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Saturday, January 23, 2010

So of course the answer is simple: Lose weight until a doctor finds you attractive
Posted by Jill | 12:47 PM
From the "Gee, ya think?" file (and Melissa):
It's shocking, but it's true: Being a woman who's more than 20 pounds overweight may actually hike your risk of getting poor medical treatment. In fact, weighing too much can have surprising -- and devastating -- health repercussions beyond the usual diabetes and heart-health concerns you've heard about for years.

Recent studies have found, if you are an overweight woman you:

• May have a harder time getting health insurance or have to pay higher premiums

• Are at higher risk of being misdiagnosed or receiving inaccurate dosages of drugs

• Are less likely to find a fertility doctor who will help you get pregnant

• Are less likely to have cancer detected early and get effective treatment for it

What's going on here? Fat discrimination is part of the problem. A recent Yale study suggested that weight bias can start when a woman is as little as 13 pounds over her highest healthy weight.

Think about that. Thirteen pounds over your "healthy" weight as defined by a medical community that quite admittedly hates you. You know what my "healthy" weight maximum is for my height? 105 pounds. You know when I weighed 105 pounds? In 1983, when I was starving myself and working out five nights a week. So I guess I haven't been entitled to have a doctor treat me like a human being ever since.

Doctors have long known that obese women are more likely to die of ovarian and breast cancers, but when Schneider and her colleagues recently gave a group of overweight ovarian cancer patients chemotherapy based on their actual weights, they found that the women were as likely to survive the illness as thinner patients. "Doctors aren't intentionally under-treating overweight women," Schneider says. "We're just working with limited information."

I'm not so sure I believe that. We live in a "No fat chicks" society after all, why not consign all of us to die simply because they don't find us attractive.

When Celina Reeder, a 5-foot-5, 185-pound woman with a torn ligament in her right knee, was told by her surgeon she needed to stop eating so much fast food before he would schedule surgery, the Woodacre, California, woman was astounded. "I left his office feeling ashamed," she recalls. "And I don't even eat fast food! The more I thought about it, the madder I got. So I switched surgeons. Anybody who thinks doctors treat heavy women the same as thin women has obviously never had a weight problem. I really felt like my doctor didn't respect me."

She may have been right. University of Pennsylvania researchers found that more than 50 percent of primary care physicians viewed obese patients as awkward, unattractive, and noncompliant; one third said they were weak-willed, sloppy, and lazy. In addition, researchers at Rice University and the University of Texas School of Public Health in Houston found that as patient BMI increased, doctors reported liking their jobs less and having less patience and desire to help the patient.

Whether they know it or not, doctors' attitudes may actually encourage unhealthy behavior. Feeling dissed about their weight can make some women turn to food for comfort. "Stigma is a form of stress, and many obese women cope by eating or refusing to diet," Puhl says. "So weight bias could actually fuel obesity."

Studies have also found that overweight women are more likely to delay doctors' appointments and preventive care, including screenings for cancer, because they don't want to face criticism. "It can be frustrating to treat obese patients," admits Dr. Lee Green, M.D., M.P.H., a professor of family medicine at the University of Michigan in Ann Arbor. "I spend most of my time treating the consequences of unhealthy lifestyles instead of actual illnesses. People come in complaining of foot or knee pain, and I'm thinking, Do you not see that you're in pain because you're 60 pounds overweight? I don't say that, of course. I try to encourage them to lose weight."

Yes, they all do that. But not one of them has any good ways of how to do it and keep it off, given the way we live today.

I always use myself because I'm the best example I know. I'm a 4'10" tall size sixteen. I don't eat fast food. I have cut extra sugary things other than the occasional square of dark chocolate and an occasional small cookie almost entirely out of my life. I don't eat fried foods. You know what I don't do much of? Exercise. It's kind of hard to carve exercise time out of your day when you leave the house at 6:15 AM, get home at 6:30 PM, and need at least six hours of sleep and preferably at least seven. The new on-site gym ought to help that somewhat, provided that a) I can get to the equipment, and b) use it during the day so that I'm not arriving home at 8 PM, eating a small dinner and then going to bed.

Every now and then you read a research study about obesity that gives tantalizing clues about how it's about more than gluttony or sitting around eating doughnuts (something I don't even LIKE). There are studies about stress as a cause. But hey, working 70 hours a week isn't at all stressful now, is it? There are studies about how exercise doesn't do much if your diet is already reasonably healthy. There are studies about ghrelin. (Funny how WebMD is sponsored by Chex Mix, isn't it?) And yet every article about these studies ends with "But if you have X sensitivity, or X tendency, you may just have to watch your diet and exercise more than other people." It never, ever occurs to anyone that perhaps being what our society calls "overweight" may in fact be normal for some people?

