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Old 08-04-2017, 09:52 AM
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Default Physicians should no longer recommend weight lose

lol...https://www.yahoo.com/gma/research-s...-wellness.html

“Recommending different treatments for patients with the same condition based on their weight is unethical and a form of malpractice,” Chrisler said. “Research has shown that doctors repeatedly advise weight loss for fat patients while recommending CAT scans, blood work or physical therapy for other, average weight patients.”

If a doctor tells a patient to lose weight its no longer acceptable. How many billions of dollars are spent due to overweight individuals? Simply having a healthy diet could cut out so many medical issues yet society is now expected to accept overweight people and boost their self esteem.

Nothing but mainstream media at it again...trying to normalize something that is not healthy. Doctors now have to be politically correct and not give obese patients sound medical advise because it may hurt their feelings.
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Old 08-04-2017, 01:07 PM
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This certainly isn't new, and it's lunacy IMO.

Society has decided that we should ignore people's physical appearance and just love everybody for who they are and encourage them to love themselves as they are rather than making any effort to deal with the outrageous damage they are doing to their bodies every day.

I deal with this every single day in my medical practice. Quite honestly, it is one significant reason that I am leaving family practice next month after 24 years. Not only do patients no longer care about their weight, they get highly offended when I broach the topic. I'm sorry but when you are coming to see me because your knees hurt, your low back hurts, your sleep apnea is keeping you awake, your heartburn is worsening, or you are getting out of breath when you go up the stairs, it's insane to think I'm not going to mention the fact that you are 5-foot-6 and weigh 285 pounds. I guarantee you 100% that if you weighed 150 like you are supposed to, you wouldn't have any of those problems.

But no, it's no longer politically correct to tell people they need to lose weight. What is odd is that one of the "quality metrics" for which I and other doctors are tracked by the insurance companies is calculating and documenting every patient's BMI. What the hell is the point of doing that if we aren't going to do a damn thing to address it?

Sorry, but this is a huge pet peeve of mine.
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Old 08-04-2017, 01:14 PM
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Originally Posted by disneysteve View Post
This certainly isn't new, and it's lunacy IMO.

Society has decided that we should ignore people's physical appearance and just love everybody for who they are and encourage them to love themselves as they are rather than making any effort to deal with the outrageous damage they are doing to their bodies every day.

I deal with this every single day in my medical practice. Quite honestly, it is one significant reason that I am leaving family practice next month after 24 years. Not only do patients no longer care about their weight, they get highly offended when I broach the topic. I'm sorry but when you are coming to see me because your knees hurt, you low back hurts, your sleep apnea is keeping you awake, your heartburn is worsening, or you are getting out of breath when you go up the stairs, it's insane to think I'm not going to mention the fact that you are 5-foot-6 and weigh 285 pounds. I guarantee you 100% that if you weighed 150 like you are supposed to, you wouldn't have any of those problems.

But no, it's no longer politically correct to tell people they need to lose weight. What is odd is that one of the "quality metrics" for which I and other doctors are tracked by the insurance companies is calculating and documenting every patient's BMI. What the hell is the point of doing that if we aren't going to do a damn thing to address it?

Sorry, but this is a huge pet peeve of mine.
I'm glad you responded to this because it is BS. I'd venture to say an overweight person probably has different underlying factors to similar medical conditions than a person who is not overweight. There is more than one cause to back pain etc.
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Old 08-04-2017, 01:21 PM
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I'm glad you responded to this because it is BS. I'd venture to say an overweight person probably has different underlying factors to similar medical conditions than a person who is not overweight. There is more than one cause to back pain etc.
I'm not suggesting that we wouldn't work up and treat an obese patient differently. We're still going to order x-rays and MRIs and physical therapy and pulmonary function testing and EKGs and medication. The problem is we're fighting an uphill battle in most cases.

