We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
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Wednesday, August 2. 2006
To a Fat Lady Seen From the Train
Our editor asked me to comment on Dr. Helen's piece on fat people. As a doctor, I tend to be a "Do as I say, not as I do" sort of guy. I smoke cigars and I am pleasantly, or some might say prosperously, or some might say, grandfatherly, well-fed.
When patients of mine are seriously overweight, I tell them straight out. The word fat does not bother me. I have a model in the waiting room of five pounds of adipose tissue designed to get a reaction. It is disgusting.
As someone who did my share of general surgery earlier in my career, I can tell you that fishing through gallons of yellow adiposity, getting your gloves so greasy you cannot hold the scalpel, is no damn fun. If you are fat, and saw what you look like under the skin, you would be horrified.
Another complication recently published is that obesity makes it more difficult to make a diagnosis. It's called "study or exam limited by body habitus."
However, I also understand that the flesh is weak, and that staying in youthful shape after 45 is no mean feat. It takes work and discipline, and the evidence that it leads to longevity or health is minimal. However, being in good shape adds a lot to quality of life. On the other hand, being obsessed with health is for the crazies.
Plus there is the vanity factor: few guys will look at a fat girl, and no gals will look at a fat guy - unless he is rich or powerful. But, at some point, unless we are narcissists, we accept reality and don't care all that much.
Final word: If you are too fat, I will say that. And, if you care, I will tell you how to deal with it. But your life choices are not my problem, beyond that: your doctor is not your Momma, nor is he/she responsible for your health. Your health is in your hands, and God's, and nature's. My only responsibility is to give you advice as your friend, and to try to help you when you get sick.
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Maybe I've spent too much time in the military, but I just cannot accept the idea of going through life as a fattie. I don't want to look disgusting or deal with the diminished physical and sexual capabilities. I’m lucky to have a wife who feels the same way.
I'm not obsessed with fitness - I just do my daily exercise (sometimes just a long walk) and move on to other things. I had to reluctantly accept that I’d never again be as lean or have the endurance I did in my early 20’s while an active duty Marine.
Why other people are willing to accept life as fatties is beyond me.
Some folks are quite comfortable with it. Go to Disneyworld sometime to watch them - thousands of happy fatties, in the sun.
While many of your patients might like your honesty.. meaning that you at least say you're thinking they're fat rather than keeping silent and having your patients know that its the elephant in the room.
As a "fatty".. I do have a bone to pick with doctors who look at a persons exterior and make up their minds whats wrong before even listening to the patients complaint. Too many times have my concerns about my health issues been rationalized as "you're too fat", because the doctor was too lazy to actually look further and find a real diagnosis.
No one wants to be 400lbs, or look like a "beached whale".. we'd all like to be 6'0, thin as a rail, and be able to shop and buy clothes in any store we pass. Thats just not the case for a lot of us. But that shouldn't mean that our concerns shouldn't be heard just as loudly and taken just as seriously.
Believe me, we do. It is just harder to make a diagnosis. And the MRI and CAT scans are very poor with fat, as are regular xrays. Plus palpation is impossible, as is auscultation. And exploratory surgery - well, you'd have to be there.
I refer plenty of folks these days to consider stapling, etc.
Believe me.. you don't. ok.. well I dunno YOU.. but Doctors as a general rule don't.
And MRI and CAT scans aside..
Most doctors don't run exploritory tests or even consider things such as thyroid, celiac, or food allergies in their overweight patients. Even in people with family histories of these conditions.
Most just tell you to "diet and exercise" (as if any idiot hasn't already tried that) or as you put it.. refer them to get their stomach stapled.
thyroid functions - always. celiac - easy to test for. food allergies? I think that is quackery, personally. being allergic to peanuts will not make you obese. and, by the way - I am not obese, just pleasantly plump.
I think you do it right, Doc. My Mom here in Winnipeg loves her carbs, and she is around 300. Honestly, she is happy and could care less. Once she got married, she didn't really care about appearance anymore. And she had seven kids, and buried my Dad, and she is going strong at 71. The Health tells her to lose weight, and she tells them to worry about themselves, not her. Says she will bury all her docs, because she is happy and content and they are hassled. Probably will.
Yes.. they're easy to test for.. but rarely done.
As for food allergies being quackery.. A few years ago I would have been right there with you on that. That was until I finally got tested.
After gaining 25-30 lbs every year no matter which diet I tried or how few calories I ate.. I really started reading and researching things. It wasn't actually til I went to Norway for two weeks. During which all my symptoms miraculously disappeared, only to return when I got back home. That I really started clueing into the problem.
