Take a look at your abdomen.

[RustedFox]

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Take a look at your abdomen.
Is there more than six inches of abdominal adiposity?
Then lose weight.

Had another case last night where the abdomen exam was completely benign, yet there was free air all over the CT. Why? 9+ inches of adiposity. There's no getting thru that. Sure, you can think you're cool and clever and you can displace the abdominal fat and "really get a good peritoneal exam", but no you can't. Not without the patient wailing like a child because you touched their belly.

Seriously, Americans. That sound that you hear is the Europeans laughing at you. Watching the Olympics is sobering.
Wife's step-dad was a fresh-off-the-boat guy from Italy. He says: "You Americans eat like cows. The bread here is like birthday cake."

He's not wrong.
Slim down, America. It's your responsibility.

Yes, it is unpleasant.
Austerity breeds excellence.

Hit the gym. Bench 225. Stop eating fastfoodslop. Eat small and good. Make it yourself. It's not hard.

 

[Apollyon]

I can "pinch an inch", but I cannot "grab a slab" or "yank a yard". So IDK.

 

[RustedFox]

I can pinch two inches. You know what I'm talking about. I'm sick of simply opting out of an abdominal exam because fatty is just too fat.

The following isn't directed at you, bro; it's an extension of my above marching-orders:

Lose weight.
Stop smoking (everything).
Run a mile.
Bike a good bit.
Take out that effing stupid piercing.
Stop it.

If you say: "I have a sLeEp DisOrDeR", I ask you: What did you do to earn your sleep today?
If the answer is: "Nothing", then you know what to do.

 

[RustedFox]

I see all these kids on E-bikes these days.
Stop that nonsense.
Oil your chains and let your quads and glutes do the work.
Beat your kids if they complain.

 

[xaelia]

The following isn't directed at you, bro; it's an extension of my above marching-orders:

Take your GLP-1 ... forever.

 

[bravotwozero]

and keep losing muscle mass...forever.

 

[vm26]

Take a look at your abdomen.
Is there more than six inches of abdominal adiposity?
Then lose weight.

Had another case last night where the abdomen exam was completely benign, yet there was free air all over the CT. Why? 9+ inches of adiposity. There's no getting thru that. Sure, you can think you're cool and clever and you can displace the abdominal fat and "really get a good peritoneal exam", but no you can't. Not without the patient wailing like a child because you touched their belly.

Seriously, Americans. That sound that you hear is the Europeans laughing at you. Watching the Olympics is sobering.
Wife's step-dad was a fresh-off-the-boat guy from Italy. He says: "You Americans eat like cows. The bread here is like birthday cake."

He's not wrong.
Slim down, America. It's your responsibility.

Yes, it is unpleasant.
Austerity breeds excellence.

Hit the gym. Bench 225. Stop eating fastfoodslop. Eat small and good. Make it yourself. It's not hard.

Not sure how things are done internationally but kinda crazy that in the US, bariatric surgery-which dramatically alters ones anatomy, is a reimbursable acceptable routine surgery, just bc individuals cannot control what they consume.

 

[WhatJobDoIPick]

It's really not hard.

I'm not ripped by any stretch but I'm in good shape.

I run a few times a week lift a few times a week, don't eat ****.

I occasionally run long distance races with the goal of finishing, not for time.

I am terrified of being fat, especially as I approach my 40s with kids.

My goal is to beat my kid in a half marathon when I'm 50.

 

[Pinner Doc]

I’m a half marathoner, and my oldest started beating me in road races at age 11. That’s when I was 44. I’m not slow - he’s just quick and has not an oz of body fat. IME, the curve from when they go from needing to be coaxed to finish a race, to beating you handily, is steep!

 

[dozitgetchahi]

Take a look at your abdomen.
Is there more than six inches of abdominal adiposity?
Then lose weight.

Had another case last night where the abdomen exam was completely benign, yet there was free air all over the CT. Why? 9+ inches of adiposity. There's no getting thru that. Sure, you can think you're cool and clever and you can displace the abdominal fat and "really get a good peritoneal exam", but no you can't. Not without the patient wailing like a child because you touched their belly.

Seriously, Americans. That sound that you hear is the Europeans laughing at you. Watching the Olympics is sobering.
Wife's step-dad was a fresh-off-the-boat guy from Italy. He says: "You Americans eat like cows. The bread here is like birthday cake."

