Dr. Bennett redux

Another obese patient has his feelings hurt:

When the surgeon came in, he asked if I knew why my back was hurting. I told him that for 30 years, I’d had a job lifting heavy things and it had taken its toll. The doctor looked at me and said, “I think you have always eaten too much.”

I told him most of my family was built large. He said, “Then they eat too much, too.” He said everybody has the same metabolism and genes do not play that big a role in your size. People who are heavy simply eat too much and do too little.

During the entire 20-minute exam, he belittled and shamed me, and continued to say the ONLY reason people are overweight is they eat too much, and that I’m in denial. I went to this doctor for pain and left feeling like a fat, worthless piece of poop.

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  • SarahW, who is rather thin

    This People who are heavy simply eat too much and do too little.

    I gotta hand the perfectly stupid award to the doctor. The above factors are not magically excluded from the influence of genetics.

    Mamipulating individual variances is probably the eventual cure for obesity. To wit:http://news.bbc.co.uk/1/hi/health/4946574.stm

  • Anonymous

    The doctor is right. Even if there is a hereditary variation in the ability to achieve satiety, you have to be in denial to habitually eat overly-large portions just because one doesn’t feel satisfied by that quantity of food. People are not cattle. Reason should be expected. So should responsibility.

    Blaming “hormones” is abdication of personal responsibility to maintain a healthy body weight.

  • Anonymous

    Evin if? Sounds like you are the one in denial. There’s no question some people are set to carry more weight, want more food, and conserve more energy. And they get fatter.

    Some people really pride themselves on their ability to suffer for a cause, I’m not one of those.

    If a simple safe change in a hormone makes someone able to carry a healthy weight without the extra struggle genes laid on ‘em, why would you be opposed to that?

    More importantly, what possible benefit does berating a patient for getting back pain do? Reduction in BMI has real benefits, but the doctor isn’t going to manage to talk his patient into doing it retroactively, and he is unlikely to push the patient into a new body with that kind of talk. The doctor, who is not only wrong, but merely indulging himself to relieve his own feelings.

  • Samson Isberg

    This is really silly. I too have scores of obese patients and am accostumed to the litany of excuses (“this is genetic”, “I have heavy bones”, “I don’t eat a thing”, “This is hormonal”) – and I always give them my stock answer (at my age, I have accumulated a lot of stock answers) is to explain to them the first law of thermodynamics , – energy cannot be created, only transformed.

    No hormones or genes can create mass by themselves, at some point energy must be admitted to the system – through the mouth.

  • SArahW

    The doctor, who is not only wrong, but merely indulging himself to relieve his own feelings, should check his own impulses (after all, he’s not a moo-cow) and offer a constructive plan to deal with excess weight, not one that focuses on how much the patient deserves his condition, having brought it upon himself.

    (Sorry for editing snafu)

  • SarahW

    Sapsom, I think you overlook the obvious. That will to eat is programmed in at such a primitive level that it has a profound effect, one which shapes the will.

    The rationalizations you hear can be dispatched without bullying and shaming. You have a hard situation, patient, but you must deal with it in order to remain healthy, is more likely to result in change than – your lifetime habits are shameful. You are worthless. You deserve to be ill. Why can’t you be more like normal people?

    It may well be that you can make fat people more like normal people – by changing physiology, instead of instilling some psychological awareness of “failure”.

  • Samson Isberg

    But you see Sarah W, my patients are pregnant. All of them. No exception.

    And as they only appear in my office when they are pregnant, I have very little time to influence them, and must therefore be very precise – not morally judging,not humiliating, not alienating, but on the other hand I must get my message through not because of the women themselves, being obese is their choice, but because of their babies – The women can speak for themselves, and if that is not enough they have their husbands, the press, the Hospital Management, their lawyers, the medical council and the Board of Health on their side; – but their babies only have one single person in the whole world to speak for them; and that’s me.

    So sometimes I have to be precise. And be heard.

  • Jacob Smyth

    Bravo to the Doc!

    Simple Cause => Effect

    Effect: bad back

    Cause: Too much weight/too much food.

  • Anonymous

    Look the bottom line is that scientific studies have proven that about only 5% of obese people have a genuine proven genetic/hormonal cause for their obesity.

    that means 95% got there by overeating/no exercise. But yet its routine for the 95% to hide behind the 5% excuse, as if hormonal problems are that rampant.

    What a joke.

