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Med Students Unaware of Their Bias Against Obese Patients
An anonymous reader sends news of a study which found that "two out of five medical students have an unconscious bias against obese people." The study, published in the Journal of Academic Medicine (abstract) examined med students from many different cultural and geographical backgrounds.
"The researchers used a computer program called the Weight Implicit Association Test (IAT) to measures students’ unconscious preferences for 'fat' or 'thin' individuals. Students also answered a survey assessing their conscious weight-related preferences. The authors determined if the students were aware of their bias by seeing if their IAT results matched their stated preferences. Overall, 39 percent of medical students had a moderate to strong unconscious anti-fat bias as compared to 17 percent who had a moderate to strong anti-thin bias. Less than 25 percent of students were aware of their biases. 'Because anti-fat stigma is so prevalent and a significant barrier to the treatment of obesity, teaching medical students to recognize and mitigate this bias is crucial to improving the care for the two-thirds of American adults who are now overweight or obese,' Miller said. 'Medical schools should address weight bias as part of a comprehensive obesity curriculum.'"
As of this posting, the vast majority of ACs took the opportunity to make disparaging comments about the overweight. Classy.
I am not a crackpot.
Fat hatred and blaming people for being fat is so universal and so conscious that it's hard to take any methodolgy seriously that finds that people are "unconscious" of their hatred of obese people.
Want to get at the real socially redeeming value of this journal entry? Study the methodolgy, understand where it went wrong, and above all never, ever use it.
..and having a bias for thinking so is a bias in this study.
can't blame them though. because people who stay obese can't follow a diet, obviously. too thin people might have some "respectable" reason for being unable to digest or eat enough, it's much harder to eat on purpose more to gain weight than it is to lose it - the other just needs you not to buy food and put it in your mouth and chew it while the other needs you to have appetite to be able to put it in your stomach and the stomach to be able to digest it(personal bias experience, had both).
also it's hard to have respect for some obese guy - at least when it comes to respecting them with knowing about them only that they're fat and have a medical problem from being obese.
next up: medical students keep sexy patients in higher regard.
world was created 5 seconds before this post as it is.
I'm not unaware. I know exactly what I think about fat people and It's not good.
but I couldn't eat a whole one
I got to the chocolate box before you, that's why the hard ones have teeth marks.
is a real thing. Despite how well my mother's bloodwork was all through chemo her doctor kept telling her to lose weight. She was doing amazingly well for someone on chemo and over and over all they could talk about was her weight. It's ridiculous.
http://transformativeworks.org/
than doctors having a bias against smokers, recreational drug abusers, sex addicts with lots of partners, etc? Each of these groups are doing things that is typically detrimental to one's health, so there seems to be an issue of self control there.
Compassion is supposed to be a hallmark trait of the medical profession. Any doctor who lets his personal beliefs get in the way of his practicing medicine in the best possible way to ANY patient - be s/he fat, thin, muslim, atheist, black, green, prisoner, retarded, or just an average joe - is a bad doctor. If a patient is obese then yes, it poses a serious health risk and a problem. My job as a doctor is not to lecture that patient or make fun of them, but to try to help them as much as I can with the tools I have at my disposal. The same for alcoholics, drug addicts, and anyone else. Because at the end of the day said behavior is usually just a symptom of a different, underlying problem.
Seven puppies were harmed during the making of this post.
For those not familiar with implicit association tests, they are based on measuring your reaction times when matching certain types of data according to different specified criteria. For example a gender association test might measure time for matching gender with staying at home raising children versus working outside the home.
Harvard has plenty of sample tests.
Having taken some of the tests I can say that the results can be quite surprising and point out biases that you are unaware of. I definitely found that some associations were much easier for me than others. (Happy to say that the gender example above was not a problem for me.)
The fact that people don't admit to their preference doesn't make that preference unconscious. From the journal article:
That doesn't seem like a very sophisticated way of assessing someone's unconscious feelings.
"anti-fat stigma is so prevalent and a significant barrier to the treatment of obesity"
Being fat-positive would help with the treatment of obesity?
"Doctors are more likely to assume that obese individuals won’t follow treatment plans"
The primary goal of our treatment plan is often to get them to lose weight to cure their hypertension and type 2 diabetes. It's not a bias if you see the same patient in clinic every few months for years and they continue to gain weight and ignore your recommendations.
**** ********* M.D. , PGY-4 Resident
Because medical professionals should just ignore obvious health problems such as obesity?
Obesity is a choice. Those fat fucks put a strain on our hospitals and take the places that could be given to other more deserving people. Fat bastards should not be allowed hospital treatment. period.
Driving an automobile is a choice. Those reckless fucks put strain on our hospitals and take place that could be given to more deserving pedestrian. Driver bastards should not be allowed hospital treatment. They knew the risk when they entered their motorized vehicle.
If I repeatedly hit my penis with a hammer three, four, or even five times per day, every day for years on end, it'd be clear that I have a mental illness.
If I soaked my scrotum in sulfuric acid three, four or even five times per day, every day for years on end, it'd be clear that I have a mental illness.
If I burned my glans with a cigarette lighter three, four or even five times per day, every day for years on end, it'd be clear that I have a mental illness.
Yet if I eat greasy fast food, snacks that are mostly sugar, sodas laden with chemicals and artificial sweeteners, and other food that don't promote good health three, four or even five times per day, every day for years on end, I don't have a mental illness? BULLSHIT!
Yet if I refuse to even attempt exercise of any sort, even something as simple as walking around, all day, every day, for years on end, I don't have a mental illness? BULLSHIT!
Aside from a small number of very isolated cases, obese people are obese solely because they show an utter contempt and disrespect for their own bodies and health. It is indeed a mental illness, even if it affects 60% or more of the American population today.
Don't pretend that obesity isn't a mental illness, because in almost all cases it is exactly that.
were obese? When my wife was in med school about half the class was obese, a few morbidly so.
They get all the care and attention, and healthy people are left out in the cold. Equal treatment for all!
No, seriously, I don't see a bias against obese patients as a problem. And I say that as someone who's pretty heavy, and by my own hand - the hand putting pizza in my mouth. Despite the laughable number of people who say "they have a glandular condition" or some such, 99.9% of the time obesity is a self inflicted injury. The doctors with this bias are, in fact, ahead of the curve. At the end of our slow march towards socialized medicine, there's a world where, if you smoked, ate too much, or didn't wear a motorcycle helmet, you government medical card isn't going to work.
Are you unaware that "Less than 25 percent of students were aware of their biases" means that 75% were unaware of their biases?
Sounds as though that is a pretty apt title.
Sure, it is biases against "various weights" not just "overweight & obese", but the point still stands.
Thirty four characters live here.
My brother-in-law is a nurse. He says that the overwhelming majority of his patients are in the hospital due to poor lifestyle choices, with obesity being the most common cause of the illness. Naturally, some people are obese due to something outside of their control, but not most. I can see it being frustrating helping a patient who wouldn't be there if they'd just done a better job taking care of themselves.
Furthermore, it's my understanding that providing care to a skinny person is easier than giving it to an obese person for a number of reasons. Combine that with the fact that we're essentially programmed to prefer skinny people, and it's obvious that there would be a bias.
Does that mean that I think obese people should receive subpar treatment? Hell no. You signed up for the job, now go and do it. I just get tired of studies that confirm something everyone already knows.
If you can't convince them, convict them.
The issue I see is that movies and tv have taught people a value of normal healthy that is actually too thin to be healthy. Too many people are chasing an idea of unrealistically thin and they do a lot of damage to themselves in the process.
I do think it is not very healthy to be overweight or fat however depending on how far overweight you are the health problems actually tend to be pretty minor. Doctors believe a lot of things that medical studies don't actually back up. Many of them still believe there is a connection between eating fat and being fat while research mostly shows that eating more things like breads, pasta etc is much more likely to make you fat.
You do need to exercise, eat well etc but the advice that doctors give is often not very helpful for that.
Mostly though we need to have real guidelines for what is a healthy weight with actual medical evidence behind it, not what someone thinks looks unhealthy.
Computer modeling for biotech drug manufacturing is HARD!
Actually, it's even worse - 25% of students were aware of the bias, and 39% were biased against obese people, so it's really only 30%.
