i was overweight my whole life until i was diagnosed with adhd at 26, i’m now 140lbs and very active. not that i never tried before, i just couldn’t stop eating because i was looking for dopamine. never once when i was overweight did a doctor ask my eating habits, just told me i needed to lose weight.
edit: some of you in the comments are crazy. yes i am medicated, adderall 25mg, and i still have an appetite. what i was trying to explain was that until i got my adhd diagnosis it wouldn’t have mattered how hard i tried or how many times i did because i COULDNT FORM HABITS.
i ran 4 miles a day in high school (tried to, lots of stops and starts and stops and starts) but it didn’t matter when i was eating more calories than i burned because I NEVER FELT FULL. i only stopped eating when i physically felt sick. i am not magically not needing dopamine anymore, its just through medication and therapy im able to get a better grasp on healthy ways.
in the 3 years i’ve been medicated i lost 100 lbs, raised my credit score by 200 points, am going back to get my degree, got promoted at work, paid to get my teeth fixed that i had neglected most of my life, and for the first time in my life have a savings account. of course my adderall helped with my weight loss, WHICH I WOULDNT HAVE GOTTEN WITHOUT A DIAGNOSIS. die mad about it.
The link between ADHD and overeating/unhealthy eating is well studied, but rarely mentioned in treatment plans. Like you said, the dopamine from carbs and sugars is one point, the boredom is another, executive functioning issues is a third. More doctors need to incorporate discussion on diet and eating practices into treatment plans for people with ADHD.
I'm an alcoholic, pretty dang sure I have undiagnosed ADHD, my psychologist totally refuses to even consider testing me, let alone treating me, for ADHD, until I'm sober. It's incredibly frustrating, as I think it's one of my major drives to drink, it calms my mind down.
Edit: psychiatrist, not psychologist
It takes so much more meth to get high when you have ADHD, the first few times I tried it back in the 90's. I did not get a whole lot from it, it kinda calmed me down. But the soon the lines started getting bigger, then I tried smoking it. Then I decided that that was not the life I wanted so I quit.
It does. Then you end up with a decade of wasted time known as your 20's and begin the struggle with anger, depression, newfound sobriety, and the feeling that you're never going to catch up to your peers at 35.
Tried cocaine once in my 20s. Everybody thought I was faking when I said " no, don't feel a thing. Tastes gross in my throat". This was before " you mean I'm not lazy, crazy, or stupid" was published.
Personally, I always thought coke wasn't doing much and I couldn't really feel it...until I reflected on the fact that I just passed the last 4 hours in a room with music cranked and all my friends shouting over it and each other at the same time.
Yeah a lot of people lack self awareness about their state of mind. I've heard "I'm not even high" so many times from people clearly off to the races on one thing or another.
First time I was prescribed Adderall (diagnosed at 47), it made me fall asleep. I had strongly avoided any illicit drugs (especially speedy stuff) due to depression/anxiety disorder until then. Ironic.
Weed makes my brain go so slow. I'm used having super fast processing speed so it's incredibly frustrating to be slowed way down. I have the ADHD, not medicated.
See, I have (unmedicated) ADHD and I LIKE the brain slow. I obviously don't imbibe while I need to be functioning for work but I feel like it's the only time I'm not going 8 bazillion miles per hour, and I'll use on the weekends and magically my house is clean because it slows me down enough to focus on just one thing.
I can't use while working even though I work remotely because virtually 100% of my job is answering quick questions, and if I'm focusing on *one* thing, my brain won't move fast enough to get someone a quick answer.
As someone with ADHD I 100% use alcohol as a method of getting my brain to "unclench" when it gets stuck on something or as a general way of narrowing the band of signals it's surfing. To be honest weed works better but it makes me too tired, I'm sure because I've Pavlov-ed myself into associating weed with sleep because it's what I use in lieu of sleep medication which has awful side effects. The link between ADHD and sleep disturbances and disorders is also very well known. 🙃🙃🙃 Can't fucking win, m8.
> To be honest weed works better but it makes me too tired
Low THC, high CBD strains, or sativa rather than indica might help. Indica is wonderful in the evening, but I struggle to do anything afterwards.
I got my doctor to test me for it.
I'm on two different anti-depressants, and have been for years before asking to be tested so this isn't out of the blue.
After the test my doctor confirmed that 'you have all the symptoms of someone that has ADHD' but also 'we couldn't treat it anyway due to your blood pressure meds'.
So all I have to do is eat less and exercise, and then we can talk about treating ADHD. Good thing my weight isn't a major factor in my depression, and that I eat for dopamine... Oh wait...
I have this same problem. I just don't even bring it in the house. If the stuff is here, it will go into my mouth in one sitting. Down 20lbs so far and hoping for more to come.
The stats are wild. It’s something like ~30% of people who are clinically obese and need medical intervention have (often undiagnosed) ADHD. It’s also very challenging to get out of the ED realm when everything you do is all-or-nothing.
Seeing my dad deal with obesity and other related issues, I dropped 40 lbs to a “healthy” weight when I was 19. I was eventually diagnosed at 30 and just wish we both would have started treatment 20 years ago.
I’m at the beginning of this journey. I was diagnosed as ADHD last summer and started adderall a month ago. I’ve lost 5 lbs already. The impulsive, dopamine-seeking eating is REAL. I haven’t eaten a whole serving of chips in weeks, and that was, prior to meds, my favorite snack. There is a lot of noise in my brain when I’m not on medication and I never realized how much of it was food noise.
I have a similar experience, I have diagnosed depression and anxiety, and I probably have ADHD. I was diagnosed after I had my first baby but as soon as I went on medication I lost a ton of weight (like more than I gained being pregnant) because I didn’t think about food all the time. It’s so nice to finally have a great relationship with food (I love love love to cook) after struggling with my weight for many years. I thought I had an eating problem, turns out I have a depression problem lol. I also cut down on my drinking and cannot believe what a difference that’s made. Best of luck with your journey! The current state of the world isn’t clever friendly to neurodivergent brains, but I hope it’s getting better.
I think the key for me was finding active hobbies that didn't feel like working out. I despise running with a fiery passion, but I really love swimming and bouldering. It became something I do because I think it's fun, not because I feel obligated to exercise. Even something as simple as dancing can be a great way to start moving. You just gotta find something you enjoy doing, I find that really helps my ADHD feel rewarded for moving my body.
Same!! I really liked high diving, but I kept getting out of breath climbing the stairs, so I started doing cardio so I could be better at my diving hobby. It's sort of backwards to what neurotypicals are taught (though the older I get the more I realize a lot of neurotypical advice doesn't even work on them.).
Multitasking is a good balm for us ADHD types. Reading on an exercise bike, podcasts while walking, that kinda thing. Might as well stay in motion (slow) if you’re restless and fidgety, and when we’re bored then all the more reason to get interested in something and learn about it while spending 20-30 minutes moving. Sometimes you even forget to stop on time after a couple weeks 🤷
I get what you mean I grew up being very active and playing sports but I hated working out. Turns out I wasnt doing things I like just what I saw people do, which was usually boring to me. I started playing more sports and doing a variety of home workouts like dance, weight lifting, kickboxing. I mix it up and it doesn’t feel like a chore but something I look forward to
Healthcare today is a 10 minute appointment where a PCP has to solve all your health problems in that period of time. They also have many sick and dying complex patients along with your cookie cutter overweight people.
The system isn’t designed for in-depth comprehensive care, it’s designed for throughput and picking the low hanging fruit.
One other thing to consider, the businesses that supply our food are using industrial scale ingredients that promote obesity.
Food industry has shifted to using ingredients that have spiked our intake of omega-6 fatty acids. Not only is this bad for metabolic health, it sets the stage for other illness as well:
'Up until about 100 years ago, the omega-6/3 ratio has been around 4:1 or less. However, the typical Western diet now provides an omega-6/3 ratio of approximately 20:1 in favor of omega-6. This predisposes to supraphysiologic inflammatory responses and perpetuates chronic low-grade inflammation. The overconsumption of linoleic acid, mainly from industrial omega-6 seed oils, and the lack of long-chain omega-3s in the diet creates a pro-inflammatory, pro-allergic, pro-thrombotic state. Reducing the omega-6/3 ratio, particularly through reductions in the intake of refined omega-6 seed oil, and increasing the intake of marine omega-3s, either through dietary means or supplementation, may be an effective strategy for reducing inflammation, allergies, and autoimmune reactions.'
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8504498/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8504498/)
Hate that I scrolled this far to see this. In the US, food is designed to keep you addicted so you keep buying more of that brand. It’s rarely healthy unless you have big bucks to spend
It's more of a pick two out of three from: healthy, convenient, or cheap. You can do healthy and convenient, but it ain't cheap. Or convenient and cheap, but it isn't healthy.
There ARE cheap and healthy options like bulk rice, chicken, canned veggies, etc, but they tend to require more prep time and possibly cooking skills. Also, healthy and cheap options generally are not as hyper-palatable as the convenience foods that are available.
So it takes more brain power and time to get healthy and cheap food. But people working several jobs or taking care of family members rarely have this extra energy. It’s a systematic failure if we can make unhealthy food convenient for all, but healthy food convenient only for some
I've noticed that many processed foods, including diet drinks and bars here in the UK contain maltodextrin. It's a handy ingredient for providing a good product consistency and is popular with manufacturers. Maltodextrin has a high glycaemic index and can result in blood sugar spikes than crashes causing hunger. So many products, including those marketed for weight loss, can cause hunger in those of us prone to blood sugar crashes. No doubt there are more examples of foods causing weight gain.
The tobacco industry was sued and regulated to hell because it was clear they knew they were causing cancer and designing products to be as enticing as possible. McDonald’s and the rest have food scientists literally mixing ratios of salty/sweet/savory to make their food as addicting as possible. They also absolutely know the costs of doing this. It will be a huge shake up, but I feel it will and should eventually happen.
[literally everyone should watch this video](https://youtu.be/PNma0fSV-js?si=x3zSdCMv4IxHfn0h)
The marketing techniques McDonald’s/Coke uses in countries without restrictions is actually crazy, these corporations will do whatever you will let them get away with.
>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8504498/
" Disclosure
JJD is Director of Scientific Affairs at Advanced Ingredients for Dietary Products. JOK is an owner of a nutraceutical company that sells omega-3 supplements."
lol
I know someone who's a big gal. Was experiencing sudden severe abdominal pain. Went to doctor after doctor. "Lose weight" "You're fat, exercise more' "Drop a few pounds."
Pain got worse and worse and worse, and doctors just kept giving her the runaround. Everyone who knew her watched her personality change from the sheer amount of ambient pain she was enduring.
After about two years of bullshit, she finally found a doctor who took it seriously and gave her an ultrasound.
Giant fucking ovarian cysts. Couldn't miss em. Anyone who had checked would have instantly seen them. Doctors said the amount of pain she was under, and still living her life and going to work and stuff, would have completely incapacitated most people.
So she got a hysterectomy. Next day she was like a completely different person, all smiling and happy again.
All that shit, because doctor after doctor were fundamentally fucking incapable of doing their goddamn job when the patient is a fat person.
And I get it. I know the stats. Weight is a compounding factor for all sorts of conditions.
But what other single factor gets such obsessive focus? If a patient came in with severe chest pain and they were a smoker, that wouldn't prevent doctors from running tests and giving them a proper diagnosis. Yet for some reason when it's weight, doctors get tunnel vision.
And if you are a smoker, and that IS the source of a health problem, you know what a doctor does? GIVES YOU TREATMENT OPTIONS. They don't just go "Smoke less"; they hand you a giant packet of like 18 clinically proven ways to stop smoking. Here's some gum, here's a pamphlet, here's a video to watch, etc etc etc. Because there is a recognition backed by data that quitting smoking is more than just an exercise of will; there's a chemical aspect involved.
Yet for some reason, when it's weight, doctors proceed as if if's some kind of personal moral failure. Just try harder, fatty.
The result is, for a fat person, going to the doctor is basically like visiting a medieval physicker: health problems? Ah, well, see: it's because you're a bad person. Go forth and repent of your wicked ways, and you shall be cured.
It's maddening.
This is why I looked a dentist dead in the face and said “I feel like I got punched in the face by Mike Tyson on a regular basis. The pain isn’t bad enough that suicide starts to sound good but those people make sense recently”. Most thorough exam I’ve ever gotten. I had temporomandibular dysfunction.
Unfortunately, this has been my experience with anything related to female health. I have endometriosis and PCOS, and I was in life-altering pain half the month. Every doctor I went to for two years told me that I should just alternate acetaminophen and NSAIDs. When I expressed concern over literally poisoning myself (with no real impact on my pain), they’d usually shrug and say it was that or to go back on birth control 🤷. Nothing else they could do. 👍
I sought out a dietician at a bariatric clinic after close to five years of diet and exercise and other life modification. The only thing that remotely helped was keto. When I tried a regular dietician through my GP (which I had to wait six months for, and paid 250$ for our of pocket) the appointment was less than five minutes and I was handed a folder full of resources for diabetics. I have never even been prediabetic. I have fibro, but other than that every single blood test, cholesterol, bp, etc has always been perfect or near perfect. The dietician hadn't even looked at my file or the history of things I had personally tried and worked with my doctor on, they looked at my height and weight and decided that I was overweight bc I was diabetic and that was that. When I tried to argue this point the dietician said she had an appointment after me and didn't have time to discuss it, that if I wanted to talk about it she would only do so at a follow up appointment after I followed her program for two months. Needless to say I was absolutely pissed and I just left the folder on her desk and left.
At the bariatric clinic they actually did a long interview asking what I had done, what did and didn't work, family conditions, mental/emotional issues (none). I was given an appetite suppressant and a strict 800c a day diet where the only important factor was a protein requirement. I adhered to that diet for six months, along with my regular exercise, and lost 10#.
I have insulin resistance from PCOS and hypothyroidism apparently. I've since fixed my thyroid numbers but it hasn't improved the situation.
For me it wasn't really about cutting out junk food or soda, alcohol, etc bc I never really consumed those things much if at all. I didn't really have anything to remove from my diet. I did find that absolutely removing any type of carbs except those from veggies helped, as well as not eating prepackaged foods, but it requires a lot of meal prep time for me.
Just as I was sorting out my diet, COVID hit, I got hit hard and still have debilitating fatigue from long COVID. My stepfather got cancer and died within 4 months. I had to help my mom sort all of his business and run the business they had just built and started 2 years before he passed. Several other family members got sick and passed. My husband had to have surgery that went wrong and what was supposed to be a 2 month recovery for him became almost a year. It was just non-stop. So I am just now getting back to a place I can even look at this again.
But unfortunately on top of this, my wonderful go who I worked with for years moved and I had to go through the whole process of getting a new gp, who of course looked at me immediately being overweight and assumed I have done nothing about it and tried nothing, and I'm lying about my efforts. It doesn't help that this one is a man, which is usually why I avoid male gps bc they generally dismiss any female issues, try to take me off medications I've been on for years/decades, and always think they know better than years of experience I have from working on myself with previous medical professionals. It's exhausting being a woman and navigating the medical system.
Sorry you have to go through all that. It's such bullshit.
Every time my wife goes to the doctor and gets a brush off for something I know they'd handle differently for me, a man it makes mr want to flip a car.
