Obesity and the Health Care Field

[smq123]

"Curing" obesity by attacking the symptom through bariatric surgery is an artificial fix (and not a fix at all, really).

Actually, one of the main goals of bariatric surgery is not just to "cure" obesity, but it is to quickly address the problems that are brought on by obesity. Bariatric surgery results in quick weight loss (which you probably knew) - but it also results in almost astoundingly rapid resolution of type II diabetes and high blood pressure.

Losing weight slowly and steadily is desired, but in the time it takes to do that, you also allow more time for diabetes and blood pressure to wreak havoc on the body. It's one of the reasons why I might tell someone to get gastric bypass instead of joining Jenny Craig.

1 thing I cant stand is when Cardio docs put thier patients on the atkins diet. theres absolutely no reason to eat 3 meals a day loaded with fat and protien you can have carbs there NOT the enemy

atkins diet is pretty outdated. i think its pretty common knowledge now that it is bogus and an unhealthy way to eat. I'd be surprised if any doc still recommended it as a healthy way to lose weight/improve health.

I wish this was tru bud but my gf's grandfather who sees a cardiologist in Hackensack NJ(supposed to be one of the best cardio hospitols around) was recently put on the atkins diet and it makes me sick. Im sure there are cardio docs out there that no better but its the older generation folk that dont

While I agree that the ideas behind the Atkins diet are outdated and a little extreme, there ARE very good reasons to tell your patients to do Atkins:

1) They've heard of it. Even 60 year olds with crappy internet skills can find GOOD information about it with ease.
2) You see quick results. Not only does ANY weight loss help people (and some patients really need to have had some of that weight off yesterday!), but patients who see results are more likely to stay on it.
3) The idea behind it is simple. None of this, "Well certain fats are good, and certain fats are bad, and some fat is okay some of the time, but other fats are never okay, and the way you can tell is because of the number of hydrogen ions it has, blah, blah, blah."

A lot of the monounsaturated/polyunsatured/saturated fats debate is WAAAAY over the heads of most of the patients that you will encounter. (This is ignoring the patients that you will have who don't speak English!)

So don't harshly judge the physicians who recommend Atkins, without understanding a little of their rationale for doing so.

Besides...if more people ate for FUNCTION rather than taste we'd be getting somewhere. Taste is relatively unimportant...

Again, this argument gets lost on most patients. Hell, this argument gets lost on ME.

You're never going to convince patients (particularly those who come from certain cultures) that this is true. You definitely need to find other ways of getting through to patients without telling them things that they will flat-out refuse to believe.

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[closer23]

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[LizzyM]

I believe far too many people who get bariatric surgery don't need it and would be much better served by losing the weight the natural and safe way.

To qualify for bariatric surgery one must weigh about 100 pounds above ideal body weight,or slightly less than that but with obesity related illness (such as diabetes).

Which of the diabetics needing to lose 75 pounds don't need surgery? Which women more than 100 pounds overweight don't need surgery?

As has been pointed out previously, enrollment in other supervised weight loss programs are often required -- if after 6 mos the patient is still >100 pounds overweight (75 lbs with a obesity related medical condition) then the patient may qualify for surgery.

You are starting to sound like someone who has plenty of uninformed opinions and it is becoming tiresome.

 

[229141]

And many people would tell you that they'd rather live a short, pleasurable life than a long, miserable one. Again, you are expecting other people to adapt to your values....

You have got a lot to learn about people.

I think that the thread about changes in pre-med curriculum are absolutely on target; we should think about adding some required courses is social science to the pre-med curriculum.

I am well aware that most people shove their face full of food and do not care. I'm also aware that they abuse themselves in many other ways and do not care. All you can do is present the information to them, the risk, etc, then tell them what to do better..its THEIR life and if they want to ruin themselves it 100% their choice. You cannot help someone that has no desire to help themselves..

By the time a patient comes to you at the age of 45 and overweight/obese, the time for that conditioning has past. They've already become addicted to the idea of food as a pleasure agent, so if we want to make change, we need to work within that paradigm. There's plenty of tasty healthy things you can make (MUCH tastier than candy bars, in my opinion) so it shouldn't be too hard.

This is not true. My Dad ate pathetically until he was 45 and once he got his blood work back and saw how bad it was he changed his entire life...and now he's a whole new person. He's not the only one..I've seen people older than that I've trained at the gym get motivated and complete change their life. We can go in circles with this all day long but the truth is many people are too lazy to make the small changes to needed to improve their diet and extend their life (which I think was LizzyM's point?)

