IMHO, and not being a doctor or even in the medical field, I think obesity is America’s #1 health problem. Every time I’m in the doctor’s office, every time, I’m the only non-fat person. Now imagine the doctor’s experience. “Fat people keep coming in with problems and I can’t figure it out!” I can see how they get blinded after awhile.
Another thing I’ve noted, next time you see someone in a leg cast, they won’t be skinny unless they’re obviously a teenage athlete. You won’t be able to unsee it.
So I can’t blame docs for wanting to eliminate the issue before them. I feel ya though. I’m a functioning alcoholic. Try getting treated for anything once you admit that.
“Doc, I’ve been drinking a 12-pack of light beer a day for 20-years, this symptom is completely new.”
“Have you thought about cutting down?”
🙄
I’ll leave you with this thought: Installing satellite for a little old preacher man in South Chicago,
“Shalafi, you ever hear the term ‘little old man’ or ‘little old lady’?”
“Of course.”
“Why you think that is?”
Funny enough for a preacher, his take was that we didn’t evolve to be tall or fat and our bodies can’t handle it into old age. 25-years later, that’s still a compelling take.
We little old ladies are little because we shrink, honey. I don’t even have osteoporosis (yay) and I have excellent posture, but I’ve already lost an inch.
I’ve discovered that when you’re old they start measuring again, like when you were a kid. And they replace “When was your last period?” with “Have you had any falls?”
(From now on, my reply to that one is going to be “I refuse to answer on the grounds it will jinx me,” because I said No and then tripped in the middle of crossing the street the next day.)
I brought spinal compression up in that interesting conversation! But as we both agreed, it’s more than that. How many truly tall or truly large people you know in their 70s or 80s?
Anecdotally, the only large elderly person I ever knew was great-grandpa. I suspect he looked like the barrel-chested gangster in “Last Man Standing”. :) He could barely walk in his 70s, BUT, made it to his mid-90s in bed. (Weirdly enough, I cannot find a pic of that actor!)
Obesity has a lot of social factors to it, too. The only cheap food is junk food, you have to drive everywhere, and your job is sedentary, and you don’t have money to play hockey… I mean, there’s a lot that goes into it. Making everything an individual medical issue is bad policy.
Have a little (or a lot of meat) on your bones is protective for bone breaks for people with osteoporosis, so you might see some leg casts on old skinny people.
But the main thing is, yes, to do a thorough workup and not stop at the first and most obvious possible cause of a symptom. The second thing to do is recognize that the person probably is a) aware of the problem and b) has all the same information you have. I’ve never been surprised by what a doctor told me, neither that I was overweight, or that I change change my diet, or that I should get more exercise. So why waste that time and also endanger the relationship with that?
I think nowadays at least we have GLP-1, which I’ve got some doubts on, but at least it’s something that’s more likely to work than Another Diet.
The problem is the doctor is a doctor. It’s the same with psychologists, the patients are depressed because their life is depressing, but the only thing the shrink can do about it is try and get them to feel better.
The psychologist isn’t making the patient the problem, simply, changing the material conditions is beyond the scope. If the patient is suicidal because they’re broke, you, as a doctor, can’t prescribe them more money. The best you can do is get them to cope with being broke, and try and put them into a mindset that will enable them to try and stop being broke. The alternative is to tell the patient “well, you’re fucked” and leave.
Likewise, if a patient has a weight problem because they live in a food desert, you, can’t follow them around and control what they eat. All you can do is give them meds for the immediate symptoms, and try and get them to make an effort to lose weight.
IMHO, and not being a doctor or even in the medical field, I think obesity is America’s #1 health problem. Every time I’m in the doctor’s office, every time, I’m the only non-fat person. Now imagine the doctor’s experience. “Fat people keep coming in with problems and I can’t figure it out!” I can see how they get blinded after awhile.
Another thing I’ve noted, next time you see someone in a leg cast, they won’t be skinny unless they’re obviously a teenage athlete. You won’t be able to unsee it.
So I can’t blame docs for wanting to eliminate the issue before them. I feel ya though. I’m a functioning alcoholic. Try getting treated for anything once you admit that.
“Doc, I’ve been drinking a 12-pack of light beer a day for 20-years, this symptom is completely new.”
“Have you thought about cutting down?”
🙄
I’ll leave you with this thought: Installing satellite for a little old preacher man in South Chicago,
“Shalafi, you ever hear the term ‘little old man’ or ‘little old lady’?”
“Of course.”
“Why you think that is?”
Funny enough for a preacher, his take was that we didn’t evolve to be tall or fat and our bodies can’t handle it into old age. 25-years later, that’s still a compelling take.
We little old ladies are little because we shrink, honey. I don’t even have osteoporosis (yay) and I have excellent posture, but I’ve already lost an inch.
I’ve discovered that when you’re old they start measuring again, like when you were a kid. And they replace “When was your last period?” with “Have you had any falls?”
(From now on, my reply to that one is going to be “I refuse to answer on the grounds it will jinx me,” because I said No and then tripped in the middle of crossing the street the next day.)
I brought spinal compression up in that interesting conversation! But as we both agreed, it’s more than that. How many truly tall or truly large people you know in their 70s or 80s?
Anecdotally, the only large elderly person I ever knew was great-grandpa. I suspect he looked like the barrel-chested gangster in “Last Man Standing”. :) He could barely walk in his 70s, BUT, made it to his mid-90s in bed. (Weirdly enough, I cannot find a pic of that actor!)
Most of my dad’s brothers. Anecdotally, that’s about 10 men right there.
Obesity has a lot of social factors to it, too. The only cheap food is junk food, you have to drive everywhere, and your job is sedentary, and you don’t have money to play hockey… I mean, there’s a lot that goes into it. Making everything an individual medical issue is bad policy.
Have a little (or a lot of meat) on your bones is protective for bone breaks for people with osteoporosis, so you might see some leg casts on old skinny people.
But the main thing is, yes, to do a thorough workup and not stop at the first and most obvious possible cause of a symptom. The second thing to do is recognize that the person probably is a) aware of the problem and b) has all the same information you have. I’ve never been surprised by what a doctor told me, neither that I was overweight, or that I change change my diet, or that I should get more exercise. So why waste that time and also endanger the relationship with that?
I think nowadays at least we have GLP-1, which I’ve got some doubts on, but at least it’s something that’s more likely to work than Another Diet.
The problem is the doctor is a doctor. It’s the same with psychologists, the patients are depressed because their life is depressing, but the only thing the shrink can do about it is try and get them to feel better.
By making the problem the patient and not their life, the psychologist is actively doing harm.
But the result is that the psychologists has clients, so the psychologist gets paid, and from that comes a whole host of emotional justifications.
The psychologist isn’t making the patient the problem, simply, changing the material conditions is beyond the scope. If the patient is suicidal because they’re broke, you, as a doctor, can’t prescribe them more money. The best you can do is get them to cope with being broke, and try and put them into a mindset that will enable them to try and stop being broke. The alternative is to tell the patient “well, you’re fucked” and leave.
Likewise, if a patient has a weight problem because they live in a food desert, you, can’t follow them around and control what they eat. All you can do is give them meds for the immediate symptoms, and try and get them to make an effort to lose weight.