[ SECRET POST #2137 ]

[case]

⌈ Secret Post #2137 ⌋

Warning: Some secrets are NOT worksafe and may contain SPOILERS.


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Notes:

Secrets Left to Post: 01 pages, 015 secrets from Secret Submission Post #305.
Secrets Not Posted: [ 0 - broken links ], [ 0 - not!secrets ], [ 0 - not!fandom ], [ 0 - too big ], [ 1 - repeat ].
Current Secret Submissions Post: here.
Suggestions, comments, and concerns should go here.

Comments

[(Anonymous)]

as someone who is training to be a doctor, this is actually something that's i've been trying to wrap my head around. like scientifically, weight gain has been directly related to so many health concerns so how are doctors supposed to not address/acknowledge that? like i get that they should probably do it in a non-asshole way and try and help the person find a lifestyle that works best for them/is reasonable but, to be very blunt and factual about it, some problems really do come from being overweight. like type 2 diabetes can actually be reversed by WEIGHT LOSS ALONE and i don't really know how one is supposed to sugarcoat that? totally open to opinions/discussion about this btw because i'm genuinely curious and trying to figure out how to be sensitive about it.

[(Anonymous)]

Sure, some conditions are caused by or related to being overweight. And some aren't. And sometimes they can have very similar symptoms. The problem is not that doctors recommend weight loss when it is appropriate to do so, it's when they fail to listen to what the patient is saying, and don't consider and rule out other possible causes before making a diagnosis and prescribing treatment.

[(Anonymous)]

thanks. i really do appreciate the reply.

this has left me wondering however, what would be the best way to go about it in the instance that someone is absolutely resistant to change and does not want to "accept" for lack of a better word that their weight is the source of the problem in the case that it really might be?

as a health care worker, you really can't do anything beyond tell a patient what their options are and help them understand their condition and educating them about it is a huge part of it. say if someone has misconceptions about their conditions which, idk they read from the internet or other people or something, and a doctor is trying to clarify that for them by going "no, it really is because of your weight" would that also make the doctor a bad guy?

while i am all for positive body image and every kind of acceptance, it's just kind of frustrating/confusing because i've run into a lot of dialogue about how BEING FAT IS NOT ACTUALLY RESPONSIBLE FOR ANY ILLNESS AND ANY DOCTOR WHO TELLS YOU SO IS A LYING ASSHOLE whereas that's actually not true.

but it does make me upset that there are doctors out there who do not rule out other causes/diagnoses before jumping on the weight because yeah, that is pretty terrible.

[(Anonymous)]

And sometimes, a patient may be very aware that his/her weight is an issue and not be able to do anything about it. I work more than full time (two jobs, totaling 27 of every 28 days at work, some days at both jobs) and still have barely enough money for my bills (I tend to eat a lot of simple carbs because they are cheap) and not enough time/energy to exercise. (And I know it is both of those, because when I inherited a bit of money, so I didn't have to worry about it for 6 months and put my second job on hiatus, I actually lost 40 pounds by being able to afford healthy food and being able to get to a gym.)

So, hearing that I need to lose weight is absolutely useless information to me and there is nothing I can do about it. So if a doctor were to harp on it, it would make me resentful rather than helping me.

[(Anonymous)]

you're completely right. i think it's important to follow through with some sort of plan or help a patient achieve a goal/guide them through it instead of just throwing it out there and then getting upset that they aren't listening. it's a lot like compliance with taking medication now that i think about it, especially since there are a lot of cases were people quite simply can't afford the meds they need so the medical advice is sort of useless on that front.

again, thanks for sharing. as i said below, hearing any and every outside perspective helps me understand better.

[(Anonymous)]

SA

I think it is also important to realize that sometimes there simply may not be a plan possible given the circumstances. Those things you mention below? The walking and taking the stairs and other things I can do without money or a huge time investment? I already do them. (Last time I got it checked (at the free clinic, as I also cannot afford health insurance), my blood pressure, glucose, cholesterol, etc levels we're fine.) And unless you want to give me a few hundred dollars a month so I can quit my second job and affort healthy food, there is nothing that can be done. I wish there were.

[(Anonymous)]

You need to tell people on a patient-to-patient basis if their weight is a direct cause of their personal health problems. You also need to be aware of their medical history and what role that plays in their pursuit or lack thereof of a weight loss program.

For example, I am both bipolar and bulimic. Weight loss is a struggle for me on a physical and mental level because I only got off medication that caused me to gain weight (eighty pounds) a year ago and because my battle with bulimia has pretty much destroyed my metabolism and relationship with food. I know I'm overweight. I'm really, really aware of that. But I also know that losing weight is far more difficult for me than it is for the average person, and I get my best results from starving myself and nearly none from a regular, healthy diet. Starving myself spins me into a cycle of binging and purging, which causes my weight to plateau or increase.

I've tried tons of diets, read everything there is to read on health and nutrition, spent several years studying to be a nurse, and know my own body and what does and doesn't work for it. When you, as a doctor, tell me to lose weight, I can pretty flatly tell you that, if I could lose weight, I would, so unless you have some miracle that will combat the damage I've done to my body and give me any results, it's not going to happen.

Ninety-nine percent of overweight people know they're overweight. They know they're supposed to lose weight. Unless you can directly point from their weight to their personal illnesses and give them advice that will work in the context of their medical history, telling them they need to lose weight is being a dick.