He's not wrong.
Slim down, America. It's your responsibility.

Yes, it is unpleasant.
Austerity breeds excellence.

Hit the gym. Bench 225. Stop eating fastfoodslop. Eat small and good. Make it yourself. It's not hard.

I’m Dozitgetchahi and I approve this message.

As a rheumatologist, I do the RAPID3 questionnaire on every patient I see at every visit. It’s a functional assessment originally validated for RA, but we have since validated it for a lot of other issues (including fibromyalgia).

One of the questions is this: “over the last week, were you able to walk two miles (or three kilometers) if you wish?”

I often hear responses like:

- I’ve never walked two mile in my entire life
- I have never “wished” to walk two miles
- I don’t think I could even walk one mile

Etc etc. And these aren’t people who have had severe joint damage from RA or something. They are mostly just obese lazy Americans who don’t care to change any aspect of their lifestyle whatsoever.

Step up, America.

If RFK and Trump decreed that every American present daily for 6am PT and exercise sessions, Soviet style, I actually would not be mad at that.

 

[Groove]

I've got a 78 year old neighbor who is like the Lance Armstrong of my neighborhood and bikes 5 days a week, usually 24-30 miles. He just kicked my ass a couple days ago. I went 22 and told him I was done so of course he had to peel off and do 2 more miles to show me how it's done. The guy has super impressive genetics. I don't think he has any idea that most people his age can't do that stuff. He's done several 100 mile races which I have no interest in doing. Hell, I can barely feel my ass after 20 miles.

 

[bravotwozero]

I majored in physical education before med school, so this topic is near and dear to me.

here's the thing I dont know if these people don't know, or understand but don't care:
You don't have to even exercise to not look like the michelin tire man. Just stop eating so much ultra high calorie food! Everyone's gotta eat sometime, so it's not like this takes up more time and money.

food that is very high calorie + very tasty + low satiety = obesogenic recipe for disaster

I'm not going to absolve people of personal responsibility. That said, I do think the deck is stacked against people in a lot of ways:

- Readily available, cheap ultra processed food (see above)
-Massive suburban sprawl with lack of bikeable/walkable infrastructure. Can't walk to the grocery store or anywhere with purpose. In the South, too hot to even want to do that 8 months out of the year.

These things are not insurmountable, but you have to take active countermeasures, like making time for exercise, getting a gym membership/home gym, home meal prep/calorie counting apps.

But like I said, it's up to the person to take responsibility. At the very least, everyone now has chat gpt and can type in 'how do I stop looking like the michelin tire man'. I have people in my own family like this unfortunately. They're all educated, some physicians themselves. They all have the time and resources to figure this out and get it done.

 

[AlmostAnMD]

Obesogenic

Quality scrabble word there

 

[sloh]

- Readily available, cheap ultra processed food (see above)

Ubereats, doordash, and even Costco are a high calorie minefield these days.

 

[CajunMedic]

Current Fitness Status: You can tell I work out, but you can also tell that I don't say no when someone offers me a cookie.

My biggest problem is my diet. I kill myself in the gym, but leave and go straight to McDonald's. I eat like crap on shift, especially when I'm at the freestanding. Every time I have successfully lost a bunch of weight, all it took was portion control and exercise.

I constantly utter the words: "Please dear God, don't let me get like that", when I come out of rooms with these doughy patients, not that older than me, with the laundry list of meds and co-morbidities.

 

[WhatJobDoIPick]

Ubereats, doordash, and even Costco are a high calorie minefield these days.

Eggs, avocados, chicken are all cheap. Your body knows what to do with these things. It's doesn't know what to do with Doritos and little debbies

 

[sloh]

Eggs, avocados, chicken are all cheap. Your body knows what to do with these things. It's doesn't know what to do with Doritos and little debbies

Gotta stay on the perimeter of grocery stores

 

[Groove]

Alright, time to hit the Peloton + home gym + shoulders/arms and then I'm gonna uber eats a burger and fries. I always order a second one for my dogs (spoiled). Then I'm gonna play Arc Raiders. I love days off!