  • Anonymous

    “Evin if? Sounds like you are the one in denial. There’s no question some people are set to carry more weight, want more food, and conserve more energy. And they get fatter.

    That is nothing more than the talk of the enabler and the apologist. Don’t worry, your efforts aren’t needed as so many of the obese are well able to offer their own excuses.

    We don’t all have our own personal thermodynamics that cruelly visit obesity on some but not on others.
    The fat comes from excess food intake over caloric reequirements, habitually and over a sustained period. Not by magic. Not by the fat fairy.

  • Anonymous

    I never see anyone who is put on the Survivor television show gain weight.

  • Anonymous

    OK. So you go to the Doc. for help for back pain. You get, “Your a fat cow, lose weight” This is somehow suppose to create a good Dr./pt. relationship and lead to a positive outcome? How?

    The pt. now not only has back pain, but you, as a physician has just lowered their self-image and self-worth. This reaction will not lead to a healthier lifestyle. It will creat tension and anxiety and guess what…When most people are stressed or anxious they eat…You have defeated your own cause.

  • SarahW

    “Look the bottom line is that scientific studies have proven that about only 5% of obese people have a genuine proven genetic/hormonal cause for their obesity.”

    That’s really sort of twisting the research. I think you know better. While one may say “there are a set of known genetic or hormonal syndromes know to cause obestiy, and a limited number of obese persons have them”, that is not to say that genetics is not a major factor in the feeding and actibity habits in every person.

    In fact, the more the subject is explored, the clearer it is all persons are not created equal and struggle to the same degree to control weight. The fact that nearly anyone, including prader Willi patients may change diet and excercise habits and affect his or her weight, does not mean that genetics and environmental factors (perhaps including viral infection) in conjunction with specific genetic differences do not have significant impact on appetite, saiety, metabolism and activity levels.

    If obese persons have less oxyntomodulin, it’s harder for them to stop eating and realize that “enough” is over-eating. The persons who got oxyntomodulin injections didn’t get away with not eating less and moving around more. Its just that the behaviour change came without the distress signals they would normally get from cutting out food or moving when their body wanted to be still.

    Since when is using an ineffective treatment plan worth of a “bravo” from a fellow physician? The berating, if it worked, would be one thing. But it’s just a useless self-indulgence on the part of the physician with the potention to harm weight loss and other healthcare goals.

    The bravo comes when you aid a patient in getting or staying healthy.

  • Anonymous

    No one is saying you shouldn’t be truthful. But there is a difference between telling the truth with respect for the patient’s feelings vs. simply belittling and berating people and offering them nothing of substance that might help. Why would patients want to take your advice about losing weight when the advice is delivered in a manner guaranteed to alienate people?

    Some of you seem woefully ignorant of the more recent research. The regulation of weight and appetite is a complex mechanism and it does not function the same in everyone.

    I don’t understand Kevin’s reference to Dr. Bennett. The link to this particular item is a letter to Dear Abby, for Chrissake. The individual has not filed a complaint with the medical practice board, as far as I can tell from his letter. There appear to be no overtones of racism. I think Kevin just likes to fan the flames, and the rest of you are happy to pour on the gasoline.

  • Moof

    Dr. Terry Bennett’s office is about 20 minutes away from me. I applaud him for having the courage to care enough about his patients to tell them the truth.

    The obese patients have probably heard the polite version before – more than once – and they are still damaging their health and risking their lives through their irresponsible behavior. Dr. Bennett got his patient’s attention.

    Sugar coating the truth doesn’t help with many people … doctors who whimp their way around a serious issue like obesity, especially obesity which is causing other medical issues that they’re having to treat, should consider following Dr. Bennett and that surgeon’s lead.

    Their patients may hate them for their honesty, but if it forces the patient to take a hard look at himself, the physician may actually end up answering the highest call of his profession: saving a life!

  • SmartNurse

    I wholeheartedly agree with the last Anonymous…so I am going to write it again…I mean, really, if you have ever been a patient, you know that you really don’t want to be insulted by your doctor, no matter WHAT kind of problem you have…it is not nice, not necessary, and very counterproductive as well.

    No one is saying you shouldn’t be truthful. But there is a difference between telling the truth with respect for the patient’s feelings vs. simply belittling and berating people and offering them nothing of substance that might help. Why would patients want to take your advice about losing weight when the advice is delivered in a manner guaranteed to alienate people?