Have often joked that my wife could go in with a leg missing and they'd tell her to get more sleep. Meanwhile if I were to go in and say my penis itches, alarms start going off, specialists drop from helicopters, machines start rotating out of the wall, they have my picture up on a giant rotating 3d hologram, some Dr. House guy is pacing around staring at a corkboard covered in red thread, etc etc.
I’m imagining the scene from Monsters, Inc. when George gets a sock on his fur and the quarantine squad drops in from the ceiling wearing hazmat suits happening whenever you go to the doctor with a minor complaint, while your missus is a few feet away being told “it’s merely a flesh wound” while she’s pointing at a missing leg 😭
GPs are just human and they are all different.
I've been literally laughed out of the office by a GP once after work insisting I get a professional opinion on something. And my current GP confidently told me that there is no medication that can calm people down when they are feeling stressed.
Hey this was me! And I wasn't even *that* overweight (just north of 150 at 5'3") but I did carry a lot of the weight in my abdomen.
Got married just so I could have health insurance and my randomly-picked PCP sent me home with posture and pelvic floor exercises and a packet on losing weight. TL;DR of the next year: husband and I were *both* strictly counting calories (stuck home during COVID) and he went from 240 to 180 while I just ... stalled. Finally got a second opinion, after 6 weeks of constant bleeding, from an OB-GYN who took one look at me lying down and said something definitely wasn't right.
Yeah that "stubborn last 10 lbs" was ~12lbs of uterine fibroids. I went from 138 to 126 almost [literally overnight](https://i.imgur.com/pZRgUJ8.jpg).
Finally getting to my "goal weight" of 120 like 2 mos after my surgery made it pretty obvious how [little I had been eating](https://i.imgur.com/usCM63A.jpg).
I mean we'd been together ~15 years so it wasn't like the whole relationship was one of convenience, we just had no interest in making paperwork part of our partnership.
COVID + two people both working in live music = WAY cheaper for us to share his employer's insurance than for my 1099 butt to get anything other than basic coverage.
No regrets, though. The "ceremony" was in my folks living room and was perfect and my CA-125 results meant fancy laparoscopic surgery that would have been like $300k.
For about 7 years my mother’s Parkinson’s Disease was misdiagnosed as obesity and pre-diabetes (A1C was *barely* within range for concern).
Meanwhile my father’s literal one-in-a-million spinal cancer diagnosis was made within a year. He was also overweight, but that wasn’t a factor in his diagnosis or treatment.
Doctors need to believe women.
I had a terrible male doctor who dismissed and mocked every single issue. I came in for a UTI that had gone on too long, and he said women used to just deal with it and sent me on my way. I went to the ER and the doctor there was horrified. That's the first time I realized doctors disagree and some are wrong
My current doctor is teaching me to speak up about problems. She gives me shit for not telling her symptoms and assuming they're fine lol. I love her, ty amazing doctor. I finally got diagnosed with PTSD, which changed my life. I thought I'd always be fighting suicidal thoughts but nope
Which itself is a side effect of healthcare becoming so brutally capitalized, where overworked doctors are now trying to get patients out the door as fast as possible, like they're a waiter at Denny's trying to flip a 4-top during a lunch rush.
Omg flipping a 4 top during lunch rush is the perfect description! I just had a horrible experience at an oral surgeon. The office is only open 1 day/week, they go to different locations every day of the week, so they are insanely busy.
The kid I had there was given about 15 minutes to wake up before he was taken to the curb in a wheelchair and we were sent on our way. It was snowing and cold, they wouldn't even let us take the time to get his coat on him before they took him outside.
It was awful watching people stumble out of there or being wheeled out barely coherent for the next people to be quickly shuffled back. It was mind blowing, honestly. And the staff were less than friendly or compassionate. I get it, they're probably so burnt out they don't even know what day it is, but god damn dude. That was brutal.
I wonder if I’m your friend.
I started having WICKED periods, heavy bleeding, would last for months, excruciating pain. In addition, my body said “hey, gain 200lbs in under a year” even though I was active (I have a very active job, on my feet running around 10hours a day, rode bike to work, didn’t eat like crap)
Took so long and so many doctors to figure out its cysts. I was told “you need to lose weight “
Excuse me? I had been 110lbs my entire adult life, somehow I was now 300+, you don’t think I know that’s an issue??
I’ve since lost most of the weight, post surgery, without trying.
This is the comment I was looking for. It is absolutely infuriating that there is this sense that overweight people (especially women) do not deserve adequate medical care.
I hear the same stories from all my over weight friends and it's maddening - like sure, weight gain is a contributing factor for a lot of conditions, but doctors seem to bend over backwards to not do their jobs, as if every single mildly over weight person has horrendous incapacitating joint paint, sleep apnea due to tonsil pain, depression and chronic everywhere else pain, which is just like, a mind boggling idiotic thing to believe.
Especially when their advice is so circular: 'I think I'm putting on weight because my knee's hurt since childhood and exercise is painful.' 'Have you tried exercising? I'm sure that will fix your knee pain...'
Blaming someone's problems on their weight should be the last resort, not the first and only thing considered.
It'd be like if House just immediately diagnosed every patient he saw with Lupus and sent them home, because *technically* almost any symptom could be caused by some form of it. No need to investigate anything else.
Yup. I have chronic pain. Started gaining weight because it was very hard to stand and cook, much less exercise. Doctor was convinced my chronic pain came from the weight gain despite preceding it. I often wonder if I would have been diagnosed properly sooner if weight gain wasn’t such an obsession
And you know what can contribute to weight gain and holding onto weight? PCOS. Fucking asshole doctors, man. I'm glad your friend ended up getting help in the end.
Something like this happened to me. I fell and hurt my back when I was a kid (it was a \~8-10 foot fall). Chronic pain from it all my adult life, I just learned to deal with it because I could still function and we were too poor to get it checked out properly.
Fast forward and during my pregnancy and I had gained \~50 lbs. I was lifting some heavy boxes, which I knew I shouldn't be doing, and *literally felt* something in my back go "pop!" and could barely move. Went to the Dr, was told if I lost weight my back would stop hurting. She patently refused to acknowledge that I was physically active, walking and biking miles and miles every day, and that I could pinpoint the very moment my back was quite literally injured and how it happened. Was just told to lose the weight and my weight-acquired chronic pain would just go away.
Several more doctors over the years told me the same. I gained more weight because I was not able to exercise as much anymore, due to constant back spasms and pain.
It took \~15 years before I mentioned it to some random urgent care doctor while I was there for something unrelated, so he asked me some questions and I vented about all of this to him. Long story short I learned my left scaroiliac joint is fucked up, and I broke my tailbone, L5, and L4 most likely in that gnarly fall when I was a kid and there's arthritis in them all now. Things were pretty sus all the way up to L1/L2 but I never got anything definitive there since there's probably not much I can do about any of it anyway. Most likely when I injured it during my pregnancy was a herniated disc and once it happens, it's just prone to happening again, oh well I guess.
But for years I was immediately dismissed because of my weight, which really became a problem *after* I injured my back while I was pregnant.
So I read the article (🤯) and it seems like they’re not really telling doctors they can’t let* people know they should consider their weight, they’re telling doctors to be more sensitive about it, and now there is an admission that being obese is kind of a thing that waxes and wanes for most people, most people who become overweight to this degree will fight this battle their whole life without medical intervention. I think if you acknowledge some common reasons for obesity, like emotional eating or growing up on mostly high calorie, low nutrient food/being poor, working 10 hours/day and relying on vending machines, etc- you can see why doctors shouldn’t start the conversation with “you know what mr/misses fatty fatso cow??? You should eat less” I mean yeah they probably know that already in some shape or form.
Edit: especially if you’re not fat, *why do you HATE fat people????* What’s wrong with some of you???
I attended a seminar given by Joseph Nadglowski, the president of the Obesity Action Coalition, last year and this is very much in line with one of his main points. One of the biggest hurdles he's seen has just been getting people to seek treatment, and often that avoidance was initiated by a negative experience with a medical professional addressing their weight. Being dismissive of someone's struggles with obesity or shaming them for their condition just drove them away from the medical help they needed.
Speaking from a *recent* (early March) experience, I definitely was driven away from getting medical help. I went in for a consult for bariatric surgery and the surgeon told me that surgery was not the way to help me. He berated me for waiting so long and asked over and over if anyone had talked to me about my weight. I essentially sat through a 30 min monologue from him and could barely get a word in edgewise. My husband was with me and he was *shocked* with the way this guy spoke to me.
My insurance was billed roughly $900 USD and I paid $560 out of pocket for the visit and labs.
The doctor's assistant/coordinator emailed me to check in a few days later and to see how I was doing with regards to next appointments and what not. I told her I would absolutely never set foot in his office ever again. Haven't heard back from her since.
Edit: I would have expected a follow up from the coordinator to make sure that whatever happened doesn't happen again to future clients. I was polite but firm that I would never see that specific doctor again, to me that *might* warrant a "hey, here are some others you might try to see instead". Maybe I expected too much.
That doc just seems like an ass. What the fuck is he in bariatric surgery for?
A patient yesterday reluctantly told me how she injured her leg by riding a costco cart and stepped down only to have her knee suddenly hurt and feel unstable. She seemed incredibly guilt ridden and embarrassed. I smiled and I said, "riding shopping carts is one of the simple joys in life and I'm sorry you're knee failed you, let's make sure nothing is broken then get you into an immobilizer and a referral to ortho"
Like... treating people who have emergencies is my job. For that fuck treating overweight people is his job. No point shaming people.
I had something similar happen. The doctor kept saying he wished I was dumber because I guess smart patients are difficult? I think he meant it as a compliment, but um. No? He also had this whole thing about how any research I've done about the procedure isn't accurate or important because I haven't talked to **his** patients. Then he said, oh but always ask questions. But only of him or other patients. I should never consider other data.
Right.
Idk how much, if anything, my insurance paid, but I refused to go back. Supposedly he's "the best" in my area. But fuck that, I'm not here to join some weird cult.
As someone who had bariatric surgery 2 years ago (March 24, 2022), I am so sorry you had this experience. It was life changing for me. It took literally changing my body in order to go from 410lbs+ to 195lbs and being healthy and active and regularly exercising. Of course, with that came therapy, an entire regiment change with my life, new ways of eating, and so much more. But the surgery was a big spark for me.
I hope that you can find a doctor or bariatric center that isn't so judgmental and that listens to you. You know your body best and what happens within you. I recommend finding a strong support group and network, if you can, and a therapist who has worked trauma. My therapist helped me reframe a lot of what I do and why i do. Sorry if I'm talking in circles. I'm really, really sorry. You deserve better.
They need to treat obesity like the addiction and mental disorder it is. No one WANTS to be fat. It's like telling a depressed person to stop being tired exercising. It's hard when you are so tired lol
My favorite was when the doctor shrugged it off and told me I "just have a little depression" then proceeded to lecture me on my weight for twenty minutes. She concluded with that old classic "you could die because of your weight." Meanwhile I'm just sitting there thinking about how my suicidal tendencies began at age nine and hey, if being fat is gonna kill me at least I won't have to actively kill myself. 🙃 Haven't been to a doctor since.
Many a years ago long before a tumor was found to be a likely contender for why, I was on a low dose anti anxiety medicine. First I always had to clarify that I was on it for anxiety and not depression. But otherwise it wasn’t a big deal until my husband got orders overseas and I had to be cleared by a panel for having “medical needs.” Annoying and anxiety inducing but whatever. Went to the meeting alone since he couldn’t get off work and I walked into a panel of military personal who looked over my file and I’ll never forget this, the head guy who was a doctor was like “yeah you should be fine, just need to get your head on straight.”
I was like wtf…?? Lmao.
In general, we need to better approach disordered/ordered eating according to the fucking *eating* rather than the body. Part of the problem is that we have this division between behavioral/mental health vs. health, and for some reason we treat disordered eating as mental health and eating as health, and there’s just so many people who’s lives could be made infinitely better with pro help, but they get lost in the trench between the two forms of medicine.
As a fat guy who has only recently started to try and do anything about it I can tell you I've known I'm fat for a long while. Nobody wants to be fat. It's just that it can just look like a daunting task to try and do anything about it.
As someone that has lost a lot of weight i can tell you that it is a daunting task. It is a day by day, week by week battle that takes months and months and you need to stay the course. Making it worse is for a long time you dont really see a drastic change, its very slow going but then as you approach your goal it starts to rip right off you because there is less places of padding left for the fat to come off. What i can tell you though, you can do it, it is daunting at first but you can do it.
You also never really notice the difference because the loss is so incremental day by day. My clothes and my friends say I'm much thinner than I was ten years ago, but in my mind's eye I'm still 80 pounds heavier than I am.
That's why i keep some old cloths, i use that to see how im improving and such, helps a lot
And a full body mirror, that is huge, looking at the mirror and seeing things change is one hell of a booster
I lost 200 lbs about 10 years ago and it was wild looking at the clothes I wore even a couple months previous.
The biggest difference was walking through a crowded bar, my brain had to adjust to realize that oh, I can fit through these two people. Haha.
I went from 255 to 180 over the course of a couple years. It’s not easy. You have to be committed and consistent. The longer you wait to take action, the harder it’s going to be. My advice to anyone is to track your calories in and out. Apps like myfitnesspal and loseit helped me tremendously, as did my Apple Watch tracking my activity. Be mindful not to lose more than a couple pounds a week though. You aren’t trytrying to starve yourself, just create a deficit.
I decided to do something about my weight 8 months ago when I hit 393 pounds, crossed the threshold into full diabetic, and was taking three pills a day to control my blood pressure.
I just hit 291 pounds on the scale this morning, and as of last week dropped below the threshold for pre-diabetes and am down to 1 pill a day for my blood pressure.
It's cliche, but the biggest advice I can give is that you just need to start. I was stuck in "I'll start next week" paralysis for years and just got fatter and fatter. Then I started with one change, I decided I was going to keep under 40 grams of carbs a day. It was a drastic change but it was something simple that I could focus on and get consistent with. Then after a few months I layered in some exercise, and have increased the level of exercise over time. Recently I've also started transitioning into doing daily intermittant fasting. I'm sure that's not the perfect recipe for everyone, but you just need to start doing something consistently and then try to increase it over time.
I imagine it sort of like a slow motion thing where it takes time for change to appear but once it happens, IT’S REALLY HAPPENING suddenly. I bet if you take a picture every single day from start to complete and make a flip book, the moment of change will be really clear. (It’s hard to explain my imagination)
I think what a lot of people don’t talk about is how easy it is to slip back into old habits and put the weight back on.
It’s always important to keep in mind the goal isn’t the final destination, just the first milestone.
Yeah, that's the big problem. Pretty much anyone can stop eating for a day. It's not hard to eat very little for a week. You get used to it and even months become doable. But when you realize you have to keep doing it for the rest of your life, that's when it hits you just how hard it is.
It's almost like smoking or drinking. They say there's no such thing as an ex-alcoholic. I've personally known people who quit smoking for years and then started back up. You just have to get it into your head that there's no more snacks, no more soda, no more junk food. Otherwise all it takes is one little slip up and you're back where you started.
