One research question that interests me (that I am not currently pursuing) is that of post-operative pain management in obese patients. Not sure what happens at most hospitals, but it always seemed to me like we were always very concerned about over-narcing our obese patients so they don't asphixiate, and not as concerned about relieving their pain to enable them to be more mobile post operatively.
I also have some not-very-fond memories of some undermedicated obese patients taking shallow breaths, with grey clammy skin, gripping the bed rails afraid to move because of their pain. This cannot be good for their recovery.
I don't really know if I'll ever study the subject, but I think it's interesting. And I expect this will be a growing problem in the future.
Anyway, I was talking about this interest with a friend of mine, and suddenly she interrupts me and says, "But don't they piss you off?"
"Who?" I asked.
"Obese patients," she said.
"Why would they piss me off? Oh, you mean because they 'don't take care of themselves,'?"
"Pretty much," she said.
So here's the thing. I know this is a hot button issue for a lot of people for a bunch or reasons. First, a lot of people find fat to be revolting, perhaps because of some subconscious self-loathing of the potential to become obese themselves. Others think obesity boils down to self control and lack thereof. A lot of people also blame spiraling health care costs on obesity. And then there's the race aspect. Many obese people are poor minorities, and I wonder to what extent disgust about skin color/class has been displaced onto body size.
So I said, "Do you have ANY IDEA how hard it is to lose weight?"
No? Well let me tell you. I have never been obese in my life. However, currently, I weigh about 5 lbs more than I have since I worked in the factory the summer I turned 18. I am developing a FUPA. I am not pleased about this. Still, I am basically a skinny person.
Yet, I am finding it im-fucking-possible to change my eating habits. Yes, the exercise-wagon I've recently climbed back on will help some, but mostly I just have to eat less. And I don't even have to change that much of what I'm currently doing. People who are morbidly obese have to change EVERYTHING.
Can you fathom how hard that must be? On top of that, I'm sure they are hungrier than I am, and have limited social support compared to what I have.
You know? We all have flaws. It's just with obesity, they're on display for everyone to throw stones at. I suggest that the next time you find yourself recoiling with disgust when you see an obese person, or internally tsk-tsking when you see an obese person with a shopping cart full of ring-dings and potato chips, you remember all the ways in which you are not perfect either and focus on that instead.
Obese people aren't just lazy tubs of lard with no self-control or feelings or pain receptors. They are people too, who deserve as compassionate and thoughtful care as anyone else. Yes, they probably are harder to care for as patients (and doctors probably should be compensated for this increased complexity), but that doesn't mean they deserve to be treated like shit.
19 Pearls of Wisdom:
You highlight a major challenge in treating obese patients - while obviously we want to treat their pain as effectively as anyone else, there is the very risk of over-narcotizing and putting someone into respiratory failure. I've seen it happen with fairly minimal drugs, and it's scary!
Glad to hear that there are other people in medicine trying to battle the assumptions about obese people.
Obesity as a whole bothers me but on the individual level it's pretty hard to blame the patient- after all, it's soooooo hard to change EVERYTHING about your lifestyle. My cousin (who's my age) and her mother have always been obese and my cousin especially tries really really hard to lose weight- but she never succeeds. Like you, I've always been thin so I don't really know what it's like to hear, "you need to change the way you live" from a doctor. It has to be frustrating.
I completely agree with you.
I'm a pretty active person, but over the past two years, basically since I decided to apply to medical school, my exercise and eating habits have gone to hell. I've gained something like 40 pounds in that time and have just now gotten serious about getting away from it. You're completely spot on about how obese patients are treated. I listen to nurses whine and complain about how awful morbidly obese people are and how they're contributing to the huge increase in health care costs. These same nurses have no problem downing a fifth of vodka in an evening or smoking a pack of cigarettes every day.
The obese and the mentally ill are some of the most poorly treated people in the medical world. I wish more people were aware of that.
