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Obese patient gets mad after I tell her to fast..

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  • #16
    I haven't read all the other posts so sorry if this is duplication, but how about something that offers food for thought and isn't entirely inconsistent with your senior, like:

    A number of researchers are concerned about the growing rate of obesity, despite increased education, particularly in the last couple of decades. There is an emerging group of scientists who have gone back to the studies that precipitated the low fat edict,and they are convinced those studies are wrong, and sugar is the problem. But by removing fat in EVERYTHING we have actually increased sugar. I am personally convinced this is right and I ditch the grains and sugars - I mean whole foods we ate 20 years ago can't be wrong. I can give you some key words for your own research or show you a good website - they show success stories. Based on this, I think you should trial for 2 weeks - no processed food, no grains, no sugar - and see for yourself how it makes you feel after you spent 2 or 3 days adjusting.

    That way, you acknowledge it against CW but hopefully patient can acknowledge the temporal connection you describe.
    Last edited by katemary; 01-14-2013, 01:16 AM.

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    • #17
      I know it is frustrating, but just play it safe for now. You're at the bottom of the ladder, stick it out until the end of your residency, then you can preach what you believe. It's not a good idea to piss off your attending.
      F 28/5'4/100 lbs

      "I'm not a psychopath, I'm a high-functioning sociopath; do your research."

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      • #18
        I remember one patient with a BMI of 50 telling me: "I will do absolutely anything to lose weight. I have tried everything. Nothing works. You seem confident you can help me to lose weight; I will do anything you say. I am willing to try anything."

        I told this patient to fast. She became incredibly angry and demanded to see the real doctor.
        Send her to MDA and have her try primal or paleo. There is a lot of "buzz" going around that fasting can really mess more with women than men. Straight up primal works great for so many people without needing to tell them to fast.

        If I came to you 5 years ago and you said "fast" with no additional information.... I'd be annoyed.

        FYI, why fasting doesn't work- the woman fasts, gets hungry, binges, fasts, gets hungry, binges. Gonna bet she has done this before. She needs the other 90% of the equation.

        http://maggiesfeast.wordpress.com/
        Check out my blog. Hope to share lots of great recipes and ideas!

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        • #19
          Honestly, start them off with avoiding refined sugars and encourage them to expand their vegetable options. Meat, veg and starch for dinner? Sweet potatoes could be a stand in for the "starch." If you happen to have a pile of delicious-looking (and tasting) recipes on hand- how terribly convenient, right? And if they just happen to be primal . . .

          Just those two things alone will start them feeling better. Once they start feeling better, they will stand a much better chance of starting to find their own options. It's also in no way a contradiction to anything else they will be told. Makes you look smarter than if you, the med student, are spouting off about stuff that "everyone" knows is wrong.

          Oh yeah- about the fasting? Dude, you did NOT want to see me when I was hungry before I was adjusted to the PB. Three squares a day was stretching my blood sugar- skipping any of them would have resulted in dead bodies. Most people, particularly people with food issues, need to discover fasting on their own. That way it will happen when they're ready- leading to a better result.
          Last edited by drssgchic; 01-14-2013, 05:38 AM.
          http://cattaillady.com/ My blog exploring the beginning stages of learning how to homestead. With the occasional rant.

          Originally Posted by TheFastCat: Less is more more or less

          And now I have an Etsy store: CattailsandCalendula

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          • #20
            I'm a physician with 35 years of experience and I can tell you you can't accomplish much of anything with most people without having a trusting, empathic relationship with them, something harder and harder to do in today's health care system. About the only thing you might try is to give your attending MD a copy of Primal Blueprint and with all humility say, "I found this interesting and had some good results for myself with this program. I'd like to know what you think if you have time to take a look."

            You'd have to have some humility, though, and be prepared to thank him/her for reading it even if s/he comes back and says, "That's crap."

            But really----take it easy on those patients. Upsetting them and then not having the relationship to support them isn't kind or effective. And kindness in a CAREgiver is really, really important.

