Do attitudes about obesity cause more harm than obesity itself?

[Anonymous]

I was struck by this article by Jorge Rodriguez entitled, "My Fat Body is More Than A Ticking Time Bomb."
(URL in case my link didn't work: https://medium.com/@JJRodV/my-fat-body-is-more-than-a-ticking-time-bomb-1f83ec7d307c)

He describes a visit to a new doctor where the first words out of the doctor's mouth were "you should consider weight loss surgery."

He didn’t ask my name, where I’m from, my challenges, my struggles, my opportunities, my environment, my hopes, and my dreams. Frankly, he didn’t even ask me about my health or what brought me to his office.

He also goes into how attitudes about obesity are especially pernicious when coupled with the issues surrounding race relations. I'm a white man with no particular weight issues, so I'm not well equipped to grapple with any of this. But my wife has always struggled with her weight and has lately opened up to me about what a mind-f**k the culture around weight and dieting can be. The article talks about how poorly sourced the connection between obesity and health outcomes seems to be, and even where those connections are sound, how the weight loss and diet industry along with popular media stretch the good science well beyond its limits. Also, the medical and other treatment recommendations have pretty low success rates and are all bound up with moral judgments about weight not to mention, according to the author, racial stereotypes. (He says the historical focus on thinness cropped up particularly as an anti-Black, anti-immigrant sentiment where the ideal of the white, Protestant patrician was to be thin.)

In any event, it seems that the treatment might be worse than the disease in some respects. The intense focus on exercise and diet seems not to be very sustainable and very often has a low success rate that is often offset by the stress and shame caused by the failure rate and reduction in perceived self-worth. If it were a pill, we probably wouldn't prescribe it with such a low success rate and such a high harm rate. If nothing else, I think the article is worth a read.

[Anonymous]

I’m not sure if the attitudes are more harmful, but the prejudice against fat people is extremely harmful. I had my eyes opened by listening to the podcast Maitainence Phase. I think one of the best takeaways from that show is that we focus exclusively on obesity and not on the harms connected to it (eg better treatments for diabetes). Fat phobia does not help to a) stop people from getting fat or b) help people lose weight.

[Anonymous]

I think it is when - like a colleague recently told me - it prevents people from accessing health care for fear of being dismissed because "if they just lost weight, xyz wouldn't be an issue." My coworker is facing major issues right now and she delayed going to the doctor for this very reason - "I don't want to walk into the office and just be told that I need to lose weight." That's a bigger deal than we realize, I think. Then it becomes a vicious cycle of compounding health issues.

[Anonymous]

I’m fat, no (ha) sugar coating it. But I was seriously depressed after my mom died suddenly. We had just moved, so I found a new PCP to get a referral and she quickly tells me that I’m not depressed, I just need to exercise more. She then makes a big show of pulling out her prescription pad and writes me a “prescription” to get a personal trainer. She refused to give me the needed psych referral.

All she could see was fat that needed fixing.

Exercise is important, but not to the exclusion of absolutely everything else. She wasn’t interested in hearing the exercise I was doing, because it clearly “wasn’t enough.”

Yay for bedside manner.

Yes, exercise is important, but WTF, lady?!

[Anonymous]

Well I mean if being overweight weren’t harmful there would be less attitude, they feel the same way about smokers and people who abuse alcohol. There’s no need to shame people. But the intersection of obesity with the body-beautiful movement is kind of wrong headed in that there is a real health cost to being fat.

[Anonymous]

Anonymous wrote:I think it is when - like a colleague recently told me - it prevents people from accessing health care for fear of being dismissed because "if they just lost weight, xyz wouldn't be an issue." My coworker is facing major issues right now and she delayed going to the doctor for this very reason - "I don't want to walk into the office and just be told that I need to lose weight." That's a bigger deal than we realize, I think. Then it becomes a vicious cycle of compounding health issues.

But I think the issue with your coworker is that she anticipates hearing this from her doctor, so it is the only thing she is focused on when the MD is talking to her. The MD probably says many other things to her which are not related to her weight, but because she knows it's an issue she needs to fix - it is all she hears.

Also if doctors do not mention weight during your appointment, and you are more than 20lbs overweight and/or you have gained this weight in a short period of time, then frankly that is medical malpractice to not discuss it as it could be depression, anxiety, something going on at home that the MD should know about.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I think it is when - like a colleague recently told me - it prevents people from accessing health care for fear of being dismissed because "if they just lost weight, xyz wouldn't be an issue." My coworker is facing major issues right now and she delayed going to the doctor for this very reason - "I don't want to walk into the office and just be told that I need to lose weight." That's a bigger deal than we realize, I think. Then it becomes a vicious cycle of compounding health issues.