Look at the diabetes epidemic. As obesity increases, type 2 diabetes increases. The oral medications we have are less and less effective as people get more and more overweight, so more and more people are ending up on insulin. Insulin is very effective but one of it's major side effects is weight gain. So by having to resort to insulin to treat a disease that was caused by the patient's obesity, we're just further aggravating the problem. It becomes a vicious cycle.
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Old 08-05-2017, 02:20 PM
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Originally Posted by disneysteve View Post
This certainly isn't new, and it's lunacy IMO.

Society has decided that we should ignore people's physical appearance and just love everybody for who they are and encourage them to love themselves as they are rather than making any effort to deal with the outrageous damage they are doing to their bodies every day.

I deal with this every single day in my medical practice. Quite honestly, it is one significant reason that I am leaving family practice next month after 24 years. Not only do patients no longer care about their weight, they get highly offended when I broach the topic. I'm sorry but when you are coming to see me because your knees hurt, your low back hurts, your sleep apnea is keeping you awake, your heartburn is worsening, or you are getting out of breath when you go up the stairs, it's insane to think I'm not going to mention the fact that you are 5-foot-6 and weigh 285 pounds. I guarantee you 100% that if you weighed 150 like you are supposed to, you wouldn't have any of those problems.

But no, it's no longer politically correct to tell people they need to lose weight. What is odd is that one of the "quality metrics" for which I and other doctors are tracked by the insurance companies is calculating and documenting every patient's BMI. What the hell is the point of doing that if we aren't going to do a damn thing to address it?

Sorry, but this is a huge pet peeve of mine.
I totally understand what you're saying. But I'm on the other end of the equation, and I see a different scenario.

In the past 30 years, pretty much 99% of the time I've seen a doctor (admittedly, that's not a lot of times as I don't get sick) the treatment plan is "lose weight"--and nothing else. Doesn't matter what the complaint is--accident with maybe a broken bone, weird rash, scary lump--lose weight and it will fall off, heal up, grow back.

I was in a weird accident in 2011--my knee ended up going totally backwards (while it was twisted to the side.) I did finally get one x-ray (the physical therapist gasped and said "OMG you've torn almost everything in your knee" but I was assured by three doctors that it would be fine once I lost weight.

Yes, it would be nice if doctors would actually look at a problem without brushing it off as "you need to lose weight" and doing nothing.

I don't know what the percentage of "just lose weight" doctors are--but in a social group we were talking about that and it was a bit scary that so many of us hadn't really received any actual medical care for a long time because we never get past the "hello, here's a diet sheet, bye bye" office visits. One joked that someone could fall, have the bone actually sticking out of their arm and would be told "lose weight and it will go back in by itself."
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Old 08-05-2017, 04:52 PM
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I totally understand what you're saying. But I'm on the other end of the equation, and I see a different scenario.

In the past 30 years, pretty much 99% of the time I've seen a doctor (admittedly, that's not a lot of times as I don't get sick) the treatment plan is "lose weight"--and nothing else. Doesn't matter what the complaint is
Well that's certainly not right and shouldn't happen. I'm sorry to hear that it does.

Look, a high percentage of what I treat every day is self-induced in one way or another (obesity, smoking, drinking, unsafe sex, etc.). I do my best to treat people for what ails them but part of that treatment is and should be counseling them on what they should change to avoid having the same problem or an ongoing problem in the future. If you come in for a chronic cough, I'm going to talk to you about quitting smoking. If you come in for an STD, I'm going to tell you to start using condoms. If you come in for type 2 diabetes, I'm going to urge you to change your diet, lose weight, and increase your physical activity.

Treating the symptom without also addressing the underlying cause is not practicing good medicine and isn't doing the patients any favors.
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Old 08-05-2017, 07:00 PM
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Do you refer to a nutritionist if someone is overweight? I've found my primary doctors to lack nutritional knowledge. I think we need to get back to the root cause of disease, which is lack of nutrition, but my understanding is it isn't profitable for the health care (sick care) industry.
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Old 08-07-2017, 06:55 AM
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Unfortunately most doctors have very little knowledge on nutrition. People that do struggle with weight need to see a specialist. Yeah anyone can tell them to eat more salads, less pasta, less sugar, blah blah. Thats not knowing and understanding nutrition. Its a good starter for sure though.