Other reasons this study is stupid:
* half as many students instead have an anti-thin bias
* about 40% of med students never even graduate and become doctors anyway
* it was done at a single "Southeastern university"
* one of the assumptions they were worried about was that they "are more likely to assume that obese individuals won’t follow treatment plans." Given the number one thing an obese person can do to improve their health is exercise, eat less, and subsequently lose weight (all achievable goals for the majority of obese people, who honestly already knew those things anyway) they probably have a reason to worry about that, and it's therefore medically significant to their treatment recommendations!
I hate sanctimonious people, and that holier-than-thou nonsense is what the prejudice against fat people is about. By prejudice I mean being biased against people with regard to things that have nothing to do with their weight. It does not mean not wanting a fat girlfriend (or in the case of Slashdotters, not fantasizing about having a fat girlfriend), or suspecting that they wouldn't be good on the track team, or even about charging them more for life insurance. It means being biased about the guy two desks down who is fat as a pig but is a great programmer, or simply that fat people aren't as good as you. Do you feel like you're so much better than the next person simply because they're heavier than you? Congratulations, everybody needs somebody to look down on. BTW, what sense of inferiority are you trying to compensate for?
It's socially unacceptable these days to be prejudiced against people because of the color of their skin or their sex, so "those people" become fat people. There are lots of other possibilities, but fat is good because you can tell just by looking at people. I'm not interested in the argument that race and sex are something that you're born with, whereas fat is something that a person has much more control over. That's an intellectual argument, and prejudice is not something that rises to an intellectual level. It comes simply from the crude desire to have a clearly defined group of "those people" that you can complain about and feel superior to.
A health care professional can be expected to have a bias regarding healthy vs unhealthy life choices.
No shit. That is not what they mean by bias in this study. RTFA:
“Bias can affect clinical care and the doctor-patient relationship, and even a patient’s willingness or desire to go see their physician, so it is crucial that we try to deal with any bias during medical school,” said David Miller, M.D., associate professor of internal medicine at Wake Forest Baptist and lead author of the study.
“Previous research has shown that on average, physicians have a strong anti-fat bias similar to that of the general population. Doctors are more likely to assume that obese individuals won’t follow treatment plans, and they are less likely to respect obese patients than average weight patients,” Miller said.
Well, you completely missed the point. Doctors who don't recognize their biases are more likely to misdiagnose patients that they're biased against.
Take me, for example. My kidneys failed due to IGA nephropathy, which has absolutely nothing to do with weight. I'm overweight, however, so for the first year of me feeling run down, getting sick often and having other health isuses my doctor insisted that I just needed to lose weight. He never bothered looking for other potential causes because, in his mind, the problem had to be that I was too fat and therefore didn't deserve any further attention.
I explained it in simple terms and offered a real life example and you still can't figure out why a doctor that doesn't recognize his biases is a bad thing?
The issue I see is that movies and tv have taught people a value of normal healthy that is actually too thin to be healthy.
And yet we have an obesity epidemic and not a too thin epidemic.
* about 40% of med students never even graduate and become doctors anyway
Cite?
* it was done at a single "Southeastern university"
Which means a follow on study should cover a broader group, not that the study is invalid. Starting with a small sample and expanding it as time and money allows is common practice.
* one of the assumptions they were worried about was that they "are more likely to assume that obese individuals won’t follow treatment plans." Given the number one thing an obese person can do to improve their health is exercise, eat less, and subsequently lose weight ... they probably have a reason to worry about that, and it's therefore medically significant to their treatment recommendations!
They said "treatment plans", not "treatment plans related to obesity". Treatment plans specifically related to obesity are, as you observed, not necessary except in extreme cases. Dealing with a broken finger or taking the entire course of antibiotics even though you're feeling better also involve treatment plans. Being fat usually means a lack of self-control or excessive self-indulgence in one particular area. The same is true about people who do any number of things, like have unprotected sex with multiple partners. It does not mean they won't follow recommendations in other areas. Your prejudice demonstrates exactly what the study is concerned about.
one thing an obese person can do to improve their health is exercise, eat less
Putting aside that that's two things, there is growing evidence that getting insufficient exercise is worse than being moderately overweight (not fat though). There are plenty of thin people who get little exercise, and exercise is not the biggest factor in loosing weight. However the amount of exercise you get is something that's easy to lie to the doctor about. Additionally a lack of aerobic/cardio exercise is not something that's immediately obvious to people you meet, hence less prejudice.
*Are* they less likely to follow treatment plans? It stands to reason that someone who won't do what's necessary for his health in one area might be less likely to do so in another area as well. If the doctors' assumption is accurate, it's not bias in the sense implied.
Second, and by far most intriguing, is the 33% (101/310) of students who openly acknowledged an explicit personal bias. Given that 39% (121/301) were found to have an actual bias on the implicit test, on the surface this result isn't surprising - but the 101 who think they're biased, and the 121 who actually have an implicit bias, don't overlap very closely. Just 40 students who thought they had a bias actually did. The study authors (and the journalists who have summarized their results) decided to frame this in the form of two-thirds of anti-fat students don't know they're biased! It's much more curious, I think, to note that a healthy majority of students who thought they were biased against the obese - 61% (61/101) - actually aren't.
Indeed, it turns out that there wasn't a significant correlation between believing one was biased and actually having a bias. So why do three out of five students who think they have an anti-fat bias hold that belief mistakenly?
~Idarubicin
You couldn't have expressed it in clearer or simpler terms, or found a better example of the problem. Let's hope "some old guy" is not a doctor.
Let me ponder this for a minute.
A health care professional can be expected to have a bias regarding healthy vs unhealthy life choices. Being fat indicates that a person has made one HELL of a lot of unhealthy choices. Like - every single day, he eats to much.
Actually, not necessarily, for two reasons:
1) There are plenty of medical causes of being fat, e.g. polycystic ovarian syndrome, type 1 diabetes (which causes fatness rather than the reverse), etc. Not just eating too much every single day.
2) Studies have repeatedly shown that overweight and moderately obese (grade 1 obese) people actually live longer, healthier lives than people of "normal" weight. Only at grade 2 and 3 obesity do these people start to live shorter less healthy lives due to type 2 diabetes and kidney disease. Underweight as a category leads to shorter lifespan than all of overweight, normal and grade 1 obesity.
My brother-in-law is a nurse. He says that the overwhelming majority of his patients are in the hospital due to poor lifestyle choices
Some people would cite a study, but you cite your brother-in-law the nurse. First, "poor lifestyle choices" are about more than being fat. Second, what are his prejudices? The prejudices we all have is why an objective study is better than your brother-in-law the nurse.
we're essentially programmed to prefer skinny people
No. In various societies at various times (including today) what we consider overweight or fat is preferred.
Do you hate obese people? Unless you celebrate obesity as a valid and commendable lifestyle choice then you're a hater. Or does that kind of attitude only work for homosexuality? And like homosexuality, obesity often has a genetic predisposition. "God/Nature made me this way" sure gets a lot of mileage in that debate.
And another thing, you want to ban trans fats, or sodas, or cigarettes, or HFCS? Where do you get off? How DARE you tell me what I can and can't do with my body. Or does that sort of thing only work for abortion?
And don't even think about playing the [in a nasaly whiny voice] "but it's BAAAAAAD for you" card. Puh-leeze, both abortion and homosexuality carry health risks, and people make all manner of other unhealthy lifestyle choices that we're supposed to not only tolerate, but celebrate. And if you don't like paying for obese people's health care, then vote conservative next time.
What would you rather tell her? You are perfectly fine and dont have to excercise? If she is fat and has to exercise then she is fat and has to exercise. If she lost 100 pounds over the last 8 months thats cool, obviously he thinks she should lose more, i dont see the problem here.
As long as you don't have data supporting that association, you can't make that claim in a meaningful way. It is is an error in reasoning that a failing in a single area must necessarily extend to other areas, or even that it has an influence on other areas. By your implication, obese people are more likely to take up smoking, work in loud environments without hearing protection, and won't shield themselves properly if they work in high radiation areas.
Studies have repeatedly shown that overweight and moderately obese (grade 1 obese) people actually live longer, healthier lives than people of "normal" weight.