But I think the issue with your coworker is that she anticipates hearing this from her doctor, so it is the only thing she is focused on when the MD is talking to her. The MD probably says many other things to her which are not related to her weight, but because she knows it's an issue she needs to fix - it is all she hears.

Also if doctors do not mention weight during your appointment, and you are more than 20lbs overweight and/or you have gained this weight in a short period of time, then frankly that is medical malpractice to not discuss it as it could be depression, anxiety, something going on at home that the MD should know about.

OMG. You have clearly never been a fat person at a doc appt.

[Anonymous]

My spouse almost died because of prejudice against overweight people, which is compounded by race and gender.

A prejudice that he had internally and then also experienced with the medical community. He was having daily nosebleeds, lethargy, weight gain, night sweats (soaking a bed at night), snoring, etc. I begged him to go to the doctor but he said he was just fat and if he worked out more, it wouldn't be a problem. Finally agreed to go to ENT for snoring. The ENT did no bloodwork and told him that the nosebleeds could be stopped with spray and that snoring could be reduced with weight loss. Now mind you, he was playing a high-level sport at this time and was SLIGHTLY overweight. My spouse was basically reaffirmed that it was all about weight. 1 year later he was having horribly itchy skin. Went to urgent care and that idiot doctor blamed it on fragrances and dry skin. I told her that we were already a fragrance-free household and that he was wearing GLOVES AT NIGHT because he was itching so badly that he was causing himself to bleed.
Finally, he went to a PCP who drew blood and gave an exam and was told to immediately go to Hopkins. At Hopkins, he was accused of being an alcoholic. I told them he did not drink more than any other mid 20s male and that his drinking had decreased because he would blackout from 1-2 drinks.

He had a MELD score of 30. Was being worked up for a liver transplant at 27. Ended up being diagnosed with a rare disease but it was very apparent that he had something wrong with him. Being overweight does not cause the symptoms he was experiencing in isolation. Being overweight is being blamed for all types of issues. And overweight people's concerns are dismissed. I was experiencing PPA/PP rage and a psych said welcome to motherhood and go get some exercise. You need to lose weight. Your weight is making your tired and lethargic and exercise will help. I went undiagnosed with Hashimoto's for 2 more years after that visit. It took me that long to go see someone else because I figured that the next person would also just make it about my weight. Because that is all they (doctors) ever want to talk about.

[Anonymous]

Anonymous wrote:I think it is when - like a colleague recently told me - it prevents people from accessing health care for fear of being dismissed because "if they just lost weight, xyz wouldn't be an issue." My coworker is facing major issues right now and she delayed going to the doctor for this very reason - "I don't want to walk into the office and just be told that I need to lose weight." That's a bigger deal than we realize, I think. Then it becomes a vicious cycle of compounding health issues.

Yep, this. I am very overweight, borderline obese. Doctors’ answer to just about any issue is “losing weight would help” (even when there is no documented correlation between weight and the medical issue), but if you ask them to recommend a program or specialist with good documented successful rates for long-term weight loss, they’re like deer in headlight. Then they mumble something about trying Weight Watchers and move on.

[Anonymous]

Anonymous wrote:My spouse almost died because of prejudice against overweight people, which is compounded by race and gender.

A prejudice that he had internally and then also experienced with the medical community. He was having daily nosebleeds, lethargy, weight gain, night sweats (soaking a bed at night), snoring, etc. I begged him to go to the doctor but he said he was just fat and if he worked out more, it wouldn't be a problem. Finally agreed to go to ENT for snoring. The ENT did no bloodwork and told him that the nosebleeds could be stopped with spray and that snoring could be reduced with weight loss. Now mind you, he was playing a high-level sport at this time and was SLIGHTLY overweight. My spouse was basically reaffirmed that it was all about weight. 1 year later he was having horribly itchy skin. Went to urgent care and that idiot doctor blamed it on fragrances and dry skin. I told her that we were already a fragrance-free household and that he was wearing GLOVES AT NIGHT because he was itching so badly that he was causing himself to bleed.
Finally, he went to a PCP who drew blood and gave an exam and was told to immediately go to Hopkins. At Hopkins, he was accused of being an alcoholic. I told them he did not drink more than any other mid 20s male and that his drinking had decreased because he would blackout from 1-2 drinks.

He had a MELD score of 30. Was being worked up for a liver transplant at 27. Ended up being diagnosed with a rare disease but it was very apparent that he had something wrong with him. Being overweight does not cause the symptoms he was experiencing in isolation. Being overweight is being blamed for all types of issues. And overweight people's concerns are dismissed. I was experiencing PPA/PP rage and a psych said welcome to motherhood and go get some exercise. You need to lose weight. Your weight is making your tired and lethargic and exercise will help. I went undiagnosed with Hashimoto's for 2 more years after that visit. It took me that long to go see someone else because I figured that the next person would also just make it about my weight. Because that is all they (doctors) ever want to talk about.