I recently had a dermatologist tell me to go to Weight Watchers, a company that had $4 billion in sales in 2007. If Weight Watchers is so damn effective, how come it makes so much money? Nestlé paid a bundle for Jenny Craig a few years ago. Nutri-System's food is, from all accounts, horrible; and Medifast looks like a pyramid scheme. My local newspaper's advertising is lately leaning heavily towards gastric band practitioners. Exploitation of the overweight is big business, and as a result, there is little motivation to rid the world of fat people by making them not fat. Who'd pay for all this crap otherwise?

I recently had the idea of switching to a local gynecologist who specializes in weight issues with postmenopausal women. It sounded intriguing, since most of us who reach a certain age find that the perfect sine wave we once had for a waistline has flatlined. Then I read about the protocol she follows, developed by a doctor. I picked up a copy of said doctor's book, and it sounded sensible; sort of like the Sugar Solution books, but then I found out that this protocol also involves an off-label use of the diabetes drug Metformin. Now, I'm not a big fan of prescription drugs under the best of circumstances. This particular one can cause lactic acidosis, which can be fatal in up to 50% of cases. It may be a perfectly fine drug for diabetics, but with a risk like this for off-label use, well, thanks but no thanks.

The FDA has FINALLY issued a warming about BPA, a chemical in plastics that has been linked for some time to obesity, and which is ubiquitous in most household products and food packaging. Funny how the so-called rise in obesity coincides with increased use of BPA. But especially now that corporations can buy their own Senators and Congresspeople, how likely do you think it is that BPA will be further studied and possibly banned?

Yet no matter how many studies come out that indicate overweight is not always about gluttony and laziness; it can be about the crap that is spewed into the environment and that lines our food containers; it can be about trying to survive in a society in which jobs are few and when you have one, you want to hold onto it. It can be about any number of things, and yet the so-called medical community only has one thing to say to us: Stop eating and spend your life on a treadmill. After all, millions of hamsters can't be wrong.

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Blogger Rhode Island Rules said...
Amen,sister Jill. I am 5'3 and a size 20-22. I have long been convinced that stress and lack of sleep contribute to my weight. The last time I was thin was when I walked 8-10 miles a day (2 hours)5 days a week and then came home an did an hour of a Jane Fonda tape. The only reason I was able to do so was that I was lucky enough to be a stay at home Mom and both my kids had finally gotten into school. Today I cannot fit in one hour of exercise never mind 3. I work 3 jobs just to keep afloat. I haven't slept through the night in 21 years. Never gave any thought to plastic until the stories started coming out a couple of years ago. Now I try to avoid it as much as I can but it is everywhere. None of these things (stress, plastic) affect the people the same way but for those of us it does... I actually eat way less and much better than I did 20 years ago. Like you I don't do fried or fast food, ice cream or chips. There is a reason for our nation and the world's rising obesity in the last 20 years that has nothing to do with video games and cars.

Blogger Interrobang said...
Sure obesity in some cases has to do with cars; not driving is correlated with lower overall body weight. Also, if you don't drive, you're more likely to get your RDA of physical activity.

Obesity also has quite a lot to do with lack of sleep. (If you haven't slept through the night in 21 years, something's seriously wrong with the way you're living. I'm surprised your body lets you get away with that kind of thing; mine doesn't. If I don't sleep enough voluntarily, I'm going to sleep enough eventually whether I want to or not. Better to schedule it than think I'm waking up for work on Wednesday only to find out it's Thursday noon.)

Want to pack on some pounds in a hurry? Try not sleeping more than three or four hours a night for three weeks or so. They used to think obese people got sleep apnea; now they're realising that people with sleep apnea become obese.

Blaming a complex systemic problem like obesity on a single factor like BPA exposure is absurd, particularly when you have no way of knowing exactly what your BPA exposure levels are. (I presume you don't have a full medical toxicology lab in your basement, that is.) As with all things toxicology, the dose makes the poison, first of all, and, using that hypothesis, how would you account for people who have high BPA exposures but aren't obese?

I will say this: At least in my case, mechanical arthritis has been a great incentive to me to exercise as often as I can manage. (The disability that also causes the mechanical arthritis gets in the way of that sometimes.) Not only does hitting the gym semi-regularly keep the pain down to a dull roar, but it also keeps me trim enough such that my own weight isn't exacerbating the problem.