Mostly because fat people live sedentary lives; the guy with a beer gut isn't going to die rock climbing. That doesn't mean they're healthier.
And it's not simply "normal" weight, it's based on actual fitness. Your body can not do as many things if it has lots of fat and little muscle, so you are functionally disabled. You don't see fat people out running because on the odd occasion that they do, they can't keep it up for very long. They can't have sex as long. They can't climb flights of stairs. They can't physically defend themselves.
They're not just sitting on their couches because they're lazy, but because it is physically painful for them to engage in long periods of strenuous activity. They are stuck in their living rooms, prisoners of the pounds of fat they carry with them all the time, and the reduced capacity of their bodies to function.
Mostly because fat people live sedentary lives; the guy with a beer gut isn't going to die rock climbing. That doesn't mean they're healthier.
Actually, no, but because the BMI scale is significantly off. Most people who go rock climbing will be considered "obese", or at very least overweight by it, because they have significant muscle mass.
And it's not simply "normal" weight, it's based on actual fitness. Your body can not do as many things if it has lots of fat and little muscle, so you are functionally disabled. You don't see fat people out running because on the odd occasion that they do, they can't keep it up for very long. They can't have sex as long. They can't climb flights of stairs. They can't physically defend themselves.
Again, wrong. Not fat, and fit are very different things. It's possible to be overweight and extremely fit and active, and its very easy to be underweight or "normal" weight, and not at all fit.
Make any sense? Are doctors really required to eliminate all bias and treat everyone equivalently? The premise of the study, that bias is bad, is wrong. Bias, which by definition means altering ones behavior based on circumstance, seems to me to be quite essential in medicine.
I love how we are supposed to not only accept but encourage obese people to stay obese. We have to say they are beautiful, healthy, and that being fat is not their fault
Do you have any evidence for such absurd ideas, or do you suffer from the mental equivalent of the sort of laziness and self-indulgence that fat people have about food,
The splorky mobile slash dot interface truncated "heroin addict" to "hero.
Freaky!
Then don't pretend that homosexuality isn't a mental illness, either. Evolution has conditioned us so that the desire to pass on our genes is a strong imperative. If you actively go out of your way to not pass on your genes, to seek partners who are incapable of doing so, then something must be wrong with your mind. On top of that, anal intercourse has a much higher chance of passing on infectious diseases than vaginal intercourse. Regularly having anal sex must be a mental illness then, too.
Does the above paragraph sound like bullshit? Then stop being a fucking hypocrite. Either both obesity and homosexuality are mental illnesses or neither is. Funny how leftists claim they support alternative lifestyles when in reality they refuse to support alternative lifestyles that are common in red states.
I'll tell you the TRUTH: my obesity is a deliberate lifestyle choice. I eat greasy food, sugary sodas, and other unhealthy food because they taste good and I enjoy it. Simple as that. My lifestyle is infinitely more important to me than my health. I would rather die young after living a life of fun and taste than waste a long life living like a monk. Now, I have no problems with homosexuality, because I recognize it as an alternative lifestyle just like my own, but go fuck yourself if you consider one person's unhealthy lifestyle choice fine but another's a mental illness.
I won't think or people as idiots anymore just based on their possibly munged comment subjects.
I'm wondering how exactly one determines fat Bias . the whole idea seems kind of ridiculous, it's like being cigarette smoker bias.
"Being fat indicates that a person has made one HELL of a lot of unhealthy choices." no it doesn't, I have cushings disease as a result of prolonged steroid use for addison's disease, I didn't make any choices to become overweight, in fact I used to be a cyclist with very low body fat.
Let me ponder this for a minute.
A health care professional can be expected to have a bias regarding healthy vs unhealthy life choices. Being fat indicates that a person has made one HELL of a lot of unhealthy choices. Like - every single day, he eats to much.
Alternately they have hypothyroidism, for example, as a result of Hashimotos. It could also be Prader-Willi syndrome, or Bardet-Biedl syndrome. There are other genetic factors and diseases which can also result in obesity. Candida Albicans infections of the gut have also been implicated. There are also medications which can result in obesity. Prednisone, which is often used to treat very severe allergies, and also as an anti-rejection drug following organ transplantation, or to treat autoimmune disorders, is one. Others include antidepressants, seizure medications, and certain high blood pressure drugs, such as atenolol and metoprolol (both beta blockers).
Are you unaware that "Less than 25 percent of students were aware of their biases" means that 75% were unaware of their biases?
Or it means that less than 25% were honest about their biases.
Exactly. This is likely about as accurate as any sex survey.
I must be one of the lucky few people in the U.S. then. I have two doctors who actually cared enough to get to know me as a person and realize why I have the problems that I have. One of those doctors is my E.N.T. He spent a lot of time and energy clearing up a chronic ear infection and has helped me with some other issues related to my health. The other "doctor" is a nurse practitioner who performed a yearly physical and found that I had a HORRIBLY under-active thyroid that lead to me gaining 30 pounds in just over 4 months. I have spent most of the past year on medication, adjusting the dosage to be correct for my needs. I figure between that and my joining a crossfit gym (if you need to know what it is use some Google fu) I will be loosing most of the weight I have gained. I had a coworker state that I am "unhealthy" because of my weight, yet this same person eats Chinese take out crap 6 days a week, and the other day he eats McDonald/taco bell/fast food and sees nothing wrong with this. He also thinks because he is thin he is in good shape. I have also seen some people who are rail thin, but have an astonishing high problem with diabetes, arthritis, high body fat percentage, and other issues. Yet the doctors tend to take one look at them and say oh you are perfect because you fit the model of health we are taught by the school/government. I have a friend who is overweight, and she knows it. She realizes she has a problem and is working on fixing it with medication, diet, exercise, and a support group. She has a medical condition that was found by a doctor, AFTER she demanded the appropriate tests. Her nutritionist and doctor spent a lot of time going round and round with the results from the test, the doctor did not believe it and thought that diet/exercise was the only reason for the problem. The nutritionist realized that it was a metabolism issue and that it would take some medication in addition to the normal move more, eat less regimen. She physically could not get appropriate nutrition from food, and that lead to eating more to get the required nutrition. This cycle lead to a bunch of other issues, the least of which being weight gain. The medical industry in the U.S. is BROKEN and requires a complete reboot. I have a friend who went to college and graduated with two undergrad degrees and had NO debt. This friend then went to medical school and racked up over three hundred thousand dollars in debt due to tuition, fees and expenses. This is after fighting to get a slot in med. school due to the AMA setting up a limit to how many slots can be made in a given year. He will now be spending the REST OF HIS LIFE paying off student loans from medical school. This same "education" taught outdated skills and minimized critical thinking outside of the industry standards. Thankfully he had an amazing bit of training from his grandparents who were doctors in another country, and knows how to fix things without resorting to over-used, over-priced medications. And he knows what it means to be unconsciously biased against as he is an openly gay man.
Again, no –fit, and not fat are not the same thing at all. I know a couple of people off hand who are significantly heavier than me, and significantly larger around the waist than me, but who can cycle significantly faster and further than me, and who can happily walk at just the same rate as me for pretty much any distance.
I hate politics,what the fuck does what color state have to do with what he said, the stupid party system show be abolished since no one ever does what they say they will anyway. What I took from the comment is why is it ok to be homosexual and not obese? Most people who are overweight already know its an issue, but most lack the will power to change. Doctors should look at the cause of an underlying condition, instead of taking the easy route of blaming it on the easy thing. Same thing occurs during flu season, 5 years ago I started getting something that is similar to acid reflux too the point where if I didn't closely monitor what I ate I would get sick. The blamed it on the flu for years and if I get a new doctor they try still.I also saw the same things working in technical support, techs that would always blame and issue on either being a bad hard drive or a virus. It was the easy way out and they would try to get them to by a new hard-drive or reload. These people have to stop being lazy and learn how to diagnose properly. You can warn people about the dangers of obesity which most people already know but not making sure that's the issue is dangerous.
*Are* they less likely to follow treatment plans? It stands to reason that someone who won't do what's necessary for his health in one area might be less likely to do so in another area as well.
Studies have shown that the most common assumption is that fat people are lazy, undisciplined, unwilling to work hard, etc. -- not just in terms of health choices. Your comment is playing directly into that bias.