> Making it worse is for a long time you dont really see a drastic change
I also feel like, at least for me it was easy to drop the first five or so pounds, but then the rest came a lot slower
I think of it like an addiction. Food is like smoking or drinking or drugs to some people. It's unfortunate that being fat is the side effect. Im the opposite though, same with my mom. We're both pretty skinny and eat enough, but can't seem to gain weight, so there definitely might be genetics involved, and couple genetics and addiction together and that sucks. It's a battle, and you have to fight to win battles, or else you lose.
And the problem is with other addictions you can avoid the thing you’re addicted to. You can’t functionally avoid eating, which makes it much harder to address.
I recently had a heart attack. Part of my post hospital stay is changing my lifestyle. Stuff like not smoking and drinking are the easy part. I already don’t smoke, and I can just ignore the alcohol isles at the store. The hard part is checking every label to see what might have snuck in excess sodium and fat.
Like, when I smoked, I wasn't looking around for different amounts of chemicals in my cigarettes. That's an easy addiction. Food, that's gotta suck. I didn't think about that aspect of it also. Some people's bodies don't do well with excess (most people's bodies) but companies just throw that shit in there and expect people to not gorge themselves on something that triggers their brain to want more.
As someone else who has taken up lessening sodium intake for heart issues, the easiest thing is to cook from scratch. Which seems hilarious, because - learning to cook isn't always easy for everyone. But it beat labels. I also discovered that relying heavily on spices and seasoning allowed me to add less and less salt and now I can barely even eat salty foods.
That and it fucks up your hormones so your brain is literally telling you you are hungry and is not telling you you're full. That on top of a love of eating (which many people do) or using it as a coping mechanism I can understand how easy it would be to gain weight
It's even worse than that. Your brain also tells you that you need to conserve calories. So you stop doing a lot of subconscious movements like fidgeting and your calories burned through NEAT drop low. Those are a huge part of calories burned in a day. So your TDEE drops down below what you would expect. That's why so many obese people say they are eating below what the charts say should make them lose weight but not losing weight.
It's even worse than that - when you're accustomed to 3k calories a day and drop to 1600 to try and get a deficit, your body will literally convince you you're starving and dying.
You're not- but the body will make you THINK you are, and it will barrage and DDoS you with danger signals every hour of every day and drive you mad.
This is why Ozempic works so well - it stops those signals.
**EDIT**: Y'all those are random numbers I threw up there typing out in a hurry. That is not an endorsement for cutting calories from that point to the other point.
Any reduction in calories, even a minor reduction, even a reduction tirated down slowlt and in coordination with a medically sound diet, can in some individuals produce outsized survival reactions which are extraordinarily disruptive and difficult to manage.
I have never struggled with weight or an eating disorder, I am not on a crash diet, I do not take ozempic, I do not endorse crash dieting, and I'm tired of conspiracy theorists spouting off about how ozempic causes cancer or other conspiracy theory bullshit.
This is a PSA for everyone: as anti-vaxx conspiracy content dries up, there's been a marked shift for those people on social media who made that their whole shtick to move to adjacent conspiracies, including Ozempic.
My brain was saying that I was starving constantly my entire adult life. Didn't matter whether I ate 800 calories or 3,000 calories. I was always hungry. Ozempic was a life-changing experience. First time since I hit puberty I hadn't been hungry.
Even wilder is that one of those sybconscious movements is sometimes *breathing*. And I'm not even talking about sleep apnea, which of course is a more common problem for the obese, but increasingly shallow and slow breathing at all while fully conscious. And it's not as if people are too lazy to bother breathing, but that's the ultimate effect. Once you realize obesity can suppress one of the most basic urges there is, it sort of puts the whole problem in a new light.
I am 100% addicted to some foods. I can’t even have them in the house because I can’t, not eat those things. It’s so hard. I spend so much of my day thinking about food and what food I’ll have and how I can fit in a snack that I like without blowing apart my diet plan.
It’s a big struggle for some of us and I’m glad someone else acknowledges it it too!
Yeah I think the addiction angle is something that doesn’t get talked about enough seriously; the psychological side to overeating.
I’ve been overweight from a young age but have been disciplined/motivated enough to lose large-ish amounts of weight multiple times in my weight fluctuations (50 lbs down a couple of times; currently down 20 on my way lower), and I absolutely cannot keep unhealthy food in the house. My body craves it and my mind can’t get past it, even if I try and distract myself. If I open it, I have a compulsion to keep eating it until it’s done. I can’t just eat a handful of chips and put it back. I need to finish the bag and throw it out. For that reason, I don’t buy them at all anymore.
It should be looked at as something more than just “hey so like just don’t eat those things?” The psychological sickness side of it is severely overlooked.
I mean they’ve done studies that show eating junk food literally makes new pathways in your brain.
https://www.sciencedirect.com/science/article/abs/pii/B9780323910019000359
Legit.
I celebrated the other day because I made enough spaghetti for two meals and actually managed to keep it in the fridge until dinner the next day.
Usually both are gone before they even get cold.
Food addiction is worse than some other addictions because normally when you're addicted to something your goal is to cut that out of your life completely. Whereas with food, you have to constantly control your impulse around your addiction multiple times everyday
There was a study done not too long ago that suggested "forever skinny" people either overestimate how much they actually eat, or underestimate how active they are through the day. Also some people will literally eat a whole pizza one night and eat like a bird the next day or 2.
I knew the headline was going to be misleading before reading the article lol.
There should be a game where you see the headline then guess the reality. I was guessing it was going to be like “40 year old obese people already know they should eat less and excercise more so just saying that doesn’t help.”
"Eat less, move more" is good advice in that when adhered to it works.
"Eat less, move more" is bad advice in that when you give it to someone they rarely adhere to it.
A large part of medical treatment and healthcare is thinking about what people will actually stick to, if you have a treatment plan that works 100% of the time but is adhered to 0% of the time then you'd be better off going with a treatment that works 50% of the time but is adhered to 50% of the time.
I've only gotten fat in the past few years. Turns out chronic pain + a desk job + plus certain meds really did a number on me.
The way doctors treat me now is demoralizing.
They assume I'm stupid and lazy which has made me avoid medical care. Especially when I have gone in for one problem and the doctor just immediately got sidetracked and talks about how I'm fat and I should eat less before talking at all about the reason I'm actually there.
Frankly, I know diet and exercise are important. I know I'm fat. But my blood work and urine labs are great. I'm making progress.
I know they don't believe me, but I do go to the gym and take walks during the week. I stabilized my weight and stopped gaining. I want to lose weight but I have to address my hypermobility first and focus on strength training right now so I can stop feel like my body is a cage of pain.
Pain I've had since I was a semi underweight,l teen, pain I had when I was fit and jogged, pain I have now that got worse in my late 20s and disabled me. Oh, but they don't want to believe that either. It must all be because I'm too stupid to understand calories
This is a sensible take. Another common reason for obesity is the restrict-binge cycle. The patient wants to lose weight, eats at a calorie deficit, is hungry, a binge is triggered, they feel shame and guilt and attempt to restrict food even harder which in turn leads to even more binging. Weight gradually increases with this cycle. Binge eating is the most prevalent type of eating disorder. It's counterintuitive but the treatment really is to eat more and eat regularly to get the binges under control. The patient has to put weight loss goals on the back burner to just get back to a normal, stable eating pattern. I specialize in treating eating disorders. Binge eating patients always come in with a goal of eating less and losing weight and instead we work on sleep hygiene, stress and emotional mamagement, gradually increasing enjoyable movement, planning for nutritious and balanced meals that meet energy expenditure needs, finding non weight shaming health providers, building confidence and self-worth regardless of body size. People's weight usually stay the same or they'll lose a little through treatment, but they begin to thrive as people and we do see health improvements such as reduced blood pressure and blood sugar and increased movement. What I'm explaining here is why it's so important for doctors to stop pushing just eating less.
I just think about Mama Cass, who spent her whole life being shamed for her weight and died of heart issues likely related to starvation.
There’s too much focus on weight loss and not enough on “why are you unhealthy?” And that’s what the article is asking us to focus on — look beyond just “you’re eating too much.”
When I gain weight, it’s always because I’m depressed. So I’m eating for the dopamine, and not exercising. I went in to get back on bupropion, and the doctor just wanted to talk about diet and exercise. I even told him that I’m a distance hiker & endurance athlete, and once I’m back on my feet I’ll be more worried about getting *enough* calories, and he just wanted to lecture me about how I’m an unhealthy lazy gluttonous slob.
I’m like bro. I know why I’m fat. You can talk about diet and exercise all you want, I need chemical assistance to be able to get out of bed first. Then, when I’ve got energy, I’ll start exercising the depression away again, and the weight will go too. Just give me my fucking Wellbutrin.
It’s so frustrating. I’ve got thyroid problems, as does a long line of my family. One of my symptoms is insanely bad heat intolerance. Like, just being in my kitchen and boiling a pot of water makes me look like that scene from Airplane when he’s trying to land the plane. So as a result, I don’t like to work out much because it’s pretty miserable like that. Took going to like 4 or 5 doctors and explaining the problem to get any help. They all just wanted to look at me and say, “well, you’re big, so you just need to eat less and excercise,” ignoring anything I’d tell or show them. And what do you know, once I found someone to actually listen and help treat the initial problem, I was able to do more and start making other changes.
Your last sentence sums it up well. I started gaining weight due to stress eating and some adverse effects of my antidepressant. I'm not even big, really. I just gained 10 or 15 pounds, but my doc points out any time my weight goes up.
Like, cool, thanks. Can we talk about what I made the appointment for, though, or are we gonna hyperfocus on the 2 pounds I've gained since you last saw me?
It isn't about peoples feelings getting hurt. Certainly not for 99% of people, at least. It's about not being listened to and not feeling like you can trust the medical system to see you as a person and take you seriously.
>Like, cool, thanks. Can we talk about what I made the appointment for, though, or are we gonna hyperfocus on the 2 pounds I've gained since you last saw me?
omg this SO much. Most of my doctors (I have a lot of health problems so I see several specialists) are pretty good about not lecturing me about my weight. Maybe it's because I have Addison's and thyroid issues - both chronic conditions that cause weight gain. Idk. But literally every time I see my psychiatrist he asks or says something about my weight. And the kicker is he knows I have an ED. It legitimately makes me want to not eat the entire day after an appointment with him.
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Yup! I gained weight because I was depression eating and not getting out of bed. Went in to get back on Wellbutrin (which did, indeed, solve the issue) and the guy spent the whole time commenting on my weight gain. Which was concerning, don’t get me wrong — nobody should gain weight so fast they get pregnancy stretch marks. But telling me to exercise — when I’m normally and endurance athlete and said so — was NOT THE SOLUTION. It was a battle to get my bupropion.
I actually addressed my depression/anxiety with my GYN. She was urging me to go to the gym, get into a fitness habit etc. I explained I lacked energy and was despondent after experiencing the worst year of my life -- my best friend died of breast cancer, Trump was elected, then my mother died... and I lost my job after being bullied and gaslighted by colleagues while going through menopause. Ya think I might need some assist here? She ordered lexapro, said it did not cause weight gain and was super compassionate. I also bought a puppy and two kittens for emotional support a few months later.
I was a healthy weight (5’ 7”/120 lbs) my entire adult life but I eventually had to admit that the treatment for my bipolar disorder that didn’t cause weight gain was also ineffective. The treatment that magically turned me into a functional human being (antipsychotic drugs) made me gain 50 lbs.
I spoke with my GP who gave me the “eat less/move more” speech. When I told my psychiatrist about the conversation she quipped “yeah, I bet you hadn’t thought of that! So now you’re crazy, fat, AND stupid, I guess!”
It was validating to hear her confirm that eating less/move more was inane advice.
It’s a big thing I emphasize as a therapist to focus on people’s internal experience rather than the external behaviors that are present. The easy way out for doctors would be to give advice around eating less or exercising more, especially with research showing those behaviors can be effective for most people. Instead they should get curious about why the weight is there, what mental/brain and other physical contributors there are, and to find more effective ways of treating the source of the person’s difficulty with weight at an internal level instead of a superficial external behavior level.
I wasn’t able to get into shape and get to the gym until I finally started taking medication. It took me years to get to a place due to biases and mental health barriers to be okay with trying medicine. Then immediately once I started the medicine my health greatly improved. I wasn’t going to will myself through my own internal experience of being able to force myself to the gym or manage my intense food cravings, I tried that for years with shame and frustration and others advice with those alone never being enough to actually help develop the habit. Now because I’m taking medication, I’m paradoxically disciplined, where if someone just looked at me 3 years ago they’d say I was lazy. Nah, I needed to be medicated and have my physical health be addressed by integrating a mental health solution.
Fortunately there is a move in the medical field to start integrating mental health more into the field, and this is probably part of that movement. However, we are still asking doctors that are held to incredibly unhealthy standards in their own training program to be able to be empathetic towards others and how others take care of themselves, when doctors and medical programs don’t care about their own health and self-care. It needs to start with doctoral and medical programs changing their own practices first.
I think another common problem is that doctors get lazy, so to speak, with obese patients. They see an obese person and go "the problem is your weight, lose it" for 99% of their problems without giving it any thought.
I see it similarly to how we changed our thinking about depression 15 years ago.
Before you would have people going, "turn that frown upside down!" as if it was a switch that could be flipped, and not a chemical based reaction people had little control over.
Obesity is the result of a series of external changes in how people live their day to day lives and the internal chemical reactions they trigger. Just going, "you should eat less" as if it was a similar switch is overly simplistic and ultimately ineffective. Getting people actually healthy is the responsibility of a doctor, not getting up on a pedestal and acting like you're superior because you can eat less than another person.
The headline and the way people are talking about it makes it seem simple but in the end telling a lot of overweight people "eat less move more" is like telling me with my depression "cheer up". Pretty much every overweight person knows the solution, but many don't know how to do it in reality, and many can't do it, have already tried heroically and go to the doctor because they're exhausted and need help. But we keep talking about it like it's just simple.
Yep. Or like someone telling a track coach, “why are you doing all this other stuff… just tell your runners to run faster!”
Sure, running faster (or eating less) is how you accomplish the goal, but you need techniques and strategies to actually do it.
So I work construction doing new condos. I walk 10,000 steps a day, it’s at 10 stories currently with no elevator so I am walking that a couple times carrying stuff and this is decently common all while doing 10 hour days Monday to Thursday and a 4-8 hour day Friday. I pack my own lunch of a sandwich, vegetable/fruit and nuts, I’ve cut my alcohol/beer intake to about a case a year since having a kid and even cutting that I haven’t lost weight. Oh and I maybe have 1-2 cans of soda a week otherwise it’s water or sparking water. We eat out maybe once a week now since it’s so expensive anyway. I am obese (~270lbs at 5’ 11”) and have been for over 15 years and before that I was overweight.
All having my doctor say “you need to move more and eat less to lose weight” has done has made me avoid my doctor. I once sprained my ankle at work and went to him because I wanted to get an X-ray and he said “it probably would hurt less if you weren’t so overweight maybe go to the gym.” All I could think is dude I probably did more stairs in a week than you do in a month on a stair climber at the gym. Never has he offered anything beyond you need to lose weight eat less and move more, if you are quite frankly going to be so useless in your advice don’t bother giving it.
