How obesity is affecting imaging studies

Another way how being obese can hurt you:

“In the past 10 years or so, medicine has become so dependent on imaging,” Uppot said. “Instead of doing very meticulous clinical examinations, a lot of doctors now rely on CT scans, ultrasounds, etcetera, to tell them what’s happening inside the body. What happens when you’re too big to fit on a table? Or you can fit on a table but the image is poor quality?”

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  • Anonymous

    In the ER, you admit these patients (ER talk for “CYA”) THen they get to the floor, and the surgeons take out organs in the vicinity of the pain (“Just in case”, ie CYA) Another in a long line of the Rapes of medicine brought to you by the AMerican Trial Lawyers Association.

  • Anonymous

    You must remember though, it is da trying task to do an ordinary physical exam also of these obesitati. Like the X-rays, your hand must push through the monstrous layers of blubber insulating these patient’s intestines from exposure to the cold and the doctor’s probing fingers alike. Try to get a hold of a uterus on a 150- 200 kg (that’
    s 300-400 lb) patient, it’s difficult enough during laparotomy not to mention trying to get a hold of what’s inside the uterus.

    - And the fatter the patient is, the more likely she is to ask for pictures during ultrasond scan, “could you tell me if it’s a boy or a girl, doctor?”, – when you are trying your best to get the ultrasound waves to penetrate 20 cms of blubber in order to see if there might be a baby in there after all.

  • Anonymous

    “Its a glandular problem.”

    How many times have you heard that excuse for some lardo whale that makes Jabba the Hutt look svelte? Who puts this “its not my fault” garbage in the heads of these people?

  • Anonymous

    Do you guys remember when in residency when you had to put a femoral line in…inevitably it is always on some fat American SOB that has a huge pannus…I would have to get the intern just to lift the panus, sometimes I needed two people, then I would stick the line in fungus-infected skin…I used to feel bad about it but now I know this is how litigious animals should be treated…

  • Anonymous

    I remember when I was an intern and was told by a nurse that she couldn’t put a urethral catheter in an overweight patient. Well, I came up to evaluate the patient, thinking “new nurse, no experience, here I go again…” and found out that this patient was not just overweight, but was massively obese and the nurse was just being nice. I could not even find the penis to put the catheter in. So, I evaluated the patient and realized that he is in urinary retention and really needs this catheter. I paged the resident, who started chewing me out for making such a silly request as to need help to put in a simple Foley catheter and what kind of stupid intern was I, anyway? So grumbling, he walked into the room and his eyes bulged out upon seeing the patient. With both of us pulling and tugging this way and that, we still could not put in the catheter. The resident, red faced, and huffing and puffing at this time, paged the chief resident and requested assistance. The chief resident starting screaming into the phone, yelling at the resident for contacting him for such a stupid request. The poor resident finally convinced the chief resident to come in to evaluate the patient. The chief resident came in and was shocked at the enormity of the patient. With all three of us, tugging/pushing/pulling, we still could not get the catheter in. Finally, the chief resident called the attending who proceeded to chew out the chief resident for such a call. He was finally coaxed to come in (some first born was made in exchange, I think), and once again, a great effort was made to locate the penis to try to place the catheter. During this time, I was trying to explain to the patient what we were doing. The patient finally said with a hint of impatience to the attending – “Hey, doc, did you find it (penis) yet?” To which the exasperated attending replied – “How do you know that you have one?”

  • Anonymous

    I do think it would be very hard to provide medical care to some of these people that weigh as much as live stock. Do you ever think that some people have an illness very much like an alcoholic or drug addict? That they must eat all the time?

    My BIL smoked non-stop, and drank his fair share of alcohol. Was never overweight. His doc told him he was killing himself with the booze and smokes. He stopped both almost immediately but then he became like an addict with food. He ate non-stop and gained about 100 lbs. in a year. He still kept eating and gaining weight. He fell dead at age 55 of a heart attack. I don’t know if that would have happened if he kept smoking and drinking or not. Or why he went from one set of addictions to another.

  • Jan

    Myocardial perfusion imaging in obese patients can yeild hedged results such as “possible inferior ischemia versus attenuation artifact” and clincal correlation advised. Then, because the patient has DOE, they get sent for cardiac evaluation, get a cath and end up with no obstructive CAD. A scenario I have seen several times.

  • John J. Coupal

    Speaking of myocardial perfusion imaging.

    When I started in nuclear pharmacy, I remember scanner and gamma camera imaging tables boasting a 300-lb patient weight limit.

    Now, they’re designed to support 400+. So they can also be used at the zoo!

  • Anonymous

    Appropriate analogy…most of these patients belong in a zoo…they’re animals and deserve to be treated as such…

  • Anonymous

    It’s pretty clear who the animals are here, and it’s not the patients.

    You people are disgusting. Get out of the profession. You have no business dealing with humans.

  • Anonymous

    What is wrong with you people? There’s no nefarious conspiracy to make sure fat people don’t feel “responsible” for their “condition.” (On the contrary, people feel nothing but self-loathing for “daring” to be above a size 2 and most would accept your repulsive abuse as something they “deserved”). Get your weenie little heads around this: there is no one to blame for fat because (gasp!) there’s NOTHING BLAMEWORTHY ABOUT FAT IN THE FIRST PLACE! I cannot believe you people are even adults, let alone presumably qualified medical personnel. Ecxept in severe cases, obesity in and of itself is not an independent health risk–I don’t care how your diet-industry-funded medical school brainwashed you. Besides, I don’t hear any concern about your unfortunate patients’ health–just deafening, aesthetic-base bigotry and puerile comparisons between your patients and livestock.
    You should all be ashamed for even having this conversation, as you’ve long lost since of any logical points that could have been made.

  • Anonymous

    A copy of these comments has been forwarded to the president of the AMA.

    It’s time you realized that all of your patients, regardless of size, are entitled to be treated with respect. Your licenses should be revoked.

  • Anonymous

    “Ecxept in severe cases, obesity in and of itself is not an independent health risk–I don’t care how your diet-industry-funded medical school brainwashed you.”

    And how do YOU define “severe”. May I suggest you take a look at tables that describe obesity. You would be surprised how many americans fit into this profile and therefore have “obesity” health related risk factors.

