fitness and interviews

[brownbaglunch]

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[Shjanzey]

One of the things non-trads need to convey is that they have the energy and vitality to endure training. How important is it for us to get our BMI under 25? I don't know all that many people over 30 years old that are that slim.

I have had this in mind as well and it has been my biggest battle. I took the drastic decisions to stop driving my car, and bike to work (20 mile round trip) and stop drinking alcohol/soda until I am at least presentable to an interviewing committee.

Start: 230
Current: 210
Goal: 180
Acceptable: < 200

First impressions are vital when giving interviews and the strongest impression is usually left by how other people see you.

I would love to hear more opinions on this.

 

[SN12357]

One of the things non-trads need to convey is that they have the energy and vitality to endure training. How important is it for us to get our BMI under 25? I don't know all that many people over 30 years old that are that slim.

BMI is not a good individualized measure. I would ignore the arbitrary cutpoints.

However, certainly there are biases in favor of attractive and fit people as there are everywhere. So being and looking healthy can only be positives.

 

[theseeker4]

One of the things non-trads need to convey is that they have the energy and vitality to endure training. How important is it for us to get our BMI under 25? I don't know all that many people over 30 years old that are that slim.

I have had this in mind as well and it has been my biggest battle. I took the drastic decisions to stop driving my car, and bike to work (20 mile round trip) and stop drinking alcohol/soda until I am at least presentable to an interviewing committee.

Start: 230
Current: 210
Goal: 180
Acceptable: < 200

First impressions are vital when giving interviews and the strongest impression is usually left by how other people see you.

I would love to hear more opinions on this.

There is no reason at all to think there is some arbitrary BMI number you need to be. I was up in the 37 BMI range when I interviewed and was accepted at the only school I applied to (with stats right around the school average) so don't assume being in the "overweight" or higher category will have a huge detrimental impact on your application. Much more important is the ability to demonstrate confidence in your interview. Sure there might be interviewers who view applicants negatively based on weight, but there is no need to delay applying over anything less than extreme obesity. (in case anyone is wondering, yes, I am very aware of both the risks associated with obesity and the hypocrisy of counseling others on weight loss as someone who is obese, which is why I have been working on it and am now just over a 30 BMI. The point is the number is not something to obsess over)

 

[Shjanzey]

There is no reason at all to think there is some arbitrary BMI number you need to be. I was up in the 37 BMI range when I interviewed and was accepted at the only school I applied to (with stats right around the school average) so don't assume being in the "overweight" or higher category will have a huge detrimental impact on your application. Much more important is the ability to demonstrate confidence in your interview. Sure there might be interviewers who view applicants negatively based on weight, but there is no need to delay applying over anything less than extreme obesity. (in case anyone is wondering, yes, I am very aware of both the risks associated with obesity and the hypocrisy of counseling others on weight loss as someone who is obese, which is why I have been working on it and am now just over a 30 BMI. The point is the number is not something to obsess over)

I agree with everything you said. My view is to lose weight just to gain an ever so slight advantage in my favor. Most likely it won't be a huge factor in getting accepted, but I am still going to go ahead and do it.

 

[Gfliptastic]

I didn't know what to expect by clicking on this thread. Interesting topic tho.

When I was interviewing for med school, there was an absence of obese co-interviewees. Granted, it's a small sampling since I only interviewed at 5 schools and there were only like 6-8 of us.

Not to say it isn't possible. Remember that you are your stats just to get to the interview!!!! If you are obese, but rock a 3.9 GPA 3.75 sGPA and a 37 MCAT, you are getting interviewed. Even if they require a passport photo!

The computer that screens interview candidates is blind to your weight. But the people that DO interview you aren't blind. To say that all matriculants are model perfection is absolutely wrong. Just looking around a lot of the classes, like mine, the Match class and classes not mine, there aren't a lot of obese people, but there are enough of us who are BMI 25-30 lol

This is a good thread. I haven't seen anyone +30 BMI yet. Again, this is anecdotal. My n is probably <200, and there are almost 17k matriculants to med school every year.

If your BMI is +30 and you are obese, at least try to lose weight for health reasons!!! 🙂

 

[wholeheartedly]

There is no reason at all to think there is some arbitrary BMI number you need to be. I was up in the 37 BMI range when I interviewed and was accepted at the only school I applied to (with stats right around the school average) so don't assume being in the "overweight" or higher category will have a huge detrimental impact on your application. Much more important is the ability to demonstrate confidence in your interview. Sure there might be interviewers who view applicants negatively based on weight, but there is no need to delay applying over anything less than extreme obesity. (in case anyone is wondering, yes, I am very aware of both the risks associated with obesity and the hypocrisy of counseling others on weight loss as someone who is obese, which is why I have been working on it and am now just over a 30 BMI. The point is the number is not something to obsess over)

There have been quite a few studies of unconscious bias in physicians regarding weight in patients and I think it would be a bit naive to assume that that doesn't cross over into an applicant interview setting. In fact in the general public, a study showed that just based on appearance people attributed characteristics like lazy and unintelligent to obese people and not skinny people. Another study showed that patients had stigmatizing opinions regarding overweight physicians, including viewing them as less trustworthy. And of course any time weight comes up here, like discussions on whether employers should be able to not hire doctors based on weight like they do based on someone being a smoker, a lot of people raise hell about overweight doctors being poor role models, so accurate or not, it's a perception held by quiet a few people. (Although I do have my own counter theory to that idea).