I think this bias, like most, actually does have some relationship to reality -- i.e., a greater percentage of fat people are likely to have these traits than others.
HOWEVER -- pre-judging an individual on the basis of a single characteristic is the very definition of "bias."
Even if 90% of obese people are lazy bastards who won't even try to listen to their doctor's advice (and I don't think the number is that high), that does not excuse a doctor who provides inferior treatment to the other 10% because of assumptions.
If the doctors' assumption is accurate, it's not bias in the sense implied.
That's like saying -- If a black person is driving around a rich neighborhood, he must be looking to steal something -- because "black people are more likely to commit crimes" is an "accurate" statistic.
Even if X is often correlated with Y, it doesn't justify the assumption that X always implies Y. When dealing with healthcare, these sorts of assumptions can literally be deadly, such as when a physician fails to search for secondary contributory causes of obesity in a particular patient because the assumption is just that the patient must be a lazy bastard who can't follow directions.
>> Being fat indicates that a person has made one HELL of a lot of unhealthy choices. Like - every single day, he eats to much.
With respect Runaway, that thinking right there is exactly the problem.
Obese != unhealthy life choices (at least not in all cases)
Take for example the 250lb person who eats right, jogs, and works out every day vs the 145lb person who never exercises, eats cookies, and pounds beer and soda but for some reason never gains a pound. The 250lb person could have a thyroid problem or other hormonal imbalance causing their metabolism to be too slow. Thus they burn less calories and keep weight easier. But they have strong lungs and a good heart. The doctor brow beats them every visit harping on whatever diet and exercise they claim to be doing as not enough, or (if they are bolder) outright lies. This does not help this patient stay healthy.
The 145lb person could have the opposite problem with imbalances causing their body to burn too many calories. They could be skinny as a rail with hypertension and be bordering on becoming Type II diabetic. But the doctor doesn't bother to run any tests or take the results too seriously because they are at their "target weight". This does not help this patient stay healthy.
Doctors should diagnose based on full spectrum data collection. Not simply based on what they see and think at first glance. That's like a climatologist looking at a clear blue sky on a good day and saying "look, no smog. Clearly climate change is not caused by man made pollutants!!! No need to look any further into this."
On second though, perhaps a car analogy would work better. Can somebody help me out here? :)
Problem is the doctors don't recognize their bias. You can't make a clear decision if you aren't aware what it's based on.
"First they came for the slanderers and i said nothing."
BMI isn't *that* far off, and the only example ever given is athletes. And not just any athletes. Body builders, mostly.
Rokk climbers tend to be slimmer, lithe types. No sense in making yourself heavier, in a sport where the primary goal is to lift yourself repeatedly. Likewise runners, swimmers, cyclists, or people who play soccer, baseball (mostly), basketball, etc ... All in the healthy BMI range, despite your claim that BMI doesn't work for athletes.
Nursing Assistants are completely aware of their bias against obese patients who are harder to turn and reposition in bed, and to transfer to a comode or the bathroom.
And management doesn't give a shit, otherwise they would have 2 staff on the floor at NOC when there are such '2 assist' patients.
Even if X is often correlated with Y, it doesn't justify the assumption that X always implies Y.
While that is true, the safe bet is still going to be that X implies Y.
If the first premise is true (X is highly correlated with Y), then to expect Y when one finds X is only natural (and takes less processing time).
Now, if we had some clear cases where X doesn't lead to Y, for example when Z is present, then we can solve the problem of unfairly expecting Y by also looking for Z. Hunting for Z will probably be more fruitful in the long run than trying to train people to ignore stereotypes that have evidentiary support.
semantics are everything!
I'd say only 40% is fewer than the general population.
In other news, 40% of police are biased against criminals, and 40% of dentists are biased against people who do not clean their teeth.
The message is I got is that if I want to be treated with respect I need to find a cuddly doctor, I'm guessing you already have an ego boosting slim one.
And did you exchange a walk on part in the war for a lead role in a cage? - Pink Floyd.
Studies have shown that the most common assumption is that fat people are lazy, undisciplined, unwilling to work hard, etc. -- not just in terms of health choices. Your comment is playing directly into that bias.
Bulls eye!
And did you exchange a walk on part in the war for a lead role in a cage? - Pink Floyd.
The problem here is that the only signal people have for what their body needs energy-wise is mediated by their hormone balance and brain-chemistry. If you have a condition where even too much energy feels like you're starving (a painful condition), it's readily understandable that you are going to eat too much, even with the best intentions. The problem of simply blaming "eating too much" is that it becomes synonymous with gluttony - a vice and failure of virtue. Even though yes, you are simply eating too much in the thermodynamic sense, it rapidly becomes a stigma where the patient is 'at fault', rather than the underlying medical condition. In this way, victimisation of obese patients is counter-productive.
Sure some people simply have no self-control - but is that because they are bad people, or because there is some factor at work that makes it hard for them? The blame game for obesity is a bit like accusing people with a birth mark of being in league with the devil and burning them - we should know better by now.
Scientists point out problems, engineers fix them
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People who are overweight and obese grade 1 are usually not so fat their life quality is reduced. They can walk, run and exercise with no or just small discomfort.
An overweight person who is somewhat fit has a *significant* higher life expectancy than any other combination of fitness and weight.
Muscle mass above a certain amount does more harm than good and reduces life expectancy
Excessive exercising over time damages the body and leads to a shorter life expectancy
- Life expectancy both for body builders and competing marathon runners are low
Body fat above a certain amount does harm to the body and reduces life expectancy
Body fat below a certain amount does harm to the body and reduces life expectancy
- The ideal amount of body fat is far more than what we perceive as "normal" weight -- it's much closer to the medieval beauty ideal then the modern one
---- Sig. gone.
Early 50's, 100kg, 6ft. I'm also able to recognize that I have the same instinctive bias toward (the not insignificant number) of people fatter than me. I don't know if other "cuddly" people have it or if it comes from my fit and fantastic youth ( one of the few "perks" of the "strong back, weak head" type of work I did back then ).
And did you exchange a walk on part in the war for a lead role in a cage? - Pink Floyd.
Even if X is often correlated with Y, it doesn't justify the assumption that X always implies Y.
While that is true, the safe bet is still going to be that X implies Y.
That is absolutely false. Particularly since in this case we have examples of not-X that have Y, it may in fact be that Y implies X, but only in some cases, or even that there is no causality at all between X and Y.
I personally don't have statistics about the incidence of "laziness" and "failure to attempt to follow doctor's advice" in non-obese patients. Do you? I'm guessing that it is probably higher in obese patients, but I don't know that.
Obesity is easy to spot. Doctors who see obese patients and recommend that they lose weight can easily tell if those patients aren't successful in following their advice (though, whether the patient actually tried and how hard they may have tried is less easy to evaluate).
On the other hand, for non-obese patients, doctors might recommend a better diet and more exercise to lots of them too. Short of major changes in blood indicators or something, how do they actually know if the patients complied?
Thus, it's pretty hard to have good data about compliance for non-obese patients, or the incidence of "laziness" among them in conforming to medical recommendations. Whereas doctors can easily make assumptions about obese patients who don't slim down, thus giving the appearance of greater incidence.
Now, if we had some clear cases where X doesn't lead to Y, for example when Z is present, then we can solve the problem of unfairly expecting Y by also looking for Z. Hunting for Z will probably be more fruitful in the long run than trying to train people to ignore stereotypes that have evidentiary support.
Maybe. Except your reasoning doesn't take into account the possibility of confounding variables. It could be that X doesn't lead to Y at all, and actually Z is the cause of both X and Y.
In the present case, for example, since there are lazy people and people who don't follow medical advice who aren't obese, perhaps we might be better off searching for commonalities between all lazy people, since they are the actual problem for medical treatment -- rather than searching for exceptions to a stereotype. Maybe there are questions that could be asked in a questionnaire or interview that would give greater insight into whether a patient might be likely to listen to a doctor's advice, and perhaps even whether there might be better strategies. I don't know. But that would be a reasonable place to start.
However, one strategy that does NOT seem fruitful is just to continue to assume that the only people who can't hide their inability to comply are the only ones not listening to doctors... and the reason for that is because they're lazy fat bastards.