  • Anonymous

    “And how do YOU define “severe”. May I suggest you take a look at tables that describe obesity.”

    My question would be who framed these tables and what agendas did they have? Statistics can be made to prove anything you like.

  • Anonymous

    “My question would be who framed these tables and what agendas did they have? Statistics can be made to prove anything you like”

    Oh crimney. Do you you really believe your drivel? In your little world do you really believe there is no relation between obesity and coronary artery disease, hypertension, diabetes, degenerative joint disease, and multiple cancer’s (though weaker)? This isn’t just playing with statisitics. Get your head out of the sand (or your ass).

  • Anonymous

    Yeah, I’ve seen report after report, shrieking about people’s BMI. What these media reports don’t tell you is that BMI is a simple weight-height correlation. It is a meaningless statistic as far as your actual health is concerned and is constantly revised downward. It does not, then, necessarily follow that those with high BMIs “therefore have obesity-related health risks.” Many of the diseses mentioned are also suffered by thin people. And, not every obese person hasthose diseases.
    The topic of this post is how obesity is affecting imaging studies, but all the focus seems to be on how fat patients affect physicians.

  • Anonymous

    Did you read this comment (maybe it was you)?
    “Ecxept in severe cases, obesity in and of itself is not an independent health risk–I don’t care how your diet-industry-funded medical school brainwashed you.”

    Obesity is a clear health risk. You are quibbling when you are talking about BMI’s. Yes BMI’s do not take into account people with high muscle mass (though % fat tests do) . Yes, Russell Crowe and Gov. Arnold would be considered “obese” via these BMI tables. BUT we are not talking about the vast majority of people in this situation. The fact is studies show a clear coorleation between obesity and CAD, DM, DJD, HTN, and some cancers. Yes “thin” people get the same diseases, but remember we are talking about relative risk here. the risks are real, that’s the fact.

  • violet_yoshi

    I’m not quite sure what to make of you “professionals”. This blog was posted at BigFatBlog.com, which is why there are so many people here advocating for fat-acceptance.

    Now, maybe I don’t exercise as much as I should. I have tried Weight Watchers twice. I’d like to let you know what happened each time.

    I would become extremely fatigued from starving my body of food, I do not overeat. Further more I now eat more organic type foods, I’m still 220 pounds.

    Aside from adopting an eating disorder or exercising compulsively, both which not that long ago actually were considered a problem. Today it seems that doctors like you are asking your clients to adopt an eating disorder.

    Now before you go into, “But overeating IS eating disorder!”, let me explain. Some people will never fit into the ever lowering standards of the BMI without becoming Bulemic or Anorexic. I still can’t belive that today 100 pounds is considered healthy, not a sign of starving one’s self.

    Have you heard of the Anti-Hippocratic society. It was a society that was formed by Nazis in WW2, to advocate for the inhumane experiments they portrayed on the people in the concentration camps.

    Now I’m not saying this, although the mention of doctors pulling organs out of a fat patient like they’re playing Operation, because they are too lazy to do the job properly, or as this blog proves, have gained as much disrespect and lack of empathy for overweight patients as Hitler did for the Jews. I am saying it is against the Hippocratic Oath to disregard the health of a patient, because they are not a size 2.

    Actually I’m really starting to wonder if they’re just letting any old joe enter the medical profession now. If they care to uphold the Hippocratic Oath or not. Perhaps you all should watch the film Anatomy, (German title spelling, Anatomie) it is dubbed into English. See how many of you relate to those doing the experiments on the patients.

    I don’t have any idea how so many people in a professional industry can be so darn ignorant. I’m rather intelligent myself, not to brag, but to say that I would think having intelligence I could get my head around such immorality. I can’t, what is wrong with you people! Why did you get into the buisness, the money? I mean do you even give a damn about your patients? You are only serving to prove that we’re right, the only reason for all this BMI crap is because you don’t want to deal with patients that don’t look like supermodels. Sorry, apperantly they didn’t tell you you’re a real doctor, not playing one on TV.

    I really think the lot of you probaly would’ve been better off not born. I don’t want to lower myself to insults, but frankly I am mad. Mad as hell at you. Why put so much energy into hating people? There have always been fat people there will always be fat people, so why not see the futility in fighting nature, and do your jobs right?

    I mean really, 80 pounds is a healthy weight? Maybe if you like your patients pleasing to the eye, and easily molestable.

  • Anonymous

    You see kids, you too can be a doctor! Collect 2 tokens from any specially marked Wheaties products to receive a free medical degree in the mail! To receive your very own medical degree, complete the order form found on the inside of specially marked packages, enclose $2.99 for shipping and handling plus two tokens and mail to the address below.

  • Elizabeth Cady Stanton

    There will always be people of different sizes. The fact that you soo vehemently hate fat people is very disheartening indeed. The level of hatred being spewed reminds me of what was said about jews in germany during wwII.

    If you truly are in the medical prof, you’re behavior is truly sad and maybe you should become accountants and not deal with the people who come in a variety of sizes.

  • Anonymous

    “Some people will never fit into the ever lowering standards of the BMI without becoming Bulemic or Anorexic”

    May I suggest you look up the definition of bulemia and anorexia.
    I’ll say it again:
    The fact is studies show a clear relation between obesity and CAD, DM, DJD, HTN, and some cancers. That is the fact.

  • Anonymous

    Anon 1:05

    Did you take basic statistics? Because one of the first things you learn is that a statistically significant “relation” between two variables does not imply that one CAUSES the other.

    Correlation between increased weight and the diseases you mention has been established. But in years of studies, have any been able to demonstrate that having an increased weight CAUSES any disease (other than, possibly, arthritis)? I’d be really interested in any research you can find that proves a CAUSAL relationship between body weight and these conditions.

    There are 2 main problems with most of the studies to whic you refer.

    The first is that many are funded (in whole or part) by companies that profit from encouraging people to use their products or services in a futile attempt to lose weight, or that they are carried out by researchers with paid positions for these companies. And if researchers like Kelly Brownell want us to be skeptical of research paid for by the beverage industry that shows that soda is not unhealthy, shouldn’t we be equally skeptical of research funded by the diet industry that shows that being overweight is unhealthy?