 

[AlmostAnMD]

I am literally in the best shape of my 4 decades of life

Hit 425 on bench 6 months ago but sidelined with a shoulder issue, not surprising given I was 40 benching 425

Dangerously close to having abs for the first time in my life

Hit gym 5 days a week with good cardio mix. I was doing that back when I was in EM too but getting out of shift work for more predictable schedule with more time for proper meals made a 300% difference.

Before I left EM I was down to 8 shifts/month so it wasn't like I was even working that much but it was enough to not be consistent

 

[Groove]

I am literally in the best shape of my 4 decades of life

Hit 425 on bench 6 months ago but sidelined with a shoulder issue, not surprising given I was 40 benching 425

Dangerously close to having abs for the first time in my life

Hit gym 5 days a week with good cardio mix. I was doing that back when I was in EM too but getting out of shift work for more predictable schedule with more time for proper meals made a 300% difference.

Before I left EM I was down to 8 shifts/month so it wasn't like I was even working that much but it was enough to not be consistent

Dude...that's fricken heavy weight, damn. I think the most I ever lifted was 325 20 years ago but too many injuries over the years and so I don't lift heavy anymore. I feel like I always have a smoldering shoulder tendinopathy that I have to be careful not to flare. I love getting older!

 

[bravotwozero]

Current Fitness Status: You can tell I work out, but you can also tell that I don't say no when someone offers me a cookie.

My biggest problem is my diet. I kill myself in the gym, but leave and go straight to McDonald's. I eat like crap on shift, especially when I'm at the freestanding. Every time I have successfully lost a bunch of weight, all it took was portion control and exercise.

I constantly utter the words: "Please dear God, don't let me get like that", when I come out of rooms with these doughy patients, not that older than me, with the laundry list of meds and co-morbidities.

Planning issue.

I know someone just mentioned Costco, which I am a huge fan of. If you shop there, then you know they've got ready made meals, that come complete with calorie information; many are pretty decent calorie wise. All you have to do is stick them in a microwave/oven/air fryer etc, and every ED has at least a microwave.

Bonus points if you download a calorie counting app with a barcode scanner - I use macrofactors. Some of them are even incorporating AI, where you can snap a picture of your plate of food with a description, and it will calculate the calories/macros it has (accuracy varies).

 

[AlmostAnMD]

Dude...that's fricken heavy weight, damn. I think the most I ever lifted was 325 20 years ago but too many injuries over the years and so I don't lift heavy anymore. I feel like I always have a smoldering shoulder tendinopathy that I have to be careful not to flare. I love getting older!

Same

Still not 100% from previous injury so 400+ might be a memory now

We'll see

Sucks so much ass to actually just randomly feel pain waking up

Aging is a bitch

 

[Groove]

Recovery def better on TRT though.

 

[BoardingDoc]

Spent yesterday and today skiing. Doing the same every day for the next week for school vacation week. Jumping off of cliffs in the woods or flying down a hill at 60mph is my favorite high risk high reward form of exercise.

I have tried to keep it below 50 lately to keep my wife from complaining.

 

[WhatJobDoIPick]

Spent yesterday and today skiing. Doing the same every day for the next week for school vacation week. Jumping off of cliffs in the woods or flying down a hill at 60mph is my favorite high risk high reward form of exercise.

I have tried to keep it below 50 lately to keep my wife from complaining.

When i go 40 I feel like I'm on a rocket

 

[JacobMcCandles]

Hit 425 on bench 6 months ago but sidelined with a shoulder issue, not surprising given I was 40 benching 425

Doing any kind of one rep max in bench after about the age of 35 is just asking for trouble. It’s just a matter of when and not if.

 

[AlmostAnMD]

Doing any kind of one rep max in bench after about the age of 35 is just asking for trouble. It’s just a matter of when and not if.

Look man

Bench is my heroin

I can't stop

I 100% know you're right

I know my arm might fall off

But I literally can't stop

It's the only activity that brings me peace, which was clearly evident by how goddam strong I got when I was in em

Edit for further context: my ortho basically told me I'm an idiot and I told him stfu and fix my shoulder. BENCH IS CALLING

 

[eyeeye_captain]

Doing any kind of one rep max in bench after about the age of 35 is just asking for trouble. It’s just a matter of when and not if.

No kidding. Before big knee and shoulder injuries in college, I was respectable for a non-power athlete. 1.5x body weight bench, 2x squat (wimpy overall, I know). I’d love to do more Olympic stuff but I can’t afford the risk, especially with my knee.