Given the above and the fact that it's never a bad idea to strive for being more healthy, I don't think it's necessarily a bad idea to aim for getting fit and healthy before an interview. Plus, feeling fit can improve confidence as well, which will come across when you speak with people. Obviously other factors will play a bigger role and I agree there isn't a specific BMI level to shoot for and you shouldn't delay an application or anything drastic based on that unless you feel you physically can't handle the training. (and I say this as someone who needs to lose quite a bit of weight at this point)

** Just an aside, while there apparently is stigma with how patients view physicians who are overweight, I still think it can help in some cases. My mom is morbidly obese and isn't at all comfortable going to the doctor for things because they make everything about her weight even when it isn't necessarily related or the primary cause of the problem. She's feels more comfortable opening up to someone who is a bit less than perfect who might be able to relate a bit and understand that losing weight isn't just about willpower and determination. So in some cases, I think an overweight physician can be seen as someone easier to open up to and a more realistic source of information on how to lose weight.

And on a personal note, I've been in physical therapy all summer and told my doc that I know I needed to lose weight to help things, and that swimming was probably going to be my best option with my injury but I felt too self conscious to get in the pool at my gym with all of the uber endurance athletes. She's carry some extra weight too and said, "If I can do it, you can too." She had a point, so I swallowed my pride and bought some new swim suits.

 

[wholeheartedly]

FOUND IT!!!

Ok, I knew I remembered reading this. If you aren't familiar with the "A Piece of My Mind" section of the Journal of the American Medical Association, I suggest you read a few of the pieces. It's a really great section, easy to read, but some pretty deep insight sometimes.

Anyway, I read this quite awhile back, but it's an article by an overweight doctor on his experience treating an overweight patient. It's called Doppelganger.

http://jama.jamanetwork.com.ezp2.lib.umn.edu/article.aspx?articleid=185438

Other cool pieces in that section include:

Waging Peace in the War on Cancer
The Artist
One last teaching moment
The Right to Fall
... and well, just go the JAMA website, search "A Piece of My Mind" and then go through them, you won't regret it. 😉

 

[Escape_Goat]

You guys just need to go in and tell the interviewer how much you curl. Better yet, just bring some dumbbells with you and get your pump on during the interview.

 

[jombojuice22]

Abstract
Objective:
Whether weight bias occurs in the graduate school admissions process is explored here. Specifically, we examined whether body mass index (BMI) was related to letter of recommendation quality and the number of admissions offers applicants received after attending in-person interviews.

Design and Methods:
Participants were 97 applicants to a psychology graduate program at a large university in the United States. They reported height, weight, and information about their applications to psychology graduate programs. Participants' letters of recommendation were coded for positive and negative statements as well as overall quality.

Results:
Higher BMI significantly predicted fewer post-interview offers of admission into psychology graduate programs. Results also suggest this relationship is stronger for female applicants. BMI was not related to overall quality or the number of stereotypically weight-related adjectives in letters of recommendation. Surprisingly, higher BMI was related to more positive adjectives in letters.

Source: http://onlinelibrary.wiley.com/doi/10.1002/oby.20171/abstract

 

[NCOldie]

One of the things non-trads need to convey is that they have the energy and vitality to endure training. How important is it for us to get our BMI under 25? I don't know all that many people over 30 years old that are that slim.

What...really? That's strange. I live in the South and even I know plenty of people in that age range who are under 25 BMI. Personally, I don't put too much thought into BMI because there are so many things that factor into weight, but it's strange that you don't know many people who fit the 25 and under BMI range.

 

[sockit]

Zoinks. I'm not disputing the value of being at a weight predictive of better long-term health, nor am I going to challenge that there's a bias against overweight people. But, I would think approaching weight loss from that motivational headspace might work against you, particularly if you hope to do it in a sustainable way.

Many people who have time-limited weight-loss goals (an interview, a wedding) push themselves too far, too fast, and overdo the calorie deficit (setting themselves up for failure -> self-blame -> putting them off the whole effort; alternatively, finding disordered eating patterns creeping in). Or they'll overdo it with exercise & hurt themselves. I'm not saying that'd be you, but it happens a lot.

I lost an eight-year-old's worth of weight some years ago now, and have been sitting at the lower end of the 'normal' BMI range since. The weight loss itself took ~1.5 years (counting calories, with a modest deficit + exercise). Would a similar rate of loss be acceptable to you?