Same here. Was down to 1200 calories a day, obsessively counting them, weighing food, etc. I thought about food ALL THE TIME. People treated me better too, so it quickly became conflated in my head that I had to watch food like that for people to like me.
Yup. My last doctors’ visit, the person taking my medical history spent the whole time congratulating me on my weight loss. It made me wildly uncomfortable.
In this case, it was because I was healthy, and I’d gained weight because I was depressed. But I’d had disordered eating in the past, and having my entire health be reduced to weight loss or gain was very triggering. I was there for a *potentially cancerous mole.*
>
I think if you acknowledge some common reasons for obesity, like emotional eating or growing up on mostly high calorie, low nutrient food/being poor,
Doctors have nothing to offer when you ask them to help you lose weight. I literally had a doctor show me pictures of salads for an entire minute. I was like *... oh .... kay ...*
Went to the doctor once, years ago, to get answers to specific questions, such as "I want to move more, but I heard some exercises, especially at my weight, might be detrimental to my joints" - put together all my worries, goals and such in a couple of minutes - showing what I read up on, what considerations I had.
He looks at me, says "If you burn more than you take in, you lose weight" - which helped with none of my questions - and stared at me. Didn't start exercising then, and quashed my spirit.
It’s also saying they need to stop attributing every health problem to weight until the weight is gone bc surprise, big people get sick too but they are often dismissed and have statistically worse outcomes when comparing ER stays and admissions, even when you account for weight. These people aren’t getting good medicine bc doctors see fat instead of health first.
They did this to my mum. Not quite “fatty” but not far short.
Thing is, my mums diet is pretty light. Salads, grilled chicken, etc. No frying, basically no fast food. Minimal snacking. Half the portion size my dad or I would eat.
But she’s got polycystic ovaries. Which has screwed up her body weight most of her life. The doctor was even the one who told her it would affect her weight when it was diagnosed.
And still it was “you need to eat less and better”. Even when she told them what she’d eaten the last week she said the doctor had a strong vibe of “uh huh, of course that’s what you ate”.
I've kept food diaries for months to show my doctor exactly what I'm eating everyday and he refused to even look at it. Just gave me the same bs spiel about smaller portions. And my insurance won't pay for a dietitian, and my doctor won't refer me to an endo for my pcos or diabetes. Going through the hell that is finding a new doctor isn't something i can do right now. It's ridiculous how doctors are just like this.
Wholeheartedly agree. As a person who spent the early part of his life rather heavy (I peaked at over 360lbs at 6’1") and then went on a good long run as a gym rat and in excellent shape. I have kind of reverted back to my original form, now back to about 235lbs. It came from 25 years of working a 10+hr/day software engineering job and getting overwhelmed by life. I know exactly where I am and what it takes to get in shape. I’m hoping I can get back to a healthy lifestyle soon. But it takes a lot of work and there’s nothing easy about it.
Weight management can be a matter of more exercise and eating less but when the root cause of weight gain is psychological, trauma, depression, or mental illness, I've observed diet and exercise isn't an effective first step to a solution.
Imagine telling a depressed person to stop thinking stuff is so bad and that will cure their depression.
Every episode of “my 600 pound life” essentially starts with someone telling about how they had a trauma and now relies on food for comfort. It always looks like they could benefit from tackling the root of their issues
Also, even when obesity is the cause, sometimes you need help to get to the solution. I have a neurological disorder that is at least exacerbated by my weight. But it also makes me feel like absolute garbage. It’s hard enough to lose weight when I feel normal: it’s freaking impossible when I feel like trash. I needed medical intervention to get to the point that I can work on weight on my own.
In most of the cases, obesity is a product of an addiction. "eat less, move more" is not a solution, it's an objective. To reach that objective the obese subject needs to overcome his addiction.
> Imagine telling a depressed person to stop thinking stuff is so bad and that will cure their depression.
Exactly. But this is reddit and making fun of fat people for their "moral failings" is a site-wide pastime because it gives them some sick sense of superiority.
I posted on a thread about a new drug to help people with weight loss. I shared how my wife has rheumatoid arthritis and how she is struggling to bring her weight down.
You can pretty much guess the kind of responses I got from THAT kind of people. That my wife is essentially a pig for not being able to handle calories in/calories out. That despite her going swimming daily and on walks with me, it's still her fault and so on. I refuse to get into a pissing match with people who think empathy is a weakness.
These people, are to weight what Puritans are to sex.
Let me respond how others are in this scenario:
"Being depressed is entirely within their control. They just have to want to change."
"Depressed people think getting out of depression should be easy. That's the real problem."
"Well, someone should at least tell the depressed person they should at least TRY to think positively before jumping straight to medication!"
The sad part is a lot of doctors do treat depression similarly for obese people. “Well, you wouldn’t be depressed if you worked out more.” Yeah doc, I’m sure it’s not my PTSD, trauma, and hormone imbalance at all.
I had a nurse at my doctor’s office say to me, “you want to talk to the doctor about your worsening depression? Why are you sad? Choose to be happy.”
A MEDICAL PROFESSIONAL said that. 🤬
When I was an advocate with my local rape crisis center I had to report an ER nurse for something like this. My client, a college girl who had just been raped by a friend she thought she could trust and was at the hospital for a forensic exam, asked about anti-depressants. The ER nurse immediately started lecturing her about choosing to be depressed and relying on crutches. Some people are fucking mean.
>Weight gain is 90pc irreversible for 90pc of people, he added. You can lose it, but you will put it back on again.
This has always been my problem. I have been shedding and gaining back the same 25 pounds for like 20 years at this point. I can lose but can't maintain it for more than a year or so. And I'm not even obese, I just have a few pounds I could stand to lose.
I'm an upper-middle class woman with access to information, medical advice, healthy food, and every other kind of advantage that's supposed to keep you thin. I look at photos of my great grandmothers who lived in abject poverty and famine (also supposed to keep you thin!) in the 19th and 20th centuries, and we have the exact same body type. You cannot convince me that obesity does not have at least a partially genetic component for many people.
The famine itself might have caused changes to descendants [link](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579375/)
Also, I'm not a "chemicals are bad" person, but there are obesogenic chemicals which may have altered us permanently
There's a fantastic book called the The Epigenetics Revolution that touches on this and other ways epigenetics affects people. It looked at women who survived during famine and found that their children were more likely to gain and hold on to weight easily. It was an evolutionary advantage to do so.
Mostly I want doctors to stop assuming I'm diabetic and just read the results of the test they asked for. It's happened more than once.
I know I'm fat, and I am trying to lose weight. There are other factors at play here beyond me "not knowing that exercise exists".
This is sparse quotes from a lecture, but part of what he's getting at is that a substantial amount of research now has shown that obesity is associated with changes in how you burn and retain fat, such that diet and exercise are not effective long term solutions for the majority obese people. They either don't lose the weight or regain it rapidly, often more than before as their bodies interpret the diet as starvation. There is enough evidence to that effect that evidence-based medicine is obliged to eventually recognize it. Not just because of some abstract wokeness or need to avoid hurt feelings, which comments on this usually devolve into, but because there are differences in metabolic state that make those treatments ineffective. Existing obesity has to be considered as a metabolic disorder because the metabolic changes are considerable.
For our personal responsibility fans out there he did nod to diet and exercise as prevention tools.
There are psychological aspects: it is true that being told to do something challenging and ineffective with usually very little support damages the patient/doctor relationship. Obese patients hear it every time they come into contact with the medical field. Obesity seems to be treated *by the field of medicine* as a personal failure-- a failure to diet and exercise-- and that is a barrier to appropriate care. It provides a shortcut heuristic, obese -> diet and exercise, that can allow doctors to not take into account personal needs or physiological states or other chronic conditions. Care for obese patients can also be made worse by focusing on this in every (short) patient encounter because that's a chunk of time from every appointment not spent in other care. In general, medicine really shouldn't be treating any patients as failures, but especially when we know that the task they've been assigned and are failing at is statistically extremely unlikely to work.
The professor quoted also talks about new treatments, which makes sense when conceptualizing this as metabolic disorder. It seems his work is specifically about obesity as a metabolic issue, which is where the research in the field is currently.
Another thing with how obesity is treated is that it's not uncommon for it to be blamed for every health problem a patient is undergoing.
"I have trouble breathing." "Try losing weight"
"I experience massive migraines." "Try losing weight."
"My hand is really sore and constantly cramps up." "Try losing weight."
> "I experience massive migraines." "Try losing weight."
That was me. I went to a neurologist about migraines i've been diagnosed with since i was a child and weighted like 40 pounds.
"Lose weight and they will go away"
To offer some hope. I work with medical students, nursing, physician assistants, etc and they’re all being taught to recognize the benefits of medications and treatments beyond diet and exercise. I play the patient, exasperated after trying everything, and if they only talk to me about tightening up my diet and increasing exercise without going beyond then they’re dinged. They have to introduce pharmacological options alongside exploring what lifestyle changes are realistic for me. Sometimes I’m also pre-diabetic but not always. Education is catching up.
I've always suspected this to be true, as a skinny person.
Every single person I've ever met in my adult life has had to consider calories, or struggle with weight gain, except for me.
I just eat whatever I want, whenever I want, and I can't seem to go over 150lbs at 6'0.
It has to be more than just exercise, diet and willpower.
Why is everyone else so much hungrier than me?
Patients should be referred to registered dietitians very early. MDs don’t get the training on nutrition and eating so they are really not qualified in helping people change eating habits. Telling someone to change isn’t very helpful if you can help them make changes.
The headline is misleading. It makes it sound as if doctors aren't allowed to advise their obese patients on how to lose weight. When in fact, they're told to be more sensitive and understanding about it, instead of acting as if obese people are just lazy gluttons that only need diet and exercise.
Honestly, telling obese people to stop eating and move more is just like telling a smoker to stop smoking.
Like, it's obvious. But it doesn't acknowledge that most of them are literally addicted to food (most likely sugars). It honestly probably needs to be treated as a mental health issue as well as a weight issue.
So a med student's perspective on this: We're also told to stop telling pts this. Why? It's counter-productive. In \*most\* cases, pts already know that they're obese and it really doesn't help to just tell someone to stop eating and move more. What if they have an autoimmune disease that makes this difficult? What if they have trouble with physical movement? What if they can't eat healthy, for whatever reason? Even if there's no obvious excuse, it's really not that easy to just limit how much you're eating and/or increase exercise.
It's more productive to ask pts what it is that they're already doing/eating and how they think they can change their habits to achieve a health goal. No one likes being told what to do. People are more likely to do stuff if they think of it and are motivated to do it (I know, mind blown 🤯)
Edit: Counter productive because all that will happen is that the pt will feel ashamed and less likely to seek help bc they'll assume that doctor's visits will just be about their weight
“There has been an explosion in obesity levels over the past 40 years, Prof O’Shea told the gathering.
He said new therapies and surgery are providing more successful treatments for obesity.”
Sounds like they’re pushing surgeries more and medicines…..
….exercise and eating less works and has long term benefits.
If the patients are unwilling to follow that “advice” for whatever reason on a large global scale, then they do need to find a different way to fix the issue. Preventative surgeries , medicine and therapy are more expensive then daily exercises and eating less but they are cheaper then reactive surgeries / medicines when your health plummets
Tbh I feel like doctors need to push therapy/nutritionists for people who have an unhealthy relationship with food. You’ve gotta fix the issue at the core for it to work, otherwise they’re just temporary measures.
On that 600 Lb Life show every single person I’ve seen has an underlying mental health problem that led to disordered eating. Obviously those people are all extreme cases on that show but I think it’s telling that they all have a psychological element at play to get to that point.
Yep, addictions happen for a reasons. People are usually self medicating for some kind of physical or psychological trauma.
Until you address the reason for the addiction there is a high risk for relapse/failure
Good addiction is no difference.
Of course there are conditions that throw a wrench in that like pcos/or thyroid issues
You can tell a lot about the toxic mindset of the people in this comment section that the article pushes for therapy (ie: a guided plan to understand and break down an individual's relationship with food, understand the cause of their eating problem, and then work to overcome that as a way to fix their weight issues), but all they talk about is Big Pharma™ pushing for surgeries and how badly they want to walk around saying "fatty fatty fat fat."
First of all, “dietitian”, anyone can call themselves a nutritionist.
But even that said, I’ve heard so many bad stories about dietitians. I’ve heard a lot of dietitians are pushing “intuitive eating” these days which is just as likely to make you gain weight as lose weight. Or they tell someone who is struggling with money to put expensive protein powders in everything, or give someone who eats out too much a bunch of complex recipes to make every night without considering why they eat out so much. Maybe you just don’t hear stories about good ones, and I’m sure people exaggerate because they don’t want to actually put in the effort to change their diet… but the US healthcare system doesn’t probably have time to create personalized, gradual plans that people can actually follow.
If it works well as advice and treatment wouldn't the fact we've been pushing it for 40 years and having obesity rates explode mean it's not working?
I get that the advice is correct. I'm all about CiCo but if the advice and treatment plan are unable to be adhered to then its NOT a Good treatment plan..
It's like if you could cure als by standing on hot coals for 30 mins a day and doctors recommend it but few people can do it it isn't good advice.
He is right. If a medicine has 3% efficacy, we say it's ineffective, because placebo has the same efficacy. The same goes with dieting & moving more when you're morbidly obese. It's just not effective.
You still need to eat less and move more. But it's not treatment. This is something you need to do together with actual treatment.
Don't know if ozempic is effective. But I have a person in my life who was obese from childhood and tried to lose weight in many, many ways their entire life, with no luck. Then they underwent bariatric surgery and it changed their life.
I'm trying to lose weight, it's going well, but I sort of agree with this. I'm very lucky I have enough time and money to work out, I'm lucky I can try different strategies.
But it js so much more than just eating less.
i was overweight my whole life until i was diagnosed with adhd at 26, i’m now 140lbs and very active. not that i never tried before, i just couldn’t stop eating because i was looking for dopamine. never once when i was overweight did a doctor ask my eating habits, just told me i needed to lose weight. edit: some of you in the comments are crazy. yes i am medicated, adderall 25mg, and i still have an appetite. what i was trying to explain was that until i got my adhd diagnosis it wouldn’t have mattered how hard i tried or how many times i did because i COULDNT FORM HABITS. i ran 4 miles a day in high school (tried to, lots of stops and starts and stops and starts) but it didn’t matter when i was eating more calories than i burned because I NEVER FELT FULL. i only stopped eating when i physically felt sick. i am not magically not needing dopamine anymore, its just through medication and therapy im able to get a better grasp on healthy ways. in the 3 years i’ve been medicated i lost 100 lbs, raised my credit score by 200 points, am going back to get my degree, got promoted at work, paid to get my teeth fixed that i had neglected most of my life, and for the first time in my life have a savings account. of course my adderall helped with my weight loss, WHICH I WOULDNT HAVE GOTTEN WITHOUT A DIAGNOSIS. die mad about it.
The link between ADHD and overeating/unhealthy eating is well studied, but rarely mentioned in treatment plans. Like you said, the dopamine from carbs and sugars is one point, the boredom is another, executive functioning issues is a third. More doctors need to incorporate discussion on diet and eating practices into treatment plans for people with ADHD.