At least I’m only 10 pounds over my peak competitive weight. And let’s be honest, when was the last time you saw a jacked ophthalmologist?

 

[VA Hopeful Dr]

when was the last time you saw a jacked ophthalmologist?

Good question

 

[eyeeye_captain]

Good question

That is as the eye gods willed it my friend. I merely follow the rules on high

 

[CajunMedic]

Look man

Bench is my heroin

I can't stop

I 100% know you're right

I know my arm might fall off

But I literally can't stop

It's the only activity that brings me peace, which was clearly evident by how goddam strong I got when I was in em

Edit for further context: my ortho basically told me I'm an idiot and I told him stfu and fix my shoulder. BENCH IS CALLING

That's me and Brazilian Jiu-Jitsu. I'm fixing to ask for permanent days off to be able to train consistently. It's the only time I can turn my brain completely off and strictly focus on the task at hand.

 

[thegenius]

Not sure how things are done internationally but kinda crazy that in the US, bariatric surgery-which dramatically alters ones anatomy, is a reimbursable acceptable routine surgery, just bc individuals cannot control what they consume.

It's terrible, and I think the issue is all the downstream health consequences of obesity that cost the system 25-50x the surgery over the pt's lifetime.

Spend 25K for the surgery when you are 30 years old. Or spend 2M over the lifetime of the patient because they are fat and get heart disease, stroke, bad joints, etc.

Sad

Our insurance model should charge you extra $$$ the more fat you are. For every 3 points in BMI above 30, you pay and extra 20%.
People would STILL not lose weight though, they would drop their insurance, go to Popeyes and stick it to THE MAN, and then go to the ER on medicaid for free when they have a medical problem.

 

[sloh]

Doing any kind of one rep max in bench after about the age of 35 is just asking for trouble. It’s just a matter of when and not if.

Used to compete in bodybuilding and I’ve seen way too many pec tears with the flat barbell bench to even keep that exercise in my routine. You EM docs def are ballsy haha. Whenever I think about snow sports like skiing I think about the risk of an ACL tear. No leg training for me if that happens (belt squat is goated Btw. No axial loading so very safe for low back, easy to sink deep down hamstrings touching calves)

 

[JacobMcCandles]

Used to compete in bodybuilding and I’ve seen way too many pec tears with the flat barbell bench to even keep that exercise in my routine. You EM docs def are ballsy haha. Whenever I think about snow sports like skiing I think about the risk of an ACL tear. No leg training for me if that happens (belt squat is goated Btw. No axial loading so very safe for low back, easy to sink deep down hamstrings touching calves)

I agree but I still do bench. I just do a weight where I can do 3 sets in the 6-10 rep range and not feel like it's going to kill me. I agree on squats and think deadlift is important as we age, too. I think the most important thing is that you aren't absolutely pushing yourself to the limit on those. Once you get into the 35+ age range there's really not much of a reason to unless you just really, really want to get injured. Besides strength training, I do think leaning out as you get older might be the most important. It seems like most guys as they age really get into the TRT replacement stuff, trying to set new PBs in the bench, etc. and just end up adding mass (i.e. mostly fat) and that is fairly counterintuitive to becoming as healthy as you can be.

 

[bravotwozero]

Too many people snack. Not a good idea, especially for adults. We've all seen it too, guy munchin on cheetos while complaining about his belly hurting.

if you're a grown @SS Man/woman, there's absolutely no need to be snacking when you're already eating 3 squares a day. I'm pretty sure a ton of people would lose weight just by cutting out snacks.

 

[Groove]

 

[Groove]

It’s leg day and I hate leg day.

 

[I'dPitThat]

Too many people snack. Not a good idea, especially for adults. We've all seen it too, guy munchin on cheetos while complaining about his belly hurting.

if you're a grown @SS Man/woman, there's absolutely no need to be snacking when you're already eating 3 squares a day. I'm pretty sure a ton of people would lose weight just by cutting out snacks.

What is this nonsense? I need at least 6 meals per day plus snacks.

 

[TooMuchResearch]

It’s leg day and I hate leg day.

Maybe it would be better if you liked it? I found myself with some extra time this week so tweaked my plan a bit to do PPLUL. Typically do ULUL but since schedule is weird and life gets in the way don't always get 4 per week.