            Pea

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            • #21
              Originally posted by Damiana View Post
              I know it is frustrating, but just play it safe for now. You're at the bottom of the ladder, stick it out until the end of your residency, then you can preach what you believe. It's not a good idea to piss off your attending.
              this
              beautiful
              yeah you are

              Baby if you time travel back far enough you can avoid that work because the dust won't be there. You're too pretty to be working that hard.
              lol

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              • #22
                As a former fatty, I have turned to Dr.s for help, only to be told that I need to follow CW and SAD. I was given list after list of fake foods, chicken breast recipes, and only drink diet soda. And, of course, nothing worked.

                I asked about lap band, gastric bypass, and all sorts of miracle pills. Each time I was told to refer to the lists. I took a chance on hCG, which ended up leading me to Paleo eating. The hCG took off a huge portion of my weight, while teaching me to embrace whole foods, healthy fats, and to stay far away from grains and processed foods.

                Until the person with the issue has hit rock bottom, there is no telling them anything. The main problem is that obesity always has an underlying emotional problems. Food is packaged and sold as a way to happiness.

                If you have the time, ask the person to tell you what all they have tried. They will say everything and that "nothing worked", but if you can delve deeper, they will tell you that somethings worked for a short while, until they got bored with the program. It's mainly because of the lack of understanding that it's not about the "diet", but what they plan to do for life.

                Once you open your practice, you will have more time to really get into the issue. Now, you are just exposing them to ideas that very few "Doctors" will back.

                Good luck!

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                • #23
                  To OP--Have YOU ever been obese?

                  As you've been advised, working with overweight patients requires a caring, long-term relationship.

                  The idea that you can give them the 'truth' in the 10 minutes you have with them is not only absurd, it doesn't say much for your own development as a medical professional.

                  And to tell an obese person to 'fast,' is insulting. That's why I asked if you'd ever been obese. I have lost over 200 lbs, but I never fast--ever--because my metabolic situation requires food at regular intervals. You know nothing about the medical issues involved in obesity if you think 'quickie advice' is a solution to a very complex problem that's often unique to individuals.

                  You may want to rethink your career path.

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                  • #24
                    The TRUTH can indeed be said in 10 minutes or less: It goes something like this; You are now eating yourself into the grave so if you want to recuperate your health you must stop eating now, because you are carrying too much food stored in your body already! So, stop eating today, JUST STOP! – and come back for a medical check every second week or so. After a few days you will feel very little or no hunger, so stop eating now!!!

                    But telling THE TRUTH is far too dangerous for a medical professional, and there will be much more money to gain by keeping the “patients” within the health care system, and there are no kids to tell the truth that the emperor is not carrying any clothes either, so my recommendation to the OP is that the best move is to keep your head low and not tell what will work best, because nobody want to lose their illusions, money, and the naked truth will only harm your career as MD!

                    Just to illustrate how touchy this topic is, check out this thread:

                    http://www.marksdailyapple.com/forum/thread74066.html
                    Last edited by Gorbag; 01-14-2013, 08:34 AM.
                    "All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident."

                    - Schopenhauer

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                    • #25
                      Originally posted by emmie View Post
                      You may want to rethink your career path.
                      I think that's a bit harsh. You think that doctors don't learn & grow throughout their career? Some don't, maybe, but that's no reason why this person can't. They're still learning.
                      Depression Lies

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                      • #26
                        Originally posted by Gorbag View Post
                        The TRUTH can indeed be said in 10 minutes or less: It goes something like this; You are now eating yourself into the grave so if you want to recuperate your health you must stop eating now, because you are carrying too much food stored in your body already! So, stop eating today, JUST STOP! – and come back for a medical check every second week or so. After a few days you will feel very little or no hunger, so stop eating now!!!

                        But telling THE TRUTH is far too dangerous for a medical professional, and there will be much more money to gain by keeping the “patients” within the health care system, and there are no kids to tell the truth that the emperor is not carrying any clothes either, so my recommendation to the OP is that the best move is to keep your head low and not tell what will work best, because nobody want to lose their illusions, money, and the naked truth will only harm your career as MD!