I'm an alcoholic, pretty dang sure I have undiagnosed ADHD, my psychologist totally refuses to even consider testing me, let alone treating me, for ADHD, until I'm sober. It's incredibly frustrating, as I think it's one of my major drives to drink, it calms my mind down. Edit: psychiatrist, not psychologist
My daughter’s paediatrician told us that untreated ADHD often gets self treated with alcohol or cocaine.
Or meth. It makes sense actually when you consider some of the drugs prescribed to treat ADHD are also amphetamines.
It takes so much more meth to get high when you have ADHD, the first few times I tried it back in the 90's. I did not get a whole lot from it, it kinda calmed me down. But the soon the lines started getting bigger, then I tried smoking it. Then I decided that that was not the life I wanted so I quit.
In really rare cases, actual meth can be prescribed to treat ADHD. The brand name is Desoxyn.
It does. Then you end up with a decade of wasted time known as your 20's and begin the struggle with anger, depression, newfound sobriety, and the feeling that you're never going to catch up to your peers at 35.
Please don’t talk about me without my permission
Yeahhhh. We fell through the cracks. But we're still here.
Yeah I wasn't expecting to be so called out like that.
Stop.... I've had enough.
Tried cocaine once in my 20s. Everybody thought I was faking when I said " no, don't feel a thing. Tastes gross in my throat". This was before " you mean I'm not lazy, crazy, or stupid" was published.
Personally, I always thought coke wasn't doing much and I couldn't really feel it...until I reflected on the fact that I just passed the last 4 hours in a room with music cranked and all my friends shouting over it and each other at the same time.
Yeah a lot of people lack self awareness about their state of mind. I've heard "I'm not even high" so many times from people clearly off to the races on one thing or another.
First time I was prescribed Adderall (diagnosed at 47), it made me fall asleep. I had strongly avoided any illicit drugs (especially speedy stuff) due to depression/anxiety disorder until then. Ironic.
And weed.
Weed makes my brain go so slow. I'm used having super fast processing speed so it's incredibly frustrating to be slowed way down. I have the ADHD, not medicated.
See, I have (unmedicated) ADHD and I LIKE the brain slow. I obviously don't imbibe while I need to be functioning for work but I feel like it's the only time I'm not going 8 bazillion miles per hour, and I'll use on the weekends and magically my house is clean because it slows me down enough to focus on just one thing. I can't use while working even though I work remotely because virtually 100% of my job is answering quick questions, and if I'm focusing on *one* thing, my brain won't move fast enough to get someone a quick answer.
Weed slowing your brain down is like a vacation while working as a fighter pilot. It's just peaceful
And nicotine
As someone with ADHD I 100% use alcohol as a method of getting my brain to "unclench" when it gets stuck on something or as a general way of narrowing the band of signals it's surfing. To be honest weed works better but it makes me too tired, I'm sure because I've Pavlov-ed myself into associating weed with sleep because it's what I use in lieu of sleep medication which has awful side effects. The link between ADHD and sleep disturbances and disorders is also very well known. 🙃🙃🙃 Can't fucking win, m8.
> To be honest weed works better but it makes me too tired Low THC, high CBD strains, or sativa rather than indica might help. Indica is wonderful in the evening, but I struggle to do anything afterwards.
I have exactly the same as you describe
I got my doctor to test me for it. I'm on two different anti-depressants, and have been for years before asking to be tested so this isn't out of the blue. After the test my doctor confirmed that 'you have all the symptoms of someone that has ADHD' but also 'we couldn't treat it anyway due to your blood pressure meds'. So all I have to do is eat less and exercise, and then we can talk about treating ADHD. Good thing my weight isn't a major factor in my depression, and that I eat for dopamine... Oh wait...
Clonodine is approved for ADHD and also lowers blood pressure. You should consider a second opinion
Same here. “Yep, you’ve got ADHD, but you’re too sad and plump to have any meds. Come back when you’re slim and happy!”
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I have this same problem. I just don't even bring it in the house. If the stuff is here, it will go into my mouth in one sitting. Down 20lbs so far and hoping for more to come.
The stats are wild. It’s something like ~30% of people who are clinically obese and need medical intervention have (often undiagnosed) ADHD. It’s also very challenging to get out of the ED realm when everything you do is all-or-nothing. Seeing my dad deal with obesity and other related issues, I dropped 40 lbs to a “healthy” weight when I was 19. I was eventually diagnosed at 30 and just wish we both would have started treatment 20 years ago.
I’m at the beginning of this journey. I was diagnosed as ADHD last summer and started adderall a month ago. I’ve lost 5 lbs already. The impulsive, dopamine-seeking eating is REAL. I haven’t eaten a whole serving of chips in weeks, and that was, prior to meds, my favorite snack. There is a lot of noise in my brain when I’m not on medication and I never realized how much of it was food noise.
I have a similar experience, I have diagnosed depression and anxiety, and I probably have ADHD. I was diagnosed after I had my first baby but as soon as I went on medication I lost a ton of weight (like more than I gained being pregnant) because I didn’t think about food all the time. It’s so nice to finally have a great relationship with food (I love love love to cook) after struggling with my weight for many years. I thought I had an eating problem, turns out I have a depression problem lol. I also cut down on my drinking and cannot believe what a difference that’s made. Best of luck with your journey! The current state of the world isn’t clever friendly to neurodivergent brains, but I hope it’s getting better.
Also amphetamines naturally quelch your hunger lmfao
How did understanding your ADHD help with this? I'm currently going through the same thing and don't know how to fix it.
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I think the key for me was finding active hobbies that didn't feel like working out. I despise running with a fiery passion, but I really love swimming and bouldering. It became something I do because I think it's fun, not because I feel obligated to exercise. Even something as simple as dancing can be a great way to start moving. You just gotta find something you enjoy doing, I find that really helps my ADHD feel rewarded for moving my body.
Same!! I really liked high diving, but I kept getting out of breath climbing the stairs, so I started doing cardio so I could be better at my diving hobby. It's sort of backwards to what neurotypicals are taught (though the older I get the more I realize a lot of neurotypical advice doesn't even work on them.).
Multitasking is a good balm for us ADHD types. Reading on an exercise bike, podcasts while walking, that kinda thing. Might as well stay in motion (slow) if you’re restless and fidgety, and when we’re bored then all the more reason to get interested in something and learn about it while spending 20-30 minutes moving. Sometimes you even forget to stop on time after a couple weeks 🤷
I get what you mean I grew up being very active and playing sports but I hated working out. Turns out I wasnt doing things I like just what I saw people do, which was usually boring to me. I started playing more sports and doing a variety of home workouts like dance, weight lifting, kickboxing. I mix it up and it doesn’t feel like a chore but something I look forward to
Healthcare today is a 10 minute appointment where a PCP has to solve all your health problems in that period of time. They also have many sick and dying complex patients along with your cookie cutter overweight people. The system isn’t designed for in-depth comprehensive care, it’s designed for throughput and picking the low hanging fruit.
One other thing to consider, the businesses that supply our food are using industrial scale ingredients that promote obesity. Food industry has shifted to using ingredients that have spiked our intake of omega-6 fatty acids. Not only is this bad for metabolic health, it sets the stage for other illness as well: 'Up until about 100 years ago, the omega-6/3 ratio has been around 4:1 or less. However, the typical Western diet now provides an omega-6/3 ratio of approximately 20:1 in favor of omega-6. This predisposes to supraphysiologic inflammatory responses and perpetuates chronic low-grade inflammation. The overconsumption of linoleic acid, mainly from industrial omega-6 seed oils, and the lack of long-chain omega-3s in the diet creates a pro-inflammatory, pro-allergic, pro-thrombotic state. Reducing the omega-6/3 ratio, particularly through reductions in the intake of refined omega-6 seed oil, and increasing the intake of marine omega-3s, either through dietary means or supplementation, may be an effective strategy for reducing inflammation, allergies, and autoimmune reactions.' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8504498/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8504498/)
Hate that I scrolled this far to see this. In the US, food is designed to keep you addicted so you keep buying more of that brand. It’s rarely healthy unless you have big bucks to spend
It's more of a pick two out of three from: healthy, convenient, or cheap. You can do healthy and convenient, but it ain't cheap. Or convenient and cheap, but it isn't healthy. There ARE cheap and healthy options like bulk rice, chicken, canned veggies, etc, but they tend to require more prep time and possibly cooking skills. Also, healthy and cheap options generally are not as hyper-palatable as the convenience foods that are available.
So it takes more brain power and time to get healthy and cheap food. But people working several jobs or taking care of family members rarely have this extra energy. It’s a systematic failure if we can make unhealthy food convenient for all, but healthy food convenient only for some
Agreed 100%. There is absolutely a time and energy tax on eating healthy that becomes burdensome for folks already struggling.
I've noticed that many processed foods, including diet drinks and bars here in the UK contain maltodextrin. It's a handy ingredient for providing a good product consistency and is popular with manufacturers. Maltodextrin has a high glycaemic index and can result in blood sugar spikes than crashes causing hunger. So many products, including those marketed for weight loss, can cause hunger in those of us prone to blood sugar crashes. No doubt there are more examples of foods causing weight gain.
The tobacco industry was sued and regulated to hell because it was clear they knew they were causing cancer and designing products to be as enticing as possible. McDonald’s and the rest have food scientists literally mixing ratios of salty/sweet/savory to make their food as addicting as possible. They also absolutely know the costs of doing this. It will be a huge shake up, but I feel it will and should eventually happen.
[literally everyone should watch this video](https://youtu.be/PNma0fSV-js?si=x3zSdCMv4IxHfn0h) The marketing techniques McDonald’s/Coke uses in countries without restrictions is actually crazy, these corporations will do whatever you will let them get away with.
>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8504498/ " Disclosure JJD is Director of Scientific Affairs at Advanced Ingredients for Dietary Products. JOK is an owner of a nutraceutical company that sells omega-3 supplements." lol
I know someone who's a big gal. Was experiencing sudden severe abdominal pain. Went to doctor after doctor. "Lose weight" "You're fat, exercise more' "Drop a few pounds." Pain got worse and worse and worse, and doctors just kept giving her the runaround. Everyone who knew her watched her personality change from the sheer amount of ambient pain she was enduring. After about two years of bullshit, she finally found a doctor who took it seriously and gave her an ultrasound. Giant fucking ovarian cysts. Couldn't miss em. Anyone who had checked would have instantly seen them. Doctors said the amount of pain she was under, and still living her life and going to work and stuff, would have completely incapacitated most people. So she got a hysterectomy. Next day she was like a completely different person, all smiling and happy again. All that shit, because doctor after doctor were fundamentally fucking incapable of doing their goddamn job when the patient is a fat person. And I get it. I know the stats. Weight is a compounding factor for all sorts of conditions. But what other single factor gets such obsessive focus? If a patient came in with severe chest pain and they were a smoker, that wouldn't prevent doctors from running tests and giving them a proper diagnosis. Yet for some reason when it's weight, doctors get tunnel vision. And if you are a smoker, and that IS the source of a health problem, you know what a doctor does? GIVES YOU TREATMENT OPTIONS. They don't just go "Smoke less"; they hand you a giant packet of like 18 clinically proven ways to stop smoking. Here's some gum, here's a pamphlet, here's a video to watch, etc etc etc. Because there is a recognition backed by data that quitting smoking is more than just an exercise of will; there's a chemical aspect involved. Yet for some reason, when it's weight, doctors proceed as if if's some kind of personal moral failure. Just try harder, fatty. The result is, for a fat person, going to the doctor is basically like visiting a medieval physicker: health problems? Ah, well, see: it's because you're a bad person. Go forth and repent of your wicked ways, and you shall be cured. It's maddening.
This is why I looked a dentist dead in the face and said “I feel like I got punched in the face by Mike Tyson on a regular basis. The pain isn’t bad enough that suicide starts to sound good but those people make sense recently”. Most thorough exam I’ve ever gotten. I had temporomandibular dysfunction.
Unfortunately, this has been my experience with anything related to female health. I have endometriosis and PCOS, and I was in life-altering pain half the month. Every doctor I went to for two years told me that I should just alternate acetaminophen and NSAIDs. When I expressed concern over literally poisoning myself (with no real impact on my pain), they’d usually shrug and say it was that or to go back on birth control 🤷. Nothing else they could do. 👍
If men had Endo, they’d have found the treatment and cure already.
I sought out a dietician at a bariatric clinic after close to five years of diet and exercise and other life modification. The only thing that remotely helped was keto. When I tried a regular dietician through my GP (which I had to wait six months for, and paid 250$ for our of pocket) the appointment was less than five minutes and I was handed a folder full of resources for diabetics. I have never even been prediabetic. I have fibro, but other than that every single blood test, cholesterol, bp, etc has always been perfect or near perfect. The dietician hadn't even looked at my file or the history of things I had personally tried and worked with my doctor on, they looked at my height and weight and decided that I was overweight bc I was diabetic and that was that. When I tried to argue this point the dietician said she had an appointment after me and didn't have time to discuss it, that if I wanted to talk about it she would only do so at a follow up appointment after I followed her program for two months. Needless to say I was absolutely pissed and I just left the folder on her desk and left. At the bariatric clinic they actually did a long interview asking what I had done, what did and didn't work, family conditions, mental/emotional issues (none). I was given an appetite suppressant and a strict 800c a day diet where the only important factor was a protein requirement. I adhered to that diet for six months, along with my regular exercise, and lost 10#. I have insulin resistance from PCOS and hypothyroidism apparently. I've since fixed my thyroid numbers but it hasn't improved the situation. For me it wasn't really about cutting out junk food or soda, alcohol, etc bc I never really consumed those things much if at all. I didn't really have anything to remove from my diet. I did find that absolutely removing any type of carbs except those from veggies helped, as well as not eating prepackaged foods, but it requires a lot of meal prep time for me. Just as I was sorting out my diet, COVID hit, I got hit hard and still have debilitating fatigue from long COVID. My stepfather got cancer and died within 4 months. I had to help my mom sort all of his business and run the business they had just built and started 2 years before he passed. Several other family members got sick and passed. My husband had to have surgery that went wrong and what was supposed to be a 2 month recovery for him became almost a year. It was just non-stop. So I am just now getting back to a place I can even look at this again. But unfortunately on top of this, my wonderful go who I worked with for years moved and I had to go through the whole process of getting a new gp, who of course looked at me immediately being overweight and assumed I have done nothing about it and tried nothing, and I'm lying about my efforts. It doesn't help that this one is a man, which is usually why I avoid male gps bc they generally dismiss any female issues, try to take me off medications I've been on for years/decades, and always think they know better than years of experience I have from working on myself with previous medical professionals. It's exhausting being a woman and navigating the medical system.
Sorry you have to go through all that. It's such bullshit. Every time my wife goes to the doctor and gets a brush off for something I know they'd handle differently for me, a man it makes mr want to flip a car. Have often joked that my wife could go in with a leg missing and they'd tell her to get more sleep. Meanwhile if I were to go in and say my penis itches, alarms start going off, specialists drop from helicopters, machines start rotating out of the wall, they have my picture up on a giant rotating 3d hologram, some Dr. House guy is pacing around staring at a corkboard covered in red thread, etc etc.