 

[RustedFox]

Maybe it would be better if you liked it? I found myself with some extra time this week so tweaked my plan a bit to do PPLUL. Typically do ULUL but since schedule is weird and life gets in the way don't always get 4 per week.

What are these acronyms?

 

[gutonc]

What are these acronyms?

Push/Pull/Upper/Lower/Upper/Lower

 

[Apollyon]

Push/Pull/Upper/Lower/Upper/Lower

Isn't that the KONAMI code?

 

[bravotwozero]

If RFK and Trump decreed that every American present daily for 6am PT and exercise sessions, Soviet style, I actually would not be mad at that.

Have you seen that old video on youtube that talked about the fitness standards JFK was aiming for in High schoolers? Less than 1% of the population could do that now, if that. I'll try to see if I can dig that up

 

[TooMuchResearch]

What are these acronyms?

Just splits.
This week I find myself with more time, I've decided to do 5 days of resistance training, split into: push, pull, lower, upper, lower. The isolated upper body push or pull days are a little less efficient but let me get some extra sets in.
More typical for me is upper / lower / upper / lower and generally have two upper and two lower body workouts that progress independent of the other.

 

[dozitgetchahi]

Have you seen that old video on youtube that talked about the fitness standards JFK was aiming for in High schoolers? Less than 1% of the population could do that now, if that. I'll try to see if I can dig that up

I do remember when he and Hegseth did that Marines “fitness challenge” where he told America to go do 100 pull ups and 50 push ups in 10 minutes or less.

I was like “bro, if you could get the average American to do one unassisted pull-up…that would be a huge increase in the average American’s fitness level…”

 

[FrustratedFamDoc]

generations of worsening obesity have normalized this ish. Diabetes management and damn near miraculous revascularization techniques have made it possible for what is at least 30% of our population to now live past 40.

 

[VA Hopeful Dr]

generations of worsening obesity have normalized this ish. Diabetes management and damn near miraculous revascularization techniques have made it possible for what is at least 30% of our population to now live past 40.

And keep most of us employed...

 

[AlmostAnMD]

yeah, I've heard that argument

I've told anyone that will listen I would have been more tempted to stay in EM if I only saw sick people

Literal sick people were like 1/5 of the patient volume but probably encompass > half of the billing (vs "my arm hurts for 5 months" BS)

So would I take a 50%-ish pay cut for significantly lower volume and consistently sicker people needing hospital care?

Hell yeah, I would. But it's an obscure hypothetical, so I left lol

 

[Apollyon]

I do remember when he and Hegseth did that Marines “fitness challenge” where he told America to go do 100 pull ups and 50 push ups in 10 minutes or less.

I was like “bro, if you could get the average American to do one unassisted pull-up…that would be a huge increase in the average American’s fitness level…”

I went to a military college, and, the record number of pull ups was 37, and that was by a cadet that was later a Green Beret. These guys would routinely score 400+ points on the PFT (physical fitness test), with the score extrapolated up (it officially only went to 300). 50 push ups is much more reasonable.

 

[Ceke2002]

Not sure how things are done internationally but kinda crazy that in the US, bariatric surgery-which dramatically alters ones anatomy, is a reimbursable acceptable routine surgery, just bc individuals cannot control what they consume.

I think some people, more so these days, tend to see it bariatric surgery as a 'quick fix' as well. I've personally only known two people who underwent bariatric surgery, and both of those were extreme cases where all other options had failed (diet, therapy, medicinal, etc). It worked out well for one of them, although still a lengthy recovery and massive life adjustment. The other one ended badly (she was our neighbour across the street). It was back in the 1970s, so the surgery was probably riskier back then (?). She got through the initial surgery okay: then came home from hospital and collapsed and died in her bathroom. Middle of a heatwave too and she wasn't found for several days. Small child me was utterly fascinated watching these people turning up in strange white suits and face masks, wasn't until much later I actually understood why they were geared up like that.

Just my layperson's opinion, but I do think bariatric surgery should be reserved for a last resort type situation.

I did also have some former ED support group friends with BED (morbid/super morbidly obese) who did really well on a high protein, low carb keto diet (medically supervised) in terms of symptoms and weight loss. So there are things besides surgery that can work, obviously (I'm preaching to the choir here).