What would be your goals? How would you approach this?

I guess my take on it would be: improve your diet where it needs help, gradually increase your activity, and accept what comes*. Do it for yourself, & for the long-term, not for the interview.

*A reasonable rate of loss imo is 1 lb a week. Some people try for 2lbs/week, but it means being in a constant state of low-level deprivation; I think if you're going to be studying, you'll want to be physically/mentally comfortable. With one pound/week, if you get your macronutrients right, it's much easier to just live normally.

 

[QofQuimica]

One of the things non-trads need to convey is that they have the energy and vitality to endure training. How important is it for us to get our BMI under 25? I don't know all that many people over 30 years old that are that slim.

Granted that younger people on average are thinner than older people, but there are plenty of people over 30 who are still "slim." Still, you're in good company if you're not one of them. And yes, it's true that being older and fatter will be held against you to some extent just because you live in a society that places such value on youth and fitness.

That being said, with all the things you have to do to prepare for med school interviews, changing your weight should be at the bottom of your list. Focus on being dressed appropriately (dark colored suit, well groomed, etc.) and being prepared to answer common questions (why medicine, why the career switch, etc.). If you can, try to find someone with experience at interviewing job candidates to mock interview you so that you can practice. Use the SDN interview feedback pages to make yourself a list of questions that other people were asked at each school.

Concerning the point that overweight and obese patients feel judged by physicians, my experience is that many of them do feel that way, and they're right to feel that way. It's not just doctors; every health care professional finds caring for the super obese (BMI > 40) in particular more challenging and difficult, from the EMTs trying to lift them onto the stretcher, to the nurses trying to insert a Foley catheter through a meatus buried in fat or needing four people to turn the patient. I will readily admit that I don't like caring for super obese patients because everything is just so much harder. Take conducting a physical exam - what do I do if I can't even hear someone's lung/heart sounds with my stethoscope because of all that padding? Or obtaining imaging - you can forget doing ultrasounds on the morbidly obese, and at the extreme end, the really huge people can't fit into the CT scanner. Or performing procedures - maybe I can't find anatomical landmarks, or I need special equipment to get through the fat. And the super obese have other challenges too, like having living ecosystems under the pannus (the extra roll of abdominal fat), being at higher risk for decubitus ulcers because there is so much weight on their pressure points, having higher risk for infections, hernias, you name it.

Relating to overweight/obese patients as a thin health care professional is a matter of finding common ground. Overweight people don't always realize that we all face the same laws of chemistry and physics. I have a BMI ~20. I remember once in med school, I was on my family med rotation and counseling a patient about weight loss. When I finished, she said, "That's easy for you to say. You're thin." I looked at her and said, "I diet every day of my life. It's not like I can just eat however much I want of whatever I want and stay thin any more than you can." See, the things I was advising her to do (climb stairs instead of taking the elevator, don't drink beverages with any calories, portion control, etc.) are all things I was recommending because I do them myself and they work!

I've thought a lot about why most people fail at diets while a few succeed. What's different about them? I don't see it as an issue of will power per se so much as a need to change one's entire lifestyle. That's the only way to keep the weight off for the long term. By default, we're hard-wired to put on fat to prepare for the next famine. That's our baseline as a species. It's the ones of us who are OCD enough to do things like wear a pedometer to count exactly how many steps we take each day, take out exactly one serving size of 17 chips from the bag, etc. who are the odd ones. But that's the kind of stuff I do. I was an obsessive child too (though not specifically about weight). So I have the opposite struggle, to be more flexible and less regimented.

Sorry for the ramble; just wanted to point these things out from the perspective of someone who is a doctor and someone who has never been overweight.

 

[brownbaglunch]

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[Shjanzey]

What a lively discussion, I have really enjoyed the different view points.

Many people who have time-limited weight-loss goals (an interview, a wedding) push themselves too far, too fast, and overdo the calorie deficit (setting themselves up for failure -> self-blame -> putting them off the whole effort; alternatively, finding disordered eating patterns creeping in). Or they'll overdo it with exercise & hurt themselves. I'm not saying that'd be you, but it happens a lot.

I have gone through what you describe before, and it is a form of weightloss that doesn't really work for the long term. Although I have a goal to be fit for my interview, I think the proper approach is to make that my lifestyle in general. In order to achieve weightloss I have made some changes which I think are reasonable. I haven't really changed my diet all that much, (except for cutting out alcohol/soda) I am now focusing more on portion control. The biggest change has been changing my car for a bicycle. I am getting way more exercise than before and it is making a huge difference. For me personally, I hate going to the gym alone. It is just so boring and I don't have any motivation for it...making exercise part of my daily routine out of necessity seems to be the only way.

My biggest hangup is that if I am going to be a physician I don't want to be a hypocrite when I have to counsel a patient.

That being said, with all the things you have to do to prepare for med school interviews, changing your weight should be at the bottom of your list.