  • Anonymous

    Today I saw a 245 lb 13 year old girl in the ER who wanted a refill of vicodin for “feet pain”. This is called acute on chronic gravity toxicity. Certainly there are good and bad ways of trying to present the truth, but damn it the truth has to be told. The excuse of being “big boned”, genetically predestined for weight gain, is all disingenious psycho babble that keeps people from confronting the reality.

  • NoAcuteDistress

    I guess that somehow Americans have cornered the market on being “big boned” or “genetically predisposed” to obesity. Somehow the French, Germans, Dutch, Swedes, etc have apparently weeded out all these bad genes.

    I think it’s the DENIAL of obesity as the source of so many medical ills which sticks in our craws as doctors. I recently saw an ad on the TV one morning as I was doing my daily stretch before going to work. There was this fat guitar strumming dude whose name eludes me (it was something like Fatty Collins). The commercial went something like this: “Hi! I’m Fatty Collins. You may remember me as the lead guitarist in the group blah blah blah. We sure lived through some fun times, eh?Well (in a folksy drawl) somewhere along the way I picked up diabetes.” (it was an ad for some new hypoglycemic drug)

    “Somewhere along the way I picked up diabetes.” Like, somewhere along the way I stepped on a thorn and now I have a problem not of my own making.

    You’re OBESE for crissakes! There’s a REASON you have Type II Diabetes. There’s a reason you have hypertension. There’s a reason you have hyperlipidemia. (Please no comments about all the innocents who have true genetic disorders). There’s a reason you have GERD. There’s a reason you have chronic back pain. There’s a reason you have Sleep Apnea.

    Until the public stops denying obesity as a major etiologic factor in so many COMMON medical conditions, we’ll contnue to look to genetic research to “Explain” away the elephant (no pun intended) under the living room carpet.

    Just think about how many times you meet a new patient and take an inventory of their medical conditions. How many times have I asked, “Do you have any medical problems?” No. “Then why are you on Lisinopril, HCTZ, Lipitor, Glucophage, Nexium?” Oh, THOSE. I DID have high blood pressure, high cholesterol, diabetes, and reflux; but now I’m OK.

  • Liz

    Moof, You really have no compassion at all for people. Odd that you would pick a health career when what you really want to do is to spend all your life agreeing and cuddling up to the Drs. Your far to opioniated to be a value to people in need. The patients are supposed to be the priority not the doctors.

  • SarahW

    The excuse of being “big boned”, genetically predestined for weight gain, is all disingenious psycho babble that keeps people from confronting the reality.

    Again, I think you are in denial about genetic factors predisposing persons to obesity. The “Psycho babble” is the attempt to shame patients into action.

    Patients need straight talk, but they need effective straight talk. An acknowlegement to a morbidly obese person that their behaviour is probably influenced by genetics does not hinder weight loss. It doesn’t mean they “get away with” eating too much or not excercising enough. It doesn’t prevent you from telling them there weight must be controlled because of x,y and z – the various complications they have or are at high risk of developing.

    Where did you ever get the idea that berating and shaming was a good way to get people to lose weight. It’s one of the least effective and counter-productive tools in your arsenal. What it is, is a good way to get people to avoid the shaming words. As a result, the patients problems may not be managed at all and they are worse off than ever.

    Why do you not get that a sober appraisal of a persons health is not prevented by avoidance of bullying, instead making asknowlegment acknowleging that a person may have a tough row to hoe and may need extra diligent attention to dient and excercise?

    In fact, that’s the best response to the Dear Abbey writer’s defense that peole in his family have always been large. You say, yes, your tendency to overweight may be a family trait. You must be especially careful and conscious of your eating and excercise habits, until the causes are better understood and there are effective treatments. Meantime, your back pain is going to be exacerbated by this extra weight, and you need to get it off for the best outcome…etc. etc.

    No “you disgust me” necessary.

  • Anonymous

    If you think you can counsel much better than docs may I suggest you go to med school :)

  • Anonymous

    “If you think you can counsel much better than docs may I suggest you go to med school :)”

    Reminds me of a minor surgery I had four years ago. Surgeon and resident walked in. Surgeon greeted me by the wrong name. Resident corrected him. Surgeon’s responded, with a snort, “Whatever.”

    If that’s what they teach you in med school, demand your money back.

  • Anonymous

    I’m just another ignorant patient, but if I can comment on this “direct approach”…

    You seem to be assuming that you (the doctor) and you alone are the only entity attempting to influence the patient. And, when you meet resistance, you respond with some apparent lack of tact.

