THCB

Shame

I saw a gentleman in my office recently.  He was having severe pain radiating from his lower back, down to his calf.

I was about to describe my plan to him when he interrupted me saying, “I know, Doc, I am overweight.  I know that this would just get better if I lost the weight.”  He hung his head down as he spoke and fought off tears.

He was clearly morbidly obese, so in one sense he was right on; his health would be much better if he would lose the pounds.  On the other hand, I don’t know of any studies that say obesity is a risk factor to ruptured vertebral discs.  Besides, he was in significant pain, and a lecture about his weight was not in my agenda.  I wanted to make sure he did not need surgery, and make him stop hurting.

This whole episode really bothered me.  He was so used to being lectured about his obesity that he wanted to get to the guilt trip before I brought it to him.  He was living in shame.  Everything was due to his obesity, and his obesity was due to his lack of self-control and poor character.  After all, losing weight is as simple as exercise and dietary restraint, right?

Perhaps I am too easy on people, but I don’t like to lecture people on things they already know.  I don’t like to say the obvious: “You need to lose weight.”  Obese people are rarely under the impression that it is perfectly fine that they are overweight.  They rarely are surprised to hear a person saying that their weight is at the root of many of their problems.  Obese people are the new pariahs in our culture; it used to be smokers, but now it is the overweight.

The fear/disdain of obesity has reached into areas where it should not be.  I regularly have to tell mothers of chubby babies that it is perfectly fine for their child to be that way.  Children under three generally regulate their eating to what they need.  I do not believe a baby can become obese on breast milk or formula.  Now, if they are giving the child french fries and burgers, that is a different matter.

Instead of patronizing obese patients with a lecture, I try sympathizing with them.  Just because something is simple doesn’t make it easy.  How do you quit smoking?  You just stop smoking.  We should just pull out of Iraq.  There should be peace in the middle east.  People should stop hurting each other and start being nice.  All of these are good ideas, but the devil is in the details.  Losing weight is a struggle, and it really helps to have people giving you a hand rather than knocking you down.

Don’t get me wrong, I don’t deny the health risk of obesity.  I do my best to work on weight loss with my patients.  But the idea that their personal worth lies on their BMI is extremely damaging.  There are a lot of screwed-up skinny people out there; just look at super-models.  It is a lot easier to lose weight when you actually like yourself and want to do something about your health.  Our culture of accusation and shame simply makes obese people hate themselves.  If you hate yourself, why should you want to take care of your body?

Is obesity a problem?  Sure it is.  But we need to get off of our self-righteous pulpits.  Obese people should not be made into a group of outcasts.  The “them” mentality and the finger-wagging are no more than insecure people trying to feel better by putting down others.

It sounds a lot like Junior High.

If we really want to help with obesity, we need to grow up.

Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at More Musings (of a Distractible Kind) where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player.  He is a primary care physician.

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CamillaJaneSacramento DentistAge SpotBobbyG Recent comment authors
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Camilla
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Camilla

This brings up an interesting question. What do you think of teens getting weight loss surgery? Obviously it is an issue and now teens are turning towards surgery as a way to rectify the issue. Is that a solution? Or do we intervene sooner? I really do wonder how we go about it but this doctor seems to want to help (http://primesurgicare.com/dr-seun-talks-young-adults-lapband-surgery-ny1/)

Jane
Guest

Great post! Obesity is really a hard issue/problem for some. The answer to this kind of problem is actually in the hands of those who suffer from it. Some people just lack the will to do the right thing. Obese people could achieve their goal to become healthy and fit by having motivation to lose weight, having a proper diet and self discipline.

Sacramento Dentist
Guest

I agree with Dr. Rick. Lecture your patients and see if they come back to visit you again. They won’t. Instead they will wait until they are really really sick and end up in the hospital. I’m pretty sure no one was taught that method in school.

Age Spot
Guest

There is a good saying. You must live by next rule: Eat to live, not live to eat.

DeterminedMD
Guest
DeterminedMD

I believe this in the difference between the consequences of smoking versus obesity: smoking is fully a choice, and while difficult to terminate, can be done if people are willing to persevere; weight gain has many variables and some are not in control by the patient, but, there still must be effort to look for factors that can impact on some weight loss at least. I see people every day who are just not interested in change, in accepting the status quo is not appropriate, and just think there are quick fixes, or even worse, who they are is just… Read more »

Peter1
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Peter1

MD as HELL says:
May 19, 2012 at 5:20 pm

“Yes they do”

I guess then cigarette companies have a right to deliver an addictive drug through cigarettes but the government has no right to counter act that?

DeterminedMD
Guest
DeterminedMD

counter it while promising health care for everyone, even those who smoke?

Counterproductive is a nice term to describe it, dumbass is better!

Here’s an idea: don’t allow people who smoke access to health care insurance, at least those under 30 years old!

Peter1
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Peter1

“Here’s an idea: don’t allow people who smoke access to health care insurance, at least those under 30 years old!”

Why the cut off of 30 years – why not everyone? Got any more health problems you’d deny insurance for? I guess though that doing that would require government interference/regulation and a certain “behavior mod business” on the part of the government.