    The second is that these studies typically use weight as a proxy for eating and exercise habits, with the implicit assumption that all people with BMIs over 25 have bad eating and exercise habits and that all people whose BMIs are lower than 25 have good eating and exercise habits. When studies indicate that people who are overweight don’t have bad eating habits, the researchers assume it’s because the study participants are either lying or deluded.

    Perhaps it’s time to end the debate and do some research that more accurately reflects the eating and exercise habits of the participants. Not everyone who is thin is healthy, and not everyone who is obese is unhealthy.

    If, instead of focusing on weight, we focused on making eating a healthier diet and exercising more the goals (rather than the means to the end of reducing weight, which might or might not happen), wouldn’t we become healthier as a society?

  • Anonymous

    You would be surprised how many americans fit into this profile and therefore have “obesity” health related risk factors.

    Um, the President of the United States is now in the “obese” end of the charts, since he put on 5 pounds and is almost 200 pounds. I don’t see any of you bitching about that! But of course, he doesn’t look obese, so he’s A-OK, right?

    I can’t believe you call yourselves “doctors”. You’re just bigots in white lab coats.

  • Anonymous

    1: Thank you I have had stats and I use it in my job. With humans it is not as easy (or ethical) to prove a direct casual relationship. You do remeber the tuskeegee syphilis experiments in the 1930′s? We do the best we can within ethical bounds.

    2:The association between weight and the various ailments I descibed is clear (though the level of assiocation may be debatable) and has not argued in the medical establishment for a long time. If you want to question it then so be it. You clearly then disagree with conventional medical expertise.

    3: re:”The first is that many are funded (in whole or part) by companies that profit from encouraging people to use their products or services in a futile attempt to lose weight, or that they are carried out by researchers with paid positions for these companies.

    I am sorry but you are wrong. Much of the STRONG BASIC RESEARCH in this subject where the stats come from (and I am not talking pharma drug studies) has been funded by the NIH. Don’t believe me…..look it up.

    4:”with the implicit assumption that all people with BMIs over 25 have bad eating and exercise habits and that all people whose BMIs are lower than 25″

    Oh come now we are not talking about people in the “overweight” category (ie BMI 25-29) and yes a BMI is not an end all as I alluded to Russell Crowe being “obese”. If you have an agenda….fair enough. But at least be honest about it.

    4: “I can’t believe you call yourselves “doctors”. You’re just bigots in white lab coats.”

    I am not the anon’s above with their abusive language but I did type the comment you linked. a question. If you have “obesity” related risk factors, isn’t it my job as your doctor to point them out and make recommendations (diet/education/medication) to minimize those health risks for your benefit? Does that make me a “bigot in a white lab coat”? Food for thought.

  • L in Michigan

    I am a fat woman who refused to go to a doctor for almost a decade because I was afraid to encounter a doctor as abusive as those above. That is probably a pretty unhealthy thing to do. And I suppose I could say that it was my fat that was making me do that but really it was the attitudes of people I encountered in the medical profession. Luckily, I was able to find a good doctor who treats me with respect.

    As for the health risks of obesity, I think it certainly is important for a doctor to share the health risks of obesity with patients. It is also important for a doctor to do that knowing that losing weight is at the very least very difficult and might even be nearly impossible for the patient. My doctor, instead of talking about losing weight with me, talked to me about how my weight increased the risks for certain things and how I should continue to exercise regularly but maybe consider joining a gym so I could get some more intense exercise. Not to lose weight so much as to counteract the possible negative effects of obesity. She said that the benefits of exercise are probably greater than the negative aspects of my weight.

    I also think it would be nice if doctors could actually tell their patients what the health risks of obesity actually are. I mean, even my doctor wasnt able to tell me that. I want to know what percentage of obese people get heart disease by age 50 compared to a similar group of non obese people. Because just because it is more doesnt mean it is significantly more or enough more to scare people the way folks do.

  • Anonymous

    If you are reading this and are actually a medical professional, the great unwashed masses streaming in from bigfatblog.com are actually for real, and it’s completely pointless arguing with them.

    Yes, these morons actually believe that obesity is not a cause of disease and that all the statistics are fudged.

    Oh, but when they show up in your ER, they still want you to treat them even though you’re an incompetent bigot who should not be allowed to be in the medical profession..

  • violet_yoshi

    Well isn’t it your job to treat whatever patients come into your ER? Or is it now, whoever you decide to help?

  • Anonymous

    Actually no, I don’t want you to treat me at the ER. I’d prefer you’d be honest and let everyone know you don’t like fat people and don’t want to treat them. Put up a sign or something. That way I could get decent treatment from someone else instead of wasting tax dollars with someone who couldn’t care less if I lived or not. Someone with a BIAS against fat would order pointless exams, mis-diagnose, push dangerous and deadly weight-loss drugs and diets and then blame the fat person as the one who did this to themselves. All while wasting time and $$$$$. Put up a fucking sign or get the fuck out of the way.

  • Anonymous

    This is from one of the thin people that commented on “Fat Doctor”‘s blog:

    “Thank you for commenting. I visit Kevin’s blog daily and am often appalled and disgusted at the comments that are made. The thread you’re referring to has to be one of the worst.

    I am not, nor ever have been, fat. But I have to work very hard at preventing weight gain, and it has become even more difficult since my thyroid was damaged by radiation therapy a few years ago. So I understand your struggles.

    I think it is ironic that Kevin’s commenters apparently feel justified and unapologetic about their demeaning, derogatory and prejudiced attitudes toward people’s physical appearance, yet are utterly blind to their own meanness of spirit.

    Their words and attitudes are far more repellent than any fat person could ever be.

    I’m glad someone ratted them out. In fact I’d like to see their heads on a stick.”

    The bolded part is really the point.

    What I think people are referring to is the arrogance of doctors who fail to prescribe treatment for, say, a broken digit just because the presenting patient weighs more than 200 pounds.

    Yes, it happens.

    It’s attitudes like those in the post and comments that permit it to continue to happen.

    If your disapproving attitude toward a presenting patient, as a physician, negatively affects the level of care you provide for that patient, please understand that THAT’S what people are really railing against.

