It’s pretty rare that I read stuff on the Huffington Post… but this morning a link on Twitter from Dr. David Katz sent me to an item he wrote that was posted there. The article is called When Doctors Judge Their Obese Patients.
The article talks about a patient of his, who was obviously obese, had been avoiding seeing any doctor as much as possible because of the judgmental attitudes of pretty much all of them she had seen over the years.
As a former fat dude myself, there wasn’t a single point in my life since about high school where I wasn’t conscious of the fat that I was “overweight”. And in later years, despite the kind protests from friends and such about how I didn’t look “all that heavy”, I was painfully aware (both physically and emotionally) of my obesity.
Sure, there were brief periods here or there I could bolster up a sense of denial by avoiding mirrors, photographs, and the like. But really, at 300, 350… heck 380 pounds, did I need anyone to tell me my weight was a problem? No.
She avoided our kind like the plague because we had been that virulent in her life. Across an expanse of medical encounters for an array of reasons across a span of years, a whole battalion of us had abused her. We had treated her not as a patient, but as a fat patient.
I had one doctor about 20 years ago that I liked… I felt he did care about me as a person. We did discuss my weight as it was a likely reason for me being on blood pressure meds at the time and also played a role in my knee pain. I was under 300 then… and I think he was looking beyond my my weight he moved his practice and the doctors I saw over the next decade I never connected with.
Whatever her reason for seeking our care, whatever her acute need — we apparently never missed an opportunity to remind her that she was fat. And we made it plain: she was to blame.
That was what was sown in my patient’s medical history. What did we reap?
While I don’t think my interaction was as bad as what this woman experienced, it did play a role in my not seeing a physician as much as I should, including not being on medication for my blood pressure at times. Am I blaming those doctors for my reaching a massive weight of 380 pounds? No. But… (there’s always a but, no?) about 5 years ago I did go back to see a doctor… and I got lucky this time.
The prime directive of the medical profession is “first, do no harm.” In deriding patients for their struggle with weight, we are doing harm. In denying patients the compassion that was the hallmark of our profession long before the cutting edge of biomedical advance was quite so finely honed, we are doing harm. In driving patients away from the very services we are charged to provide them, we are doing harm — and violating our professional oath.
I found a doctor I connected with, Dr. Rosenstein. Despite the rush ‘em in, rush ‘em out type of care you get in general these days, I didn’t feel like just a number on a file to him. And while I would love to say he gave me idea to have weight loss surgery, or he gave me any other sort of eye-opening ideas on how to lose weight, he didn’t. But what he did do was give me a place, a person I could turn to with my questions as I was looking for my own answers. And when that search for me did turn to weight loss surgery, he was receptive, honest and above all encouraging as well as encouraged that I was ready to take some action.
I don’t see my doctor every three months like I used to, when I needed to get my bp meds refilled. In fact I haven’t been in to see him since my 1-year post-op checkup about a year ago, though I have bumped in to him a couple times outside the office (I’m frequently in the building where his office is), and he’s always shown genuine interest in how I’ve been doing and was very supportive of my decision to pursue a career in nutrition.
I think I’ve been doubly-lucky in that I found an equally great surgeon at the bariatric clinic Dr. Rosenstein recommended me to. Maybe it’s because I have done some volunteer work through the clinic that Dr. Johnson remembers me so well, but he too has been nothing but encouraging of my progress (both in my weight loss and current career goals), as well as truly grateful for my participation in the talks and such at the clinic.
To react to the largely unmet challenge of weight control in the modern world with judgment and blame helps no one; harms many; and redounds to our profession’s shame.
I’m not delusional, I know this is a business for him and I know with the thousands of patients he has had it would be near impossible for him to remember a lot of specifics on every single patient, but I truly believe his interest and concern and pride in the success of his patients is genuine.
Go read the entire article Dr. Katz wrote – maybe even share it with your own doctors. If you want to find out more about Dr. Katz, his website is davidkatzmd.com – and he is also the founder of the Turn the Tide Foundation – a group who’s vision is a future in which obesity is no longer a major cause of chronic disease, no longer epidemic, and no longer a threat to our children. A modern world in which eating well, being physically active, remaining lean and enjoying robust good health all lie along the path of least resistance, and are simply routine.
photo credit: adamci
That was a great article, read it yesterday. Brings back memories, and not good ones.
