Kevin, M.D. - Medical Weblog

I agree. These people are doomed and need to know the life threatening risks they expose themselves too.

How do you determine if someone 350+ lbs with abdominal pain has appendicits? or subarachnoid hemorrhage? or pulmonary embolus? When they can't fit into scanners and procedures are not feasible. How difficult is it to find a place to put a life saving IV under inches of blubber, or intubate someone? This country needs to realize that it is NOT OK to be obese.

Once in our ER a 600lb lady had the "worst headache of her life." She and her husband demanded a CT scan. We made every possible effort to explain limitations and accomodate her. We called every hospital within 50 miles to see if we could find a CT scan to accomodate her. We found that the only possibility was a animal zoo 200 miles away. After doing everythin humanly possible the patient filed a complaint to the hospital, medical board, and local newspaper. Ridiculous.

Some things that make you go Huh?

-The 293lb 9 your old I saw this week

-The multitude of mothers bringing in their blubbery, waddling, 50lb 3 year olds with chief complaint of "vomiting, can't keep anything down"

-The 13 year old 250 lb girl wanting a "refill of vicodin" for feet pain. And all other obese people complaining of back pain, knee pain, shortness of breath.

I am not a miracle worker. Take some personal responsibility America.
 

Hey, anon -- I presume you are recommending calorie restriction for fat folks. Are there any figures on how effective such programs are in the long term?

If the 95%-98% failure rates bandied about by the media are correct or nearly so, is there any other course of medical treatment that would be widely recommended despite a 95%-plus failure rate?

(Yes, of course I'm fat!)
 

There are many medical treatments that, in the absence of "compliance," that is, actually following the advice, are rarely successful.
 

"If the 95%-98% failure rates bandied about by the media are correct or nearly so, is there any other course of medical treatment that would be widely recommended despite a 95%-plus failure rate?"

"(Yes, of course I'm fat!)"

Calorie restriction works, but you have to keep it up. It "fails" when people resume their former eating habits, neglect to make the required permanent changes in their behavior, and fail to include exercise and other lifestyle changes a part of their healthy weight maintenance plan.

Griping about high failure rates of plans as an oblique way of excusing oneself from making an effort is just one more version of abdicating personal responsibility. So is expecting your doctor or any professional to "treat" your obesity.
 

Anonymous:
Language such as "life-saving IV under inches of blubber," "blubbery, waddling 50lb 3 year olds," and "these people are doomed" makes me shudder to think you have any patient responsibility whatsoever--I sure hope you are not a doctor. Of COURSE it's not OK to be morbidly obese in this, or any other, country. But your attitude is the last thing these people--hell, any patients--need. When I think of a 600-lb person needing a horse CT scanner or a 50 lb 3-year-old, I feel concern and pity, not disgust.

Most "diets" fail because they are just diets. To change one's lifestyle in the literal sense is a monumental task when it involves going against one's own biology, lifelong learned behaviors, psychological stress, and potentially undermining home/social environment. Unless all of these things are treated simultaneously with equal concern, failure is almost guaranteed.

But I guess when your primary concern is to get the POOB out of your ER, these things don't really matter.
 

I didn't write the above blog you're whining about Enrico, but to be honest, I support it. This website is a place for us docs to vent, and it's frustrating that, in case you missed it, about 10 years ago people lost responsibility for their own actions or health and have decided it's OK to blame others for your own problems. It wasn't the 30 years of abusing your body that caused the MI, it was the 30 minutes spent in the waiting room, and now you're going to sue. Welcome to the United States of blame someone else for your own mistakes.
 

Tort filings have declined for the last 10 years. Damn facts!
 

Enrico,

I am an ER doc, and I think I can speak on behalf of essentially every doctor I know. We do not view these cases with "disgust" but rather with deep pity and very grave concern. I especially pity the morbidly obese children because I fear they have no chance at experiencing a vibrant and healthy life.

I will exhaust every resource available and go through extraordinary contortions to try to save a life or make the correct diagnosis. I think the point that was bluntly made is that these cases pose severe limitations that can't be overcome with "pity" and "concern". A physician or hospital cannot be held responsible for physical limitations, such as inability to perform a life saving procedure, obtain a CT scan, etcetera.
 

"Tort filings have declined for the last 10 years. Damn facts!"

So has gang murders where I live, but I still get really upset every time I read about one.
 

Of course patients need honesty. Preserving their health and participating in their body's recovery are both often aided by them having an accurate assessment of their condition.