No such condition can result in obesity. All they affect is feeling of hunger. Ie, it's somewhat harder to control yourself but it physically can't make you fat.
There were no obese people at Auschwitz, hormones or not. Uncle Adolf's diet went to the other side, by being nutritionally deficient, but you can't deny it prevented being fat. Limit food intake, and you will not get obese, period.
The creatures outside looked from Alt-Right to Antifa; but already it was impossible to say which was which.
"Until age 56 annual health expenditure was highest for obese people. At older ages, smokers incurred higher costs. Because of differences in life expectancy, however, lifetime health expenditure was highest among healthy-living people and lowest for smokers. Obese individuals held an intermediate position."
As mentioned by the authors, there are studies that have reached opposite conclusions, as there are assumptions which can dramatically change the conclusions. In the comments section of the paper, there are reader comments which point out some very important problems with this particular paper (most of which seem to revolve around Ecological Fallacy-type assumptions):
Thomas Mittendorf: "It seems that the study has a major flaw in the inclusion of cost. The authors incorporated average health care costs in the model. These costs of course are higher the older the individual gets. But, as they are taking a prospective incidence orientated approach analyzing what happens to 20 year olds in the rest of their individual life it is not correct to use average costs. The average cost figures have to be differentiated between those costs that are incurred by persons that die and those who survive in the respective year. This has to be done for all cohorts. If the healthy people get older healthy and die five years later than the rest, dying gets cheaper. On the other hand dying is more expensive in younger cohorts."
David Strip: "Much in line with the response by Mittendorf, the validity of the results lies very strongly on key assumptions that are not demonstrated. The analysis assumes that the cost of an incidence of the 22 key diseases is independent of the risk factors being tested. Likewise, remaining health care costs, which account for 85% of health-care spending in the Netherlands , are assumed to be uncorrelated to risk factors. Given that this latter class of spending dwarfs the former, the importance of demonstrating the lack of correlation is particularly important. The incidence of numerous co-morbidities with obesity argues, in fact, that one might reasonably expect to find that the annual health costs are higher in the obese and that the cost of treatment in the last months preceding death may be quite different from the non-obese."
Was this in "Amerika"? It was wasn't it? After all, the majority of fat people in this county is no thing but lazy f-tards.
There are objective tests. Doctors with a bias won't give them. I went and got hydro-statically weighed. I know that my lean body mass is 169 lbs. My height is 5'11" and at my last physical I was 212 lbs. That put my body fat percentage at 21%. This is at the high end of "ideal". On the other hand, the BMI put me at the high end of "over weight" and only 3 lbs shy of "obese". According to the BMI I should not weigh more than 178 lbs. That would be 5% body fat. This is the point that you start eating into your essential body fat. So, according to the BMI my body fat should be between 5% and -30% body fat. That is right. The BMI says I should be between sick and dead.
At this physical, my doctor is telling me that I need to lose weight because 212 is "a lot of weight". He didn't car that my body fat % was fine. He just kept pointing out that BMI is "the best indicator of healthy weight". He has a bias against fat people. Even worse, his definition of "fat" is completely twisted and dangerous.
Even worse is that I have been 5 lbs over weight. 5 lbs overweight isn't even close to obese. It also isn't "some buff slav". But, what I hear is from dumbasses saying "Your not Mr. Universe, so the BMI is correct."
A healthcare professional should give you the same advice as any other person with the *actual conditions* you have.
Being obese is not a state of health. A heart condition is, as are bad joints. Being a smoker is not. Lung cancer is.
There's no room in my mind for a healthcare provider showing bias for or against any* patient, healthy or otherwise.
*My mother being a retired RN, I've heard many stories about bias against failed suicide cases -- I can understand bias against those who try to purposefully do themselves harm, but again, the job is to help them, not to be their guidance counsellor.
- Michael T. Babcock (Yes, I blog)
True story to back this up -- I was 140 lbs at 6'5 in highschool with very bad joints and asthma I sadly seem to have inherited. Both limit my exercise immensely, as does my job in computers.
Having subsequently moved and having a different doctor now than then and weighing substantially more, I have no new health problems than then but my new doctor upon hearing of my breathing and joint issues blamed my weight and told me to lose it, which obviously won't help, as I had the same problems when clinically under-weight.
Bias is wrong -- and leads to poor assumptions.
- Michael T. Babcock (Yes, I blog)
Go to a GP with any general illness and 99999 times out of 100000 they will diagnose it as either the flu or allergies.
If I lost the weight my doctor recommended, I would die. Not figuratively. Literally. My doctor recommended that I achieve the weight shown by the BMI chart for my height. That would put my body fat % between 5% (dangerous) and -30% (long dead). EMEL is bumper sticker medicine along with the BMI that goes with it.
Let's remember that obesity is an unhealthy condition. It is unhealthy and overwhelmingly self-inflicted. Medical students are quite often idealists and are all about the science of medicine. Combine the two and what do you get? What's surprising is the 2 of 5 number isn't 4 of 5 or higher.
also it's hard to have respect for some obese guy - at least when it comes to respecting them with knowing about them only that they're fat and have a medical problem from being obese.
So let me get this straight. For women, men are supposed to see beyond their breasts and hips to see them as a person not as an object, but you can't do the same thing for an overweight person, male or female? Same thing for people of color or ethnic and religious background. In all of these things we can see the person as an individual but you are saying you cannot do that for an overweight person?
It seems that we should have respect for all people, regardless of whether they are fat or thin or black or white or Muslim or Atheist. Anything less speaks more about us than it does about the other person.
Er...so let's see: one day you discovered you had medical conditions preventing you from maintaining a healthy weight via adequate energy output i.e. exercise. Obviously then, without adequate energy output, some of the energy you consumed was going to be stored, wasn't it? So then how come you didn't reduce your energy intake to compensate? And how come you still don't?
Technically correct. But you aren't assuming that all people's hunger drives are the same strength, are you? Because that would be rather foolish.
And what happens?
Nearly all of the time you get better after a few days, and if things persist they can investigate more.
What else would you want? 100 tests every time you got sick?
No such condition can result in obesity. All they affect is feeling of hunger. Ie, it's somewhat harder to control yourself but it physically can't make you fat.
Sorry, but you're wrong:
Prednisolone: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0011824/?report=details#side_effects ...Rapid weight gain ...Swelling in your hands, ankles, or feet ...Gaining weight around your neck, upper back, breast, face, or waist ...Increased appetite ...Unusually full or round face
Possible side effects:
Methylprednisolone: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0011173/?report=details#side_effects ...Swelling in your hands, ankles, or feet, rapid weight gain ...Weight gain, increased hair growth, roundness or swelling of your face, thinning skin.
Possible side effects:
Synthetic corticosteroids cause weight gain, pretty much "period".
Another bit I've heard from a couple of surgeons is that they hate operating on obese people because it is far more difficult and the chances of survival is lower. Apperantly that's why many operations for conditions that are not immediately life threatening are put off for months with the patient given instructions to lose weight. I'll spare you some anecdotes about cutting through a lot of fat because they were disgusting even though I didn't fully understand the details.
You have no idea what you're talking about. Many rock climbers are very, very muscular. Mostly boulderers, but bouldering is probably the most popular type of rock climbing currently.
And even your other sports don't check out. Lebron James, for example is 6'8" 250 lbs. That's a BMI of 27.5 - overweight. Mike Trout (baseball player) is 6'2" 230 lbs. - 29.5 - borderline obese.
What's the most popular fitness activity in the US? Weightlifting. BMI was developed almost 200 years ago, when bloodletting was still standard medical procedure. We should be using body fat percentages if we do population-wide statistics, and not demonizing mass. Mass isn't the issue.
...
Then tell me where do they magically pull nutrition from?
They increase the appetite, making people feel like they want to eat more, nothing else. They do not cause weight gain. Otherwise, you could go breatharian consuming nothing but this drug and still gain weight :p
The creatures outside looked from Alt-Right to Antifa; but already it was impossible to say which was which.
Kudo to that. I have an aunt who's been obese for the last 20 years or so. Last year they found a pineapple-sized tumor inside her, pushing against her kidney, thus making her fat (bloated rather than fat actually). Why didn't they find that monster before ? Because they probably thought her 'health choices' were the cause (she works in a restaurant).