 

[SDN2013]

more kids need to watch Wall-E

 

[Lukkie]

more kids need to lay off the xbox and go outside

 

[SDN2013]

whats xbox

Edit: nvm googled it

 

[Lukkie]

you cant be serious

 

[jinx520]

I think the point needs to be made that although we may think it is an issue of common sense and/or motivation/lack of that patients avail themselves of "common" knowledge re: nutrition, it would behoove both doctor and patient if the patient is met where they are at and then building from there. Throwing statistics and pronouncements at a patient rather than trying to help them identify the issues regarding poor nutritional choices (or smoking, or bad habits in general) isn't going to do much good. Helping people identify why they make bad choices and suggesting how they can make smarter choices (w/o throwing everything out that is important to them) would be more effective in the long run.

 

[LizzyM]

^agree. There is also a lot of behavioral science research that can be helpful in meeting people where they are and helping them make and maintain positive changes.

 

[Helen Wheels]

Actually, I have been thinking of the issue of obesity on my upcoming application to med school as I am obese. I have started working very hard to lose weight. I have been exercising and have learned a lot about healthy eating. I have lost 63 pounds and I intend to keep going. I believe that my personal reasons for obesity were many factors: untreated metabolic disorder, sedentary life style, back problems that further added to aforementioned sedentary lifestyle, and never having learned healthy eating habits. Sure, I was not in control of my eating and did not show much discipline but it was much more complex than just personality shortcomings.

There is a lot of social psychology research out there that shows that people automatically judge an obese person negatively, even knowing nothing else about the person. It bothers me a lot that at an interview the interviewer may have a conscious or unconscious bias against me. They won't know how much weight I have lost (I doubt it will come up in the interview). They will just assume I am fat and happy with it. I don't like it and I am working to change it and one of my main motivations to losing weight is so that I can be taken seriously as a health care professional. Frankly, with 2/3 people in the US obese or overweight, I think I would bring a great perspective to my patients. I also think I might like to do obesity research.

 

[scarletgirl777]

Actually, I have been thinking of the issue of obesity on my upcoming application to med school as I am obese. I have started working very hard to lose weight. I have been exercising and have learned a lot about healthy eating. I have lost 63 pounds and I intend to keep going. I believe that my personal reasons for obesity were many factors: untreated metabolic disorder, sedentary life style, back problems that further added to aforementioned sedentary lifestyle, and never having learned healthy eating habits. Sure, I was not in control of my eating and did not show much discipline but it was much more complex than just personality shortcomings.

There is a lot of social psychology research out there that shows that people automatically judge an obese person negatively, even knowing nothing else about the person. It bothers me a lot that at an interview the interviewer may have a conscious or unconscious bias against me. They won't know how much weight I have lost (I doubt it will come up in the interview). They will just assume I am fat and happy with it. I don't like it and I am working to change it and one of my main motivations to losing weight is so that I can be taken seriously as a health care professional. Frankly, with 2/3 people in the US obese or overweight, I think I would bring a great perspective to my patients. I also think I might like to do obesity research.

Not med school, but I have seen an applicant be turned down for a fellowship at least partially because of their obesity. I know this because I sat in on that meeting and one of the interviewers said, "she's great, but I don't think people were take her seriously because she's so big." It was a health-related fellowship that was supposed to teach people to be advocates for the communities they came from and hopefully leaders in those communities. It's annoying (especially because the health issues she was focusing on had nothing to do with diet), but the world sucks.

 

[LizzyM]

Some schools have a supplemental essay about anything else you want the committee to know, or some other question that would lend itself to an essay about your problem and how you are in the process of solving it. That way schools would know that you have had some success with this bear and that you continue to work on it.

Obesity is a chronic disease. Being someone who is going to need to work hard to maintain a healthy weight and who can by empathetic as well as a role model for others who are struggling with the same chronic disease, as well as those with other chronic diseases with a lifestyle component, can be an effective "hook" on your application and in interviews. You aren't applying to be a patient but having walked a mile in "patient shoes" you know the struggles. Not everyone will respond to what worked for you but saying, "I know what you are going through, it isn't easy and relapses happen but I'm willing to help you on this journey" can go a long way.

 

[closer23]

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[LizzyM]

Far too many people get bariatric surgery who would be better served losing the weight the natural and safe way. Not to mention, they will come out as stronger people if they don't take the easy way out....

People who have a disease will be "stronger" if they don't take "the easy way"? Do you think having general anesthesia and a surgical procedure is "easy"? Do you think making a major change in behavior and having very negative consequences associated with back sliding into old habits is "easy"?

By stronger are you insinuating that people who are obese are weak and that obesity is a moral failing? Is obesity a sickness or a sin?