  • Literacygirl

    I’ve lost 60 pounds, and regained 35. I am so mad at myself. I was POSITIVE I was NOT going to be part of the 80% that regains their weight. I was DIFFERENT. Well, guess I am not. I am still not sure why I let it happen. My T says maybe I don’t love myself enough. That could be, I do really hate myself. I WISH PEOPLE COULD UNDERSTAND THAT ITS NOT ABOUT THE FOOD! If it was just that easy to stop eating, I would like right this second. IT’S THE ISSUES BEHIND THE FOOD. And that is what I am working on right now. DO YOU THINK I LIKE BEING FAT? F-No!!!!! I think about it every single second of the day. I wish these skinny biotches got that. Anyway, the book I am reading and working through is: THE SEARCH FOR SIGNIFICANCE by Robert McGee. AMAZON it! It’s slowly helping me replace the lies I tell myself, with the truths that I am worthy and enough.

    I wish you could see behind my fat, and see how hard I am working on it.

    I wish you could see I was a person with feelings.

  • Anonymous

    What you fat advocates don’t seem to realise is that it isnt an extreme black or white choice, “Morbidly Obese vs. Anorexic”

    Theres a middle choice called “A healthy weight range” which is reached by practicing MODERATION and SELF CONTROL. To be in the HEALTHY weight range, i.e- NEITHER “anorexic” nor “obese” you could have a BMI of between 19 and 25. For the average 5″4 woman, thats 110-145 lbs. Not even close to anorexic. Nobody is saying you should starve yourself to 80 lbs instead of eating everything in sight to 280 lbs.

    Anonymous said…

    “Actually no, I don’t want you to treat me at the ER. I’d prefer you’d be honest and let everyone know you don’t like fat people and don’t want to treat them. Put up a sign or something. That way I could get decent treatment from someone else instead of wasting tax dollars with someone who couldn’t care less if I lived or not.”

    Yeah, good luck finding someone out of the blue, at the last minute when you suddenly fall over from an obesity induced heart attack. Where do you think the ambulence will take you? To the ER. Where the very doctors posting here will do their best to try and save you from what you’ve done to yourself by choosing to stay fat instead of practicing some MODERATION and SELF CONTROL in what you choose to eat and drink.

  • JP

    As one of the “morons” from BigFatBlog, here goes: the vehement response from the fat masses, including me, isn’t about any cultish belief that being overweight causes no risk to one’s health. It’s about the fact that the terms many of you supposed medical “professionals” posting are using to describe people you are supposed to treat and “do no harm” to.

    Dehumanizing your patients, calling them “animals,” and saying that they deserve to be treated as animals is not only shocking and inexcusable, but it inspires me to issue this fond wish: please, please get the balls to sign your names to your posts so that some fat and pissed off lawyer can research your records, publish your comments to your patients, and encourage them to link your comments to your no-doubt negligent or even reckless treatment of them.

    You are privileged in your power, and you have a duty to treat your patients well and with respect. Under cover of your anonymous comments, you are oh-so-brave. Show yourselves, cowards, so the trial lawyers can find you and give you exactly what you deserve.

  • violet_yoshi

    I just saw a show on the Discovery Health Channel, called Untold Tales from the E.R. Where a 16 year old girl went into a emergency room, with a extremely life-risking heart rate. What from you ask? Diet pills, with Ephedra and caffine.

    You aren’t talking about the women like her. The woman who risk their lives to become thin. Why should you care, as long as they’re thin? This girl could have died because of people like you.

    The show didn’t go into her history, but they considered she might’ve attempted suicide. Maybe because between the media, and the doctors claiming Anorexia is healthy, she felt she’d never be thin enough.

    To the person who claims 110-145 pounds isn’t Anorexia. It’s darn close. Perhaps you professionals forgot that it’s unnatural for anyone to weight the same that they did when they were 12 years old.

    I don’t spend all day eating, morons. This is a myth consistantly spouted by children. So you’re no better than children in your thinking? I have tried dieting, moderating my food. Only to become exhausted because my body is forced to go into starvation mode. You know what? When I start to eat again, my body gains pounds back because it’s still assuming it must prepare for another starvation.

    It isn’t healthy for anyone to yo-yo diet. It’s not a matter of will-power. If it was Anorexia and Bulemia wouldn’t be considered a eating disorder, they’d be considered healthy. Oh but we’re already down that road aren’t we?

    We’re already telling people if you weigh more than you did at age 10, starve yourself. It’s not Anorexia anymore, it’s healthy! Here take some cleverly disguised Speed too, so you can elevate your heart rate. Sure high blood pressure is a problem, but somehow it’ll magically not be a problem once you’re thin, right? Oh and don’t forget the laxatives and probe to help you vomit what food you do eat. Perfectly healthy as long as you become thin.

    This is the message you are sending. You are not being Doctors, you are killing people. You are murderers. They should put you in jail, for ignoring people’s health issues in pursuit of vanity for your own selfish wants.

    Nobody ever will look to you as an example of a good doctor, you’ll never be asked to be on TV or tell a story. Nobody wants to hear how a fat nazi, killed a fat patient because they feel they’re God-like. You are nothing, just a mistake. In fact all you so-called doctors here, probaly should’ve been aborted. You are not curing, you are the disease.

  • Anonymous

    I am within what is considered the healthy weight range, but have had weight problems in the past. I gained control of my weight with the help of a doctor that was tough on me and vigorously explained the risk i was taking by remaining overweight. While at the time i thought it was a little overkill, i now understand that her approach was necessary. I am HEALTHIER. That is the bottom line. However, the comments made here are just plain disgusting. As medical professionals you have a duty to treat each of your patients with respect. The thought of the people i am PAYING to look out for my health in areas that i am unable to discussing me in this way is horrifying. Do you discuss people with skin cancer in this way? How about those that come in after putting their hand through a plate of glass? Yes, people that are overweight have contributed to their problems, but so has your attitude. Truly appalling.

  • Anonymous

    “To the person who claims 110-145 pounds isn’t Anorexia. It’s darn close.”

    If the BMI is between 19 and 25, as it would be for a 5″4 woman weighing 110-145 lbs, then no, its nowhere near “darn close to anorexia”

    Maybe if YOU had any medical knowlege at all, you’d realise that is the healthy weight range.