Non-Linux Penguins ?
Doctors should diagnose based on full spectrum data collection. Not simply based on what they see and think at first glance.
I had this discussion a dozen times with my brother who is a medical student and the tl;dr is "nobody has the time or money for that".
A doctor will always assume the most likely cause for any given combination of symptoms (even if they don't match 100%) and only start thinking about less likely alternatives if his treatment doesn't lead to improvements. Yes, sucks to be someone with a rare disease (that will only be diagnosed correctly very late if at all) but symptoms are often so unspecific and a thorough examination would be so expensive (let's do a blood screen every time you catch a cold because you might have some ultra-rare disease?) that this is the only practicable way.
Hormonal causes for obesity are possible but pretty rare - a much larger share of obese patients claims to suffer from e.g. thyroid issues than statistically possible. "Just eat less" is the right answer for the vast majority of obese patients and as they will lie to you about their food intake and exercise (admittedly often unconsciously, but then they don't tend to cooperate well when you ask them to keep a diary of every single thing they eat to make the more self-conscious) you never know if your original attempt at treatment did work or not. The share of patients who will lie into your face about having tried everything is probably still much larger than the share of patients who have actually followed your advice and it didn't help because they have some underlying physical issue.
The standard medical procedure of most likely diagnosis -> treatment -> in-depth examination if treatment doesn't show results just breaks down as the doctor has no way of knowing whether the treatment ever took place or not.
Dude, I am a lard ass, but at tue same time I am an avid cyclist (800-1000 km per month) and I also can run and XC ski.
"It's such a fine line between stupid and clever" -- David St. Hubbins, Spinal Tap
The problem in this case that if the patient has X but complains of Z, the doctor will only discuss Y. Same if the patient has A, B, or C, none of which are ever due to Y.
Most fat people are fat because .... they eat too much compared to their body absorbance capability and their energy requirement.
Beeing Fat was known during the middle age as a synonym for beeing rich, because only the rich could afford of eating a lot of food with a lot of energy. The poor were eating only soups with mostly water, some vegetables and could dream of meat ;-)
Nowadays, in rich countries fat peope are mostly poor people, because food is seen as a replacement for "enjoying life". And among the rich, beeing fat means you are not taking care of yourself, so not a smart person. These are all cliché, but unfortunatly true :(
Think of it, do you see lot of fat people in poor countries ?
When food was scarce, beeing able to take the best out of the food was a great capability. But nowadays where food is everywhere, the same people that had those great skills are now getting fat, bad luck.
Remeber that aside from few people with serious illness, you don't get fat by only drinking water .... but soda, burgers & FFries helps a lot ;-)
If you are fat, you have 3 choses :
- stay like this because you don't care
- move according to what you eat (can be very chalenging for some of us)
- eat less according to what you move
An forget all those regime/diets or meds that are suppose to make you thin with muscle & all thos bullshit. All you need is to choose (your) life :)
To be in topic. My wife always battled with being overweight. She has managed to bring it down to healthier levels, eg when we got married, but it is an eternal struggle. If your body keeps yelling "I'm hungry", try stopping eating. Anyway, given her mode of suicide,, she seriously limited her mobility and I don't see how she could ever lose weight again to "medical accepted levels". She's overweight, but constantly the same weight.
Ahhh...the great dumpster continuum. Many a free computer will be found there. -- sowth (748135)
Funny you should mention that. The majority of obese people I come across happen to be smokers. And here's mention of a study that seems to agree.
Also weight problems and heavy smoking both are more prevalent in schizophrenics.
Cool story, bro!
Eat less.
Your body is a closed system. If energy in energy out you will lose weight. It's not rocket science.
Oh no, I totally get that. I have a friend who was a med student -- doctor now... chose anesthesiology no doubt because of his disgust of obesity -- told me all kinds of bothersome stories like that.
Perhaps while this story is about 2 of 5 maintaining "unaware" bias, the remaining 3 of 5 are quite aware of it.
The title only implies that at least two med students are unaware of their bias.
The body can't store energy if it has no excess. Even if it tried for some reason if would pull it back from fat stores later the same day for normal operation.
If they're still gaining weight, then your "reasonable calorie diet" is set too high.
The creatures outside looked from Alt-Right to Antifa; but already it was impossible to say which was which.
Bias? I think I missed the memo on when "fat" became healthy.
gaining weight without having changed eating habits
I used to have lightning fast metabolism when I was young, but can't eat as much nowadays (or I get fat). The solution is simple: eat less.
Being addicted to overeating doesn't make it a good decision, yet like any addiction can be treated, by strong will or other means. It's just that people are offended by the thought they might be mentally ill.
The creatures outside looked from Alt-Right to Antifa; but already it was impossible to say which was which.
Your metabolic and self-recovering abilities are weak when you're overweight, buddy. It's a fact that chubby people have more health problems.
I'm not sure that will necessarily help with the general levels of obesity. On the one hand, I know that being overweight is due to consuming more energy than you're using, but we've got god-knows how many generations of evolution fighting against our appetites.
Over the last year or so, I made an effort to reduce my weight a bit as I'd bought a nice new road bike and thought the most cost-effective way of increasing its speed/lightness was to reduce my own weight. Obviously, increasing energy output is an easy way to reduce weight as long as you keep an eye on what you're eating (it's so easy to justify eating a pack of biscuits if you've just burnt the equivalent calories, but it's not going to be the best for your health).
What has amazed me is the sheer amount of calories found in typical food. Food manufacturers are so busy trying to cram calories into us that it takes a continual, conscious effort to eat the appropriate level of calories. I think it's a matter of training your mind/body about the amount of food you consume, but once you get used to a certain level of nutrition, your appetite tends to normalise and you no longer feel hungry most of the time.
However, society puts a huge amount of weight on being thin and this means that most overweight people end up having a really poor self-image which doesn't help them fix the problem (if their weight is a problem to them). When you're food choices are governed by emotions rather than rational thinking, then you're going to opt for the low-fat, high-sugar, diet options out of guilt and the high-fat, high-sugar options due to wanting to feel good.
It doesn't make sense to make fat people feel worse about themselves in public as they'll then find it even harder to lose weight in private (eat salad for lunch, then eat a whole packet of chocolate biscuits every night).
If anything, we should start glorifying chubbies. We need to start having celebrities and catwalk models being a bit on the larger side of average to redress the balance. It seems ridiculous that the modern fashion is for an incredibly low body-fat when so much of socialising is based around eating and drinking.
You're a temporary arrangement of matter sliding towards oblivion in a cold, uncaring universe
Hmm, it does appear to be a popular diagnosis these days: "The problem is you're fat, and you need to lose weight to cure the disease." "Yes doctor, but what led to the change to a sedentary lifestyle, when I was fairly active before?" "That would be the at." "Right...med school isn't doing so well these days, is it?"
I am John Hurt.
More bothersome is that doctors are not pursuing the cause of the disease like a wanted criminal, investigating every avenue. This is, after all, someone's life we are talking about.
I am John Hurt.
Indeed. Off the top of my head, I can think of several things responsible for unintentional weight gain, and which are not going to fix themselves through 'exercise and working out.' #1 is cancer (tumors, etc.) which are always fun to find...is it in the person's brain, is it in the thyroid gland, is it...etc., #2 is H.Pylori...nasty bacteria which, once it colonizes a stomach, coaxes you into eating more to prevent feeling pain, and is also a PITA to destroy, #3 is diabetes, which is a catch-all these days, and the first thing I discount, as the pharms have a rather unhealthy fascination with it, #4 would be mono, or rather any viral disease that would affect someone's metabolism / energy / comfort level / etc., #5 is malaria, always a fun thing, might as well check for protozoa in the blood, #6 is actual gastrointestinal damage...i.e. are the walls of the stomach still there? Do we have Crohn's Disease lurking somewhere lower?, #7 is depression, another thing I place on the watch list because of the unhealthy fascination from pharms with it (it's a catch all, IMHO, and usually a sign that you're missing something).
But then, IANAD. ;-)
I am John Hurt.