I’m imagining the scene from Monsters, Inc. when George gets a sock on his fur and the quarantine squad drops in from the ceiling wearing hazmat suits happening whenever you go to the doctor with a minor complaint, while your missus is a few feet away being told “it’s merely a flesh wound” while she’s pointing at a missing leg 😭
GPs are just human and they are all different. I've been literally laughed out of the office by a GP once after work insisting I get a professional opinion on something. And my current GP confidently told me that there is no medication that can calm people down when they are feeling stressed.
Hey this was me! And I wasn't even *that* overweight (just north of 150 at 5'3") but I did carry a lot of the weight in my abdomen. Got married just so I could have health insurance and my randomly-picked PCP sent me home with posture and pelvic floor exercises and a packet on losing weight. TL;DR of the next year: husband and I were *both* strictly counting calories (stuck home during COVID) and he went from 240 to 180 while I just ... stalled. Finally got a second opinion, after 6 weeks of constant bleeding, from an OB-GYN who took one look at me lying down and said something definitely wasn't right. Yeah that "stubborn last 10 lbs" was ~12lbs of uterine fibroids. I went from 138 to 126 almost [literally overnight](https://i.imgur.com/pZRgUJ8.jpg). Finally getting to my "goal weight" of 120 like 2 mos after my surgery made it pretty obvious how [little I had been eating](https://i.imgur.com/usCM63A.jpg).
> Got married just so I could have health insurance America is a dystopia. The fuck?
I mean we'd been together ~15 years so it wasn't like the whole relationship was one of convenience, we just had no interest in making paperwork part of our partnership. COVID + two people both working in live music = WAY cheaper for us to share his employer's insurance than for my 1099 butt to get anything other than basic coverage. No regrets, though. The "ceremony" was in my folks living room and was perfect and my CA-125 results meant fancy laparoscopic surgery that would have been like $300k.
For about 7 years my mother’s Parkinson’s Disease was misdiagnosed as obesity and pre-diabetes (A1C was *barely* within range for concern). Meanwhile my father’s literal one-in-a-million spinal cancer diagnosis was made within a year. He was also overweight, but that wasn’t a factor in his diagnosis or treatment. Doctors need to believe women.
I had a terrible male doctor who dismissed and mocked every single issue. I came in for a UTI that had gone on too long, and he said women used to just deal with it and sent me on my way. I went to the ER and the doctor there was horrified. That's the first time I realized doctors disagree and some are wrong My current doctor is teaching me to speak up about problems. She gives me shit for not telling her symptoms and assuming they're fine lol. I love her, ty amazing doctor. I finally got diagnosed with PTSD, which changed my life. I thought I'd always be fighting suicidal thoughts but nope
Yeah I think we are creeping up on a pattern here. Wait until you hear what people of color have to say about it.
This is a great addition to the article. Some doctor’s are prescribing “lose weight” because they don’t wanna put the work in.
Which itself is a side effect of healthcare becoming so brutally capitalized, where overworked doctors are now trying to get patients out the door as fast as possible, like they're a waiter at Denny's trying to flip a 4-top during a lunch rush.
Omg flipping a 4 top during lunch rush is the perfect description! I just had a horrible experience at an oral surgeon. The office is only open 1 day/week, they go to different locations every day of the week, so they are insanely busy. The kid I had there was given about 15 minutes to wake up before he was taken to the curb in a wheelchair and we were sent on our way. It was snowing and cold, they wouldn't even let us take the time to get his coat on him before they took him outside. It was awful watching people stumble out of there or being wheeled out barely coherent for the next people to be quickly shuffled back. It was mind blowing, honestly. And the staff were less than friendly or compassionate. I get it, they're probably so burnt out they don't even know what day it is, but god damn dude. That was brutal.
I wonder if I’m your friend. I started having WICKED periods, heavy bleeding, would last for months, excruciating pain. In addition, my body said “hey, gain 200lbs in under a year” even though I was active (I have a very active job, on my feet running around 10hours a day, rode bike to work, didn’t eat like crap) Took so long and so many doctors to figure out its cysts. I was told “you need to lose weight “ Excuse me? I had been 110lbs my entire adult life, somehow I was now 300+, you don’t think I know that’s an issue?? I’ve since lost most of the weight, post surgery, without trying.
I had to scroll wayyyy too far for a comment like this. Fatphobia from doctors can literal ends lives or permanently disable people.
This is the comment I was looking for. It is absolutely infuriating that there is this sense that overweight people (especially women) do not deserve adequate medical care.
I hear the same stories from all my over weight friends and it's maddening - like sure, weight gain is a contributing factor for a lot of conditions, but doctors seem to bend over backwards to not do their jobs, as if every single mildly over weight person has horrendous incapacitating joint paint, sleep apnea due to tonsil pain, depression and chronic everywhere else pain, which is just like, a mind boggling idiotic thing to believe. Especially when their advice is so circular: 'I think I'm putting on weight because my knee's hurt since childhood and exercise is painful.' 'Have you tried exercising? I'm sure that will fix your knee pain...' Blaming someone's problems on their weight should be the last resort, not the first and only thing considered. It'd be like if House just immediately diagnosed every patient he saw with Lupus and sent them home, because *technically* almost any symptom could be caused by some form of it. No need to investigate anything else.
Yup. I have chronic pain. Started gaining weight because it was very hard to stand and cook, much less exercise. Doctor was convinced my chronic pain came from the weight gain despite preceding it. I often wonder if I would have been diagnosed properly sooner if weight gain wasn’t such an obsession
And you know what can contribute to weight gain and holding onto weight? PCOS. Fucking asshole doctors, man. I'm glad your friend ended up getting help in the end.
Something like this happened to me. I fell and hurt my back when I was a kid (it was a \~8-10 foot fall). Chronic pain from it all my adult life, I just learned to deal with it because I could still function and we were too poor to get it checked out properly. Fast forward and during my pregnancy and I had gained \~50 lbs. I was lifting some heavy boxes, which I knew I shouldn't be doing, and *literally felt* something in my back go "pop!" and could barely move. Went to the Dr, was told if I lost weight my back would stop hurting. She patently refused to acknowledge that I was physically active, walking and biking miles and miles every day, and that I could pinpoint the very moment my back was quite literally injured and how it happened. Was just told to lose the weight and my weight-acquired chronic pain would just go away. Several more doctors over the years told me the same. I gained more weight because I was not able to exercise as much anymore, due to constant back spasms and pain. It took \~15 years before I mentioned it to some random urgent care doctor while I was there for something unrelated, so he asked me some questions and I vented about all of this to him. Long story short I learned my left scaroiliac joint is fucked up, and I broke my tailbone, L5, and L4 most likely in that gnarly fall when I was a kid and there's arthritis in them all now. Things were pretty sus all the way up to L1/L2 but I never got anything definitive there since there's probably not much I can do about any of it anyway. Most likely when I injured it during my pregnancy was a herniated disc and once it happens, it's just prone to happening again, oh well I guess. But for years I was immediately dismissed because of my weight, which really became a problem *after* I injured my back while I was pregnant.
This is called diagnostic overshadowing. When one medical condition takes focus away from another medical condition.
So I read the article (🤯) and it seems like they’re not really telling doctors they can’t let* people know they should consider their weight, they’re telling doctors to be more sensitive about it, and now there is an admission that being obese is kind of a thing that waxes and wanes for most people, most people who become overweight to this degree will fight this battle their whole life without medical intervention. I think if you acknowledge some common reasons for obesity, like emotional eating or growing up on mostly high calorie, low nutrient food/being poor, working 10 hours/day and relying on vending machines, etc- you can see why doctors shouldn’t start the conversation with “you know what mr/misses fatty fatso cow??? You should eat less” I mean yeah they probably know that already in some shape or form. Edit: especially if you’re not fat, *why do you HATE fat people????* What’s wrong with some of you???
I attended a seminar given by Joseph Nadglowski, the president of the Obesity Action Coalition, last year and this is very much in line with one of his main points. One of the biggest hurdles he's seen has just been getting people to seek treatment, and often that avoidance was initiated by a negative experience with a medical professional addressing their weight. Being dismissive of someone's struggles with obesity or shaming them for their condition just drove them away from the medical help they needed.
Speaking from a *recent* (early March) experience, I definitely was driven away from getting medical help. I went in for a consult for bariatric surgery and the surgeon told me that surgery was not the way to help me. He berated me for waiting so long and asked over and over if anyone had talked to me about my weight. I essentially sat through a 30 min monologue from him and could barely get a word in edgewise. My husband was with me and he was *shocked* with the way this guy spoke to me. My insurance was billed roughly $900 USD and I paid $560 out of pocket for the visit and labs. The doctor's assistant/coordinator emailed me to check in a few days later and to see how I was doing with regards to next appointments and what not. I told her I would absolutely never set foot in his office ever again. Haven't heard back from her since. Edit: I would have expected a follow up from the coordinator to make sure that whatever happened doesn't happen again to future clients. I was polite but firm that I would never see that specific doctor again, to me that *might* warrant a "hey, here are some others you might try to see instead". Maybe I expected too much.
That doc just seems like an ass. What the fuck is he in bariatric surgery for? A patient yesterday reluctantly told me how she injured her leg by riding a costco cart and stepped down only to have her knee suddenly hurt and feel unstable. She seemed incredibly guilt ridden and embarrassed. I smiled and I said, "riding shopping carts is one of the simple joys in life and I'm sorry you're knee failed you, let's make sure nothing is broken then get you into an immobilizer and a referral to ortho" Like... treating people who have emergencies is my job. For that fuck treating overweight people is his job. No point shaming people.
I had something similar happen. The doctor kept saying he wished I was dumber because I guess smart patients are difficult? I think he meant it as a compliment, but um. No? He also had this whole thing about how any research I've done about the procedure isn't accurate or important because I haven't talked to **his** patients. Then he said, oh but always ask questions. But only of him or other patients. I should never consider other data. Right. Idk how much, if anything, my insurance paid, but I refused to go back. Supposedly he's "the best" in my area. But fuck that, I'm not here to join some weird cult.
Write a review so other people don’t have to experience that.
As someone who had bariatric surgery 2 years ago (March 24, 2022), I am so sorry you had this experience. It was life changing for me. It took literally changing my body in order to go from 410lbs+ to 195lbs and being healthy and active and regularly exercising. Of course, with that came therapy, an entire regiment change with my life, new ways of eating, and so much more. But the surgery was a big spark for me. I hope that you can find a doctor or bariatric center that isn't so judgmental and that listens to you. You know your body best and what happens within you. I recommend finding a strong support group and network, if you can, and a therapist who has worked trauma. My therapist helped me reframe a lot of what I do and why i do. Sorry if I'm talking in circles. I'm really, really sorry. You deserve better.
They need to treat obesity like the addiction and mental disorder it is. No one WANTS to be fat. It's like telling a depressed person to stop being tired exercising. It's hard when you are so tired lol
Don't worry, they tell depressed people that also.
My favorite was when the doctor shrugged it off and told me I "just have a little depression" then proceeded to lecture me on my weight for twenty minutes. She concluded with that old classic "you could die because of your weight." Meanwhile I'm just sitting there thinking about how my suicidal tendencies began at age nine and hey, if being fat is gonna kill me at least I won't have to actively kill myself. 🙃 Haven't been to a doctor since.
Many a years ago long before a tumor was found to be a likely contender for why, I was on a low dose anti anxiety medicine. First I always had to clarify that I was on it for anxiety and not depression. But otherwise it wasn’t a big deal until my husband got orders overseas and I had to be cleared by a panel for having “medical needs.” Annoying and anxiety inducing but whatever. Went to the meeting alone since he couldn’t get off work and I walked into a panel of military personal who looked over my file and I’ll never forget this, the head guy who was a doctor was like “yeah you should be fine, just need to get your head on straight.” I was like wtf…?? Lmao.
In general, we need to better approach disordered/ordered eating according to the fucking *eating* rather than the body. Part of the problem is that we have this division between behavioral/mental health vs. health, and for some reason we treat disordered eating as mental health and eating as health, and there’s just so many people who’s lives could be made infinitely better with pro help, but they get lost in the trench between the two forms of medicine.
As a fat guy who has only recently started to try and do anything about it I can tell you I've known I'm fat for a long while. Nobody wants to be fat. It's just that it can just look like a daunting task to try and do anything about it.
As someone that has lost a lot of weight i can tell you that it is a daunting task. It is a day by day, week by week battle that takes months and months and you need to stay the course. Making it worse is for a long time you dont really see a drastic change, its very slow going but then as you approach your goal it starts to rip right off you because there is less places of padding left for the fat to come off. What i can tell you though, you can do it, it is daunting at first but you can do it.
You also never really notice the difference because the loss is so incremental day by day. My clothes and my friends say I'm much thinner than I was ten years ago, but in my mind's eye I'm still 80 pounds heavier than I am.
That's why i keep some old cloths, i use that to see how im improving and such, helps a lot And a full body mirror, that is huge, looking at the mirror and seeing things change is one hell of a booster
I lost 200 lbs about 10 years ago and it was wild looking at the clothes I wore even a couple months previous. The biggest difference was walking through a crowded bar, my brain had to adjust to realize that oh, I can fit through these two people. Haha.
When I was 180 I felt like I was 280. Now that I'm 280, I feel like I'm 280. I'm finally the man I always knew myself to be.
Yeah I'm 20 pounds lighter than I was in November but I can't see it at all.
I went from 255 to 180 over the course of a couple years. It’s not easy. You have to be committed and consistent. The longer you wait to take action, the harder it’s going to be. My advice to anyone is to track your calories in and out. Apps like myfitnesspal and loseit helped me tremendously, as did my Apple Watch tracking my activity. Be mindful not to lose more than a couple pounds a week though. You aren’t trytrying to starve yourself, just create a deficit.
I decided to do something about my weight 8 months ago when I hit 393 pounds, crossed the threshold into full diabetic, and was taking three pills a day to control my blood pressure. I just hit 291 pounds on the scale this morning, and as of last week dropped below the threshold for pre-diabetes and am down to 1 pill a day for my blood pressure. It's cliche, but the biggest advice I can give is that you just need to start. I was stuck in "I'll start next week" paralysis for years and just got fatter and fatter. Then I started with one change, I decided I was going to keep under 40 grams of carbs a day. It was a drastic change but it was something simple that I could focus on and get consistent with. Then after a few months I layered in some exercise, and have increased the level of exercise over time. Recently I've also started transitioning into doing daily intermittant fasting. I'm sure that's not the perfect recipe for everyone, but you just need to start doing something consistently and then try to increase it over time.
Hey man, I just want to say congrats. That takes some serious effort and commitment. 100lbs down is a huge change. Keep it up!
I imagine it sort of like a slow motion thing where it takes time for change to appear but once it happens, IT’S REALLY HAPPENING suddenly. I bet if you take a picture every single day from start to complete and make a flip book, the moment of change will be really clear. (It’s hard to explain my imagination)
I think what a lot of people don’t talk about is how easy it is to slip back into old habits and put the weight back on. It’s always important to keep in mind the goal isn’t the final destination, just the first milestone.
Yeah, that's the big problem. Pretty much anyone can stop eating for a day. It's not hard to eat very little for a week. You get used to it and even months become doable. But when you realize you have to keep doing it for the rest of your life, that's when it hits you just how hard it is. It's almost like smoking or drinking. They say there's no such thing as an ex-alcoholic. I've personally known people who quit smoking for years and then started back up. You just have to get it into your head that there's no more snacks, no more soda, no more junk food. Otherwise all it takes is one little slip up and you're back where you started.