    Anorexia Nervosa is defined as a BMI of UNDER 17.5

    Nobody said genuine anorexia is healthy. Like i said before, it isnt either obesity OR anorexia, there is a middle ground and its called the healthy weight range.

    “Perhaps you professionals forgot that it’s unnatural for anyone to weight the same that they did when they were 12 years old.”

    If a person was obese as a 12 year old, then it is indeed a vast improvement if they weigh less as an adult, so long as they are in the HEALTHY weight range. This isnt about vanity. Its pure and simple medical fact.

  • LD

    This is one of the most disgusting things I have ever read. Do you really think overweight people want to be overweight? Don’t you think if they could lose the weight they could? It’s not a matter of being lazy or having no self control. Usually there is a emotional reason behind the eating. As a dietitian and now a medical student, I am disgusted by the attitudes of many people leaving comments in this blog. Any person who is overweight and attempts to lose weight has taken a massive step forward and no matter how small the weight loss, they have reduced their risk of diabetes, CVD and cancers. These people should be encouraged and supported. Grow up and stop leaving ridiculous comments on something most of you obviousley have no idea about.

  • LD

    Ooops that should read, “don’t you think if they COULD lose the weight they WOULD.”

  • Anonymous

    For whomever said this “To the person who claims 110-145 pounds isn’t Anorexia. It’s darn close.”

    I just wanted to tell you about my own personal experience with this. I am 5’3″. A healthy BMI for me puts me at about 125-130. At 125, i feel like i am starting to look sickly, my opinion. At 130, i feel ideal. However as SOON as i gain an extra 5-10 pounds i notice a difference. The most i’ve ever been was 147. I was tired all of the time, lethargic, not able to run without getting out of breath. Is that any way to go through life? Even at 135, i still felt that way, was still concious of the roll of fat hanging over my jeans.

    It’s amazing how much difference a few pounds can make, but i’ve found my ideal weight and i’m sticking to it. I currently weigh the same as when i was 18 yrs old.

    It’s really disgusting that you could call someone like me anorexic. I am strong, i exercise almost daily, i eat healthy foods, fruits & veggies etc. However, i do NOT deprive myself of the good stuff. cookies, chocolate, french fries etc. IN MODERATION!!!! When people like you call people like ME anorexic it’s as damaging to my self esteem as it is when i call YOU,”FAT.” It’s happened to me in public before when my coworkers etc see me eating a small lunch and label me as “anorexic.” It’s damaging to one’s self-esteem and public image.

  • Anonymous

    I’m not going to argue the statistics angle…I could, but it’s late, and I have things to do.

    What I will ask of you, doctors, is that you keep in mind that each larger patient you see is not just a ball of “blubber.” We have lives, experiences, and feelings. And not all of us overeat (contrary to what you probably think).

    In my own case, I was two years old when I was put on my first diet by my grandmother (who had food issues of her own) and a pediatrician who refused to stand against her. I was a normal toddler, with normal amounts of baby fat (if I could post a pic, I would, but you’ll have to take my word for it – by everyone’s definition, I was normal). I was literally starved throughout the majority of my childhood. I remember turning 8 years old and thinking, “8 years old and 800 calories, maybe when I turn 9 they’ll let me have 900!” I was always, always hungry. I was an active child, too, a tomboy really – always climbing trees or riding my bike. But what I remember most about my childhood was sneaking into the kitchen to eat something whenever I could because I was so, so hungry. Oh, I was my “ideal” weight, but the cycle of binging whenever food was available was something that stayed with me well into my teens and early twenties. I finally had to see an eating disorder counselor, who told me something no one ever had in my entire life: Eat whatever you want for a week. I binged for two days, and then it was over. I haven’t binged since. I eat normally and am still quite active, but I can’t lose weight, thanks to the non-existent metabolism I now have. And tell me, what options do I Have? Dieting? Well, decades of it have proven it dangerous for me. I’m told that if I diet again I’ll most likely end up back in the same cycle. And WLS is not an option, as I’ve known too many people that have died from it (and I’m only in my late twenties – not anywhere near ready to give up my life to be thin). I have no other health problems, aside from the “obesity” that you insist is a problem all by itself. But, as a 400-pound woman, you would judge me the instant I hit the door, wouldn’t you? Next time, stop and think. There’s probably more behind that patient’s size than you imagine.

  • Anonymous

    I’m not going to argue the statistics angle…I could, but it’s late, and I have things to do.

    What I will ask of you, doctors, is that you keep in mind that each larger patient you see is not just a ball of “blubber.” We have lives, experiences, and feelings. And not all of us overeat (contrary to what you probably think).

    In my own case, I was two years old when I was put on my first diet by my grandmother (who had food issues of her own) and a pediatrician who refused to stand against her. I was a normal toddler, with normal amounts of baby fat (if I could post a pic, I would, but you’ll have to take my word for it – by everyone’s definition, I was normal). I was literally starved throughout the majority of my childhood. I remember turning 8 years old and thinking, “8 years old and 800 calories, maybe when I turn 9 they’ll let me have 900!” I was always, always hungry.

    I was an active child, too, a tomboy really – always climbing trees or riding my bike. But what I remember most about my childhood was sneaking into the kitchen to eat something whenever I could because I was so, so hungry. Oh, I ended up at my “ideal” weight -for a week or so- but the cycle of binging whenever food was available was something that stayed with me well into my teens and early twenties.

    I finally had to see an eating disorder counselor, who told me something no one ever had in my entire life: Eat whatever you want for a week. I binged for two days, and then it was over. I haven’t binged since. I eat normally and am still quite active, but I can’t lose weight, thanks to the non-existent metabolism I now have.

    And tell me, what options do I Have? Dieting? Well, decades of it have proven it dangerous for me. I’m told that if I diet again I’ll most likely end up back in the same cycle, and only become heavier. And WLS is not an option, as I’ve known too many people that have died from it (and I’m only in my late twenties – not anywhere near ready to give up my life to be thin). I have no other health problems, aside from the “obesity” that you insist is a problem all by itself.