I challenge anyone...next time you see your doctor and you have high blood pressure or they find you have high blood pressure...ask them what causes it. Guarantee 99.9% of them will say salt intake. Thats what everyone believes. Its complete and utter BS. Some moron did a study on rats in the 50's...gave the rats 50x the recommended amount of sodium and guess what...the rats had increased blood pressure (go figure.) That has stuck ever since. Dont believe me...just do a search yourself. This idea of daily salt intake is spiking your blood pressure is ridiculous yet its regurgitated over and over and over.

Same with high cholesterol and eating eggs. Another BS myth that people run their mouths about.

If you cant find a doctor that doesnt know these 2 then its time to find a new doctor. Maybe someone who is more up to date on current practices.

Look at the food pyramid diagram. The largest section is: bread, rice, potatoes, pasta and other starchy foods. "should be eaten with every meal."
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Old 08-07-2017, 07:53 AM
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Do you refer to a nutritionist if someone is overweight?
Sometimes. It depends on the patient. A patient needs to be ready to address the problem. Sadly, a great many patients not only aren't ready to lose weight, they don't even agree that they need to. I've actually had many patients come to see me asking how they can gain weight even though they are already severely obese.

I do my best to make them understand how dangerous their obesity is and all of the health problems it is causing or putting them at increased risk of developing but in their minds, the heavier they get, the better.

I haven't seen any formal studies to back this up, but my observation has been that as obesity has become the norm in this country, people have simply forgotten what normal is. I've even had obese parents bring in their non-obese child to find out what is wrong with him. It's sad and frustrating.
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Old 08-07-2017, 08:08 AM
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I challenge anyone...next time you see your doctor and you have high blood pressure or they find you have high blood pressure...ask them what causes it. Guarantee 99.9% of them will say salt intake.
I don't think that's true at all. I'm sure that your 99.9% of doctors are well aware that high blood pressure is a genetic disorder. Certainly diet and lifestyle can aggravate it, including being overweight, having a sedentary lifestyle, smoking, drinking too much alcohol, and yes, eating too much sodium. All of those things factor into the picture.
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Old 08-10-2017, 04:13 PM
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Interesting discussion and I don't know how I missed it. I know that part of my trouble with my AO and RA is my weight which I managed to put on over the space of the first 4 years I was married. I was active, had a job most of the time where I ran my tail off up and down the halls and about the only time I got to sit was for writing nurses notes and lucky times that I could get to the bathroom (yes, most nurses could use a catherter on shift!).

My hardest thing is my non-arthritis doctors that would like to see me on a diet that consists of food that takes prep which at this point in my life is very difficult to do. When I can barely stand for more than 2-3 minutes, it is hard to make a meal. And it doesn't help that I am always tired. But when the same person recommends the same thing each time I see them, it gets a bit old hat to tell them once again, that I can't do it. Funny thing, my arthritis doctors get it and just shake their heads at the other doctors. They can tell from the sort of person I am I would be doing what I could if I could. I can't afford a cook and not eligible for meals on wheels.

I due know that the excess weight truly effected my life in a bad way. As did the marriage as a whole. Believe me I don't want to be this big. I would love to take walks and was still taking them up to a few years ago. Today I barely made it to the mailbox and back and I wasn't sure if I was going to collapse or not before I got inside the front door. No one wants to live that way and that is for sure.

I am getting so tired of everything having to be so PC anymore it makes me sick. I do a lot of reviews and an author asked me to read and review her books. I hadn't read such a PC children's book before. In the classroom and equal mix of girls and boys, children of all colors, a child with two moms, etc. and I didn't recognize hardly any of the children's names as everyone seems to be making up their kids names now. You know what? All that PC nonsense took most of the interest out of the story. And the author never asked me to review another one of her books.