What I said about my weight was maybe a little tongue in cheek. The other things you have mentioned are definitely high priority, however I feel like I have them under control. I enjoyed reading your remarks on preparing for interviews, and caring for super-obese patients. Very instructive. Thanks!

You guys just need to go in and tell the interviewer how much you curl.

I have a powerpoint presentation prepared as well as a youtube video of me doing PRs in crossfit. I feel like the interviewers need the benefit of me screaming as I go into full beast mode.

 

[monkeyfeet]

I have a powerpoint presentation prepared as well as a youtube video of me doing PRs in crossfit. I feel like the interviewers need the benefit of me screaming as I go into full beast mode.

I'm totally planning on showing off my snatch during interviews...

 

[Nasrudin]

I'm totally planning on showing off my snatch during interviews...

I am rather hoping you're a dude and the snatch to which you refer is the weight lifting maneuver. Otherwise I've made a grave error in not being more administratively involved in such desperate times.

To the point of the thread, I think, as others have said, the framing of the issue is key. Wt loss should be a part of overall fitness. I've seen some heavy people that could really move well and who are very athletic. And likewise some skinny people who look frail and weak and otherwise unimpressive.

In regards to the thread title it really should be fitness and life. Primates respond to the physical presence of each other. An unimpressive physical presence will not be given the same level of social respect. Always. Facts are facts uncomfortable or otherwise.

And medical school is devastating to your physical presence. As is preparing for it. The sedentary lifestyle requiredis also not properly framed. It's often looked upon as physically neutral if you don't gain too much weight. Nonsense. It's a form of sever deconditioning where your core musculature weakens and atrophies.

I'm fighting it now. A good fighting wt for me is 220-230. I'm up to 250. After making to 4th year and the promise land. My chief objective is to be physically in top notch condition before intern year. Weight is a small factor. As I might put on muscle as I accelerate my training regimen.

So wt loss should be slow and steady and more of a component of being more physically powerful and impressive.

 

[Goro]

Quit fussing and ignore society's obsession with size 3 women's sizes. I have students who are either fit, pot-bellied, over-weight, and some even obese.

A patient may actually be more open with you if you share some characteristic with them. Hence, if you're a typical American and overweight, don't sweat it.



QUOTE=brownbaglunch;14384702]One of the things non-trads need to convey is that they have the energy and vitality to endure training. How important is it for us to get our BMI under 25? I don't know all that many people over 30 years old that are that slim.[/QUOTE]

 

[sockit]

I've thought a lot about why most people fail at diets while a few succeed. What's different about them? I don't see it as an issue of will power per se so much as a need to change one's entire lifestyle. That's the only way to keep the weight off for the long term. By default, we're hard-wired to put on fat to prepare for the next famine. That's our baseline as a species. .

The Harvard Health Professionals and Nurse prospective studies have found certain common lifestyle factors that support normal-weight BMI. I don't know how many subjects were always-thin vs once-obese, though:
http://www.nejm.org/doi/full/10.1056/NEJMoa1014296?query=TOC&

The National Weight Control Registry (which obviously just deals with the once-obese) has a few numbers, as well: http://www.nwcr.ws/Research/default.htm

I agree, weight loss is certainly not a question of willpower. Obesity researchers are starting to uncover certain metabolic/endocrinal changes accompanying significant gain that they think might undermine people's best efforts, and a lot of research is pessimistic about long-term weight loss success. However, it's obviously possible for at least some people to lose weight. My personal view is that at least some of the problems people have historically faced relates to method -- unrealistic goals and misguided approaches, like short-term dieting. I know some really smart people who have resorted to the Master Cleanse diet, Atkins, things like that. Those are not sustainable approaches.

I can't cite everything I've read over the years, or validate my own observations in my own process (which includes watching those of others) -- I say that, because any suggestion around diet is usually attended by controversy of some kind -- but there's a lot to recommend the "TDEE-15%" approach (eating 15% less than your total daily energy expenditure). Higher proportions of protein, fat, and fibre contribute to satiety -- that means just what you'd expect: lean protein sources, vegetables, whole grains. Daily & *accurate* calorie counting helps -- there are a number of excellent websites and smartphone apps that can help with this, and many have communities of knowledeable people who can offer really fantastic support. I am someone who has had to learn to consciously manage impulses and emotions, and is not naturally particularly consistent or rule-driven, and these methods have worked for me (and are supported by research).

Now: lifestyle change is obviously a biotch. There's a huge (and emotional!) learning curve. It can take a number of tries, and lots of support. I think (and research shows) that timing and motivation can be crucial -- often, people who succeed are those who began at turning points in their lives in other ways (divorce, being on the cusp of illness, etc). So, backtracking a bit, this window here -- applying to med school, career change -- can be a useful thing. (I just wanted to encourage people to embrace seemingly conservative goals and methods, rather than dive headfirst into a failing approach because of time pressure/ambition.)