When I had knee injury number 3, my doc insisted that I go to her favorite ortho doc instead of mine. He is the best in the state so I agreed. He was not the nicest, but hey it was close to the holidays and I was at the end of the day. I made the mistake of asking him if a foot injury could be without pain for a few days and then hurt like hell. He sighed, ripped my tied tennis shoe off my foot making the comment that if I would just lose weight I wouldn’t be in there. For me, good thing it was the wrong foot, that would have killed me otherwise. Couldn’t get out of there fast enough! The receptionist asked me if I needed another appointment, and I told her I wouldn’t be seeing him again and hopped out on my crutches.
When people ask me about ortho docs, I make sure they know he is a jackass.
I’ve created a PDF document you can download, it’s a copy of the above article as well as Dr. Katz’s original article. Please feel free to download and print and give a copy to your own physicians or email to others to do the same.
I truly believe this is a message worth spreading.
And please feel free to share your own thoughts here in the comments.
Man is that ever so true! I’ve said before it’s almost as if when they tell you you’re fat you are supposed to be shocked and appalled that you hadn’t noticed this yourself! Like we don’t see! I still remember one particular doctor who just went off on me about having my ‘disease’ (asthma) out of control because of my weight and how my sandals that day were cute but they weren’t good for walking and exercise which is what I really needed! And no one had told me I even had asthma prior to that! Oh, and guess what? He wasn’t skinny!
I so agree! Up until recently, my doctors always did that. I FINALLY found one that didn’t a few years ago!
HOWEVER, my 10 year old also has weight issues and they NEVER miss a chance to lecture me. NEVER. I took him in because I thought he might have had whooping cough (we had an outbreak at school) and they talked MORE about his weight than the illness. I get so angry.
The worst part of it is that it makes my son feel TERRIBLE. He knows he is overweight, we know it. We are trying. BUT I hate it when he gets so upset about it.
My son was a big reason for my own decision to have surgery – I figure if I “fix” myself first, then I can work on him by being an example and an exercise buddy.
BTW – I am in the process of moving my son to my own doctor. Luckily she is a family practitioner so she can take kids. I really like the way she actually treats my problems, not just my weight.
Jen
If the doctors would focus on helping the obese to become less so instead of scolding and making them feel as if it is always just an issue of eating too much we might start to see the current tread turn. My husband and I both had doctors try to get us on depression meds when we were both MO and we rejected that idea because we did not think we needed them. They never bothered to talk to us enough to discover that we were self medicating with food, although they probably suspected as much. I can’t say that I would have agreed to take them but if they had explained to me that the depression they suspected was a contributing cause of my size and health issues it would have certainly made more of an impact, because I did not perceive myself as being so stressed I was depressed.
To me, someone depressed was one who was suicidal and I was not and had never been. It was not until the stress got too much too handle at work, I could not eat to deal with it, and I thought I was loosing my mind, that I sought help for it. Just two little pills a day, and things are not perfect, but the certainly are better and I am much more even keeled and more productive. I am not saying that that could have kept me from having to have WLS because by then I had too many other co-morbidities, but maybe I would not have gotten as heavy as I was or would have decided to do the WLS sooner.
Bottom line, they need to actually get to know their patients and try to help instead of summing them up in the first few minutes, labeling them as Obese and a lost cause and moving on to the next person in line.
I remember going to a gyn at 225 sitting in a too small paper dress and having all my concerns being dismissed b/c I was fat. I stared at the drs feet that were swelling out of her shoes. The next day I bought Nutrisystem She made me feel dirty and worthless
I once went to a Weight Loss Clinic where during the initial interview the elderly doctor actually reached over, smacked me on the hand and said, “Shame on you for doing this to yourself.” This from a man I came to for help.
He doesn’t know how close he came to being decked that day, but I told him off in no uncertain terms.
Thanks for posting this, Rob. I had a PCP for years that was a bodybuilder and into physical fitness. I was also very athletic in my youth and had remained active as I got older. But I kept gaining weight as the years rolled by. I would ask to try every latest thing (usually a new wonder drug) that came down the pike to help me lose weight. I would tell him, “All I need is something to give me a jumpstart”. He would always tell me, “You know what you should do” referring to diet and exercise. I actually did thank him, after the fact, for not giving me Phen-Phen and Redux when I asked for it.