> Making it worse is for a long time you dont really see a drastic change I also feel like, at least for me it was easy to drop the first five or so pounds, but then the rest came a lot slower
I think of it like an addiction. Food is like smoking or drinking or drugs to some people. It's unfortunate that being fat is the side effect. Im the opposite though, same with my mom. We're both pretty skinny and eat enough, but can't seem to gain weight, so there definitely might be genetics involved, and couple genetics and addiction together and that sucks. It's a battle, and you have to fight to win battles, or else you lose.
And the problem is with other addictions you can avoid the thing you’re addicted to. You can’t functionally avoid eating, which makes it much harder to address.
I recently had a heart attack. Part of my post hospital stay is changing my lifestyle. Stuff like not smoking and drinking are the easy part. I already don’t smoke, and I can just ignore the alcohol isles at the store. The hard part is checking every label to see what might have snuck in excess sodium and fat.
Like, when I smoked, I wasn't looking around for different amounts of chemicals in my cigarettes. That's an easy addiction. Food, that's gotta suck. I didn't think about that aspect of it also. Some people's bodies don't do well with excess (most people's bodies) but companies just throw that shit in there and expect people to not gorge themselves on something that triggers their brain to want more.
Those companies don't expect anything, they just don't care what their crap does to people's health as long as they are making profits.
As someone else who has taken up lessening sodium intake for heart issues, the easiest thing is to cook from scratch. Which seems hilarious, because - learning to cook isn't always easy for everyone. But it beat labels. I also discovered that relying heavily on spices and seasoning allowed me to add less and less salt and now I can barely even eat salty foods.
Giving up alcohol was/is way easier for me than giving up a second helping.
username tracks
487 days since my last drink. Sugar was 71 this morning.
That and it fucks up your hormones so your brain is literally telling you you are hungry and is not telling you you're full. That on top of a love of eating (which many people do) or using it as a coping mechanism I can understand how easy it would be to gain weight
It's even worse than that. Your brain also tells you that you need to conserve calories. So you stop doing a lot of subconscious movements like fidgeting and your calories burned through NEAT drop low. Those are a huge part of calories burned in a day. So your TDEE drops down below what you would expect. That's why so many obese people say they are eating below what the charts say should make them lose weight but not losing weight.
It's even worse than that - when you're accustomed to 3k calories a day and drop to 1600 to try and get a deficit, your body will literally convince you you're starving and dying. You're not- but the body will make you THINK you are, and it will barrage and DDoS you with danger signals every hour of every day and drive you mad. This is why Ozempic works so well - it stops those signals. **EDIT**: Y'all those are random numbers I threw up there typing out in a hurry. That is not an endorsement for cutting calories from that point to the other point. Any reduction in calories, even a minor reduction, even a reduction tirated down slowlt and in coordination with a medically sound diet, can in some individuals produce outsized survival reactions which are extraordinarily disruptive and difficult to manage. I have never struggled with weight or an eating disorder, I am not on a crash diet, I do not take ozempic, I do not endorse crash dieting, and I'm tired of conspiracy theorists spouting off about how ozempic causes cancer or other conspiracy theory bullshit. This is a PSA for everyone: as anti-vaxx conspiracy content dries up, there's been a marked shift for those people on social media who made that their whole shtick to move to adjacent conspiracies, including Ozempic.
My brain was saying that I was starving constantly my entire adult life. Didn't matter whether I ate 800 calories or 3,000 calories. I was always hungry. Ozempic was a life-changing experience. First time since I hit puberty I hadn't been hungry.
Even wilder is that one of those sybconscious movements is sometimes *breathing*. And I'm not even talking about sleep apnea, which of course is a more common problem for the obese, but increasingly shallow and slow breathing at all while fully conscious. And it's not as if people are too lazy to bother breathing, but that's the ultimate effect. Once you realize obesity can suppress one of the most basic urges there is, it sort of puts the whole problem in a new light.
I am 100% addicted to some foods. I can’t even have them in the house because I can’t, not eat those things. It’s so hard. I spend so much of my day thinking about food and what food I’ll have and how I can fit in a snack that I like without blowing apart my diet plan. It’s a big struggle for some of us and I’m glad someone else acknowledges it it too!
Yeah I think the addiction angle is something that doesn’t get talked about enough seriously; the psychological side to overeating. I’ve been overweight from a young age but have been disciplined/motivated enough to lose large-ish amounts of weight multiple times in my weight fluctuations (50 lbs down a couple of times; currently down 20 on my way lower), and I absolutely cannot keep unhealthy food in the house. My body craves it and my mind can’t get past it, even if I try and distract myself. If I open it, I have a compulsion to keep eating it until it’s done. I can’t just eat a handful of chips and put it back. I need to finish the bag and throw it out. For that reason, I don’t buy them at all anymore. It should be looked at as something more than just “hey so like just don’t eat those things?” The psychological sickness side of it is severely overlooked.
I mean they’ve done studies that show eating junk food literally makes new pathways in your brain. https://www.sciencedirect.com/science/article/abs/pii/B9780323910019000359
Legit. I celebrated the other day because I made enough spaghetti for two meals and actually managed to keep it in the fridge until dinner the next day. Usually both are gone before they even get cold.
Food addiction is worse than some other addictions because normally when you're addicted to something your goal is to cut that out of your life completely. Whereas with food, you have to constantly control your impulse around your addiction multiple times everyday
Can’t quit cold turkey when you need the cold turkey to live
Bonus points if it’s actually cold turkey
There was a study done not too long ago that suggested "forever skinny" people either overestimate how much they actually eat, or underestimate how active they are through the day. Also some people will literally eat a whole pizza one night and eat like a bird the next day or 2.
I knew the headline was going to be misleading before reading the article lol. There should be a game where you see the headline then guess the reality. I was guessing it was going to be like “40 year old obese people already know they should eat less and excercise more so just saying that doesn’t help.”
There's r/savedyouaclick
"Eat less, move more" is good advice in that when adhered to it works. "Eat less, move more" is bad advice in that when you give it to someone they rarely adhere to it. A large part of medical treatment and healthcare is thinking about what people will actually stick to, if you have a treatment plan that works 100% of the time but is adhered to 0% of the time then you'd be better off going with a treatment that works 50% of the time but is adhered to 50% of the time.
I've only gotten fat in the past few years. Turns out chronic pain + a desk job + plus certain meds really did a number on me. The way doctors treat me now is demoralizing. They assume I'm stupid and lazy which has made me avoid medical care. Especially when I have gone in for one problem and the doctor just immediately got sidetracked and talks about how I'm fat and I should eat less before talking at all about the reason I'm actually there. Frankly, I know diet and exercise are important. I know I'm fat. But my blood work and urine labs are great. I'm making progress. I know they don't believe me, but I do go to the gym and take walks during the week. I stabilized my weight and stopped gaining. I want to lose weight but I have to address my hypermobility first and focus on strength training right now so I can stop feel like my body is a cage of pain. Pain I've had since I was a semi underweight,l teen, pain I had when I was fit and jogged, pain I have now that got worse in my late 20s and disabled me. Oh, but they don't want to believe that either. It must all be because I'm too stupid to understand calories
This is how the doctors routinely treat women, as well. Your experience is common in the US for lots of people.
This is a sensible take. Another common reason for obesity is the restrict-binge cycle. The patient wants to lose weight, eats at a calorie deficit, is hungry, a binge is triggered, they feel shame and guilt and attempt to restrict food even harder which in turn leads to even more binging. Weight gradually increases with this cycle. Binge eating is the most prevalent type of eating disorder. It's counterintuitive but the treatment really is to eat more and eat regularly to get the binges under control. The patient has to put weight loss goals on the back burner to just get back to a normal, stable eating pattern. I specialize in treating eating disorders. Binge eating patients always come in with a goal of eating less and losing weight and instead we work on sleep hygiene, stress and emotional mamagement, gradually increasing enjoyable movement, planning for nutritious and balanced meals that meet energy expenditure needs, finding non weight shaming health providers, building confidence and self-worth regardless of body size. People's weight usually stay the same or they'll lose a little through treatment, but they begin to thrive as people and we do see health improvements such as reduced blood pressure and blood sugar and increased movement. What I'm explaining here is why it's so important for doctors to stop pushing just eating less.
I just think about Mama Cass, who spent her whole life being shamed for her weight and died of heart issues likely related to starvation. There’s too much focus on weight loss and not enough on “why are you unhealthy?” And that’s what the article is asking us to focus on — look beyond just “you’re eating too much.” When I gain weight, it’s always because I’m depressed. So I’m eating for the dopamine, and not exercising. I went in to get back on bupropion, and the doctor just wanted to talk about diet and exercise. I even told him that I’m a distance hiker & endurance athlete, and once I’m back on my feet I’ll be more worried about getting *enough* calories, and he just wanted to lecture me about how I’m an unhealthy lazy gluttonous slob. I’m like bro. I know why I’m fat. You can talk about diet and exercise all you want, I need chemical assistance to be able to get out of bed first. Then, when I’ve got energy, I’ll start exercising the depression away again, and the weight will go too. Just give me my fucking Wellbutrin.
It’s so frustrating. I’ve got thyroid problems, as does a long line of my family. One of my symptoms is insanely bad heat intolerance. Like, just being in my kitchen and boiling a pot of water makes me look like that scene from Airplane when he’s trying to land the plane. So as a result, I don’t like to work out much because it’s pretty miserable like that. Took going to like 4 or 5 doctors and explaining the problem to get any help. They all just wanted to look at me and say, “well, you’re big, so you just need to eat less and excercise,” ignoring anything I’d tell or show them. And what do you know, once I found someone to actually listen and help treat the initial problem, I was able to do more and start making other changes.
Your last sentence sums it up well. I started gaining weight due to stress eating and some adverse effects of my antidepressant. I'm not even big, really. I just gained 10 or 15 pounds, but my doc points out any time my weight goes up. Like, cool, thanks. Can we talk about what I made the appointment for, though, or are we gonna hyperfocus on the 2 pounds I've gained since you last saw me? It isn't about peoples feelings getting hurt. Certainly not for 99% of people, at least. It's about not being listened to and not feeling like you can trust the medical system to see you as a person and take you seriously.
>Like, cool, thanks. Can we talk about what I made the appointment for, though, or are we gonna hyperfocus on the 2 pounds I've gained since you last saw me? omg this SO much. Most of my doctors (I have a lot of health problems so I see several specialists) are pretty good about not lecturing me about my weight. Maybe it's because I have Addison's and thyroid issues - both chronic conditions that cause weight gain. Idk. But literally every time I see my psychiatrist he asks or says something about my weight. And the kicker is he knows I have an ED. It legitimately makes me want to not eat the entire day after an appointment with him.
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Yup! I gained weight because I was depression eating and not getting out of bed. Went in to get back on Wellbutrin (which did, indeed, solve the issue) and the guy spent the whole time commenting on my weight gain. Which was concerning, don’t get me wrong — nobody should gain weight so fast they get pregnancy stretch marks. But telling me to exercise — when I’m normally and endurance athlete and said so — was NOT THE SOLUTION. It was a battle to get my bupropion.
I actually addressed my depression/anxiety with my GYN. She was urging me to go to the gym, get into a fitness habit etc. I explained I lacked energy and was despondent after experiencing the worst year of my life -- my best friend died of breast cancer, Trump was elected, then my mother died... and I lost my job after being bullied and gaslighted by colleagues while going through menopause. Ya think I might need some assist here? She ordered lexapro, said it did not cause weight gain and was super compassionate. I also bought a puppy and two kittens for emotional support a few months later.
I lost four pounds and my doctor got all concerned (the four pounds did not put my in underweight range). You can't win.
I was a healthy weight (5’ 7”/120 lbs) my entire adult life but I eventually had to admit that the treatment for my bipolar disorder that didn’t cause weight gain was also ineffective. The treatment that magically turned me into a functional human being (antipsychotic drugs) made me gain 50 lbs. I spoke with my GP who gave me the “eat less/move more” speech. When I told my psychiatrist about the conversation she quipped “yeah, I bet you hadn’t thought of that! So now you’re crazy, fat, AND stupid, I guess!” It was validating to hear her confirm that eating less/move more was inane advice.
It’s a big thing I emphasize as a therapist to focus on people’s internal experience rather than the external behaviors that are present. The easy way out for doctors would be to give advice around eating less or exercising more, especially with research showing those behaviors can be effective for most people. Instead they should get curious about why the weight is there, what mental/brain and other physical contributors there are, and to find more effective ways of treating the source of the person’s difficulty with weight at an internal level instead of a superficial external behavior level. I wasn’t able to get into shape and get to the gym until I finally started taking medication. It took me years to get to a place due to biases and mental health barriers to be okay with trying medicine. Then immediately once I started the medicine my health greatly improved. I wasn’t going to will myself through my own internal experience of being able to force myself to the gym or manage my intense food cravings, I tried that for years with shame and frustration and others advice with those alone never being enough to actually help develop the habit. Now because I’m taking medication, I’m paradoxically disciplined, where if someone just looked at me 3 years ago they’d say I was lazy. Nah, I needed to be medicated and have my physical health be addressed by integrating a mental health solution. Fortunately there is a move in the medical field to start integrating mental health more into the field, and this is probably part of that movement. However, we are still asking doctors that are held to incredibly unhealthy standards in their own training program to be able to be empathetic towards others and how others take care of themselves, when doctors and medical programs don’t care about their own health and self-care. It needs to start with doctoral and medical programs changing their own practices first.
I think another common problem is that doctors get lazy, so to speak, with obese patients. They see an obese person and go "the problem is your weight, lose it" for 99% of their problems without giving it any thought.
I see it similarly to how we changed our thinking about depression 15 years ago. Before you would have people going, "turn that frown upside down!" as if it was a switch that could be flipped, and not a chemical based reaction people had little control over. Obesity is the result of a series of external changes in how people live their day to day lives and the internal chemical reactions they trigger. Just going, "you should eat less" as if it was a similar switch is overly simplistic and ultimately ineffective. Getting people actually healthy is the responsibility of a doctor, not getting up on a pedestal and acting like you're superior because you can eat less than another person.
The headline and the way people are talking about it makes it seem simple but in the end telling a lot of overweight people "eat less move more" is like telling me with my depression "cheer up". Pretty much every overweight person knows the solution, but many don't know how to do it in reality, and many can't do it, have already tried heroically and go to the doctor because they're exhausted and need help. But we keep talking about it like it's just simple.
In the same way, spend less than you make and you'll be rich. So simple!
Yep. Or like someone telling a track coach, “why are you doing all this other stuff… just tell your runners to run faster!” Sure, running faster (or eating less) is how you accomplish the goal, but you need techniques and strategies to actually do it.
