Originally posted by starayamoskva
I have not "forgotten" what caused me to gain weight in the first place as it is a daily battle to maintain my weight (even more so as I creep closer to 40). I was not in my prior post nor have I ever claimed perfection.
Okay, why did you gain weight in the first place? Were you depressed? Were you just lazy and wanted to eat? Did you not have the will power not to gain weight, so much that it has become a regular "battle" (your word) for you? What motivated you to change? Who in your life helped you? How did you learn to successfully manage your weight despite the fact that you still struggle with it? Do you still beat yourself up on a daily basis because you struggle?
Don't you think sharing that type of story instead of getting all preachy would have been a better lesson for people reading this thread?
Originally posted by starayamoskva
I posted that it would be negligent not to council patients about obesity because as little as 5 to 10 years ago many physicians didn't bother counciling their patients to quit smoking because "they weren't going to quit anyway" and many today have a similar attitude about obesity.
I disagree. If your training has been anything like mine, you know this is not the case. What has been the problem has been
effectively talking about this issue. I've seen some (and posted some myself) good ways to do this. The original issue that started this thread was never about
not counseling (pardon the double negative) patients at all. It was about doing it effectively. So, why did you bring it up?
If anything, the reason why this hasn't been broached in the past is more likely BECAUSE doctors were so afraid they were going to offend. Likewise, it has become much more of a problem (obesity) in the past 5-10 years than it ever has been before. (And, yes, I can find statistics to support that, as I'm sure you can very easily as well.)
Now, as for the claims about smoking, I also don't believe you. I think doctors have consistently since, at the very least, the early 1980's (if not earlier) tried to broach this subject and advocate to their patients to quit. There are massive anti-smoking campaigns and medical science has known and understood the dangerous effects of smoking since the early 1960's.
It is a well documented fact that doctors who show empathy and concern for their patients not only get sued less, they also have better treatment compliance and lower patient turn-over rates. This applies not only to adherence to medication regimens, but also to such things as smoking and weight loss.
Now, doctors who don't bring it up at all... If I were to be too cynical, I'd say many doctors don't discuss it because they don't really see it as within their domain and feel that they have better things to do with their professional time. You could argue that such a misperception of the physicians role, especially the primary care doctor, may be true to a degree. But, that's a different discussion and you're not going to convince some physicians of anything anyway. The point is how to effectively communicate, especially if the patient brings it up. I'm sure you realize that after being a nurse for fifteen years. (I worked in a hospital for two years and was then involved in pharmaceutical clinical research for seven years prior to starting school. I was no spring chicken when I started school, and am well into my thirties as well. So, don't intimate the "age/experience" thing on me. It won't work.)
Originally posted by starayamoskva
I made no claims to have done extensive research in obesity. I think it is pretty well known that the people who post on this forum are medical students or medical students to be and hopefully no one is coming here as their only source of information. If you want research papers and statistics I suggest that you do a medline search.
I
have, in fact, done a large amount research on obesity and my current plans are to have some part of my future practice - if not the entire practice - dedicated to this field. I understand how the various diets and treatment modalities work as well as where they fail. I further understand that success is ultimately up to the individual. I have a good grasp of the complex behaviors at play with the various "diet failure" types. I do not claim to know everything, nor can anyone else. Yet, I am certain that "blaming" patients for their behaviors (or lack thereof) will not work, especially those who are repeated failures. You're a third year. You should understand the concepts of Behavioral Science, especially conditioning, by now.
Or, perhaps instead you should heed your own advice, as posited in the last sentence of that paragraph.
Originally posted by starayamoskva
Let's hope you interact better in real life than you do on a forum other wise I feel really sorry for your patients.
This is just
ad hominem. But, if you take the attitude you expressed in your OP to your patients, you will be the one having problems, not I. Why don't you go back and fully read what I said earlier on this very thread. Then, re-read your own.
The answer you originally suggested, and the reason why you have managed your weight effectively, are more complex than simply your "choosing" to exercise more and eat less. What we want to know is how you decided - what motivated you ultimately... what 'changed' in you - to make that painful leap in admitting how serious your problem was (if it was at all serious and not really a few exagerrated "vanity pounds", as people sometimes call them) and then doing something about it. That would be helpful to this conversation, since you've now offered that you have/had a weight problem (in so many words).
-Skip