Years later, I am going to the same practice but seeing a different PCP. When I first mentioned to him about weight loss surgery, he seemed supportive and encouraging. I could tell I was the first patient that had approached him about getting this procedure and that he was curious as to how this would pan out. I told him the surgeon that I wanted to use and he told me that he had written referrals for him, for many different reasons, and that he was an excellent surgeon.
Now, when I go to see him he is always smiling. He looks at my normal BP, my knees that don’t hurt anymore, my cholesterol which is now normal and my latest bloodwork labs which were great (except for some elevated liver enzymes) and shakes his head. He asks how I’m feeling and is genuinely happy when I tell him I feel great. He tells me that I look great and how amazing the transformation has been but he doesn’t really have to say anything. The look on his face is enough of a reward to me. Thanks to Dr. Scott Kuptsow for listening to me when I finally accepted the fact that food had been the controlling force in my life and helping me to follow this path to a more healthy lifestyle. I will forever be gratefu
Excellent article thanks for the link Rob
It made me think a little of Childhood obesity and our role as parents…..
This past weekend we were at a family wedding and Jessica’s cousin had a baby girl two weeks before Aidan so it’s always natural for them to compare notes etc…..
Now the little girl is a tad heavy and has just had to have some cavities filled on a trip to the dentist…..
She was amazed at how little Aidan ate and what he would and wouldn’t eat. Her child was chugging soda, downing cupcakes, fried chicken and demolishing MM’s like they were going out of style. Aidan had a little salad, cottage cheese, grilled chicken, water, half a banana and some Greek yogurt.
I’ve had similar experiences with the Moms at Aidan’s pre-school asking me how we get Aidan to eat “Healthy” food and not junk food….. At first I thought it was a trick question.
This is another hidden benefit from my WLS…. Aidan is not exposed to the crap I used put in my body before surgery. I shudder to think what he would be eating today if I had not changed my lifestyle and thus eliminated crap from our household.
Great article – it made me cry, actually, remembering the judgment from doctors in the past who didn’t know how to help me but sure wouldn’t stop telling me my obesity was causing much of my problem. No shit, sherlock. Help me figure out how to lose the weight – how NOT to be so out of control with food.
None of them even thought to study up. I had one doctor that I loved and who was compassionate – I broke down in his office once telling him of my many diets and struggles and seeming inability, no matter what, to lose the weight and keep it off. He gave me a big hug, patted me on the back, and prescribed me a pill – basically speed – called Adipex (in the streets it was a Speckled Bird when I was 19 and testing that stuff out). Because he just didn’t know what to do. Most doctors are ignorant of the addictive behavior, the metabolic issues, the insulin response. Seriously, it floors me. Hell, they’re still telling diabetics to eat lots of carbs, as long as they’re not in the form of pure sugar!
Scuse my language. This makes me so sad, because I feel like we have finally started to learn – and many medical doctors still don’t know the basics.
Rob, Thanks so much for posting this. I sat here reading it and just cried. I have always hated Dr’s just for this reason. I always felt stupid, ashamed and as Kierie said, dirty. I had one doc actually look at me and say, “really, you’re here for a sore throat? You should be here because you’re just fat”.
I was mortified and did not go to a doctor for three years after that because I was so scared and fat. I was lucky enough, like Burnett, to find someone who actually cared about me though as a patient. That is my current PCP. I owe my life to him because of his compassion and help. This article does need to be shared with all doctors. Thanks again.
This thread reminded me of when I went to Dr. Bernstein’s health and diet program. It was a “medically supervised” starvation diet.
For me, “medically supervised” meant that the doctor I saw once a week told me to tie a string on my finger to remind not to eat carbs and stay in ketosis. Then she corrected herself… “why don’t you tie the string on your mouth so you can’t eat.” I didn’t go back after that.
That’s why the phrase “Just look at you!” cuts me like a knife. It was said like, “How could you let yourself go like this?”
I was in my late teens, early 20′s when an OB/Gyn said this to me… after making me stand, facing him & the nurse with my paper gown hanging open. I was mortified!! He probably meant it in some warped sense of motivation but I’m sure he had no idea how much damage he did to me with those words. All these years later, I still remember the sting as if it happened yesterday.
The first dr I saw for my back said, “the x rays are clear, you just need to lose weight and get to the gym”. The 2nd dr did an MRI and found I had 4 herniated discs.
I was so mad that the first doc didn’t even do further tests and blamed it all on me. It’s sad to think of what could be missed in an examination room, because they don’t bother to look if you’re fat.