Anyhow, obese or not all of us are entitled to the best care anywhere. And controlling our weight is part of what the patient can do to help themselves.
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Old 08-12-2017, 09:58 PM
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I don't think that's true at all. I'm sure that your 99.9% of doctors are well aware that high blood pressure is a genetic disorder.
My Internist's recommendation was a blanket "reduce your sodium intake".
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Old 08-13-2017, 06:27 AM
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My Internist's recommendation was a blanket "reduce your sodium intake".
Was that all he/she said?

I absolutely tell all of my high blood pressure patients to reduce their sodium intake. That's serves a dual purpose since it is primarily processed foods that are high in sodium. If I can get them to start paying attention to sodium, they are likely to also reduce their fat and calorie intake in the process.

But I also counsel them to increase physical activity, stop smoking, drink less caffeine and alcohol, lose weight, and take their medication every day. Sodium is part of the problem but it's not the whole problem.
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Old 08-13-2017, 06:57 AM
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Reduce sodium intake is a bit vague. Reduce by how much? Doesn't one need to know how much they are consuming and then know a level to achieve to lower blood pressure.

I asked my doctor how to raise my Vitamin D levels, which are on the very low of normal despite walking outside for an hour a day without sunscreen. I was told to eat more cheese! Really? Like how much more cheese and for how long?
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Old 08-13-2017, 07:52 AM
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Reduce sodium intake is a bit vague. Reduce by how much? Doesn't one need to know how much they are consuming and then know a level to achieve to lower blood pressure.
The more specific and detailed instructions are, the less likely they are to be followed. At least that's the case in my patient population.

Americans consume way, way, way too much sodium, so I focus on pointing out common foods that are high in sodium to give them an idea of the sorts of things they need to reduce their intake of and what the healthier choices are that they should be eating more of.
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Old 08-13-2017, 08:50 AM
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Was that all he/she said?

[snip]

But I also counsel them to increase physical activity, stop smoking, drink less caffeine and alcohol, lose weight, and take their medication every day. Sodium is part of the problem but it's not the whole problem.
Yes, because we'd already talked about everything else you mentioned...
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Old 08-13-2017, 09:30 AM
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Yes, because we'd already talked about everything else you mentioned...
Sounds like all good advice.
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Old 08-13-2017, 01:16 PM
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The more specific and detailed instructions are, the less likely they are to be followed. At least that's the case in my patient population.
Wow! I sure don't want my physician to assume I can't handle detailed instructions. If I asked specifically how to make a change I should be able to get that information from them or be referred to someone who can.

I do understand that you likely know some of your patients well enough to know if they will follow through or not and would, of course, tailor your advice accordingly.
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Old 08-13-2017, 03:29 PM
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Wow! I sure don't want my physician to assume I can't handle detailed instructions. If I asked specifically how to make a change I should be able to get that information from them or be referred to someone who can.

I do understand that you likely know some of your patients well enough to know if they will follow through or not and would, of course, tailor your advice accordingly.
Agreed. You need to understand the patient population that I deal with. My office is in one of the poorest cities in America, very low education level, high levels of illiteracy, a great deal of drug and alcohol abuse as well as untreated mental health conditions, and huge socioeconomic challenges all around. It is also a "food desert" as far as easy access to nutritious foods. We do what we can and that often means taking baby steps and celebrating small victories. If I can get someone to cut back from smoking 2 packs a day to 1-1/2 packs a day, that's a win. If someone goes from drinking a 12-pack a night to a 6-pack, that's a win. If as a result of seeing me, they switch from putting salt on everything they cook to using Mrs. Dash, that's a win.

When I have a motivated patient, by all means I give them all of the information and support that I can, but those patients are few and far between.
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