Is fat a dirty word?

Picture 5

LATE AFTERNOON, GP’s OFFICE, OBESE PATIENT & WIFE STRUGGLE TO FIT INTO CHAIRS.

GP: clicking through results on computer So, I’ve found it difficult to get to the bottom of your shortness of breath. Your lung function tests have come back okay, + you don’t appear to have a virus or bacterial infection. Heart looks alright. Your blood pressure is being managed well. But you’re still getting symptoms?

Pt: just when I push myself too hard. You know, walking up stairs.

GP: Okay.

Pt: Yeah.

GP: Mmm.

*pause*

GP: Well, we can keep looking…

My brain: HE’S OBESE.

The consultation continued & at no point was the patient’s weight, diet or lifestyle addressed. It was at this point, that I realised that the GP I was on placement with was also overweight. I hadn’t noticed it before but suddenly the (large) elephant in the room was pointing at the fact that maybe weight loss wasn’t being mentioned because of the GP’s own weight?

I’m wondering what percentage of GP’s do push weight loss on patient’s as a first line treatment. This probably sounds extremely naive + green of me, but in a country that has recently overtaken the USA in terms of an overweight population, then shouldn’t we have more focus on…er…losing said weight?

This patient may go home thinking that their weight in not an immediate danger because the doctor didn’t mention it. But my heart just bleeds for the years of substandard quality of life/health that he has lived because of his weight. I feel strongly that excess weight IS a disease-state & should be treated as such. As doctors, I feel there is a responsibility to help patients achieve their ideal healthy weight. I’m not talking, turning everyone into paranoid anorexics but if you read any WeightWatchers or Slimming magazines (my mum used to be a WeightWatchers Leader) the majority of people being profiled say that their wake up call was from their doctor.

On the other hand, for all I know, the GP had tried unsuccessful for the last ten years to get this pt to lose weight. That must be disheartening. But, with my naive optimism, I’d like to think people would still try.

If obesity or weight loss ever becomes a health care specialty, it’s an area I’d really like to work in. I find the determination & psychology behind extreme weight loss inspiring. But then again, I could easily become the doctor who gives up & just stops mentioning it…

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7 Responses to “Is fat a dirty word?”

  1. dragonfly Says:

    Lots of areas deal with it apart from GP, but some surgeons do lapbands almost full time and they need good anaesthetists to manage those airways (and the reflux and the obstruction). Lots of people comment on the issue you mention, i.e which doctors are less keen to push weight loss. Some aren’t as aggressive (or are diplomatic about it), knowing that those people are quite likely to already have low self esteem. But I have seen quite a few encourage weight loss in really constructive ways, with heaps of encouragement, positive reinforcement etc. It is a difficult area. But (no pun intended) a growing one.

  2. *C Says:

    I think it’s a difficult line to negotiate. My GP is quite blunt about telling his patients about their weight – and I think his approach is just as effective as not saying anything at all. I watch the patients put up their defensive barrier and the exchange after that is quite awkward and painful.

    Our relationship with food is such an interesting topic. I think of how I cook and what I know about food, and the real lessons and appreciation come from my family and upbringing. Can you imagine how difficult it would be to get your head around cooking low GI if you’ve grown up with microwave meals and take away?

    One of my housemates is currently trying to lose weight and she’s gone the weight loss company route. She gives me little lectures on the fat content in the nuts I’m snacking on, or the BAD carbohydrates in my porridge, and I can’t help wonder how sustainable her weight loss is… bc you can’t eat pre-packaged crap when your out with family or friends, and do you really want to be so dependent on X named brand food for the rest of your life? It seems they give a little education about diet, but if you think nuts are bad and carbs are evil, I don’t think you’re getting the point.

    Sorry, little off topic. Clearly I’m procrastinating….

  3. dragonfly Says:

    You are right though. Lots of people think I am “obsessed” with food, but I am used to cooking the way I do because that is the way I have always done it. We used to live somewhere where you couldn’t get so much prepackaged stuff, so everything was pretty much from scratch (unless you are talking about instant noodles or something, which I have once in a blue moon). But the processed diet shakes and fad superfoods drive me up the wall. I had a flatmate whose sister lived on nothing but salmon and blueberries. Oh, and champers when she went out. Am sure she was just brimming over with antioxidants….

    My mother had a wake up call from her doctor after we had all tiptoed around the subject for years. I had offered to exercise with her to make her fitter, but after she had that talk from the doctor, she started exercising and lost 16kg and came off BP meds. She has a heart condition which improved significantly as well and most importantly felt so much better and happier. She didn’t need to change her diet as it was already pretty good, but she ended up eating a bit more after kicking her metabolism into gear.
    When people talk about “Celebrity Slim” or whatever I have to try not to roll my eyes. I don’t see how that is good for you, eating fresh/whole food that isn’t processed, in smaller amounts + exercise is always better. Anyway, not meaning to preach to the choir πŸ™‚ Happy procrastinating.

  4. *C Says:

    On a side note, the “Austudy” diet seems to proving quite effective πŸ˜›
    Especially for some one who’d rather go without than stinge on the quality of her chocolate!
    Though one should cease using the godawful coffee at uni as an appetite suppressant when one has forgotten to bring one’s own lunch.

  5. doctor007 Says:

    Bah, the Austudy diet is a farce! Haha, I’m overweight as you know C, but I promise I’ll tell them to shift the weight. After all, hypocrisy is not illegal, is it?

  6. dragonfly Says:

    πŸ™‚ I can also recommend the “16 hour day” diet. However the “night shift” diet has the opposite effect unfortunately. Too much sitting around eating grilled cheese sandwiches at 3am and consultants/registrars buying everyone pizza if they think you have worked hard, and your metabolism is whacked by the shift-lag anyway.

  7. C Says:

    Dr007, I think ‘hypocrisy’ in this case is even beneficial! Yeah, it’s hard and sometimes you don’t find time to exercise or eat right and a Dr going through that same thing can empathise more.

    Dragonfly & *C, I can also recommend the ‘get braces & a stomach bug’ diet. Survive on iceblocks for a week before passing out on your hospital placement that you ‘didn’t want to miss’. πŸ™‚

    you guys are right about relationships with food. Some people grow up with real food that comes from the ground and others are fed from packets. I’ve lost count of the number of conversations I’ve had with people who don’t know which fruits & veges grow on trees or under soil or on a bush!

    and oohhh those Celebrity Slim/Tony Ferguson things are horrid. Had an extreeeemely slim person tell me recently they wanted to go on those to just lose ‘a little bit’. Argh! I feel a whole series of post coming on re this…:)

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