I already know the guidelines and I still believe bariatric surgery is becoming too normal.

Why should an effective treatment for a disease not become the standard of care for patient who meet the criteria for the treatment protocol?

If you aspire to a life in medicine, you are going to have to leave some of your moral judgments about patients at the door and recommend what evidence indicates is effective in the treatment of a patient's condition. If there are several effective treatments, you need to present the facts and guide the patient in making a decision that best meets their needs and reflects their values. (With the understanding that if you believe that a particular act is morally wrong, you are not obligated to participate.)

 

[236116]

If you aspire to a life in medicine, you are going to have to leave some of your moral judgments about patients at the door and recommend what evidence indicates is effective in the treatment of a patient's condition. If there are several effective treatments, you need to present the facts and guide the patient in making a decision that best meets their needs and reflects their values. (With the understanding that if you believe that a particular act is morally wrong, you are not obligated to participate.)

Ugh, thanks to the conscience rule, not anymore. Bastards.

 

[smq123]

I agree, which is why I called it an act of desperation. However, I believe far too many people who get bariatric surgery don't need it and would be much better served by losing the weight the natural and safe way.

Well, what does "safe and natural" really mean?

For some people who are morbidly obese, quick weight loss might be "safer" than having them slowly take off the weight one pound every other week.

Also, I would never recommend that someone should join Jenny Craig. And Atkins is one of the most ridiculous diets America has seen to such popularity. It deserves none of your defense...

- If you don't recommend Bariatric surgery, Atkins, OR Jenny Craig, what DO you recommend then?

- Atkins isn't the best or most sensible diet. But what I said STILL stands - if you give your patients information that is above their comprehension level, it won't help them AT ALL. At least they've heard of Atkins, and probably know someone who was on it.

Not to mention, they will come out as stronger people if they don't take the easy way out.

I would NOT characterize bariatric surgery as "the easy way out."

 

[closer23]

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[LizzyM]

Ugh, thanks to the conscience rule, not anymore. Bastards.

I don't see how the conscious rule can be construed to contradict what I said in the context of the treatment of obesity: "If you aspire to a life in medicine, you are going to have to leave some of your moral judgments about patients at the door and recommend what evidence indicates is effective in the treatment of a patient's condition. If there are several effective treatments, you need to present the facts and guide the patient in making a decision that best meets their needs and reflects their values."

Does the conscious rule applies to "moral judgements about patients"? I would argue that it does not; it applies to specific treatments or acts but not patients. I don't know of anyone who would apply the conscious rule to obesity treatment unless someone was asking for physician assisted suicide as a treatment option.

 

[pianola]

Where did you get this? I said that overcoming obesity the natural way would result in a stronger individual than overcoming obesity with help from a surgery. How could anyone be in disagreement with this?

YouTube bariatric surgery sometime. I remember watching this video of a woman who described in excruciating detail exactly what she had to eat and when following her surgery. She had to eat 5 small portions of very specific things that would only fit in a cup the size of her fist, otherwise she got violently, violently ill. She had to take all these different supplements and vitamins, too. Not to mention the scars.

I don't think there's ever an 'easy' way to lose 100 lbs or more.

 

[closer23]

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[LizzyM]

Bariatric surgery is considered the easy way out. If you don't agree with this, I don't know what to say. Those lifestyle changes are forced by the surgery. If the patient could make those changes on their own, they wouldn't need the surgery.



Where did you get this? I said that overcoming obesity the natural way would result in a stronger individual than overcoming obesity with help from a surgery. How could anyone be in disagreement with this?

Are people with type II diabetes (also known as non-insulin dependent diabetes or adult-onset diabetes -- although we're now diagnosing it in obese kids) stronger (better people) if they control their disease with diet alone rather than using a medication like metformin to bring blood sugar levels down to levels associated with optimal outcomes?

If you oppose proven medical and surgical treatments for conditions associated with significant morbidity and mortality because changing one's behavior is better and makes the sick person a stronger (better) person, I do think that you need to think about why you want to be associated with a profession that uses medication and surgery for the treatment of diseases caused by lifestyle (behavior).

I think that closer23 is confusing "clinically more effective" with "easier".

 

[closer23]

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[Lukkie]

far too many people undergo bariatric surgery who don't need it!

oh yeah? do you have a statistic to prove this?

 

[closer23]

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[LizzyM]

It's too subjective.

Precisely. You have an opinion that is unsubstantiated with evidence.

 

[pianola]

There isn't. However, as I said above, if overcoming obesity isn't any easier with bariatric surgery, why get it?