    But, as a 400-pound woman, you would judge me the instant I hit the door, wouldn’t you? Next time, stop and think. There’s probably more behind that patient’s size than you imagine.

  • Anonymous

    Interesting anon you look at WW II europe when the whole continent was undernourished and thereafter with better food caloric intake the whole continent didn’t balloon up after the war now did it.

  • Anonymous

    “Ooops that should read, “don’t you think if they COULD lose the weight they WOULD.”
    # posted by LD : 6:21 AM”

    I was in the “obese” weight range just over 5 years ago. Then, I lost 80 lbs in a year and now I’m in the lower end of the “healthy” weight range. I’ve stayed that way ever since by keeping daily track of calories, yet still eating the foods I like in moderation. Keeping track of what I eat is a very small price to pay to have the body and the life I want. I only wish I’d learned that 7 years earlier then I did. Anyone can lose weight, it just takes effort, self control and knowlege of how the human body works.

  • Anonymous

    If “anyone can lose weight,” why do more than 95% of diets fail, and why do the vast majority of dieters end up gaining even more than they started with?

  • Anonymous

    “If “anyone can lose weight,” why do more than 95% of diets fail, and why do the vast majority of dieters end up gaining even more than they started with?”

    Because they go back to their previous bad habits once the excess weight is off, or often before its even had a chance to come off.

  • Anonymous

    I’ve been fat (size 22) and thin (size 4). I must say, from my own point of view, that I felt tired and sick at 230 pounds.
    Meaning: I don’t understand the argument denying that fatness has anything to do with health issues. It sounds like pure crap to me… But still, fat people deserve to be treated like people – not zoo animals.

  • Ms. Fraser

    Hello.

    I’m a 30+ woman who at 275 pounds and 5’7″ is considered morbidly obese, although with muscle mass counted in, I’m probably more comparable to someone on the low end of the obese range. (I was 5-10 pounds over-fat when I was 190 pounds.)

    I was a relatively active kid (always in swimming lessons, on the swim team, and at various points also took skating, gymnastics, floor hockey, cross-country skiing….)

    I’m a relatively active woman, despite my size. I’ve done one of those looooonnnnng all-weekend walks to end breast cancer. I can swim a couple of kilometres. I gave up my car for a bike and public transit. I’ve always been into camping and canoe trips, since I was 13. Even at 320 pounds, my highest weight ever, I was still taking friends on canoe trips, on which I would simultaneously solo-portage my canoe and a 60-75 pound pack. I garden. I walk to stores. I hate most traditional sports, and definitely have my couch potato moments, but I move, too.

    I have always had a lot of muscle. Embarrassingly, when I was 14, during one of the few periods in my life when I didn’t look overweight at all, the school nurse made me get off and back onto her scale three times so she could rebalance it at zero in disbelief. She thought it was malfunctioning suddenly. I guess she finally resigned herself to believe the number, because with my classmates listening in line behind me, she finally looked up at me and said “My God, what do you do? Do you lift weights? You look to be about 140 or 150, not 180.” I told her I swim, and booked it out of there.

    I know that when people first see me as an adult, they don’t imagine I’m so fit because of the fat layer on top, my massive caboose, and the size 20-24/26 or 3X clothes I wear. And I see the looks on their faces, especially when I occupy more than my ‘fair share’ of space in a bus, plane, or theatre seat. (And yes, I’ve had a Digital Imaging Technologist tell me to my face that she couldn’t get the image she was trying to get, because of my belly.)

    I never heard of either your blog, or BigFatBlog, until today when I was doing research to help a young woman who is 5’9″, weighs 125, and wants to lose the ‘extra 25′ to be 100 pounds by Christmas.

    (It’s very hard to convince a young woman that she’s body dysmorphic, or bulemic, thanks to the anti-fat sentiment that is ubiquitous everywhere.)

    I understand your desire to vent, Kevin. I have enough friends who are doctors, and I’ve worked in social services with some very difficult clients, and I know that a little ‘black humour’ can help you vent a frustration and move on. I’m giving you the benefit of the doubt that the things you’ve typed here are not actually your day-to-day attitude, but a letting off of steam, so to speak. But context is critical. I do wish you’d be more tactful in a publicly-searchable blog. Save it for where it won’t damage people, or your reputation.

    I thought I’d share my experience, that might be of interest to you and your readers (both health care providers, and those visiting from BigFatBlog) I’ve been somewhat overweight since I was 8 years old. The doctor I’ve had since I was 3 or 4 was always so wonderful about it. Despite my mother’s concerns (shared with him in front of me from the age of 10 on!) he was always friendly, encouraging, and nice with me. And he never advocated ‘dieting’ in any way. He would simply encourage me to ignore the other kids’ comments, keep active, and eat healthy, just having a junk food treat now and then. Completely liveable!

    On that advice, I stayed active, stayed positive and confident, and usually stayed within 10-20 pounds of my healthy weight until I was in my late teens/early 20′s.

    It’s true I hated running and most sports I had to be on my feet for. I avoided them like the plague, after age 11 or 12. Two of the reasons for that, I only much later understood. One was what was later diagnosed by the head physician at a Toronto hospital as exercise-induced asthma, and the other was my discomfort running because I require orthopaedic shoes for a 1.5 inch leg length difference and longer-leg collapsed arch, that have always caused my frequent hip and knee pains. But my favourite sport, swimming, wasn’t affected much by these. (A disproportionate number of Olympic swimmers have had asthma. I think the rhythmic breathing of the sport actually helps us. That, and no one can hear me breathing hard/gasping/panting, so I don’t get embarrassed.)

    After that, my father’s negative comments (about me getting to be ‘as big as a house’) got to me, and I tried a diet. It wasn’t a fad diet, or a gimmicky one, but it did restrict calories. People lauded my success in dropping 30 pounds (some was muscle mass) over 3 months (which is the so-called ‘healthy’ pace, right?).

    When I resumed the eating that had maintained my weight in a balanced way before I ever dieted, I regained 60 pounds. Over 10 years, I went through this cycle three times. (That’s just three times I tried 3-6 months of healthy but restricted eating, folks.) Total ultimate weight gain? 140 pounds.

    Yes, it’s true. I didn’t seriously STRUGGLE with my weight until after the first diet must have altered my metabolism.