The "truth" can be conveyed in a variety of ways, though. Think about dealing with conditions such as obesity that have a significant contributory behavioral component. The choice of how to share the truth becomes as, if not more, important than facts themselves.

And even more than sharing the truth is the deeper, more fundamental obligation of facilitating health/healing. Though necessary, diagnostic and symptomatic truths alone aren't sufficient. Bennett's own experience shows that(see Manchester "Union Leader" 8-22-05).

The medical community demands more from its practioners. As a reminder, recall the following 3 excerpts from the Hippocratic Oath:

"I will apply, for the benefit of the sick, all measures which are required..."

"I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug."

"...nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery."

If self-destructive behavior underlies a patient's pathological condition, "all measures" obligates that physician to also utilize the "art" of medicine and, either personally or through medical colleagues, do whatever is within his power -- directly or indirectly -- to reverse, or at least diminish, his or her patient's self-destructive behavior. Is this easy? Hell no. But it's the standard to aspire to.

Bennett wants to change lives. Yet even his own attorney calls him "old fashioned". All they need (or he's willing to offer) is a mirror and a good scare.

Does his shock lecture approach work? He saw the complaining patient 5-6 times and "discussed her obesity" with her. She not only failed to lose weight, she continued to gain.

Does it advance the patient/physician relationship? She filed charges.

Bennett acknowledges having been a physician "a very long time". He's had other obese clients over the years. The pattern is familiar: upsetting lecture and, if they take offense, offer an apology.

What about his other patients? What's his track record with them? The one other obese patient cited in the article admits to receiving -- and ignoring -- his "lectures" for the past 15 years to her own detriment.
 

mbu,
Thanks your view. You essentially summarized exactly how I feel and see the situation. I'm an older med student, so I see things a bit more realistically than my 20-something classmates. I'm not jaded by years of threatened lawsuits, unappreciative patients, etc., but I hope to have a general sense of optimism about myself and those I eventually treat in spite of the hostile environment so many docs seem to complain about.
 

"If the 95%-98% failure rates bandied about by the media are correct or nearly so, is there any other course of medical treatment that would be widely recommended despite a 95%-plus failure rate?"

It takes work to loose weight once you gain it, but the post talked about 3-year olds. How did the parents allow their 3-year olds to get fat in the first place? I can understand a person in a sedentary job gaining weight as he/she gets older -- your metabolism slows down and you move less, but you forget that you can no longer eat as you did when you were young. As someone who was slowly but surely gaining weight for ten or so years leading to middle age, then - when the weight hit 140 (5'2") - decided it is way too much, and lost 18 pounds and kept it off for 2 years since, I can understand both how one can gain weight easily and how difficult it is to loose it. But it is possible, if you really make this decision, if you eat less and differently - exersize more, set small short-term goals like 1 pound less next week, and don't make exceptions because 'it is do-and-so wedding' or 'this is vacation or cruise', etc.

But what about kids?! Surely parents must have some sense. Most of us would've had liked to only eat sweets when we were young, but our parents hadn't allowed it. Currently it seems parents just keep overfeeding kids.
A collegue of mine's daughter is taking ballet classes. So, the other day, some mother brought in a very round-looking 5-year old; the teacher very politely said that she cannot possibly accept the girl until she looses 20 pounds or so. The mother got really mad. While it is admirable that she wants some physical activity for her daugher, surely she must've realized that ballet is hardly the best place for her. A 6-year old hardly got 20 pounds overweight by buying herself food, did she?
Now, I do believe that the doctor had no business bringing woman's future marriage chances and black men - this was just stupid; although reading some posts I can understand the frustration better. Still, if the woman didn't follow doctor's advice before, he should've just realized the woman doesn't want to loose weight and gave up. After all, it is ultimately her choice.
 

i dont appreciate all the obese bashing. i weigh 780lbs. and all i need is some motivation and support.why don't you all live one day in my shoes and then tell me how it feels.
 