Much like my former doctor, you're dismissing a genetic condition as being caused by weight. It's an idiotic thing to do and it shows that you have the same bias which blinds you to the actual facts. The moment you found something that suggested that weight had an effect, you completely dismissed the genetic aspect of the disease. Your response is exactly why doctors need to be able to recognize their own biases.
You clearly don't understand the article you linked. At best, losing weight might slow down the destruction of the glomeruli, but the destruction is inevitable. It's a genetic disorder which cannot be fixed by losing weight.
My doctor dismissed them my symptoms saying "just lose weight and you'll feel better", which was absolutely wrong. Losing weight would have reversed the damage that was causing my symptoms.
In fact, the one thing that would have helped more than anything else would have been going on a protein restricted diet. No such advice was offered, however, because protein restriction isn't something you would prescribe unless you'd diagnosed a condition that called for it and my doctor was too much of an asshat to do any testing. I wasn't diagnosed properly until I was in full renal failure and then it was too late to do anything other than go on dialysis.
I'm not surprised that you have no sympathy for what happened to me. Frankly, you're a lot like my former doctor; an asshole who jumps to the conclusion that any problem a fat person has must be due to their weight. God forbid you should actually look beyond that and search for underlying causes.
IgA nephropathy isn't something you recover from. It's a genetic disorder. If you have it, the destruction of your kidneys is inevitable.
That I could read the comments and be sure they would be full of people saying essentially "Fat people are fat because they eat too much" which is pure ignorance. Admittedly eating a high calorie diet will make you fatter if you don't burn off the calories at the same time for a typical person, but there are a lot of other reasons why someone ends up obese, ranging from lifestyle choices (where they are at fault) to depression, medical conditions, bad diet due to poverty (the cheap processed foods that poor folks often end up buying are also the least healthy shit sold as food), etc.
But I knew I would see the "blame the fat people" line first and foremost, scattered throughout the comments for one simple reason: even in our age of political correctness, fat people are the one public group everyone feels okay about laughing at or making cruel comments. Everyone seems to agree its okay to be biased against fat people, period.
The results of this study come as no surprise to me at all.
"The first time I got drunk, I got married. The second time I bought a chimpanzee, after that I stayed sober" Arian Seid
You only think this way because you are unaware of the rest of my belief system, which also says that the moment you cannot be kept alive with routine medical care, you should be allowed to die.
Because I really AM a doctor, and see the gutwrenching practice of spending an entire family fortune keeping someone alive for just one more week, I can say on pretty good authority that we should stop allowing family members to make end-of-life medical decisions for their unresponsive or otherwise terminal family members. They do not make the right decisions for the patient, and this is the ONE AND ONLY reason that these so-called "studies" can claim that fat people cost less - because emotional, irrational people are sitting there with a bag of life savings ready to blow it all for one more week with dear old dad, who is laying there in intense pain, or laying there without his marbles, or laying there in a coma, just waiting to die.
On the surface it may be true, but only because of the other elephant in the room - and that is the fact that we erroneously allow emotional family members to make the wrong decisions at end of life.
I wouldn't think it wise to assume that just because you've felt "OK" being overweight in the past you wouldn't ever experience extremely common symptoms of being overweight in the future.
You're seriously suggesting that someone who felt okay in the past should dismiss new symptoms that they're feeling and not bother trying to find out if they have a life threatening illness?
That's the absolute dumbest response I've seen on here so far.
I was still active. I gradually dropped from hiking ten to fifteen miles in the mountains every weekend (hooray for living close to a national park) to barely being able to finish a two mile hike over a period of about two years. I knew something was wrong and it wasn't a sedentary lifestyle. Unfortunately, there was no way for me to figure out what the problem was on my own and the doctor I was seeing at the time was an idiot.
probably less than 5% of obese people are obese from the above listed medical conditions. The rest are obese from too much eating.
http://endocrine.niddk.nih.gov/pubs/Hypothyroidism/
http://www.annualreviews.org/doi/abs/10.1146/annurev.publhealth.29.020907.090954
..........FULL STOP.
Any chance that the camp had a bias against fat people and executed them first?
If absolute power corrupts absolutely, what does this say about renewable power?
So what is this condition that wouldn't allow her to absorb nutrients but would allow her to absorb fat (which is itself a nutrient...)?
Have gnu, will travel.
I know quite a few fat people and many of them are my friends, BUT I have to admit it does lower my opinion of them and my willingness to accept their technical opinions over other equal or even less qualified people. I have observed this bias is wide spread in society in general. For a few it is a legitimate medical condition and those have my deepest sympathy and concerns. I do know a couple of people where it is medical and not a choice, but unlike many they work very hard with their doctors to keep it in check. Now when I say obese, I don't mean 30 extra pounds or that belly bulge common in older men although they are an indication that they should do something about it.. I mean really obese. Legs that look like pantaloons or a butt that looks like two bear cubs fighting in a gunny sack. I mean people where it affects their life style. With these people "for most" it is a life style choice and is reflected in most of what they do. They let them selves go, they let their house go, they let their car go, and they let their personal hygiene go, and their personality reflects it.. Course the poor car is just a victim. When they get in the car it drops down so far on one side you think it's going to capsize. I know one guy who has no restraint he can no longer walk because he's too heavy for his legs.. Like eating, if his wife let him have the check book or credit card they'd be bankrupt in a week. Look on the net for "photos from Wall mart" they treat fat and sloppy as a joke. If we ignore all but the health issues, these people are "usually" a load on the medical system and their life choices use limited resources that are needed by people with illnesses that are not by choice.. The over weight problem causes many serious medical conditions that use a lot of resources, drastically shortens their lives, and makes then and those around them miserable. Many can't work because of their weight so they are supported by you and me. They require special assistance to travel, at stores, at restaurants, and you hope you never get next to one on a plane. There may be hope there though as some airlines ticket prices are by weight as they are with freight. Probably never happen in the US because of discrimination law suits. More weight means more fuel burn. Obesity is a nation wide problem in the US and creates a heavy (no pun intended) and unnecessary load on the economy of which most people are aware and although they may not recognize it, the problem does create a bias. Often a very strong bias. They have to be careful what they say, but I think that % of bias in students just grows after they become professionals. I know Therapists in Physical rehab hate to see them coming. Instead of working with the therapist to get better, they just complain.
Exactly what kind of calories do you think you're going to intake when you can't absorb nutrients from food? The calories are a direct result of the nutrients absorbed.
Well, you completely missed the point. Doctors who don't recognize their biases are more likely to misdiagnose patients that they're biased against.
Take me, for example. .
Sure... where do you want to be taken?
That is part of the issue.... Patients have bias too.
I recall a lady from my childhood that told the doctor she had XYZ problem.... and she got pills for XYZ.
A couple years later the pills proved to be noneffective so they did surgery to remove her gall bladder.
The surgery discovered ADVANCED cancer... All they could do was stitch her back up....
While the issue about doctor bias is important, patient and family bias are equally important because as much or more than doctor bias other bias sets the stage as much or more.
Truth is stranger than fiction, but it is because Fiction is obliged to stick to possibilities; Truth isn't. Mark Twain.
So, care to tell me how the healthy and fit patient is supposed to feel walking into a doctors office to find the nurse waddling up to their industrial-strength chair?
And then finding yourself growing impatient as you have to wait an extra 10 minutes for your obese doctor to come wheezing in from his smoke break to talk to you about lifestyle choices?
Funny thing about bias and obesity. It tends to swing both ways. Seems the arrogance of the med industry thinks this is a one-way door.
Of course it goes both ways, and the study makes no claim it doesn't, or does it now?
Btw, I've had a doctor a bit like you describe (not as over the top, but the drift is same), and he was one of my best doctors. He never judged people but did his best to help with whatever was their problem. If he thought the patients life choices may affect how he/she follows the treatment he might have verbally pushed the importance of it, but never did he mistreat at least me.
I wouldn't know, but maybe the fact he knew that he too was only a human might have had something to do with it.
In capitalist USA corporations control the government.
Maybe we as a species have a built in biological disgust of obesity, so trying to change or alter our attitudes is probably pointless. And before anyone flames me, you all know it's true. Just think, how many times have you seen a morbidly obese person and felt disgusted? Admit it, all the time. And studies have shown that morbidly obese people are actually disgusted by themselves. I'm telling you, it's genetic. Our brains are just wired that way.