    So I spent a year working with a doctor at McMaster University Medical who specialized in eating disorders and healthy weight loss. That year I reported every bit of activity, every food and its portion (right down to a single Hershey’s Kiss) – all of it, to her. We met every 1-2 weeks. She was encouraging and honest, and would call me on it if I ate too much or too little of any food group in a given week.

    And the result? She said, at the end of the year, “I really don’t get it. You ABSOLUTELY should have lost 40 pounds in a healthy way by now. You’ve gained 15.”

    The medical tests began. It took a while (years) to tease it all out, but I had a combination of factors working against me.

    Hypo-active thyroid was the first factor to be identified. We spent a year sorting out the right medication level. That helped some, but there still seemed to be a missing piece.

    I developed Mono, and it stuck around for too long of a time, even for Mono. More tests were done, to see if something could be contributing to my fatigue lasting on and on. Bingo! Insulin resistance related to both PCOS, and Type 2 diabetes. Metformin successfully treated both. (My last hemoglobin test showed an average blood sugar of 5.6 over the previous three months. And for the first time in my life I have truly regular cycles.)

    A year after these diagnoses, I happened to be diagnosed with ADD by my childhood doctor (then confirmed by a psychiatrist specializing in AD/HD), after he learned more about its often-differential presentation in women. I was begun on Ritalin. This had an interesting side-effect. I’ve heard people say that they worry that Ritalin can cause appetite loss. That was definitely not the case with me. But for the first time in my life, I truly UNDERSTOOD my appetite.

    For years I had commented that unless I was famished, I never truly knew if I was actually hungry, or by how much. I always felt like I could eat. If food was served, or the clock suggested it was time to eat, or everyone around me was eating, I filled up a plate and ate. And I ate everything on my plate, because nothing in me ever told me “OK, you’re done.” (Unless I’d eaten enough to be painfully full, like at holidays!)

    After starting the Ritalin? Either my appetite control mechanism kicked in, or I became able to tune in to it. I suddenly found myself being able to guage how much was enough, either for the first time, or probably since very early childhood. I effortlessly lost 45 pounds (w i t h o u t trying) and it has stayed off for almost a year.

    (At that point I began consciously maintaining my weight at its current level, because I am wearing my ‘smaller’ clothes that I hauled out of storage, and can’t afford to replace my whole wardrobe if I drop another 15 pounds right now.)

    There’s an interesting chapter on ADD and disordered eating in Patricia Quinn and Kathleen Nadeau’s text “Gender Issues and AD/HD: Research, Diagnosis and Treatment”. It’s definitely worth looking at, for anyone working in medicine.

    In sumary, I guess I want to say this:
    - others’ attitudes can help make or break success (my doctor’s helped me, my dad’s drove me to try a diet that ended up hurting me by slowing my metabolism, and causing a much worse weight gain)
    - there may be a myriad of subtly-related issues that will take years to discover and sort out
    - there can be some surprising contributing factors
    - not all of us who are big are in pain or hyper-defensive about it, by some miracle
    - even when you have a correct understanding, a healthy attitude, a willingness to ‘do something about it’, and a healthy fitness/activity level, people can still see you as a lazy fat-a*s
    - medical training should probably include a good look at all the different things that CAN influence or promote weight gain or metabolism, and when initial efforts at reasonable weight control fail, these should be examined as possible contributing factors. (Preferably not taking 2.5 decades to assess and address.)

    I’m so glad I had the privilege of a doctor who believed in lifelong learning, and had the wisdom and perhaps the humilty to contemplate ADD in my adulthood, rather than being dismissive or even embarrassed it wasn’t caught when I was a child. It wan’t considered BECAUSE of my weight or appetite issues, but turned out to be a very significant piece of the puzzle in my case. (Dr. B, if you happen to ever read this, my hat’s off to you!!!!)

  • Anonymous

    I came across this thread in search of information helping me to prevent weight gain after my total thyroidectomy.

    I joke that I have gained and lost 1,000 pounds in my lifetime. The truth is I have always had to carefully manage my weight. I was a runner for a long time. Ran my first marathon, had a car accident 6 months later. NO more running. Had to learn other ways to stay healthy and had to change my eating habits.

    Upon taking a steroid two years ago for complications due to my back surgery, I gained a lot of weight. Once off the steroid I followed Weight Watchers and started walking as soon as I got the go ahead from the doctor. Nothing. Started writing down everything I ate and recorded my exercise. Nothing. I was tired, I assumed from the extra weight. Didn’t even notice that my hair was falling out.

    Didn’t want to go to the doctor. Didn’t feel sick. Figured it was an over 40 thing and had to work harder. Nothing helped. Was eating 1000 calories, working out 5 days a week and lost 4 pounds in 7 months.

    When I went to the doctor, she immediately told me to eat less. Showed her my food diary and told her I was tired. She suggested anti-depressants.

    Long story short and a better doctor later, Needed a full thyroidectomy, got it, and am on with my life.

    There are doctors that are prejudiced against people who are overweight and are obviously not capable of doing the job they are paid to do.

    Sad part is, you can have a very high level of education and still be ignorant.

    The name calling throughout here is a clear testament to that.

    Here is the deal. NO one wants to be overweight. I think blind tolerance is dangerous. However, I would never determine someone to be less of anything because they are overweight. Their demons show for the world to see. I pity them. I know that sounds condescending, but I truly do. I know what it’s like to have someone stare at you and judge you.

    But know what? The whole desire for acceptance is unrealistic. Short of a medical condition, you know that you are the reason you are overweight and you feel lousy about yourself. Somewhere inside you know that there is some truth to the judgement out there and you can’t blame anyone for it.

    All that being said, I can’t believe the hate I have read. There are so many things out there that are so much more horrible. I pray for all of you.

    There isn’t any need to hate someone who is overweight. You are making the issue your own.