    Consider how frequently the patient is exposed to TV commercials for weight-loss products, in which actors dressed as doctors claim that taking a pill can make the pounds drop away.

    Even if the patient recognizes those snake-oil pitches for what they are, there are more ads for legitimate drugs (statins) that explicitly state the influence of heredity on cholesterol. No, cholesterol and weight are not the same, but I’m betting a lot of people link the two.

    You say that metabolism is the same for all people, but if that’s the case, why is the TSH test included in most blood workups? My doctor advised me to take Synthroid for slow metabolism due to sluggish thyroid function. Nobody else in my family has that problem. Are metabolisms all the same or aren’t they?

    My point is that with today’s express lane checkups, most doctors probably don’t know that much about their patients and what external factors have resulted in them having the beliefs they do. You’re suggesting that to get your message through quickly, all you have to do is act like the stereotypical English-speaker in a foreign country: Yell, and maybe they’ll understand.

    I appreciate that you want to help the patient, but you might be able to accomplish that better through more two-way communication rather than issuing directives and getting upset when you don’t get instant compliance.

  • Anonymous

    Why would patients want to take your advice about losing weight when the advice is delivered in a manner guaranteed to alienate people?” From SmartNurse

    Because the surgeon in this case is purposely alientating the patient, not to encourgage him to lose weight, but to make certain that he never shows up in the surgeon’s office again. The surgeon couldn’t care less if this patient ever loses weight. He just doesn’t want to treat overweight people.

    It’s too bad that patients aren’t asked if they have x,y or z condition when they call up for an appointment, so they don’t end up making the appointment, waiting several weeks, only to find out that a surgeon doesn’t like treating people with x, y, or z condition.

    I’ve been on the receiving end of this ‘alienating’ behavior twice. And it works. I’ve gotten the message loud and clear – Don’t come back to this office! Though, invariably, the surgeon writes a report back to my family doctor, saying that I can always be referred back to him ‘on a p.r.n. basis.’ I’ve learned to read through this obfuscating language, and to go by how the surgeon behaves, and not go by what he writes.

  • Moof

    Anonymouse Blogger Liz (11:21 PM)

    “Moof, You really have no compassion at all for people. Odd that you would pick a health career when what you really want to do is to spend all your life agreeing and cuddling up to the Drs. Your far to opioniated to be a value to people in need. The patients are supposed to be the priority not the doctors.”

    Liz, my dear, I’m 5’2″, and I once weighed nearly 170 pounds. I was wearing 2X for shirts, and had outgrown my husband’s pants.

    By the time it all caught up with me, I had a blood pressure that rang in at over 280/160. It was a very rough ride from that point forward – and still is.

    I don’t believe there’s any compassion in lying to people, even when it’s in the form of “a lie of omission.” I feel that’s about the unkindest thing you can do to someone.

    If I have a hole in the seat of my pants, and I’m prancing about in public … and none of my “friends” give me a “heads up” … then I would no longer consider them my friends. I would feel as if they didn’t care enough about me to call something negative to my attention – and that would just be for the sake of embarrassment! How much more important for the fellow in whose hands you’re placing your very life to be honest with you about your condition. Even if he has to be blunt to really get your attention.

    The doctor who molly coddles someone with polite political correctness isn’t helping a patient who needs a jolt to understand where he’s headed …

    About spending all of my “life agreeing and cuddling up to the Drs” … you don’t have a clue. I disagree with a lot of doctors, and when I disagree, I’m not afraid to say so. I never post anonymously, and if you do enough comment reading on other physician’s blogs, you’ll likely find that I’ve posted as many negative comments as positive ones.

    “Your far to opioniated to be a value to people in need.”

    Well, lots of “people in need” tell me just the opposite, but that’s your opinion,, and it’s simply another judgment which you’ve made without knowing me. My opinions are about situations and circumstances, not individuals and their relative worth in the overall scheme of things.

    Mine is an opinionated statement about a situation, yours is a personal attack – on someone you don’t even know, and through the anonymousness of an unlinked comment, with no email address.

    Also – I disagree with you that “The patients are supposed to be the priority not the doctors.”

    The relationship between a doctor and a patient should be co-equal. The doctor has the knowledge that the patient needs in order to get well. The patient goes to the doctor for that very reason. The doctors advice (treatment, etc.) should be the priority to the patient, and the patient’s illness should be the priority for the doctor.