Finally, infrastructure and culture matters. The design and politics of many cities, and food culture/economics, can obviously work against us too. (E.g., living in a car-focused town, among a demographic that doesn't welcome businesses and services/products that support healthier lifestyles, doesn't help.) So people in that situation, unfortunately, have to work harder. But it is possible to arm yourself against those forces. (E.g., choose a gym location that's very close to work/school; learn food preparation and storage techniques to pack lunches rather than be forced to choose between burgers and pizza in a food court. People on those calorie-counting websites are a store of all kinds of amazing hacks.)

There's a lot of learning, it's true. But when this knowledge and these habits are learned, and consistently observed, it becomes easier to lose and maintain.

Good luck to everyone working on this, I wish you the best! You can do it 🙂

Concerning the point that overweight and obese patients feel judged by physicians, my experience is that many of them do feel that way, and they're right to feel that way.

No, the fact that it might be annoying to examine someone doesn't justify anything less than a fully professional approach. If you want to help people, medically, empathy is better at furthering that goal.

 

[Nasrudin]

Quit fussing and ignore society's obsession with size 3 women's sizes. I have students who are either fit, pot-bellied, over-weight, and some even obese.

A patient may actually be more open with you if you share some characteristic with them. Hence, if you're a typical American and overweight, don't sweat it.



QUOTE=brownbaglunch;14384702]One of the things non-trads need to convey is that they have the energy and vitality to endure training. How important is it for us to get our BMI under 25? I don't know all that many people over 30 years old that are that slim.

Sorry this is just bad advice. I like a woman built like a brick house myself. But fitness cannot be overemphasized. Particularly for older people, for whom as Q suggests, have greater facility with storing calories.

We have to biohack this system that is elegantly designed to take care of us, over the course of our evolutionary development, as we loose speed, strength, endurance, and dexterity to hunt and gather resources. Since there is no modern equivalent for the need to do those things it becomes incumbent on us to simulate them. Eating crap and studying all day is an abysmal quality of life. And it makes us feel ****ty too.

Obsession with frail weak physiques is one problem. A mutual co-dependence society on mood related eating and lack of physical activity is another one. Both suck. While we're mentioning enabling cultures of physical ineptitude how about the intellectual one which sees the development of the physical body as vulgar and passé.

Nope. Get your @sses to the gym or the studio or the world for long walks or runs. There's been quite enough to contribute to our obese lifestyles that we don't need enabling from our physicians.

 

[Nasrudin]

One of the above poster's points about lifestyle change and the need for momentum and the advantage of major events was fantastic.

But since the OP is concerned about interviews specifically, I think it's worthwhile to note, as others have, that there are several important things to consider beyond just physicality.

As someone coming from the trades to healthcare--jeans and then scrubs daily--my ignorance of how to dress was horrible. And also how to interview. Had I also had physicality as a miss, who knows. I think it could've been different.

For interviewees, since I'm also interviewing for residency programs, we need to study and polish the necessary skills to do well. I will never, ever walk into an interview again without a perfectly fitted suit and without being well prepared. Don't make the same mistakes I did. I was a hot mess in medical school interviews.

 

[Courtjester8]

Looking around my med school lecture hall of 113 students, there are 3 maybe 4 people who are noticeably overweight. Of them, there is a single commonality-- they carry their weight well and present themselves well through dress, hygiene, and body language. Lose some weight, sure, but more importantly buy a nice suit, get it tailored to fit well, don't slouch, speak with confidence, make sure your hair has been cut recently, and suck in your gut a little. Also, make sure you submit a very slimming looking picture to admissions when they ask for it (as most adcoms usually do). Chances are they'll forget your appearance and rely on the picture you submit. You could be as fit as they come, but if you don't have a properly fitting suit, have shaggy hair, slouch, and submit a bad picture, that's really whats going to impact you in terms of appearance.

-cj8

 

[monkeyfeet]

I am rather hoping you're a dude and the snatch to which you refer is the weight lifting maneuver. Otherwise I've made a grave error in not being more administratively involved in such desperate times.

Nah, I'm a chick. But I do have a nice snatch. I jerk pretty well too, from what I've been told...

 

[Escape_Goat]

I'm totally planning on showing off my snatch during interviews...

Where are you interviewing? 😎

 

[wholeheartedly]

This is certainly a more productive discussion than it would have been in pre-allo.

 

[Nasrudin]

Nah, I'm a chick. But I do have a nice snatch. I jerk pretty well too, from what I've been told...

Excellent. I'd be as corruptible as Billy Clinton with such a display. Best of luck. And keep up the powerful female physicality aspect. That's wassup y'all.

 

[QofQuimica]

No, the fact that it might be annoying to examine someone doesn't justify anything less than a fully professional approach. If you want to help people, medically, empathy is better at furthering that goal.