If you think about it it makes sense too. Throughout most of the course of human history food has always been scarce and a valuable commodity. Someone who was morbidly obese meant they were clearly getting a disproportionate amount of food than other people, meaning they were a hindrance to a community. Not only could they not physically contribute, but they were consuming far more than their fair share of food. Very easy to see why such people would be shunned, despised and disgusted.
It's 25% were unaware: so 75% must have been aware
Correct, if in 100% of cases a bias actually exists.
Confucius say, "Find worm in apple - bad. Find half a worm - worse."
Assume a fat fucking bastard has been to a doctor before. Assume that the doctor told him to lose weight, in order to not be such a fucking fat bastard.
If they're still fucking fat fucking bastards the answer would appear to be "fucking-a yes".
Confucius say, "Find worm in apple - bad. Find half a worm - worse."
Other things being equal, being overweight is unhealthy. I want my doctor to see that as a negative.
Heavy is the head that wears the tinfoil hat.
Sounds like your new doctor is unaware of your medical history.
Pain is merely failure leaving the body
Even though yes, you are simply eating too much in the thermodynamic sense, it rapidly becomes a stigma where the patient is 'at fault', rather than the underlying medical condition. In this way, victimisation of obese patients is counter-productive.
Sure some people simply have no self-control - but is that because they are bad people, or because there is some factor at work that makes it hard for them? The blame game for obesity is a bit like accusing people with a birth mark of being in league with the devil and burning them - we should know better by now.
I'm very lucky that I stay relatively thin and somewhat athletic without significant excercise, despite eating whatever I want. But I can imagine how hard it would be to accept that I'd have to change my food- and exercise habits in order to lose weight, knowing that I basically have to keep doing it for life. I am not sure I would be able to do so myself, if the need should arise down the line. I did gain about 7 kgs over the past 6-7 years (I'm 37), so I might have to start considering it :)
However, your AC parent is correct, although he stated it in a somewhat aggressive manner. "A small percentage" of overweight people (I've read about 1% cited from an MD in a news article which I can't find at the moment) have some physiological condition which makes it impossible or extremely difficult to lose weight. Thus the cold, hard reality is that the vast majority simply eats too much and moves too little. To be flippant, "being too fond of cake" is usually not a medical condition. Of course there are also various mental "disorders" of different severities, often connected with the overweight itself, which can make it very hard to focus on a healthy lifestyle.
This still indicates that the vast majority of overweight people need to be aware of the fact that yes, they are responsible for their weight, and that they themselves are ultimately the only ones that can do something about it, even though it can be damned hard. There is no need to go it alone, there are a lot of programs one can join, I imagine that is also the case in the US, but you need to instigate the change *yourself*.
On a side note, there are some loud people who skew the public opinion against obese people. A notable example in Norway is Jørgen Foss, the spokesman for the Norwegian National Association of Overweight People, who is a complete clown. He might possibly be the worst spokesman for any organisation ever, as he keeps harping on about how he's completely innocent and unable to to anything about his weight, that some people prefer to be huge, and stuff like that. He dismisses lifestyle changes as a measure (claiming it's impossible), and frowns on programs which could actually help people (there's supposedly no reason for him to even try, as a program wouldn't help him anyway; he would just continue overeating). That doesn't exactly tend to instill any sympathy in me.
Another spokesperson for the same organisation famously complained that "Not even the chairs at McDonald's are big enough. Some of us have experienced that the chairs are stuck to us when we get up." This is not a satirical article, nor did the statement seem to be uttered in jest. In the QA session she very aggressively dismisses any suggestion that laying off the snacks and junk food (of which she consumes a substantial amount) is a viable course of action.
Shit like this seriously harms their cause, and is very much the wrong message to send to people in that situation IMO.
Are you a grammar Nazi? I'm trying to improve my English; please correct my errors!
Doctors should diagnose based on full spectrum data collection. Not simply based on what they see and think at first glance. That's like a climatologist looking at a clear blue sky on a good day and saying "look, no smog. Clearly climate change is not caused by man made pollutants!!! No need to look any further into this."
On second though, perhaps a car analogy would work better. Can somebody help me out here? :)
Sorry - no car analogy [they usually suck in any case :) Yes, a thorough examination should of course be done, that goes without saying. To be fair, only "A small percentage" (I've read that the real number is slightly above 1%) *actually* has any physiological excuses, but a doctor should be on the look-out for those, and additionally be able to work with attitudes and mental "disorders" affecting the patient's weight control. In the end, except for those 1%, it comes down to eat less, move more. Even though actually doing that could prove somewhat hard, it's the only way weight loss is going to happen.
With respect Runaway, that thinking right there is exactly the problem.
Obese != unhealthy life choices (at least not in all cases)
Take for example the 250lb person who eats right, jogs, and works out every day vs the 145lb person who never exercises, eats cookies, and pounds beer and soda but for some reason never gains a pound.
I used to know a guy of the former variety, except he weighed about 250 kg. His body mass was a lot of fat, but his personal best bench press was 243 kg. In a Norwegian strength thest where you lie on your back and use your feet to push weights straight upwards on rails, he piled on all the weights he could find (about 600kg), and subsequently asked me and a buddy to perch on top, and he nailed it. I've also seen him on the ski slope. He's quick and agile, because he has almost superhuman strenght, ample to support his large bulk. Working as a door man a trick of his was famous; he grabbed two ~100kg sacks of food waste in *each hand* and carried them two flights of stairs down and then 100m to the container. In another situation, written up in the local paper, he restrained a huge body-building type by lifting him up, putting him gently face down on the ground, and placing his hand on the guys back. He couldn't move.
He started losing weight after being told to do so by his doctor to (his body is *hard* on his heart and other organs), but he dropped it because "I couldn't maintain my strenght, and suddenly everything was wearying". He obviously was comfortable being enormous. In most cases, though, I agree with Runaway that obesity stems from unfortunate life style choices.
Are you a grammar Nazi? I'm trying to improve my English; please correct my errors!
In my case, I dealt with a stuffed up nose for ~7 years. Every time I would mention it to the doctor, they would tell me that "it was allergies". It didn't matter that it never got better or worse no matter what city I lived in or what time of the year it was. Turns out that 2 months of ultra low carb eating, and my nose cleared up. When I started eating carbohydrates again, it didn't come back. I can't say for sure what the problem was, but I suspect that I had some kind of infection that couldn't survive when I cut out the sugar.
No matter what the problem was, the doctors were completely uninterested in figuring it out.
Just the one?
Confucius say, "Find worm in apple - bad. Find half a worm - worse."
Sure. If it won't start, what do you check first? Fuel in the tank, battery charged. Then pop the plugs (if any) out & check for a good strong spark. Is fuel reaching the engine? Your nose will tell you that.
I'm going to guess that's 99% of cases cleared up. Only then do you assume goblins stole the crankshaft to make a scepter for their king.
General principle: investigate the most probable causes first and then (if necessary) consider the more exotic ones.
Confucius say, "Find worm in apple - bad. Find half a worm - worse."
And they run with scissors. You hit the nail on the head. People who are overweight or underweight are not necessarily that way simply due to eating. There may be a pre-existing condition other than too much or too little food. Genetic disposition, mental condition and the individual's overall environment come into play with each and every person. I am lucky enough to have been blessed with great health when it comes to my weight, and I don't even have to work at it. My sister, on the other hand, has to be very strict about her diet and exercise or will quickly gain weight. If the Jiro's comments were true, my sister would be regarded as fat and lazy, while I would be seen as restrained and responsible. I assure you that is simply not the case (as I am eating a pizza by myself right now).
The problem is that people refuse to accept that obesity is a mental health issue (as that carries a stigma) and either glorify it or try to fix its consequences rather than source.
The creatures outside looked from Alt-Right to Antifa; but already it was impossible to say which was which.
I don't have a weight problem -- I could care less about my weight. I have a joint and asthma problem, neither of which is helped by your suggestions.
cf. actual studies on how fat people spend less time in hospital than skinny people in the UK before you assume so much based on pop culture rather than actual medicine.
- Michael T. Babcock (Yes, I blog)