

I'm done with this set of posts -

 

My concern was that it seems impossible to dialogue at a 'heart' level. And I'm only having that confirmed. Just so folks know - the internet does not equal cold and impersonal. I know some of the names on this board quite well over the years! On other listservs, the group has become a place where it is possible to challenge, engage, piss off, apologize to, support, celebrate and generally communicate from the heart with each other. But that's a list for trained therapists...would that the folks in and going into medicine looked for that as an ideal!

 

My concern has been confirmed. So - i am very pissed right now - i'm told to reveal myself for what? to get my points challenged one by one, except for the point saying I'm angry? only logic need apply? now, this is a thread about addictions, the possibility of what it means to heal ourselves, what it means to 'live, breathe healing' or 'health as my job'. all very interesting, but i don't wanna be here if i can't have my heart! if i'm told i'm nothing in terms of humanity, of humans relating, just another post to reply to. i'm done with this thread.

[Guest Jochi1543]

Am I the only one who's extremely confused?8o Or is it just because I'm mega-high after this cigar I just smoked?8o :lol

[Guest try2dstress]

no Jochi you're not alone...I'm also quite confused.

Since no one is making sense anymore perhaps that should signal the end of this thread. Everyone obviously has a strong individual viewpoint - which I think is a good thing as it facilitates discussion. If you've posted a position one way or another it means you have a passion for the profession of medicine and the way it is perceived. That in itself will probably make you a caring, accountable physician. So cheers to all of you!

[Guest happy2bme]

I'm slightly confused as well, and speaking of addictions.... We are all addicted to this damn board!

[Guest The Law]

I can see the valid points in both arguments. I don't think that you can simply attribute it soley to genetics/psychological factors and soley to the motivation/lifestyle of the person. For every human being, it will differ. Exercising and not eating as much fat is good for health, regardless of what it does to a person's body weight.

 

It is also to remember to account for some other factors that contribute to weight. One thing I'd like to point out, before everyone goes and says "fat people are too blame"... what about our food suppliers? Did you know that some of our food suppliers intentionally use products that inhibit hormones from doing their jobs? For example, "High Fructose Corn Syrup" is a molecule that does not allow leptin hormone to reach receptor sites in the brain. For those who don't know, leptin is a hormone associated with "the full feeling" you get. It gets secreted when your body senses your fat levels rising (i.e. when you've eaten). While this isn't the only thing that would cause obesity, it's just some food for thought ... our food suppliers are not making matters any better. "Those twinkies are so yummy, I could eat 20 and still not feel full"... while that's an extreme example, I hope you get what I'm saying.

 

Also, yes, aerobic exercise helps to increase your basal metabolic rate. And yes, we are living an increasingly stagnant lifestyle where we sit around... watch tv, work, and avoid exercise.

 

While these factors are also contributing factors to the problems/solutions... it is important to remember that everybody's situation is different. Anyone who says "overweight people don't have enough motivation" is being ignorant to the complex nature of obesity. You can't judge a book by its cover, and while being overweight isn't what a physican would want... especially since he or she is the role model for health, it's important to remember that the physican is also a human being. Perhaps he or she doesn't exercise enough, or maybe perhaps he or she attempts to diet, but for some reason it doesn't work (genetic factors?)... I don't think that this will make them a bad physican.

 

I also think it's better if a physican tries to lead a healthy lifestyle. Try to fit that aerboic exercise, try to decrease the amount of saturated/trans fats.... while this may not always lead to weight loss... it will lead to an overall healthier body.

 

My 2 cents.

LK:eek

[Guest peachy]

90% of them can lose their extra pounds provided they have enough will power

My apologies for reopening this thread, I just thought that the following site explained what I was trying to say before far better, and is a worthwile read, so I wanted to post it: the case against weight loss dieting. Better to respond to the specific points raised in that article there rather than here, though, I think.

[Guest muchdutch]

great read peachy! I still think the whole approach is a bit weak though. Sure, Jenny Craig and weight watchers (as well as the dreadful atkins, zone and south beach) won't work over the long term. But the biggest problem with this is not the diets themselves (although there are numerous problems there!), it's the fact that people think they can diet, lose the weight, then go back into their old eating habits and be okay. Wrong. You need to combine both a healthy diet (not a diet, but a healthy consumption of appropriate portions and types of food) as well as increased activity levels for the rest of your life. That can work over time (the study in question doesn't mention any changes in physical activity). I know it's cliche, but look at Jared from subway - he changed his lifestyle, not just his diet and he's managed to keep it off (correct me if I'm wrong, which I may be). And everybody knows somebody who's lost a tonne of weight and kept it off for years, I know a few who have. But these people have altered everything about their lifestyle. One goes so far as to say 'bread? no, I can't touch bread, because then I'll binge on the whole loaf and never go back!". This is extreme, but she manages to balance her carbs and grains in other ways, and knows that bread is one thing she can't, and won't, eat - ever again.

 

So yes, it is very complicated, and yes, it's hard, and yes, it takes A LOT of willpower and a lot of planning and a lot of work, but it can be done. This is a low-risk, effective means for weight loss, just no studies have done it because can you think of the issues it involves? Adherence, subject mortality, untruthful caloric reporting etc. Even the link you posted mentions a 77% drop-out rate - whether due to lack of stick-to-it-ive-ness, or lack of seeing motivating results or whatever, either way they are still dropping out.

 

Unless I meet someone who I know honestly exercises a lot and is active and eats appropriate portions of balanced meals (and doesn't eat late at night or closet-binge like mentioned before, and who can really know that without being with someone 24/7?) and still is obese, I will not believe that achieving a healthy weight is impossible for (most) people (keeping in mind that healthy does not equal thin!).

 

(peachy - I don't want you to feel like I'm attacking you because you do bring up some good points!)