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Thread: Obese patient gets mad after I tell her to fast.. page 4

  1. #31
    momrn's Avatar
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    However you handle this, DON'T rethink your career path. The medical field is in dire need of thinking individuals who have more than a passing interest in their patients. Stay the course, finish your residency and get out there and get some experience. You'll misstep, but you will learn.

    Don't give out your number. Really.

    Emmie, sounds like that touched a nerve with you. Obese people can and do sucessfully fast. It isn't for everyone, but it isn't forbidden advice.

    And so you know, it goes the other way. When we told my NP how we lost weight and improved ALL our blood chemistry, she said, "oh, that's not healthy!" Say what?!

  2. #32
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    A couple years ago if someone had told me to fast, I would have freaked also. If you're talking to someone who has a metabolic issue where they are hungry every 2 hours - and I'm talking hungry to the point where if they go too long without food they cannot function physically or mentally- then they are going to reject the idea of fasting outright. Due to a combination of thyroid disease and too many carbs in my diet, I was that person. I would "crash" and get the shakes and literally not be able to think straight, I'd get angry and irritable, and I couldn't physically do anything because I'd get so weak. If anyone at that point had told me I needed to fast, I'd have told them to get me the real doctor as well. You have to get the person's metabolic issues taken care of first. I found after I began thyroid treatment with replacement thyroid hormone that I could go longer between meals. When I cut sugar, I could go longer. When I cut grains and went primal, all crashes stopped, period. So now I might entertain the idea of fasting. In fact, now it just sort of happens. On Saturday I ate one time and was good for the rest of the day. That would never have happened before.
    High Weight: 225
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    Primal Start Date: 11/26/2012

  3. #33
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    One of the problems is that only now that obesity is so prevalent and causing so much disease is it being taken seriously. So, in my mind, it’s relatively new “science.”

    First, I believe that eating less and moving more is the only solution.

    However, having been anywhere from 112-263 pounds in my life, it’s elegantly simple, but not anywhere easy.

    A drunk who finally makes the decision to stop drinking has all kinds of support and by the way, can live a healthy life never drinking alcohol again. A fat person generally only gets, “yeah whatever” as support, no insurance covers 30 days at a fat farm, and can’t give up food for the rest of her/his life.

    One sign of addiction is doing something you know will cause you harm. A drunk drinks knowing s/he’ll miss work, feel miserable, alienate friends and family, etc. A person addicted to overeating acts the same way, though the issues are usually those of self-esteem because alcoholism has been granted disease status, while overeating is thought of as a personal failing.

    Right now, we only treat the end result. I.e., we’re not getting to the root causes. Are they emotional? A sucky metabolism? Something hormonal? If I look at someone like Oprah Winfrey, for example, I see a woman who has the intelligence and perseverance to have completely changed her life. She is certainly not a weak willed person. And yet, the weight thing.

    To waggle a finger in the face of a fat person is counterproductive. Someone used the phrase “rock bottom,” and that’s also a phrase used in some alcohol rehab programs.

    I will tell you that the first time I went over 200 pounds, if someone (even a doctor) who had never had to lose weight tried to tell me how to do it, s/he would have been met with stony silence at best, and a “walk in my damn shoes first,” at worst.

    We’ve all met thin people who eat SAD. Are they healthy on the inside? We can’t know, but we do know that we don’t judge them, ridicule them, or think of them as weak willed.

    Maybe, hopefully, someday, we’ll understand why one child can eat two cookies after school and be satisfied, while the other keeps sneaking to the cookie jar ‘til it’s empty.

    For now, I believe there is no real professional help for the obese. Each has to find her/his own way. WW, 1800Jenny, etc., are all crocks. The doctors and other health professionals all contradict each other. And exercise, without addressing the compulsion to overeat only leads to disappointment. As a note, most doctors complain that most of their patients don’t take their advice, not just overweight patients.

    OP, you sound like you really want to help people. But until you understand what drives an overeater (and that each is different), you’ll just be spouting words to them, whether primal or CW, you won’t be addressing the why.

    True story (long post, I’m sorry). I knew a man who used to eat so fast, it was alarming. I came to find out that there was a time in his youth when he had to hide from authorities for a long time and often went days without food. Do you think telling him to fast would have been received in a positive manner?
    "Right is right, even if no one is doing it; wrong is wrong, even if everyone is doing it." - St. Augustine

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  4. #34
    oxide's Avatar
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    Surely the OP can do something? The Primal-Screed-In-10-Minutes is clearly too crazy, but at the same time, I don't want him to suck it up and push CW for four years.

    A patient could probably handle ONE thing. If you could convince them to do ONE thing, what would it be? If I were the OP, I would play up either of these:

    1. The GERD angle: I don't know if there is proof, but there is a lot of anecdotal evidence that GERD is a symptom of gluten sensitivity. Maybe you could suggest this to the GERD patients. Switch to the gluten-free stuff and see if the GERD gets better. Don't mention weight at all. If ditching gluten works on the GERD, maybe they'll come back for more information.