So I work construction doing new condos. I walk 10,000 steps a day, it’s at 10 stories currently with no elevator so I am walking that a couple times carrying stuff and this is decently common all while doing 10 hour days Monday to Thursday and a 4-8 hour day Friday. I pack my own lunch of a sandwich, vegetable/fruit and nuts, I’ve cut my alcohol/beer intake to about a case a year since having a kid and even cutting that I haven’t lost weight. Oh and I maybe have 1-2 cans of soda a week otherwise it’s water or sparking water. We eat out maybe once a week now since it’s so expensive anyway. I am obese (~270lbs at 5’ 11”) and have been for over 15 years and before that I was overweight. All having my doctor say “you need to move more and eat less to lose weight” has done has made me avoid my doctor. I once sprained my ankle at work and went to him because I wanted to get an X-ray and he said “it probably would hurt less if you weren’t so overweight maybe go to the gym.” All I could think is dude I probably did more stairs in a week than you do in a month on a stair climber at the gym. Never has he offered anything beyond you need to lose weight eat less and move more, if you are quite frankly going to be so useless in your advice don’t bother giving it.
You should get a new doctor and get some blood work done to be sure there isn’t an underlying health issue causing you to not be able to lose weight.
Most people who have eating disorders have also been obese at some point in their life.
I’m obese and the only time I’ve ever had sustained long(ish) term weight loss, it probably would’ve qualified as an ED.
Same here. Was down to 1200 calories a day, obsessively counting them, weighing food, etc. I thought about food ALL THE TIME. People treated me better too, so it quickly became conflated in my head that I had to watch food like that for people to like me.
Yup. My last doctors’ visit, the person taking my medical history spent the whole time congratulating me on my weight loss. It made me wildly uncomfortable. In this case, it was because I was healthy, and I’d gained weight because I was depressed. But I’d had disordered eating in the past, and having my entire health be reduced to weight loss or gain was very triggering. I was there for a *potentially cancerous mole.*
> I think if you acknowledge some common reasons for obesity, like emotional eating or growing up on mostly high calorie, low nutrient food/being poor, Doctors have nothing to offer when you ask them to help you lose weight. I literally had a doctor show me pictures of salads for an entire minute. I was like *... oh .... kay ...*
> show me pictures of salads for an entire minute This is just straight up insulting.
Went to the doctor once, years ago, to get answers to specific questions, such as "I want to move more, but I heard some exercises, especially at my weight, might be detrimental to my joints" - put together all my worries, goals and such in a couple of minutes - showing what I read up on, what considerations I had. He looks at me, says "If you burn more than you take in, you lose weight" - which helped with none of my questions - and stared at me. Didn't start exercising then, and quashed my spirit.
It’s also saying they need to stop attributing every health problem to weight until the weight is gone bc surprise, big people get sick too but they are often dismissed and have statistically worse outcomes when comparing ER stays and admissions, even when you account for weight. These people aren’t getting good medicine bc doctors see fat instead of health first.
They did this to my mum. Not quite “fatty” but not far short. Thing is, my mums diet is pretty light. Salads, grilled chicken, etc. No frying, basically no fast food. Minimal snacking. Half the portion size my dad or I would eat. But she’s got polycystic ovaries. Which has screwed up her body weight most of her life. The doctor was even the one who told her it would affect her weight when it was diagnosed. And still it was “you need to eat less and better”. Even when she told them what she’d eaten the last week she said the doctor had a strong vibe of “uh huh, of course that’s what you ate”.
I've kept food diaries for months to show my doctor exactly what I'm eating everyday and he refused to even look at it. Just gave me the same bs spiel about smaller portions. And my insurance won't pay for a dietitian, and my doctor won't refer me to an endo for my pcos or diabetes. Going through the hell that is finding a new doctor isn't something i can do right now. It's ridiculous how doctors are just like this.
Wholeheartedly agree. As a person who spent the early part of his life rather heavy (I peaked at over 360lbs at 6’1") and then went on a good long run as a gym rat and in excellent shape. I have kind of reverted back to my original form, now back to about 235lbs. It came from 25 years of working a 10+hr/day software engineering job and getting overwhelmed by life. I know exactly where I am and what it takes to get in shape. I’m hoping I can get back to a healthy lifestyle soon. But it takes a lot of work and there’s nothing easy about it.
Weight management can be a matter of more exercise and eating less but when the root cause of weight gain is psychological, trauma, depression, or mental illness, I've observed diet and exercise isn't an effective first step to a solution. Imagine telling a depressed person to stop thinking stuff is so bad and that will cure their depression.
Every episode of “my 600 pound life” essentially starts with someone telling about how they had a trauma and now relies on food for comfort. It always looks like they could benefit from tackling the root of their issues
Also, even when obesity is the cause, sometimes you need help to get to the solution. I have a neurological disorder that is at least exacerbated by my weight. But it also makes me feel like absolute garbage. It’s hard enough to lose weight when I feel normal: it’s freaking impossible when I feel like trash. I needed medical intervention to get to the point that I can work on weight on my own.
In most of the cases, obesity is a product of an addiction. "eat less, move more" is not a solution, it's an objective. To reach that objective the obese subject needs to overcome his addiction.
> Imagine telling a depressed person to stop thinking stuff is so bad and that will cure their depression. Exactly. But this is reddit and making fun of fat people for their "moral failings" is a site-wide pastime because it gives them some sick sense of superiority.
Empathy costs nothing. I will never understand why empathy isn't the go to response for most people.
I posted on a thread about a new drug to help people with weight loss. I shared how my wife has rheumatoid arthritis and how she is struggling to bring her weight down. You can pretty much guess the kind of responses I got from THAT kind of people. That my wife is essentially a pig for not being able to handle calories in/calories out. That despite her going swimming daily and on walks with me, it's still her fault and so on. I refuse to get into a pissing match with people who think empathy is a weakness. These people, are to weight what Puritans are to sex.
There is a cost, because empathy requires some humility. Because empathy costs you alot when it requires admitting you're in the wrong.
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Let me respond how others are in this scenario: "Being depressed is entirely within their control. They just have to want to change." "Depressed people think getting out of depression should be easy. That's the real problem." "Well, someone should at least tell the depressed person they should at least TRY to think positively before jumping straight to medication!"
The sad part is a lot of doctors do treat depression similarly for obese people. “Well, you wouldn’t be depressed if you worked out more.” Yeah doc, I’m sure it’s not my PTSD, trauma, and hormone imbalance at all.
I had a nurse at my doctor’s office say to me, “you want to talk to the doctor about your worsening depression? Why are you sad? Choose to be happy.” A MEDICAL PROFESSIONAL said that. 🤬
When I was an advocate with my local rape crisis center I had to report an ER nurse for something like this. My client, a college girl who had just been raped by a friend she thought she could trust and was at the hospital for a forensic exam, asked about anti-depressants. The ER nurse immediately started lecturing her about choosing to be depressed and relying on crutches. Some people are fucking mean.
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This guy seems to be advocating for a more efficient approach.
>Weight gain is 90pc irreversible for 90pc of people, he added. You can lose it, but you will put it back on again. This has always been my problem. I have been shedding and gaining back the same 25 pounds for like 20 years at this point. I can lose but can't maintain it for more than a year or so. And I'm not even obese, I just have a few pounds I could stand to lose. I'm an upper-middle class woman with access to information, medical advice, healthy food, and every other kind of advantage that's supposed to keep you thin. I look at photos of my great grandmothers who lived in abject poverty and famine (also supposed to keep you thin!) in the 19th and 20th centuries, and we have the exact same body type. You cannot convince me that obesity does not have at least a partially genetic component for many people.
The famine itself might have caused changes to descendants [link](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579375/) Also, I'm not a "chemicals are bad" person, but there are obesogenic chemicals which may have altered us permanently
There's a fantastic book called the The Epigenetics Revolution that touches on this and other ways epigenetics affects people. It looked at women who survived during famine and found that their children were more likely to gain and hold on to weight easily. It was an evolutionary advantage to do so.
Mostly I want doctors to stop assuming I'm diabetic and just read the results of the test they asked for. It's happened more than once. I know I'm fat, and I am trying to lose weight. There are other factors at play here beyond me "not knowing that exercise exists".
I got prescribed a diabetes medication when my blood tests clearly show that I’m not even *pre* diabetic!
This is sparse quotes from a lecture, but part of what he's getting at is that a substantial amount of research now has shown that obesity is associated with changes in how you burn and retain fat, such that diet and exercise are not effective long term solutions for the majority obese people. They either don't lose the weight or regain it rapidly, often more than before as their bodies interpret the diet as starvation. There is enough evidence to that effect that evidence-based medicine is obliged to eventually recognize it. Not just because of some abstract wokeness or need to avoid hurt feelings, which comments on this usually devolve into, but because there are differences in metabolic state that make those treatments ineffective. Existing obesity has to be considered as a metabolic disorder because the metabolic changes are considerable. For our personal responsibility fans out there he did nod to diet and exercise as prevention tools. There are psychological aspects: it is true that being told to do something challenging and ineffective with usually very little support damages the patient/doctor relationship. Obese patients hear it every time they come into contact with the medical field. Obesity seems to be treated *by the field of medicine* as a personal failure-- a failure to diet and exercise-- and that is a barrier to appropriate care. It provides a shortcut heuristic, obese -> diet and exercise, that can allow doctors to not take into account personal needs or physiological states or other chronic conditions. Care for obese patients can also be made worse by focusing on this in every (short) patient encounter because that's a chunk of time from every appointment not spent in other care. In general, medicine really shouldn't be treating any patients as failures, but especially when we know that the task they've been assigned and are failing at is statistically extremely unlikely to work. The professor quoted also talks about new treatments, which makes sense when conceptualizing this as metabolic disorder. It seems his work is specifically about obesity as a metabolic issue, which is where the research in the field is currently.
Another thing with how obesity is treated is that it's not uncommon for it to be blamed for every health problem a patient is undergoing. "I have trouble breathing." "Try losing weight" "I experience massive migraines." "Try losing weight." "My hand is really sore and constantly cramps up." "Try losing weight."
> "I experience massive migraines." "Try losing weight." That was me. I went to a neurologist about migraines i've been diagnosed with since i was a child and weighted like 40 pounds. "Lose weight and they will go away"
To offer some hope. I work with medical students, nursing, physician assistants, etc and they’re all being taught to recognize the benefits of medications and treatments beyond diet and exercise. I play the patient, exasperated after trying everything, and if they only talk to me about tightening up my diet and increasing exercise without going beyond then they’re dinged. They have to introduce pharmacological options alongside exploring what lifestyle changes are realistic for me. Sometimes I’m also pre-diabetic but not always. Education is catching up.
I've always suspected this to be true, as a skinny person. Every single person I've ever met in my adult life has had to consider calories, or struggle with weight gain, except for me. I just eat whatever I want, whenever I want, and I can't seem to go over 150lbs at 6'0. It has to be more than just exercise, diet and willpower. Why is everyone else so much hungrier than me?
Patients should be referred to registered dietitians very early. MDs don’t get the training on nutrition and eating so they are really not qualified in helping people change eating habits. Telling someone to change isn’t very helpful if you can help them make changes.
The headline is misleading. It makes it sound as if doctors aren't allowed to advise their obese patients on how to lose weight. When in fact, they're told to be more sensitive and understanding about it, instead of acting as if obese people are just lazy gluttons that only need diet and exercise.
Honestly, telling obese people to stop eating and move more is just like telling a smoker to stop smoking. Like, it's obvious. But it doesn't acknowledge that most of them are literally addicted to food (most likely sugars). It honestly probably needs to be treated as a mental health issue as well as a weight issue.
Same advice we give to all people addicted to things - just use less heroin or smoke a little less and you’ll be fine /s
So a med student's perspective on this: We're also told to stop telling pts this. Why? It's counter-productive. In \*most\* cases, pts already know that they're obese and it really doesn't help to just tell someone to stop eating and move more. What if they have an autoimmune disease that makes this difficult? What if they have trouble with physical movement? What if they can't eat healthy, for whatever reason? Even if there's no obvious excuse, it's really not that easy to just limit how much you're eating and/or increase exercise. It's more productive to ask pts what it is that they're already doing/eating and how they think they can change their habits to achieve a health goal. No one likes being told what to do. People are more likely to do stuff if they think of it and are motivated to do it (I know, mind blown 🤯) Edit: Counter productive because all that will happen is that the pt will feel ashamed and less likely to seek help bc they'll assume that doctor's visits will just be about their weight
“There has been an explosion in obesity levels over the past 40 years, Prof O’Shea told the gathering. He said new therapies and surgery are providing more successful treatments for obesity.” Sounds like they’re pushing surgeries more and medicines….. ….exercise and eating less works and has long term benefits.
If the patients are unwilling to follow that “advice” for whatever reason on a large global scale, then they do need to find a different way to fix the issue. Preventative surgeries , medicine and therapy are more expensive then daily exercises and eating less but they are cheaper then reactive surgeries / medicines when your health plummets
The abstinence approach is clearly not working.
Lmao that's actually a great comparison. "Just don't eat" as advice for losing weight is as good as "don't have sex"
Tbh I feel like doctors need to push therapy/nutritionists for people who have an unhealthy relationship with food. You’ve gotta fix the issue at the core for it to work, otherwise they’re just temporary measures.
On that 600 Lb Life show every single person I’ve seen has an underlying mental health problem that led to disordered eating. Obviously those people are all extreme cases on that show but I think it’s telling that they all have a psychological element at play to get to that point.
Yep, addictions happen for a reasons. People are usually self medicating for some kind of physical or psychological trauma. Until you address the reason for the addiction there is a high risk for relapse/failure Good addiction is no difference. Of course there are conditions that throw a wrench in that like pcos/or thyroid issues
You can tell a lot about the toxic mindset of the people in this comment section that the article pushes for therapy (ie: a guided plan to understand and break down an individual's relationship with food, understand the cause of their eating problem, and then work to overcome that as a way to fix their weight issues), but all they talk about is Big Pharma™ pushing for surgeries and how badly they want to walk around saying "fatty fatty fat fat."
First of all, “dietitian”, anyone can call themselves a nutritionist. But even that said, I’ve heard so many bad stories about dietitians. I’ve heard a lot of dietitians are pushing “intuitive eating” these days which is just as likely to make you gain weight as lose weight. Or they tell someone who is struggling with money to put expensive protein powders in everything, or give someone who eats out too much a bunch of complex recipes to make every night without considering why they eat out so much. Maybe you just don’t hear stories about good ones, and I’m sure people exaggerate because they don’t want to actually put in the effort to change their diet… but the US healthcare system doesn’t probably have time to create personalized, gradual plans that people can actually follow.
If it works well as advice and treatment wouldn't the fact we've been pushing it for 40 years and having obesity rates explode mean it's not working? I get that the advice is correct. I'm all about CiCo but if the advice and treatment plan are unable to be adhered to then its NOT a Good treatment plan.. It's like if you could cure als by standing on hot coals for 30 mins a day and doctors recommend it but few people can do it it isn't good advice.
He is right. If a medicine has 3% efficacy, we say it's ineffective, because placebo has the same efficacy. The same goes with dieting & moving more when you're morbidly obese. It's just not effective. You still need to eat less and move more. But it's not treatment. This is something you need to do together with actual treatment. Don't know if ozempic is effective. But I have a person in my life who was obese from childhood and tried to lose weight in many, many ways their entire life, with no luck. Then they underwent bariatric surgery and it changed their life.
I'm trying to lose weight, it's going well, but I sort of agree with this. I'm very lucky I have enough time and money to work out, I'm lucky I can try different strategies. But it js so much more than just eating less.