Telling a patient to lose weight = "Fat hatred"

A daughter blames a doctor for indirectly causing her mother’s death from a blood clot:

A few days before she died, she fell down in a parking lot. Tripped, I guess. The coroner said that may have been what dislodged the blood clot which eventually killed her. Of course, if she’d been getting decent medical care, she might have gotten proper treatment for all this long before, and maybe she’d still be alive today.
But, you know, that doctor had told her not to come back until she’d lost 50 pounds, and she trusted him. She took him to heart. He was a doctor, after all.
I hope he’s proud of himself. His words, over 20 years ago, helped kill my mother.

(via Fat Doctor)

Comments

Anonymous
Note the 97 comments, many of which relate a similar story from another physician.
Anonymous
Kevin’s caption, “Telling a patient to lose weight = fat hatred,” is misleading to say the least.
I read the entire post that was linked. It was clear that both daughter and mother knew mom was overweight and needed to do something about it.
The issue here is that the doctor told her not to come back until she lost 50 pounds. In other words, “I’m not going to help you until you fix yourself.”
Try reading the entire article (with an open mind) before jumping to conclusions about what you think it says.
Beach Bum
I think the original doctor’s decree was indefensible. That being said, I was somewhat alarmed by the tone of many of the comments on the original post.
They did seem to support the idea that “telling a patient to lose weight=fat hatred.” There were hints at the “we’re fat, but that’s ok as long as we’re healthy fat” message, and the idea that doctors should ignore the weight of a patient (often a huge factor in their overall health), just because mentioning it or suggesting a plan to change it would make the patient feel bad.
My question, which I lack the balls to post on the original post is this, “How do physicians motivate/help their patients lose fat, without being labled a FAT HATER?”
Anonymous
We’ve all seen similar scenarios. The anger a family member has at a death and then the lashing out at… somebody. Here a doctor is a jerk and tells a patient to not come back until she loses weight and he’s responsible for her death years later? I don’t think so! The author really is angry at herself and can’t face that.
Still, we should all be a bit more nonjudgmental when it comes to weight but I fear society is becoming more judgmental not less.
Anonymous
You’re not getting a fair assessment of the message board replies because the moderator removed any “un-friendly” posts.
Anonymous
Beach Bum,
If you sincerely want to know so you can use the insight to help your overweight patients, why don’t you ask? Who knows, you might get some excellent responses.
We need to be able to talk about this without everyone getting so defensive and judgmental on both sides of the aisle.
That said, I admit it’s a challenge to bring up the topic with someone who’s overweight and not have them get upset… probably because they have endured so much judgment that they’ve become hyper-sensitive in response. Patience and kindness are key here.
Anonymous
What I want to understand is why we are a society in general who seems to work against us? At one time I needed to lose weight and joined WW. My husband immediately began to bring me home hugh boxes of chocolates and wanted to take me out to eat at all these high fat serving restaurants. Like this lady that has died, he also told me he expected me to cook, as always, meaning, meat, potatoes and everything fattening including homemade desserts for him and the family. This is almost an impossible scenerio, to be able to lose weight. My family also used things like telling me how I was much nicer before I started a diet, and it was just a nightmare to continue. Maybe this is where some attention needs to be. I mean when we are dealing with other health issues getting family support is a big part of it, why should it be different with weight lose? If you cant get the support of family, never mind your physician, you will almost certainly fail. But, to tell someone not to come back until you lose 50 pounds, is just so wrong.
feeling and looking good
Take the lesson you were intended to take.
Shaming fat people is counterproductive.
If you believe a patient should lose weight to keep or regain health, it is your job to assist them as you would assist them with, say, the clap, or pregnancy, or heart disease from smoking or cervical cancer or a a sky-diving injury or any other number of self-inflicted health problems. You focus on positive action. You provide solutions. If you do not have time or expertise to handle the problem, you make a referral.
Delving into the homefront is not taboo for other conditions…why should it be so for obesity.
Specific goals or dietary changes with followup and reassessment of strategey is done for other problems…why not obesity?
I am thin, through a great deal of hard work. It took management of underlying illness to get my weight under control. Now, I am healthy and fit.
Shame did not get me here. A desire to be well and help getting well from doctors did.
Evil HR Lady
What we hear isn’t necessarily what was said. The doctor’s instruction to “not come back until you’ve lost 50 pounds” may well have been, “you need to lose 50 pounds. Come back and see me in 6 months.”
As someone who was once fat and is not now (weighed in at WW this morning, so I proof I’m not fat), I think I can see both sides of it.
I admit that I prefer not to go to the doctor (I prefer to read their blogs), and when I was fat I used the excuse of, “oh, he’ll say me problem with x is because of my weight, so I need to lose weight before I go in.”
But, now, it has been 11 months since I hit my goal weight and I still have the same problem and have I been in to see the doctor? No.
So, it’s not all about being fat.
Mike
If anyone who reads KevinMD or the internet in general was told by a doctor not to come back, they would just go see another doctor.
Has everyone lost sense??? We should feel bad because this lady was so unsophisticated she couldn’t get herself to see another physician??? She had psychological problems all related to weight gain. Besides the Weight Watchers attempt, there is nothing there about her taking responsiblity for her size and getting on a bike or telling her husband that her health was more important than his dinner.
The thing this doctor did wrong was misdiagnose her. And it sounds like it was a difficult diagnosis to make, what with her size and noncompliance with medical followup.
Obesity is greater now than ever. To what do all of the people out there attribute this? To the world changing? No, its diet and exercise choices, plain and simple. All the “disease-i0fying” in the world doesnt change that, or the blame with which this sad and angry daughter seeks to heap on the rest of the world for her mother’s bad outcomes.
Obese people have ALWAYS been ridiculed, even since Shakespeare (i.e. Falstaff) so just get over it people.
slim girl
Obese people need not be ridiculed by the persons charged with helping them get well, however. A physician who believes his patient needs to lose weight to be healthy has more effective options for facilitating that goal than telling a patient to lose it, without guidance, without support, without appropriate treatment of conditions or environmental factor that might contribute to obesity and which must be controlled in order to achieve lasting success.
Fat people, even the fat acceptance weirdos, internalize all the criticism and they can kill themselves hiding from the shame.
It may be personally satisfying to scold a failure of a patient, but it isn’t good medicine.
Jackie
Honestly, it’s just another case of a lazy doctor not wanting to do their job. Forget fat people. I think they’re wastes of space anyway. This is about doctors. They always look for the simplest thing to blame things on just so they can push patients through quicker. It’s ridiculous.
Want a good example? C-sections. The convenience of being able to schedule a delivery so they don’t have to miss out on a golf game leads to just about EVERYTHING being a cause for a risky pregnancy. The fact that they can get more from the insurance company for the surgery makes it an even sweeter deal.
Doctors are lazy and pathetic. They could care less about patients. Your best bet is to make a nurse practitioner your health care provider.
As far as fat people go. It’s simple. Bariatric surgery. If there’s no underlying medical condition for the excess weight, it’s the only way to go according to the research.
Once your body becomes accustomed to carrying extra weight any weight loss will be temporary without bariatric surgery.

Telling a patient to lose weight = "Fat hatred"

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