  • Anonymous

    I used to think Doctors were supposed to care about their patients. Though, with now giving up on my dream of becoming a doctor, due to seeing the hypocrisy in the Hippocratic oath, I am becoming more and more disheartened daily.
    It appears that it has come to a point that weight bears an inverse relationship to one’s worth. Doctors should be above that, though, alas, they seem worse than the majority of their peers. Just reading these horror stories makes my skin crawl. By horror stories, I mean that a person who takes an oath to care for and help their fellow humans, can forget that they might be one themselves. We preach about tolerance, and discrimination daily. Their are sensitivity trainings for almost everything under the sun. Everything accept for obesity, that is. Instead, we are raised to think and act like it is a public service to insult and mistreat heavy people! But, much like everything in life, ignorance to something, does not negate it’s wrongness. Just because some educated idiot is preaching the goodness of discrimination, doesn’t make it right to lower yourself and join in!
    Doctors are becoming worse and worse. My own doctor is no better than any of you either! I personally have a BMI of 28, I openly admit it. It doesn’t mean I don’t work out, or eat healthy, it’s just my body, who I am. I did however have a full thoracic and lumbar fusion with harrington rods when I was a kid, and it does limit me and cause plenty of pain. But because of my fear of persecution from the doctors, I bit it and took it. I pushed myself through everything. Still, to this day, I only take a guaiphenesin based muscle relaxer for the spasms. I had a physical recently, and tried to talk to my Dr about how the pain was becoming worse as I aged, and do you know what his response was? “Well, if you lost the weight, it wouldn’t hurt any more!” Really? And here I was, under the impression that the spasms were caused by the surgery and the metal, and all this time, it was the few extra pounds I carry!?? He didn’t even know I had the surgery! He cared so little about his patient who didn’t wear a size 2, that he never noticed the scar that extends from my neck to my ass, he never noticed that I had to turn completely to talk to him, or that it was written in my records!
    And this, that man, these “professionals” on this forum… These are the bigots patients entrust their lives to!!!!!! It’s scary, it truly is! I hope, with every fiber of my being, that some day, you too, shall be on the receiving end of such mistreatment! I pray that you shall be able to walk in the shoes that you hate so much!

  • Anonymous

    Everyone is in agreement that no one wants to be demonized. The point that a lot of you seem to be missing is that there is something very wrong about the people with such extreme opinions about their fellow human beings (both doctors and patients alike).

    As a physician, I can tell you that the rude comments posted in this thread are not common to the most of us in the profession. It is unacceptable to dehumanize patients and it is exceptionally immature to do so in an “anonymous” public forum.

    To put some of the comments in perspective…

    Dealing with pediatric medicine is often compared to veterinary medicine because kids can’t usually tell you what’s wrong with them. Neither kids nor obese people are beasts, certainly. However, there is some truth to the fact that otherwise simple tasks are more difficult with obese patients compared to non-obese ones.

    From my own experiences, it is neither a pleasant nor normal task to resort to using procedural sedation and the effort of two staff members each holding up a leg that was wider than my own entire torso to conduct what should have been a routine gyne exam for a morbidly obese patient. In this case, because her obesity prevented her from moving her legs normally, whether you blame her family more for perpetuating her disease than focusing in on anything she could’ve done on her own, the fact is that when she comes in with whatever medical problem she has… we doctors treat her the best we can. And sometimes it has to require extraordinary measures in order to do so.

    Health is only going to be achieved when patients participate in the process, too, though. The days of strict “Doctor knows best” are gone, but some doctors are better than others at reaching a middle ground with their patients so that shared goals can be reached.

    As an FYI, the fastest “healthy” weight loss rate recommended by educated professionals is 1 pound on average per week (approximately 500 less calories per day than whatever your daily intake would be at a steady state of weight). The goal weight loss over one year should be no more than about 50 pounds. Anything more than that is more likely to be unsustainable and result in regaining the weight back. Both BMI’s greater than 30 or less than 20 can be associated with specific health risks. And none of the criteria for diagnosing bulemia, anorexia nervosa, or body dysmorphic disorder rely on BMI as defining characteristics of the disease.

    A healthy exercise regimen might include begining with as little as 30 minutes of moderate activity three times a week. The Preventative Health Task Force actually publishes specific guidelines for the above if you care to read them yourselves.

    Unhappily, the only reason I found this forum was that I was looking for the origin of the myth that obese patients could be sent to the zoo for CT/MRI imaging. (Of course it is a myth, although I haven’t found any indication of where it started). Like I said earlier, no one should be made to feel like a beast. It is sad that so many of you are caught up in this argument of who is more the animal.

  • Wanderer

    A few comments from a medical brat:

    2nd Anonymous: You’re confusing “ordinary physical exam” with a laparotomy. If you can’t remember the difference, you’re in trouble.

    Yes, getting hold of a uterus through any sizable abdominal fat deposit is hard. What, you thought this was easy? Laparoscopy avoids the incision complications, anyway, and avoids you having to plunge your hand into them. Keep that in mind.

    Likewise, the ultrasound will go faster and produce a sharper image if you insert a probe to scan the uterus from the vaginal area; the closer probe and higher frequency produce better results, as well. Next time, read your manual, please.

    3rd Anon.: Actually, I’ve never heard that from anyone who didn’t have hypothyroid. Guess you’re just lucky.

    4th Anon.: “Litigious animals”? You mean you operate only on lawyers? Talk about a specialist…

    Seriously, they like getting it even less than you like inserting it. That’s speaking as an “American SOB”, btw.

    P.S.: You’re wearing gloves, so why are you kvetching about intertrigo?

    5th Anon.: I’ll congratulate you on not being as insulting as your attending, though I admit he was under unusual stress. I presume you eventually got it in?

  • Anonymous

    In my personal opinion, the doctors really have no idea what they’re talking about. My doctor told me the same thing everyone hears, “you shouldn’t lose more than 1lb per week”. Well, I have gone on a Slim Fast diet, taking in only 1,000 calories per day, as well as swimming for 3 hours per day after work. In the first two months I lost 50lbs, and have been successful at not gaining any back, as I do not want to go back to my old eating habits ever again, I’m too happy thin. My recent visit to the doctor was the same as always, he told me it was unhealthy to lose all that weight that quickly, but he did admit, he couldn’t find anything wrong with me. DOCTORS ARE FOR SICKNESSES! THEY ARE NOT TRAINED TO ASSIST IN WEIGHT LOSS AND YOU SHOULD NOT LISTEN TO THEM, I SURE AS HELL DON’T.

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