You're misunderstanding my point. It's not about taking care of the patient being annoying, or about treating them worse than other patients simply because they're overweight. Sure, there probably are some docs who are consciously jerks toward patients because of biases about weight, but I don't think that's the majority. Still, a lot of health care people do view obesity as being an issue of willpower, and overweight people pick up on the subtle unconscious signals we all send when we're frustrated with someone else. As a physician, you don't want to feel like you care more about someone else's health than they do. And we're all human; sometimes you just plain don't like a patient. It takes effort to step back, acknowledge the feeling, and be professional in spite of it. Some of us are also better actors than others.

There's another aspect to it as well, and that's fear. This is a hard thing for premeds or even med students to appreciate, because you're not responsible for anyone else's life or limb. But the first time you start doubting yourself because you're not sure you got a good exam, or you're worried that you might not have put the central line in the right place, or you can't check whether the patient has a pulmonary embolism because they're too big to fit into the CT scanner, or your ICU gets cited because someone fell on the floor and couldn't be picked up, then you'll understand where I'm coming from when I say that taking care of the super obese can be very anxiety-provoking.

 

[Nasrudin]

I'm curious if anyone has actually researched empathy vs motivational interviewing vs something else more football coach like. Personally I don't think all the empathy in the world could unfat and desedentarize America. People pay trainers to push them. Hard.

After working in peds and dealing with chubby codependent spineless parents seemingly indefatigable in in their cultivations of obese hypertensive pre diabetic 8 year olds its difficult for me to see what empathy is. Empathy is a general Patton in a jump suit yelling you out of bed at 5 am to train.

In any case. I'm not sure the difference between enabling and empathy is appreciated in medicine. I personally want people to be healthy because it feels good and I want everybody to feel that. I buy that genetics vary and that might contribute to obstacles as well as social status and what type of community you live in. But what you put in you mouth and how much you don't exercise is on you.

I'm not going into a general medicine field for this reason among others. I'm somewhat dispassionate about dealing with insidious chronic fat American problems.

 

[Quizlet04]

I went and lost about ~30 lbs and have so far kept it off, though I need to do another 20. I'm at a BMI of 28 and I'm the happiest I've felt about my body in years. It's helped my GERD and probably my ankles.

One thing to think about is professional clothing. It'll be easier to find good-quality professional suits for smaller women than for larger women.

 

[Nasrudin]

I went and lost about ~30 lbs and have so far kept it off, though I need to do another 20. I'm at a BMI of 28 and I'm the happiest I've felt about my body in years. It's helped my GERD and probably my ankles.

One thing to think about is professional clothing. It'll be easier to find good-quality professional suits for smaller women than for larger women.

It's a great point. I don't fit off the rack suits either. But realizing my problems and recognizing what looks good when I see it I dug into the Internet and self-educated on how to go about getting a custom suit for a reasonable price.

Some of my other items are from eBay. And a few more from 2nd hand stores that I got fitted up by a superb tailor. And I'm looking as clean as Steve McQueen.

I never realized how unconfident and uncomfortable my appearance was for these occasions until I learned how to do it right.

 

[Gfliptastic]

No, the fact that it might be annoying to examine someone doesn't justify anything less than a fully professional approach. If you want to help people, medically, empathy is better at furthering that goal.

Based on how many physical exams and patients are you basing this off of again???

One of my last patients in IM was 450 lb guy w/ cellulitis and a r/o DVT. His calves were as big as my waist. Do you think a doppler works on that? Yes, we can try the ol CT scan machine, but do you know the weight limit for that machine? I'll tell you it's NOT 450.

So the team gives the med student (me) the fun job of trying to schedule as urgent an appt w/ either the nearest network hospital w/ the "BIG" CT machine, and yes it's true...the zoo.

Of course we can treat him w/ blood thinners, but getting a guy this big PT/INR into therapeutic range is going to take a few days. We were going to try some of the newer pharmaceutical treatments, but there aren't any studies about how to dose it for someone this large (I know cuz it was my job to search for dosing). Can't just give him a s***-ton since you should know there are bleeding complications.

Mind you, we don't even really know if it's cellulitis WITH a DVT or just cellulitis.

These are complications you don't encounter w/ even just obese patients. And he will complain of epigastric pain. Palpate him for his liver and spleen, ok? IDK, can't really feel it. Don't forget, he's too fat to put in our CT machine.

Did we just say, "you're too fat, sorry, go to a different hospital"?? NO because fat or skinny we care about every patient. Was he a complicated case that wouldn't be one if he was even south of 300 lbs. Yes. Were we annoyed? I was some, but what "annoys" us even more is NOT really knowing if this guy has a DVT or not because of complications from his weight.

Like Q stated. It's not like that. Body habitus had EVERYTHING to do w/ his medical care. DVT's are horrible situations. Not knowing because of body habitus is troublesome. NOT "annoying".

 

[kad690775]

I'm not the fittest person, and weight has always been something I struggled with. Even though my body fat % is not ideal I have greatly increased the way I feel just by lifting weights a few days a week, and I also walk everywhere. I probably look about the same but I am more self confident and I carry myself differently when I'm more active, and I'm sure that will carry over well in an interview.