  • Anonymous

    I also hear these excuses : slow metabolism, I barely eat anything… all the time. “Doc, my thyroid must be off”.
    We have to be honest to our patients and tell them, without insulting them, that obesity is as simple as a math problem : you need to add and to subtract and, more important, be honest to yourself. In general, lately, people seem to be more aware of their weight problem but many of them are not motivated enough to lose the fat. It is like a child : you can motivate him only that much, he also has a responsibility that results from his freedom.
    There is another problem : many times the insurance just does not pay for that kind of counseling and there is only so much I can do for free.

  • Anonymous

    I think that is the key “honesty without insult”…It is possible to relay this to patients without making them feel terrible. I struggled with weight issues for years once i started having babies. I certainly was aware I was overweight but it seemed the more I worried about it, the more I ate. Negative responses from people DID NOT help the situation. My PCP said to me one day..”Your far to pretty to be this overweight” That one comment did it for me. I joined weight watchers and learned how to eat right. I’m a lifetime member there and have been for many years. I lost all my weight years ago but I still attend the meetings. Like an alcoholic going to AA I guess.

    It’s not your message that is wrong, it’s the delivery of it.

  • Anonymous

    You could have sued the physician for sexual harrasment for that comment or reported him to the medical society…why don’t you do that, or are you happy living your mediocre existence on $10 an hour…go for the payday…

  • Anonymous

    anon 8:55 and 8:55

    1st. You are stuttering, please stop.

    2nd. You’re quite deranged.

    3rd. Why would I sue anyone? I thought it was you guys that made the magical 10.00×2/hr….Isn’t that what everyone has been harping on at Dr. charles?

    4. May I buy you for what you’re worth? I would then like to sell you for what you “believe” you’re worth.

    5. That would be one hell of a payday!

  • Anonymous

    Besides, his comment was “You’re far to pretty to be this overweight.”

    His comment was not “Wanna fuck?”

  • Anirban

    How you define yourself, positively or negatively, how do you respond to a situation depends on your life experiences the upbringing you had and the messages you’ve heard from others throughout your life . be it a doctor or patient ,human beings are very complex, with a wide spectrum of temperament and emotional intelligence . it doesn’t make any of them inherently bad . the doctor advised something in his way ,patient interpreted in his/her ways. The strategy that worked for some didn’t work for this guy , quite sad ,but the doctor will get his kind of patient and so the patient who will be better served by someone else. This little drama can’t seek to demonise any of them. Its quite funny that we have generated 30+ posts over this.

    N.B. considering a lot of resentment among ladies over doctors like this , a basic male female communication gap looks quite alive. I’ve just completed a wonderful book (You Just Don’t Understand: Women and Men in Conversation ) which tried to peep into this complex issue

  • Anonymous

    Why is it that most of the Drs. who are so rude, to patients about weight loss, seem to be about 100lbs. overweight themselves? Don’t tell me I need to lose weight, when you have to stop after every 2 words to catch your breath.

  • Anonymous

    “Don’t tell me I need to lose weight,…”

    So a doc isn’t supposed to do preventative health care? Just wink wink. You go to the doc for YOUR issues not the docs right?

  • Anonymous

    Well, when you tell patients they need to stop smoking, you wouldn’t do that while sitting there smoking a cigarette, would you. Or, would you be drinking some JD while educating about the risk of alcohol consumption?

    Why then would you not work to lose your own weight, if you are going to educate about the risks of being overweight? You teach by example!

  • Anonymous

    I’m sure anecdotally you have one specific obese physician in mind, but your comments are amusing considering that physicians are, on average, 31% less likely to be obese than the general population. Oddly enough, the trend doesn’t hold for nurses, though I can’t explain why.

  • Anonymous

    “The trend doesn’t hold true for nurses, although I can’t explain why”…

    Nurses are overweight from the constant abuse they take from Drs. harrassing them about being overweight.

  • Anirban

    Nurses are overweight from the constant abuse they take from Drs. Harrassing (sic) them about being overweight.
    Wait a minute. By the same logic are these doctors obese, because they also take harassment from patients like you or say lawyers. The list of factors causing obesity just getting long. It is sad that you are comfortable being coddled like a baby all the time, hoping it can strip off your individual responsibility as an adult. Please grow up.

  • Anonymous

    anon 9:13..Please say you did not insult this 13 yr. old child that came to you for help? Absolutely her issue needs to be addressed, but not by insulting her. I hope you had the thoughts to take her mom or dad aside and tell them what they were allowing to happen to their daughter.

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