Coming from the other side of the fence, so to speak.. I had gastric bypass in 2005 to overcome morbid obesity. But now, 6 years later, it's becoming increasingly clear that the only thing the surgery changed was the size of my stomach. I still think the same way about food and exercise.
As old habits start to become current habits again, I panic at having to 'change everything.' I blew my chance to change it, and now I have to deal with my doctor reminding me that I've put some weight back on.
It's definitely not easy. I fully take responsibility for eating too much and moving too little.. but I can guarantee you that many obese people are even more disgusted with themselves than others are with them. It just seems to be an insurmountable task.
I've been overweight since depression set in when my parents separated when I was 10. I'm currently the heaviest I've ever been. I'm currently working on lowering my weight - but it's extremely hard. I've started my own blog to track my efforts, and it helps a little that my dream career is one that relates to the need to lose weight (and swim better, and get SCUBA certified), and I have a couple friends (online) that are supporting me.
It's so easy to judge others. It's so hard for me to sit with my 100lb friends and hear them complain about how fat they are. It's so hard to change everything at once. :/ My sister has a lap-band and has lost like 150lbs. However, she's not changed her habits, at all. She throws up a lot (not intentionally) and only exercised because she had to.
It's a sore subject, and I can easily see why - I worked as a CNA for a while, and it was painful as heck to try and deal with the more obese pts, especially when you're managing 25 by yourself in the middle of the night.
It can also be ridiculously expensive to change a lifestyle...Fruits and vegetables, even processed fruits and vegetables, aren't as cheap as they used to be and there also isn't enough education within those low-income communities that teach parents that juice ISN'T an alternative to fruit (among other things).
I wish more people would bring awareness to this issue. I am currently about 25 pounds heavier than I would like to be, but I seriously just completely stopped exercising when I moved to Oklahoma. My husband is very obese though. I have actually almost gotten into a physical altercation with a girl who was being horribly rude to him. He has been trying very hard to lose the weight, but it's slow. He didn't gain it all overnight and he won't lose it overnight. No one knows what internal struggles someone else is going through and people should just give it a rest. It might be easy to point and blame them for their own problems and they certainly have to take responsibility before anything can change, but we don't know what led those people to where they are or the struggle that it can be to try to change a situation.
Thank you for sharing some great insight and empathy. We all have our biases, and our good/bad days, but the only way I know of to overcome that is to imagine yourself in the other person's shoes. I hope whoever said that to you figures gets called out some day soon.
Sol Din -- A friend of mine ordered some valium so a patient of his could get an MRI. She was only about 300 lbs, but barely fit into the machine, and was frightened. She stopped breathing and died. So yes, it TOTALLY happens.
C -- It makes me insane when the doctor tells me to change anything (I am perfect, afterall). To hear about how fat I am every time I went would be too much to bear. I'd probably just stop going eventually.
MSO -- Good luck. It ain't easy.
Hunter's Mom -- The thing is, you really can't change everything at once. It's too hard. Far better to change a little thing one week, and then try to add something else the next week. Still, sticking with it sucks, especially when you're not seeing the results you want.
Iowa -- FWIW I also hate it when my skinny friends complain about how fat they are (I try not to do it myself), and pass judgements on what other people are eating. I can't imagine how difficult it must be to be a nurse caring for an obese patient.
Rhonda -- I find it horrible that people are actively rude to your husband, as though just being obese in someone else's presence justifies it. Some people really need to learn to keep their mouths shut.
KM -- I hope she figures it out too. Sadly I have a lot of friends who think this way. I hope they don't act on their thoughts.
Mingle -- Tell me about it. I can't believe how much we've been spending at the grocery store lately. I suppose the good news is that as you start eating less, your grocery bill should eventually start to decline.... hopefully. At least this time of year fruits like berries and nectarines are in season and don't cost so much.
Though seriously, I tried eating a red pepper and hummus yesterday for dinner -- which was probably about 450 calories in total. Who knew hummus had so many calories! And then I had a nectarine and some soy milk, and presto, I'm up to 800 calories like that. And I felt like I was eating NOTHING. So yes, change is hard. And that probably wasn't a cheap meal either.