Well, you're basically choosing between several evils in choosing to get the surgery or not. On the one hand, if you're obese, you can choose to take the challenge to restrict portion sizes and eat more. The challenge will be in overcoming your natural instinct to eat the food that is in front of you.

On the other hand, if you get the surgery, your body will discipline you that "eating this food will make you very ill" -- vomiting, diarrhea, whatever -- but at the cost of your being forced to eat very specific things at very specific times. Your food choices are severely, severely limited for the rest of your life.

It's just a different set of challenges with the surgery, IMO. Maybe some people respond better to the latter challenge.

 

[closer23]

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[closer23]

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[Lukkie]

It's far too subjective. The effectiveness of bariatric surgery cannot be used as evidence unless it's compared to lifestyle changes in a wide study.

so until this study is done, you have no solid evidence to support your claims. and you are going off in this thread about how lifestyle changes are superior to these operations and medications, which may or may not be true, yet you spout them as truth.

 

[closer23]

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[236116]

Does the conscious rule applies to "moral judgements about patients"? I would argue that it does not; it applies to specific treatments or acts but not patients. I don't know of anyone who would apply the conscious rule to obesity treatment unless someone was asking for physician assisted suicide as a treatment option.

Lazy people will argue that they no longer have to check moral judgements, and thus can deny anything they want on the specious grounds of "morality" and no longer have to provide a referral elsewhere. Basically, you no longer have to do your duty to patients.

I can think of a few ways to do it.

 

[dahdah]

What a shocker. Pre-meds debating about what treatment is right for a person that is obese. Why don't you all read up on the literature that describes how obesity is treated in a clinical setting by an actual doctor.

 

[LizzyM]

You have an opinion that is unsubstantiated with evidence as well. Clearly bariatric surgery has been effective, but can you compare it's effectiveness against just lifestyle changes? No.

Patients don't get surgery unless they have failed to respond adequately to a trial of behavoral change. I'm going to need some time to dig out the clinical trial literature comparing bariatric surgery to other treatments.

As long as you continue to link illness with moral weakness, lack of discipline, and bad behavior, and blame the patients for their failure to heal themselves, you will be ineffective, and frustrated, as a medical professional.

 

[closer23]

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[jinx520]

I'm done for now. The majority of recent responses have simply twisted my words or exaggerated what I've said. This discussion is no longer of any use to me.

However, if someone posts something worthwhile (whether in agreement or disagreement), I'll consider replying.

closer, I do happen to agree with you somewhat as far as bariatric surgery being presented as the first-line solution. I am not privvy to what thought processes doctors go through to recommend the procedure to their patients. However, I have seen ads targeted to the patient that tout how wonderful this procedure is, "ask your doctor if it is right for you", etc.

This doesn't mean that DOCTORS are pushing the procedures on their patients any more than they usually are, though. It may mean that patients actually do ask their docs for the procedure in hopes that they don't have to diet. Are the patients lazy or unmotivated? Maybe, maybe not. It certainly reflects the mindset of the medical device manufacturers--more procedures, more profit, for them. Yes, I think we all agree that taking off the weight slowly and sensibly, utilizing smarter dietary choices and exercise, is the best course of action.

However, I think what others were trying to point out to you is not "the procedure should be a last resort". I think what they were trying to get you to see is that you can't just attribute a patient's failure to lose the weight sensibly to a "lack of will" and write them off. This is what I was talking about earlier--trying to meet the patient where they are. WHY do they have no will to lose weight sensibly? WHY have they tried every diet known to man and are only gaining weight? Do they have a metabolic imbalance? Are they clinically depressed? Do they endure rejection from their loved ones (also obese) when they take positive steps to address the issue (i.e. are they in a co-dependent relationship where food is the bonding agent)? Are they afraid of how their lives will be if they were to lose the weight? Are they unaware of how to implement these choices? I think it's safe to say that nobody WANTS to be ostracized and ridiculed b/c of their weight, but many people don't honestly know how to make weight loss happen. Or they do know but lack the proper coping strategies to deal with the emotional fallout of losing weight.

If I were obese and went in to my doc to ask if bariatric surgery was right for me 'cause I seen it on the TV, I would sincerely hope that my doctor was empathetic enough to explore what weight-loss methods I have already tried, and more importantly WHY they were ineffective in the past, and recommend some new strategies based on that information. And if bariatric surgery was the best treatment given my particular condition, recommend that. If, however, my doc gave off the vibe that he thought I was a fat, lazy cow and I was repulsive to him, even if he were to say the same exact things as in the first example, I would probably go home and eat 6 large pizzas to ease my depression. And never go back, and never try again.