Got a request from Ted to talk about this story:
http://www.washingtonpost.com/wp-dyn/content/article/2008/01/25/AR2008012502926.html?referrer=emailarticle
Basically, it's about obese people's experiences getting poor medical care due to MDs' stigmatization.
I guess my first thought is that patients get stigmatized for addictions of all kinds and eating addiction (which I would argue is the root of most obesity) on average probably gets MORE sympathetic treatment than other addictions. But of course, that doesn't justify prejudging people and compromising their medical care.
The issue of behavior influencing medical conditions is a huge one for physicians. We want patients to follow our instructions and be flawless. REalisitically, I don't think we can get rid of this desire; the best we can do is be aware of these expectations and supress negative transference of our judgments. The bottom line is, the patient pays us for a service and being disrespectful, judgmental and dismissive is not good service. Education, of course, and acknowleding the patient's ambivalence towards making change probably goes a lot further.
And this is not to say I don't struggle with being judgmental of my patients.
I am curious to know what 'medical condition' is predisposing people to obesity (see the article). I have a feeling the 'experts' may be referring to metabolic syndrome which of course is more of an effect, rather than cause of obesity.
12 comments:
Obesity is simply the imbalance between calorie intake and expenditure. A very very small fraction of people may have a "glandular" problem (hypothyroidism). But, if that was the cause of obesity, then obesity would be virtually extinct because hypothyroidism is easy to screen for and easy to treat.
"Part of the problem is that primary care physicians don't really have a lot to offer [to obese] patients," said Arthur Frank, medical director of George Washington University's Weight Management Program. The standard advice to eat less and exercise more isn't very helpful to obese individuals, some of whom are increasingly believed to suffer from a metabolic disorder rather than a failure of will, he said.
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this is the quote. I doubt this guy is referring to hypothyroidism so I'm curious to know what he's talking about.
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As for the addiction question, obese people continue to compulsively pursue their calorie imbalance despite negative social and physical consequences. This is the definition of addiction.
thanks for humoring me with the blog entry. never thought of obesity as a result of addiction, but makes sense. indeed, it might have helped the article to analyze it as such, because the complexities of addiction are what i think the author is driving at. so, from the author's perspective, for a doctor to simply prescribe less calories and more exercise is easier said than done -- even for the non-obese -- and such a prescription is obtuse to the psychological issues of an addict. the counterargument, is, of course, that overcoming obesity (or its negative effects) is not easy, and psycho-babble notwithstanding, the best treatment is for you to get healthy and into shape...
What about the leptin theories and inability to be sated? That would probably count as a metabolic disorder, no?
yeah, what's the latest on the leptin stuff? I heard a lot about that in residency and then it disappeared probably because now I don't learn about or read anything that doesn't involve oxycontin.
interesting point Ted. There is a school of thought that says acknowledging ambivalence/ exploring with the patient reasons why they WANT to keep eating/snorting oxycontin actually engages them in treatment. And insight=power to change. On the other hand, if not done correctly, it may come off as accepting/normalizing/enabling such behavior and the goal message (STOP!) may get lost. Especially if they have no insurance and can't come for follow up.
I wonder if anyone has lost huge amounts of weight via hypnosis...Anyone believe in that stuff?
I believe in hypnosis. I overcame my intense fear of eyeballs by hypnosis. I didn't completely "overcome" it but I have not passed out when confronted with an eye since I was hypnotized 8 years ago. Birds are next.
Hypnosis as a cure for fear of birds, not hypnotizing birds to lose weight.
-ED.
Apparently, Matt Damon and Ben Affleck have overcome smoking through hypnosis. Some folks swear by it.
BTW, speaking of overcoming addictions, last night's SB was so traumatic and disillusioning, I have given up watching sports. Really.
ted - I can see traumatized but why disillusioned? did you think the Pats lacked heart (I don't -- just wondering)? or just that empty feeling of caring so much about something that kicks you in the nuts and you're powerless to change (See Baltimore Orioles 1998 to present)
It's the getting kicked in the nuts part that did me in. Getting so close to 19-0 -- something that may never happen again by any team - and then having that chance disappear in 90 seconds, just killed me. I feel a bit like Al Gore after the 2000 election -- want to go into eternal hibernation, grow a beard, and focus on other hobbies.
TK -- we'll keep our eyes peeled for the Inconvenient Truth II -- the story of an aging linebacking corps who held it together for an 18.75 win season.
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