    2. The "whole unprocessed foods" angle: I know I know, I'm the MDA poster who is always hatin' on the phrase. But maybe you could convince a patient to at least start with whole ingredients and cook everything themselves. Including baked goods, if necessary. "You want bread, fine, make it yourself. You want beef? Fine, make your own lunches with meatballs." At the very least, that will take them off the worst of the offending chemicals.
    5'0" female, 43 years old. Started Primal October 31, 2011, at a skinny fat 111.5 lbs. Low weight: 99.5 lb on a fast. Current weight: skinny-fat 106.5 lbs because of sugar cheating.

    MY PRIMAL: I (try to) follow by-the-book primal as advocated by Mark Sisson, except for whey powder and a bit of cream. I aim for 80-90 g carb/day and advocate a two-month strict adjustment for newbies. But everybody is different and other need to tweak Primal to their own needs.

  5. #35
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    Dude, you are going to have to back off for now. I am in Chinese medical school and observe doctors in the clinic every week. We get 1 hour and 15 minutes with the patient, and I often see them for weekly for up to 3 months. Our patients are generally motivated and willing to try different things. There is no way I would recommend fasting in the first 10 minutes of working with a patient. They will NOT be able to process the concept without lots of support and you aren't able to do that. My attending would hand my ass to me for suggesting it too.

    For now, suggest cutting out soda and juice and eating more vegetables. It will get the ball rolling and no one will disagree with your approach.

  6. #36
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    Quote Originally Posted by oxide View Post
    Surely the OP can do something? The Primal-Screed-In-10-Minutes is clearly too crazy, but at the same time, I don't want him to suck it up and push CW for four years.

    A patient could probably handle ONE thing. If you could convince them to do ONE thing, what would it be? If I were the OP, I would play up either of these:

    1. The GERD angle: I don't know if there is proof, but there is a lot of anecdotal evidence that GERD is a symptom of gluten sensitivity. Maybe you could suggest this to the GERD patients. Switch to the gluten-free stuff and see if the GERD gets better. Don't mention weight at all. If ditching gluten works on the GERD, maybe they'll come back for more information.

    2. The "whole unprocessed foods" angle: I know I know, I'm the MDA poster who is always hatin' on the phrase. But maybe you could convince a patient to at least start with whole ingredients and cook everything themselves. Including baked goods, if necessary. "You want bread, fine, make it yourself. You want beef? Fine, make your own lunches with meatballs." At the very least, that will take them off the worst of the offending chemicals.
    Michael Pollan's "Food Rules" contains something similar:
    You can have all the junk food you want, as long as you make it yourself.

    I recommend Pollan more than Paleo/Primal, just because it bridges the gaps between us all:
    Eat Food. (Not processed crap.)
    Mostly Plants. (By volume, yes, I can agree.)
    Not too much. (Easier when you aren't craving sugar and other such things constantly).

    His NYT piece "Unhappy Meals" is a great place to start, for those of you not familiar with his works.
    Linky: Unhappy Meals | Michael Pollan

  7. #37
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    I do agree on the Whole Foods angle.

    Medical weightloss advice is of two types "don't drink sugar soda, skip the fast food and walk" (most fat people know that). Or some kind of crazy ass liquid diet.

    Right now, we only treat the end result. I.e., we’re not getting to the root causes. Are they emotional? A sucky metabolism? Something hormonal? If I look at someone like Oprah Winfrey, for example, I see a woman who has the intelligence and perseverance to have completely changed her life. She is certainly not a weak willed person. And yet, the weight thing.
    Yes, find out why she is fat. But you don't really have enough time. On this board, we have so many people who had different issues- metabolic disease, addiction to wheat, sugar addicts, people who just ate junk, people with no perception of proper portions, emotional eaters.... If the woman is like me, telling her to bake her own goodies if she wants them just makes her a master baker. Telling some people on this board to eat fruit makes them binge. Then there are people with a mix of issues to address.

    What these people really need is time with someone who can assess why they overeat for their metabolism so they get the right solution. There is no one solution to longterm, sustainable weight loss, though it starts with a healthy diet and lifestyle of whole foods.

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  8. #38
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    Quote Originally Posted by magnolia1973 View Post
    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.
    very true.

  9. #39
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    If someone would have told me what wheat and sugar can do to you a long time ago I might have saved myself a lot of misery. Once I stopped eating grains and sugar and ate real actual animal fat I felt like a normal person for the first time. I actually got a little angry that I had spent so many years blaming myself for having such a weak willpower and being such a glutton, but really it wasn't my fault. It was just all the chemical reactions to wheat and sugar. So it makes me mad when people say stupid shit like "moderation" and count your calories and whole wheat is healthy, because for many of us if wheat or sugar are in the picture, there can be no moderation and willpower only lasts so long.
    Female, 5'3", 49, Starting weight: 163lbs. Current weight: 135 (more or less).
    Starting squat: 45lbs. Current squat: 170 x 3. Current Deadlift: 220 x 3

  10. #40
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    The safest thing for a medical doctor that want to have a good career is probably to treat the symptoms of the obesity only, prescribe drugs as they mostly do anyway, and let the obese persons sail their own boat until it stop floating and they get enough motivated to seriously do something with their lives! And be by all means tell them what they really want to hear; that the obesity is not their own fault, that they have the metabolic syndrome, or are insulin resistant, or that it is a fructose conspiracy made by the food companies et cetera, et cetera…


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