I will add that my spouse is AA and I 100% believe that this compounded his issues and dismissal of issues as "due to weight".

[Anonymous]

Anonymous wrote:

Anonymous wrote:I think it is when - like a colleague recently told me - it prevents people from accessing health care for fear of being dismissed because "if they just lost weight, xyz wouldn't be an issue." My coworker is facing major issues right now and she delayed going to the doctor for this very reason - "I don't want to walk into the office and just be told that I need to lose weight." That's a bigger deal than we realize, I think. Then it becomes a vicious cycle of compounding health issues.

But I think the issue with your coworker is that she anticipates hearing this from her doctor, so it is the only thing she is focused on when the MD is talking to her. The MD probably says many other things to her which are not related to her weight, but because she knows it's an issue she needs to fix - it is all she hears.

Also if doctors do not mention weight during your appointment, and you are more than 20lbs overweight and/or you have gained this weight in a short period of time, then frankly that is medical malpractice to not discuss it as it could be depression, anxiety, something going on at home that the MD should know about.

Holy cow do you even hear yourself? Unless you are sitting in appointments with her, you have absolutely no clue whether this is true. All you have done here is to establish yourself as belittling and derogatory toward overweight people, which makes your opinions worthless.

[Anonymous]

If doctors are going to focus on obesity at all, then they actually also need to recommend a solution that actually works. Focusing only on behavior modification (dieting) DOES NOT WORK. So every time they bring it up they 1) are inflaming a shame spiral and 2) they don't offer a solution that works.

It's stupid and has no health benefits to patients.

[Anonymous]

As a PP mentioned, I generally view obesity along the lines of smoking or abusing alcohol. With some exceptions, it's a problem that people have more control over than other health issues but it costs everyone paying for health insurance a lot of $$ so I can see why people who do make the effort to exercise, eat healthy, etc may not look highly on those who don't.

My ILs, for example, were both obese- ate horribly for years and lived very sedentary lives. Two years one of them had a very expensive (for insurance) major health problem and almost died. They were pretty much scared straight because the dr told them the IL would certainly die if they didn't change this lifestyle, and within months of this they had both lost massive amounts of weight just by walking and eating more normally. To their credit they have kept the weight off but they ignored doctors for years and this problem was completely avoidable so it's hard to be overly sympathetic.

[Anonymous]

Anonymous wrote:As a PP mentioned, I generally view obesity along the lines of smoking or abusing alcohol. With some exceptions, it's a problem that people have more control over than other health issues but it costs everyone paying for health insurance a lot of $$ so I can see why people who do make the effort to exercise, eat healthy, etc may not look highly on those who don't.

My ILs, for example, were both obese- ate horribly for years and lived very sedentary lives. Two years one of them had a very expensive (for insurance) major health problem and almost died. They were pretty much scared straight because the dr told them the IL would certainly die if they didn't change this lifestyle, and within months of this they had both lost massive amounts of weight just by walking and eating more normally. To their credit they have kept the weight off but they ignored doctors for years and this problem was completely avoidable so it's hard to be overly sympathetic.

Since you are so well-informed on this issue, I am sure you can point to effective programs with high success rates for long-term weight loss. I’m sure people here would be happy to have you share any information you have about those miracle programs that the public generally isn’t aware of.

[Anonymous]

Anonymous wrote:Well I mean if being overweight weren’t harmful there would be less attitude, they feel the same way about smokers and people who abuse alcohol. There’s no need to shame people. But the intersection of obesity with the body-beautiful movement is kind of wrong headed in that there is a real health cost to being fat.

Yeah, but the reason this movement has gained traction is because of the attitudes against fat people. When, as PP did, you go to a doctor and tell them that you are dealing with extreme grief and would like mental health care, and they write you a "prescription" for exercise, there's a pretty valid criticism of that health care provider. Now multiply that times the thousands of these interactions happening and it's a valid criticism of health care providers in general. And if you become convinced that the health care system as a whole isn't competent to listen to your concerns then why listen to their concerns about your body?

My own personal story is that my weight was a constant concern of my mother's from the time I would a young teen. When I was a healthy weight in HS she offered me $1000 to lose 20 lbs. that would have put me below a healthy BMI for my height. She was never verbally or emotionally abusive - never name called, etc. - but my weight was always on her mind. And so it was always on mine. As a result I was never satisfied with how I looked and deprived myself the joy of having a strong body regardless of the number on the scale. And when I did gain weight during a period of depression it was easy to tell myself I was never good enough so why did it matter.