[(Anonymous)]

ayrt

thanks for sharing that with me. i get that the bigger picture is super important and very easy to miss at first look so yeah, this is definitely a good perspective to have.

also i hope you do get better with respect to all of your health concerns. e i can definitely understand how that's a case where things kind of keep cycling onwards and feedback to each other. just, i wish you all the best and, again, thank you for sharing. i always hope that i can get a better understanding from people who can tell me about their experiences and go outside the box of what school and textbooks teach us and every bit helps.

[(Anonymous)]

But...being fat isn't solely responsible for any illness. It may contribute to a health issue (such as limiting poor mobility even more), or be related to it (such as sudden weight gain being a symptom), but I can't think of anything where losing fifty pounds is a cure-all and you need no other treatment or management whatsoever. So any doctor who tells you to lose weight and washes their hands of the situation until you do, really is a misinformed asshole.

[(Anonymous)]

well no, not "solely responsible" but in the sense that weight loss alone has actually statistically treated a lot of people of a lot of issues, type 2 diabetes, polycystic ovarian syndrome, some forms of arthritis, and obstructive sleep apnea to name a few, so it's just really tricky to ignore that when talking to patients. also, it's like you're sort of obligated to let them know what their options are and often, that's the one in bold neon lights even though it's not always the nicest or most polite one.

[(Anonymous)]

sa

and of course washing your hands of the situation but just saying "lose weight" and that's it would be terrible and if a doctor even said that to me i would not be seeing them again

but i mean more in the sense of when it is something you have to address because it is very very often that you do and with more than 1/3 adults in the united states being obese and all the health complications associated with it, to say that it's considered bad medicine to ignore it would be an understatement.

[(Anonymous)]

I've worked in hospitals for over 20 years and a lot of my work is tackling unhealthy behaviours with people. Fact is, none of us like being told what to do. It's why doctors find patients not taking their medication, or following any of the "advice". Think about it, someone tells you what to do, you immediately form arguments as to why you won't do it. It's the way we work cognitively, we argue against things, and decide to do things just to spite the person who has the gall to boss us about.

Also we don't want to be judged, so don't tell our doctors the whole truth about our behaviour.( I know I never do, and I don't expect patients to tell me the truth, it's amazing how patient's stories change as you get to know them...)

Most people who are overweight know it, you telling them something that's obvious is only gonna put their back up and increase resistance. Those doctors and clinicians who really listen and work with the patients to come up with their own plans for behaviour change, or to work with their ambivalence about changing, they are the ones who have some success. I think you can do a lot more than tell the patient their options and educate them. You can let them be the expert in their own lives, and help them as the person who can do the tests they need, and prescribe for them and give them any information that they require, or helps them, rather than lectures that just make their eyes glaze over and take the same time as more effective discussions.

[(Anonymous)]

thanks for saying this. all too often people want to say SO NOT MY FAULT when, yeah, if you really looked at your own behaviors, at your own thought processes? it is your fault.

I remember once telling someone the fastest way for me to lose weight is to stop eating white bread and cut out processed sugar.

I can't tell you how many people chimed in saying 'OMG I COULD NEVER GIVE UP MY BREAD AND MY FROSTED FLAKES'. yeah. okay. so...stay fat, then. but it's not 'other medical problems' that may be contributing to it. you are just a fucking douchbag because you don't want to make some changes because it's haaaaaaaard. or you don't want to be told what to do!

if you are physical capable otherwise, park at the back of the parking lot and walk to the store/mall.

walk to your mailbox.

take the stairs instead of the elevator.

cut out white bread (or at least cut down. take half the bun off your fucking cheeseburger). use sugar-alternatives.

we have a great measure of control over our lives. if you choose not to utilize it, no one is to blame. not the doctors, not some medical condition.

you.

[(Anonymous)]

Um. I really hope you keep an open mind with your heavier patients for their sake.

I only became overweight (not obese) recently because of stress, a more inactive lifestyle, and bad eating habits (not how much I was eating, what I was eating).

I got a new primary last year. I was being told that the symptoms I had been describing BEFORE weight gain were being CAUSED by my current weight. That's bullshit. I won't deny that being overweight aggravates symptoms for certain conditions but don't sit here and bullshit me because you want to be lazy. Told that fucker off and finally got a proper diagnosis and treatment like a year later (glaucoma and pcos).

[(Anonymous)]

I think it's just a case of needing to take things on a case by case basis and trying to be sensitive to patients' circumstances and needs. I know that sometimes you don't have the luxury of knowing what a patient's personal life is like and how that might factor in with their ability to lose weight, but it's always an important thing to consider. I think that some doctors and health care professionals tend to take the "shame people into losing weight" tact, which is never very effective in my experience. And honestly, some of those doctors are probably just thinking that if they're up front about it and point out that patients are overweight that they'll be compelled to lose weight, but life is a lot more complex than that. Most people who are overweight are very aware that they're overweight and that there are health risks associated with that, but there are a lot of individual circumstances and other factors that contribute to their being overweight in the first place, and can hinder weight loss.

... so, that really was kind of crap in the actual advice department, but I'd say the best advice is probably to just stop and think about things, consider that there are a lot of things coming into play here (and as a doctor you may not know all of them), and just try not to be a jerk when discussing weight with patients. You can express concern about weight and its relationship to certain health problems without coming off as accusatory. The fact that you're even asking this question shows that you're pretty thoughtful about the issue already, though.