 

[DrMidlife]

With respect to being older and concerned about how that's perceived in interviews, and looking at weight as one way to address this concern, I don't disagree that physical fitness is a net positive for an older candidate. I'm going after surgery in my 40's, and I have a weight target and fitness goals, not just because I want to be healthy but because I want to come across as healthy. I would file this under PD bias toward people who can generally keep their act together. Complexity of reasons for being obese aside, it's just going to be an easier sell if you don't look like a bucket of health problems waiting to happen. And to be honest I wouldn't go after surgery if I looked fat fertile and forty.

But energy level and enthusiasm, in my opinion, are the real deal for an older candidate. In my experience in software engineering, when I was interviewing a candidate who had been in the company for several years and was looking for a lateral or slightly vertical move, my #1 concern was whether the candidate had any steam left. A lot of folks are just completely overloaded by family/money/health issues by the time they hit 30 and have nothing left to offer at work but repetition of tasks already learned. One guy who had been a blast to work with as an intern in 1991 looked like a senior citizen by 1998. I keep that image for reference.

Best of luck to you.

 

[QofQuimica]

Like Q stated. It's not like that. Body habitus had EVERYTHING to do w/ his medical care. DVT's are horrible situations. Not knowing because of body habitus is troublesome. NOT "annoying".

We had a patient like that on my last ICU rotation too. Huge guy, had hypoxia suspicious for PE, couldn't fit into the CT scanner. Even if the zoo had been able to accommodate him, we couldn't give him dye anyway because he was in acute renal failure. He was also intubated and couldn't answer questions, so we had to go solely based on clinical judgment. We wound up treating him empirically w/ heparin and he seemed to be improving at first....and then he started bleeding from everywhere. We wound up having to transfuse him. We wound up having to code him. And in the end, he probably didn't have a PE in the first place, though his family declined the autopsy, so we'll never know for sure.

Ain't no amount of empathy going to change that guy's outcome.

 

[JourneyAgent]

The empathy theme (and it's irony) is I think, germane, to the OP's topic. And I think DrML and Q have the perfect take on it. It is a question of transmitting vitality. And it is also a matter of practical evaluation. In DrML's case, does this woman have the juice to be a surgery intern. (hell yeah!, but me knowing it is different than them). The question is not empathy in our evaluation. It's what kind of goods am I getting with this human in front of me. Much like a pick-up in a bar. That quick, that immediate, that irrational, and very much vibe oriented. In Q's case is the same in immediacy and practicality if more rationally and clinically--what are the potential problems with my work up with this person. Empathy is a tool for establishing rapport and for gathering a good history and for therapeutic alliance. But it's they who have the jobs and me who's trying to get it. So it's on me to empathize, to listen to, and establish rapport with them. Not the other way around.

I see the clinical encounter as choosing a form of empathy that is effective. I'm not sure what that is. But you'll not see me criticize a former supervisor of mine who went in like a Jamaican grandmother on this mother of 3 who was brought to the ED for acting foolish strung out on PCP by her 9 year old daughter. I've not been granted such pomposity by the Agencies of Liberal Co-dependence to criticize her clinical intuitions for engaging in that way.

And so how do you transmit vitality and vigor and enthusiasm and so on. Well, you don't do what I did and show up in a tent-like suit that you appear ill at ease in and that makes you look greenish and sickly. I seriously wore a circus tent in the lovely shade of greenish gray. I didn't have polished answers for stock questions like what are your faults/weaknesses. I had the insane notion that you were supposed to talk about what's wrong with yourself when asked. And so on.

But with vitality you could basically summarize it in how to create a favorable impression within the first few seconds. Part physicality, part dress, part demeanor. If those are all polished. Then the interview is down hill.

At least these are my notes from studying these things in an academic self-study for the first time in my life in the hopes of deploying them effectively in the next few months.

 

[kraskadva]

My dad is an endocrinologist and working in his office I would constantly hear people saying how glad they were that he would just come straight out and tell them "you're too fat. You have to lose weight or you're going to die a slow painful death within the next ten years" If a kick in the a** is what someone needs to get them going, they'd be more appreciative of that in the long run than of any empathetic hand holding. But different strokes...

The biochemistry does contribute in a huge way for the majority of people who are morbidly obese. Many of them have been ineffectively trying for years to lose some of that weight and there is a lot of frustration,and even depression tied up in that. If you start feeling like it's futile, then what's the point? Proper medication can jump start the process and help keep it off in the long run, but getting off the couch and learning to eat right is entirely on them and the only way to make the whole process work.

As far as eating right goes, if your grandmother or great grandmother wouldn't have recognized it as food, you shouldn't be putting it in your mouth (ie all the processed stuff in the middle of the grocery store). And eating like a pig at a trough is both a bad idea and unappealing. I almost never go to any kind of buffet restaurant because I completely lose my appetite watching huge people shovel it in.