I am an overweight mother of an overweight child, and have met many medical professionals whose narrow minded, non-empathetic views fit into the comments shown here. No, I have never "blamed my doctor" for my or my daughter's weight. When I confessed to my own doctor that some of my weight loss was due to bulemia, he excitedly asked me what weight I was able to maintain as a bulemic, and never admonished my desperate attempts to meet my weight goal. It was only when my daughter became old enough to become aware of my "secret" that I decided to end it, having already ruined several of my teeth and caused other health problems. My doctors only comments were disappointment at my weight gain. My daughter's paternal grandmother is currently using the Atkins diet, and experiencing several health problems and a lack of energy that leaves her virtually unable to interact with my daughter. Her doctor lauds her weight loss and ignores her other concerns. Many of the members of my husband's family fall into the category of obese - his method of maintaining a lower weight is to smoke 2 packs of cigarettes a day and drink a 12 pack of diet colas to kill his appetite. Our doctor applauds his ability to "overcome" his families bad health habits, and doesn't want to know too much about how he achieves it. My own adoptive mother was very thin - at one point in her mid-thirties, she was shopping from the children's clothing department to supply her wardrobe. When I weighed in at 120 lbs at 5'2", she called every diet clinic and inpatient program in town, trying to find someone who would "work" with me to lose weight and end her embarrasement due to my appearance. I am trying to find a middle ground approach in working with my daughter, but if I have to choose between my daughter being overweight or having a childhoold of self loathing, I'll take a chubby child any day. As for the overweight teen with foot pain who is asking for a prescription refill much to the posting doctors disgust, what is his soulution? That she deserves the pain because she does not meet supermodel status? Would he have happily given me painkiller's when I ripped my throat apart vomiting after each meal as long as my weight met his magic chart? Does he think the pain in her feet will encourage her to walk several miles each day for excercise? Why can't these medical professionals treat their patients for who and what they are now, instead of punishing them by withholding care until they meet the standards they may never reach?
 

I am an overweight mother of an overweight child, and have met many medical professionals whose narrow minded, non-empathetic views fit into the comments shown here. No, I have never "blamed my doctor" for my or my daughter's weight. When I confessed to my own doctor that some of my weight loss was due to bulemia, he excitedly asked me what weight I was able to maintain as a bulemic, and never admonished my desperate attempts to meet my weight goal. It was only when my daughter became old enough to become aware of my "secret" that I decided to end it, having already ruined several of my teeth and caused other health problems. My doctors only comments were disappointment at my weight gain. My daughter's paternal grandmother is currently using the Atkins diet, and experiencing several health problems and a lack of energy that leaves her virtually unable to interact with my daughter. Her doctor lauds her weight loss and ignores her other concerns. Many of the members of my husband's family fall into the category of obese - his method of maintaining a lower weight is to smoke 2 packs of cigarettes a day and drink a 12 pack of diet colas to kill his appetite. Our doctor applauds his ability to "overcome" his families bad health habits, and doesn't want to know too much about how he achieves it. My own adoptive mother was very thin - at one point in her mid-thirties, she was shopping from the children's clothing department to supply her wardrobe. When I weighed in at 120 lbs at 5'2", she called every diet clinic and inpatient program in town, trying to find someone who would "work" with me to lose weight and end her embarrasement due to my appearance. I am trying to find a middle ground approach in working with my daughter, but if I have to choose between my daughter being overweight or having a childhoold of self loathing, I'll take a chubby child any day. As for the overweight teen with foot pain who is asking for a prescription refill much to the posting doctors disgust, what is his soulution? That she deserves the pain because she does not meet supermodel status? Would he have happily given me painkiller's when I ripped my throat apart vomiting after each meal as long as my weight met his magic chart? Does he think the pain in her feet will encourage her to walk several miles each day for excercise? Why can't these medical professionals treat their patients for who and what they are now, instead of punishing them by withholding care until they meet the standards they may never reach?
 

I starting googling the phrase "withholding medical care for obese" and found this blog.

Frankly, I feel there is no other option than "shock therapy" here. If you are 100 lbs over your even "unhealthy" weight range, then it is a truly willful act. It is clear that you want to be unhealthy. Why does another person owe you care? I would not feel guilt if I had to choose between treating a child who had a genuine illness and a seriously obese person who had eaten himself into an illness requiring hospitalization. I wonder if it must come to formally making the morbidly obese "uninsurable."

I would even be comfortable with not insuring, nor treating, other forms of behavior related illnesses, such as alcoholism, and others. Obesity is not a mental problem, it is a will problem.

We cannot afford to save all of you, nor should we. In a modification of "he who shall not work, shall not eat..." he who shall not attempt to be healthy, shall not be treated. I would venture to guess that fully half of the illnesses today could be eliminated if people stayed within 20 lbs of their appropriate weight.

Eat 1300 calories a day: whole wheat bread, lettuce, apples, water, rather than chips, beer & pizza. Seriously, try bran cereal and skim milk. Do that for 6 months, then I defy you to respond that your body isn't healthier.

At some point, there won't be a medical system here to help you so help yourself.