I'm morbidly obese and have been since having my first child. I've modified my eating habits(some - still working on that one) I go to the gym daily. After my emergency c-section, they wouldn't believe me when I told them I was in a lot of pain even with the pain meds and started treating me like a drug seeker. One nurse told me,"Well, honey, you're an overweight new mom - pain is just part of life for you now."
I have to admit, I don't go to the doctor anymore. Last time I went, I was so depressed after "the speech", I drowned my sorrows in a whole bag of peanut butter M&M's.
Thanks for sticking up for overweight and obese people. My whole family is overweight and I PROMISED myself I would never let myself get as overweight as them when I was 7 years old. But I still find it hard as hell to keep myself under the "obese" BMI. I'm trying to exercise and eat right, but it must be ten times harder for someone already obese. You give me hope for the humanity in doctors ;)
Awesome post! There are many causes for obesity from genetics to endocrine, and people shouldn't assume someone's weight is in their control anymore than they should assume people who are clinically depressed just need to buck up. Just because medicine hasn't figured out the entire pathway & mechanism of a condition doesn't mean that condition is not a "real" and worthy of the same treatment & compassion as any other.
I love over 75 lbs with diet and exercise after I was done with college football (275 to 200; this was long before the pre-dx super weight loss). I completely agree that changing your diet and completely revamping everything in your life sucks ass. However it can be done and the bitch of it is changing everyone else around you too. You can make great strides but if noone is supporting you the continuation of that success is doubtful.
lost over... damn my inability to proof read
@Rachel - I talked to my PA and her advice was "eat less, move more". Ah, if it was just that simple...I smiled, thanked her, and left.
If it was that simple, I would've been skinny years ago.
One of those "easier said than done" things.
@OMDG - it's hard because two of my "good" friends are Asian and naturally tiny. Because she's fiiveeee pounds heavier than younger sister, she goes on and on and on and it makes me want to slap her. Kind of the beached whale feeling, I think?
I've worked as a CNA in the past and I'm friends with both nurses and current nursing students. The obese pts were the hardest part of my day/night. :/ I couldn't move them on my own, and the other CNAs would throw a huge fuss when I wouldn't break policy and take care of them by myself. I'm sorry, but if my back goes out, they'd throw me under a bus for violating the care plan.
Thank-you for writing this and having such an open mind.
The other thing that people often neglect in the obesity conversation is that obesity is a NATIONAL TREND. Sure, some of it is on the individual (or the eating/exercise habits they learned as children), but there's something else going on, too. Our food industry is out of control and with the cheapest, most long-lasting food being among the guiltiest in terms of potentially hazardous to health, it's no wonder that the poorest of our people are the most affected. What obese patients need is not a lecture but hope for change, though I admittedly don't know what's out there in terms of support for legitimate change.
As a health care provider, it is super-frustrating to deal with obesity - harder to move, harder to take care of in general. But I think ultimately it's important to separate the person's BEING from their problems.
Thank you for this! I've never been skinny as an adult, but I had to take prednisone for almost two years to get an autoimmune condition under control and I shot up from 170 pounds to 270 pounds. I knew the prednisone would probably cause weight gain, so I started seeing a dietician while I was taking it, but she eventually told me that she wouldn't be seeing me anymore because she believed I was lying about what I ate and she couldn't help me if I wasn't "being truthful.". It was very frustrating, especially because for a while I was too sick to exercise regularly. I've been off it for a few months now, and I've actually managed to lose about 20 pounds, but I'm only 5'5" and 250 pounds is quite a bit on a short woman, so I still get a lot of dirty looks. I eat healthy 90% of the time, but every now and then I like to have a treat, and I've actually had people ask me things like, "Do you really think you should be buying a chocolate bar?" I'm also starting medical school this year, and people have come right out and told me that they don't think a future doctor should weigh as much as I do. Sometimes I enlighten them about the cause of my weight gain, but I wish I didn't have to make excuses for myself.
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