I'm trying to lose weight too (~29 BMI now) but simply for the sake of being healthy. I don't look awful and I do know how to dress well, but this is about 40 lbs overweight for me. I've seen the issues that come with unmanaged metabolic syndrome and obesity and I want none of that. What I'm doing is a) exercising by walking to and from school (~4 mi round trip), b) cooking real food instead of the junk that's far too easy to pick up and dropping out the extraneous simple carbs, c) only eating when I'm hungry and only until I feel comfortable, not clean the plate. Lost about 10lbs so far this summer, which I feel pretty good about, but the hard part will come when it gets cold and I just want to sit inside and eat comfort food while I'm studying. I would like to fit back in the nice clothes I have by interview time in a year or so, rather than looking like I was melted and poured into them. 😳

 

[MDforMee]

One of the things non-trads need to convey is that they have the energy and vitality to endure training. How important is it for us to get our BMI under 25? I don't know all that many people over 30 years old that are that slim.

You're already showing defensiveness and justifying/rationalizing your overweight.

You have no excuses here, poofy cakes.

 

[sockit]

You're misunderstanding my point. It's not about taking care of the patient being annoying, or about treating them worse than other patients simply because they're overweight. Sure, there probably are some docs who are consciously jerks toward patients because of biases about weight, but I don't think that's the majority. Still, a lot of health care people do view obesity as being an issue of willpower, and overweight people pick up on the subtle unconscious signals we all send when we're frustrated with someone else. As a physician, you don't want to feel like you care more about someone else's health than they do. And we're all human; sometimes you just plain don't like a patient. It takes effort to step back, acknowledge the feeling, and be professional in spite of it. Some of us are also better actors than others.

There's another aspect to it as well, and that's fear. This is a hard thing for premeds or even med students to appreciate, because you're not responsible for anyone else's life or limb. But the first time you start doubting yourself because you're not sure you got a good exam, or you're worried that you might not have put the central line in the right place, or you can't check whether the patient has a pulmonary embolism because they're too big to fit into the CT scanner, or your ICU gets cited because someone fell on the floor and couldn't be picked up, then you'll understand where I'm coming from when I say that taking care of the super obese can be very anxiety-provoking.

I obviously have misunderstood you. Thank you for this sensitive description of what you face when dealing with patients (and colleagues, probably).

People go into medicine partly because they want to see results for their efforts. I have no doubt it's challenging when the task is sisyphean on the regular, as it is with so many of the chronic diseases of lifestyle (and the real fix for those is almost always political, imo). I think all signs point to future doctors seeing more of these people and illnesses, rather than less, and that they should be prepared for and supported in caring for those who, for now, are not ready or equipped to [stop eating too much, smoking, drinking; riding motorcycles; leave an abusive partner].

The kind of empathy I think is required to help such people isn't soppy. (And I doubt there is a single 'best approach'). I just mean that e.g. SES, readiness & life circumstance (in addition to a changed hormonal environment, with obesity) should be deeply taken into account when it can -- in a preventative capacity, not in the ICU -- and that a patient who feels understood is more likely to seek, understand and follow medical advice. And again, the answer, I think, should come from questioning systems (medical training, hospital infrastructure, health economics, etc), and not (just) individual doctors.

But I don't have a dog in this fight - I'm not premed, just nontrad.

 

[brownbaglunch]

.

 

[Shjanzey]

You have no excuses here, poofy cakes.

 

[sockit]

Sounds like you've got a handle on things. Completely agree that making nutrition & fitness convenient is the way to go.

I was asking about appearance because I won't be back down to my fighting weight before my interviews start. More importantly, I intend to buy a new suit soon. The one I have now isn't tailored, and is a little worn. I have three interviews in 10 days starting in four weeks. I suppose if I lose 10-15 pounds after I have the new suit tailored, I can just have it altered.

Even if you only get three good wears out of a $300-500 suit (could go for something discounted/1-2 seasons old?), that's still equal or better value-for-wear than I've gotten on any dress I've had to buy to go to any wedding, so.. here, I'm afraid, my empathy well runs a bit dry 😉 Just kidding. Get a great fit, stand tall, and show your awesomeness. Congrats on your interviews 🙂

 

[jakeislove]

Skipped ahead.

Fitness is a lifestyle choice. Everyone here is too educated for all the rationalizations lay-people can get away with.

 

[oldnewdoc]

Why is this even a thread? You know the answer. If you feel confident in yourself, then you are fine. If you don't feel confident in yourself, then you are not fine. End of argument, period. Your application is about you, if you think weight is an issue in your application, then that is your problem, you might want to address that before an interview, otherwise you will sabotage yourself and you have worked too hard for that!

 

[Shjanzey]

Start: 230
Current: 205
Goal: 180
Acceptable: < 200

Almost there. Biking 100 mi/week with portion control seems to be working