Thats when I got tested and started avoiding corn. I have a mild allergy (IgE) to corn, milk, eggs, and white bean. Which means it won't kill me probably (though I'm not taking any chances), but it does do a number on my health.
Since avoiding those foods, I've been able to stop taking a daily antihistamine for airborne allergies, no sinus infections, no body acne, no daily diarrhea, no stomach cramping, no migraines, no general sleepiness all day. I'm actually awake when I'm awake now. Oh and I can grow my nails out without them breaking. (before I didn't even realize these things weren't normal) I've also lost 50lbs and am continuously losing more and more without any real effort other than avoiding those problem foods.
As long as I avoid those foods, I can eat as much as I want of whatever I want. I don't gain a pound.
So call it quackery if you want to.. but it works. You may find researching "food allergy addiction" a bit more helpful to you.
For what it's worth, my mother went to at least 5 physicians over the course of 8 years before they ran a thyroid panel and found it was abnormal, and that was only done because her other symptoms became severe and it was clear she had a medical problem. Historically, physicians treat fat people as mental problems rather than medical problems. Times have changed and physicians are better when it comes to thyroid diagnoses, but the medical community as a whole still views being fat as a lack of will power. Perhaps it is but I suspect there is more to the story.
Von - if it works, what the heck - do it. No science in it, though.
DRJ - hypothyroidism can lead to a certain kind of obesity, but it is a rare but easily corrected cause.
DRJ - Your point was mine exactly. If you're fat, most doctors out there won't give your valid medical concerns the time of day, because obviously whatever your ailment it must be caused by you being too fat.
I lived with daily diarrhea, acid reflux, nausea, dizziness, confusion, plus everything I mentioned in my previous post etc.. for over 10 yrs, before I finally figured it out myself. My family history is filled with diabetes and thyroid problems, and while that wasn't my problem, no doctor even thought to test for it. I had to think of it and insist. My family is also filled with allergies.
And Doc, you can insist all you want that food allergies don't have any basis in medical science, but thats like telling someone who is allergic to shellfish.. to eat shrimp cuz its all in their head.
von: maybe I wasnt clear - food allergies exist, of course. I meant their relationship to obesity
Let me see if I can explain. As in Celiac disease, what happens when such a patient eats gluten? Their body reacts, attacks it (even mistakenly attacks itself), and they don't digest food properly. They become malnutritioned. Even though they are eating, their body is starving itself because it is unable to digest.
What happens to a body that has been starved? When it finally gets food, it whisks it away and holds it as fat just in case of further starvings. Its how our bodies are built. Is it not? And if such a person is continuously periodically starved for a few days then fed, then starved, then fed, would they not actually gain weight as a result?
Now consider a person who is mildly allergic to a common food, lets say milk for argument. If they eat something with milk in it, their body reacts, attacks it, and they dont' digest the food properly. The body doesn't digest the food but escorts it out of the body as fast as it can, thus starving the body of any nutrients from that eating session.
Now you'd think people would notice that when they eat milk they get sick, but even IgE reactions can take hours. And things like diarrhea, acid reflux, nausea.. are easy to explain away as over eating. And if your body is constantly starving, it would be easy to overeat. And what if the person eats milk at their next meal? It becomes an endless cycle where the body adjusts to absorb what it can, when it can, and holds onto it for dear life.
Footnote: http://pathmicro.med.sc.edu/ghaffar/hyper00.htm "Type I hypersensitivity is also known as immediate or anaphylactic hypersensitivity. The reaction may involve skin (urticaria and eczema), eyes (conjunctivitis), nasopharynx (rhinorrhea, rhinitis), bronchopulmonary tissues (asthma) and gastrointestinal tract (gastroenteritis). The reaction may cause a range of symptoms from minor inconvenience to death. The reaction usually takes 15 - 30 minutes from the time of exposure to the antigen, although sometimes it may have a delayed onset (10 - 12 hours)."
Why do you rush through the field in trains,
Guessing so much and so much?
Why do you flash through the flowery meads,
Fat-head poet that nobody reads;
And why do you know such a frightful lot
About people in gloves as such?
And how the devil can you be sure,
Guessing so much and so much,
How do you know but what someone who loves
Always to see me in nice white gloves
At the end of the field you are rushing by,
Is waiting for his Old Dutch?
"The Fat White Woman Speaks", by G.K. Chesterton
World is full of fat buggs,how ever not only by eating maggies but many fat contains items.Don't have a time to indicate them may be other tim.
it good topic people don't like fat people because they look bad shape and it's causes different dieases like cholester heart attack.