DeterminedMD
Guest
DeterminedMD

Why should such people be allowed to access health insurance as of 2012 when it is painfully obvious smokers have much more morbidity and mortality than non smokers? And why the hell did the idiots who passed PPACA do nothing about the role of smoking in the legislation to begin with? Oh yeah, the tobacco lobby controls all, just like the insurance and pharma lobby did in their role with PPACA too! Sorry, smokers can’t die fast enough for me. There is no tolerance for dependency that just ruins it for all around them. Call me prejudiced, bigoted, discriminatory, I… Read more »

BobbyG
Guest

NO ONE should have ANY access to health care unless they pass the DMD test for Comprehensive Lifestyle Probity.

Lutz E. Kraushaar
Guest

As a scientist I’m working on primary prevention of chronic lifestyle dependent diseases. We do know that a healthier lifestyle prevents disease. What we don’t know is what prevents a healthier lifestyle. I have been working on the answer to this question for the past 15 years. I do not claim to have found the answer, but, surprisingly, stigmatization is at the heart of it. It is easy for us in public health to point a finger at the obese and to lay the fault for their obesity on them. But once you get into the biobehavioral origins of obesity,… Read more »

Barry Carol
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Barry Carol

I think one of the more unfortunate aspects of human nature is that most people don’t like to be told what they don’t want to hear and I’m not talking just about healthcare. For example, it seems that too many people want more benefits and services from government than they’re willing to pay for whether we’re talking about local, county, state or the federal government. They expect someone else, presumably the rich, to pay but not them. They think more medical care is better care and they want someone else to pay for that too. If they’re overweight, maybe there… Read more »

Peter1
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Peter1

“To think you’ll reverse it by a “tax” is to think you’ll turn the river with a sandbag.”

Didn’t say that I cared about turning the river. But I do care about paying for irresponsible behavior that costs other people.

“No government is going to force people to be healthier in the long run.”

The nicotine delivery industry didn’t force people to be healthier, it was government action through taxes and non-smoking areas, as well as a realization that clean air is for everybody, that reduced rates of smoking. It can be done, but it takes time and the right policies.

rbaer
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rbaer

What a bizarre discussion. Of course incentives play a role, the question is to what extent. Price of fuel goes up, Americans drive less all other things being about equal; subsidize solar energy in Germany, and you have a quite a bit in a rather cloudy, northern climate (don’t say it makes sense); complicated back surgery (multilevel fusion is paid better), surgeons do it way more often … there are probably 100s more examples. And does shame work? 1st, As I said, physicians are there to help, to connect and to work with the patient, and to empower him/her. However,… Read more »

tim
Guest
tim

When I eat whatever I feel like eating, I gain weight. At 20 pounds heavier than I am right now, I feel bad all over. My hips and knees hurt, and my back strains easily. I don’t like myself and I avoid the mirror. Of course, eating whatever you feel like eating is irresponsible. When I take responsibility for my weight, I lose weight. For me, when I stop eating at a certain calorie count, I lose weight at an utterly predictable rate. It is a mathematical exercise. I can choose a number and land there. (I do not have… Read more »

Elias
Guest

True. Accusing others and making them feel guilty is not helpful (except for the accuser, who feels he/she is better). Lecturing on things the person knows is futile too. Instead finding a way to encourage them (and participating in the effort) is not only much better, but very effective. You can get tips on keeping fit on: http://freedomnow-online.com/exercise.html

Dr. Rick Lippin
Guest

THANKS!

I gave up “wagging my finger at patients” a long time ago. I interact withpatients on an adult to adult level where paternalism, humiliation and shame have no role.

DeterminedMD
Guest
DeterminedMD

Social Darwinist here to note that if solution A offered can have a realistic impact on 2/3 the population targeted, then why are people dismissing it for the 1/3 who will lose? Liberal attitudes fail this society because they allege to HAVE to save all, just like conservatives fail because they only want to benefit the few and their own. This society is going to have to contract if it will endure. Pay attention to who gets outraged by this comment, if they rebut. People who can change, can adapt are those intended to move forward. This planet can’t handle… Read more »

Lynn in SC
Guest
Lynn in SC

It has taken most of my lifetime to change our culture to reduce our rate of smoking and almost as long to increase the rate of seat belt usage. Social change is slow and hard. Weight management and good nutrition have only recently been reintroduced to the realm of the “medical.” [Remember MDs used to advertise cigarettes.] It’s simple but not easy…food cues are all around us. We live in an abundant food economy where the poor are obese and the wealthy are thin. It’s a complex psycho-social-economic-social problem and like our health care problem, “We have met the enemy,… Read more »

Alex
Guest
Alex

Thank you for writing this. I have battled my weight for 15 years. Sometimes I win, somethimes I get pushed back. Weight gain and obesity are complex issues and there is no ‘one-size fits all’ solution. But what has never helped is shame. I have only managed to lose weight when I feel better about myself. I sometimes weigh nearly 400lbs – telling me i need to lose weight is not helpful. I work in healthcare, I understand what I am doing to myself. If obesity is a national crisis, then those who dismiss it as a problem of ‘willpower’… Read more »