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I saw a gentleman in my office for his sciatica. He was having severe pain radiating from his lower back, down to his calf.
I was about to describe my plan to him when he interrupted me saying, “I know, Doc, I am overweight. I know that this would just get better if I lost the weight.” He hung his head down as he spoke and fought off tears.
He was clearly morbidly obese, so in one sense he was right on; his health would be much better if he would lose the pounds. On the other hand, I don’t know of any studies that say obesity is a risk factor to ruptured vertebral discs. Besides, he was in significant pain, and a lecture about his weight was not in my agenda. I wanted to make sure he did not need surgery, and make him stop hurting.
This whole episode really bothered me. He was so used to being lectured about his obesity that he wanted to get to the guilt trip before I brought it to him. He was living in shame. Everything was due to his obesity, and his obesity was due to his lack of self-control and poor character. After all, losing weight is as simple as exercise and dietary restraint, right?
Perhaps I am too easy on people, but I don’t like to lecture people on things they already know. I don’t like to say the obvious: “You need to lose weight.” Obese people are rarely under the impression that it is perfectly fine that they are overweight. They rarely are surprised to hear a person saying that their weight is at the root of many of their problems. Obese people are the new pariahs in our culture; it used to be smokers, but now it is the overweight.
The fear/disdain of obesity has reached into areas where it should not be. I regularly have to tell mothers of chubby babies that it is perfectly fine for their child to be that way. Children under three generally regulate their eating to what they need. I do not believe a baby can become obese on breast milk or formula. Now, if they are giving the child french fries and burgers, that is a different matter.
Instead of patronizing obese patients with a lecture, I try sympathizing with them. Just because something is simple doesn’t make it easy. How do you quit smoking? You just stop smoking. We should just pull out of Iraq. There should be peace in the middle east. People should stop hurting each other and start being nice. All of these are good ideas, but the devil is in the details. Losing weight is a struggle, and it really helps to have people giving you a hand rather than knocking you down.
Don’t get me wrong, I don’t deny the health risk of obesity. I do my best to work on weight loss with my patients. But the idea that their personal worth lies on their BMI is extremely damaging. There are a lot of screwed-up skinny people out there; just look at super-models. It is a lot easier to lose weight when you actually like yourself and want to do something about your health. Our culture of accusation and shame simply makes obese people hate themselves. If you hate yourself, why should you want to take care of your body?
Is obesity a problem? Sure it is. But we need to get off of our self-righteous pulpits. Obese people should not be made into a group of outcasts. The “them” mentality and the finger-wagging are no more than insecure people trying to feel better by putting down others.
It sounds a lot like Junior High.
If we really want to help with obesity, we need to grow up.
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I just…I just wanted to say thank you. For the honesty, for the understanding, for seeing a problem that is a phantom in our society and that hurts far more than most people seem to see.
That’s it, really.
Thank you.
On the other hand, I don’t know of any studies that say obesity is a risk factor to ruptured vertebral discs.
I wish more doctors were like you. I have been in six car accidents, and additionally a work-related injury to my back. Unfortunately, with the work related injury, I lost any chance at workman’s comp because the doctor I went to claimed my injuries were due to my weight and not the fact that a woman weighing more than I was falling from a greater height, and instead of allowing her to fall, I caught her. And I was too young and ignorant at the time to get a lawyer involved to actually make sure I got the care and support I deserved.
I live with constant back pain. I do my PT related exercises in order to have any kind of reasonable movement. But I’ve always been fat. NO matter what diets, what exercise programs, or whatever, I have never been able to lose more than 50 pounds. I eat less than my husband, who is stick thin.
And I’m sick of the doctors who are convinced that I must be lying about my caloric intake.
So, to you sir, I tip my hat. Thank you for being at least one doctor that wants to PARTNER with his patients on their health instead of being a close-minded martinet that thinks shame is an appropriate response!
I disagree with some of the points here — I don’t believe that being fat is a sign of self-hatred on any level (my self-esteem is just dandy, thanks!) or of an unwillingness to “do something” about it — but those are just my opinions, and I don’t argue with people in areas where they are expert and I am not.
That said, this is a great post, and a wonderful attitude to see from a doctor. Physicians are (obviously) not immune to cultural attitudes, and the hatred and contempt for fat people that is so widespread now is bound to affect them. It’d be great if more physicians were professional enough, and kind enough, to keep their prejudices and judgments out of the doctor-patient exchange, but that doesn’t seem to be realistic.
It’s funny, though. Many doctors would, quite properly, never dream of criticizing someone for other choices (assuming being fat is a choice) in terms like the ones they routinely use to speak to fat people. Say a wildly promiscuous person came in to be treated for an STD for the umpteenth time. A doctor might say, “Have you considered condoms?” but would never say, “Stop sleeping around, you silly slut.” Yet the same doctor might tell a fat person she is lazy or a glutton or say, “Push yourself away from the table” or “Just stop stuffing yourself.”
And that disbelieving smirk so many doctors adopt when a fat person talks about his or her weight is every bit as bad as a crude remark. Worse, in fact, because it’s so much harder to respond. I speak up when I see it — but I’m fiercer than most.
Good points, Tuxer. No, I am not saying that obesity is a sign of self-hatred, but that it often is a cause of self-hatred. When society treats you like contempt, it is not hard to start going along with society.
Very good point on the STD. I truly feel more sympathy with the obese than with the over-sexed. The latter, however, is a sign of significant psychological pathology.
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