                        Just to illustrate how touchy this topic is, check out this thread:

                        http://www.marksdailyapple.com/forum/thread74066.html
                        because locking a group of people up in a cage with guards with guns is always a sane idea

                        even if it's just a "thought experiment", as you liked to keep saying
                        beautiful
                        yeah you are

                        Baby if you time travel back far enough you can avoid that work because the dust won't be there. You're too pretty to be working that hard.
                        lol

                        Comment


                        • #27
                          Originally posted by namelesswonder View Post
                          I think that's a bit harsh. You think that doctors don't learn & grow throughout their career? Some don't, maybe, but that's no reason why this person can't. They're still learning.
                          +1
                          We need more med students like you so change can happen.
                          5'7'' 127 lbs, primal since August 2011

                          My journal:
                          http://www.marksdailyapple.com/forum/thread78819.html

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                          • #28
                            Originally posted by ulnauy View Post

                            Btw, it's interesting to see a Canadian using the term SAD but I suppose it isn't much different up there in Manitoba. "
                            I must have picked up this term here, on MDA while reading. However, I can assure you that almost nobody here knows about SAD: they know the Canadian food guide. I have never lived in the US. What I can tell you is that this province is way different than the east coast (of Canada). Probably r/t the great majority of people being aboriginal. That explains why we have the highest rate of amputation r/t diabetes in Canada. I lived on the East coast for 29 years and I have never seen that. There are things here that I only knew about because I saw pics in my nursing textbooks. Manitoba is not a good representation of Canada imho.

                            Moving out of here this summer, heading to the Maritimes. Finally!
                            5'7'' 127 lbs, primal since August 2011

                            My journal:
                            http://www.marksdailyapple.com/forum/thread78819.html

                            Comment


                            • #29
                              It's possible that for some of your patients you could recommend a support group to help them lose weight. FA actually will tell your patients to avoid refined sugars and all flour products from all grains (although not whole grains in their natural, whole state). They will also tell your patients that every meal needs to have at least a quarter cup of olive oil for satiety. I know two people who have had remarkable success. One lost 130lbs right in front of her husband. It took her husband a few years for that to sink in and then he tried it and now can't stop talking about it. Not everyone can be reached and not everyone will be interested, but support groups are at least something that doctors don't object to. FA is a 12-step program.
                              Food Addicts In Recovery Anonymous: Home
                              Female, 5'3", 50, Max squat: 202.5lbs. Max deadlift: 225 x 3.

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                              • #30
                                I am only speaking for women, but probably 90% of obese women have more knowledge about how to lose weight than most doctors. They have probably tried EVERYTHING if they are wanting the lap band.

                                It's really fucking hard to lose weight if you are addicted to grain and sugar, which these women likely are. It's a HUGE leap of faith to give up grains. I ate grains this Christmas.... same old things started happening.

                                You have to get them away from the toxic foods, which is hard since 90% of what most people eat is toxic crap. You have to teach them to cook. Shop. Handle "food situations". Satisfy cravings with good foods. You have to beat it into their heads that the "whole grain bagel with light cream cheese" is why they eat a snickers every day at 2pm and why they are fat despite eating "salad with light dressing" for lunch.

                                They are ashamed of the damn snickers they have to have(weak willed fatass) and confused why they aren't satisfied by the meals Dr. Oz pimps. They are convinced bacon and eggs are for the real fat asses. And if they switch to full fat dressing, they'll gain 10 more lbs. Their friends shove crappy foods in their faces as a way of bonding. They have exactly zero time to workout. Less time to cook a real meal. And they have tried and failed on low fat, low carb, South Beach, Weigh Watchers, Slim Fast, maybe some did some good old disordered eating (a form of fasting (holla!)). They probably killed themselves at cardio at one point.

                                YOU, skinny, 130 lb MD probably can't help them in a meaningful way. Send them to the paleo and primal sites and let them talk to women like me- who have been there. Who for the first time ever just eat foods they enjoy. We are their peers and the ones they can learn from. They can see my fat ass picture, can hear about my crazy eating past and see themselves in that and see something that works.

                                I was an angry obese woman 18 months ago killing myself with workouts and eating awful "health food" punctuated with sugar binges. I thought I was going to be fat forever.

                                http://maggiesfeast.wordpress.com/
                                Check out my blog. Hope to share lots of great recipes and ideas!

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