First of all, I apologize for taking so long to answer your post. When I received it I was still out of town. Second, I wanted to write something thoughtful and I needed time to not write something out of anger. Anger that you would accuse me of doing harm by not mindlessly insisting on weight loss as the ultimate solution to a fat person’s health problems.
To start with I would like to state that I do not refuse to advocate weight loss, where it is appropriate to do so. I assume that you are operating on the false assumption that being fat automatically makes a person unhealthy. I can assure you that it does not.
"But, what about the obesity epidemic? What about the diabetes epidemic? But what about…?" I hear you ask.
There are lots of illnesses that have been statistically correlated with being fat. But the thing to understand is that correlation does not equal causation.
Lets use Type 2 diabetes and fatness as an example. Diabetes type 2 is an illness of insulin resistance. That means the body requires more insulin to produce the same sugar lowering effect than a nondiabetic body would need. Insulin is produced by cells in the pancreas called beta cells.
Contrary to popular belief, people don’t just go from being nondiabetic to diabetic overnight. Rather there is a process that occurs. We have found that there are differences in a person’s beta cells that happen long before a person even begins to show signs of insulin resistance. Many people who go on to become type 2 diabetics will have higher levels of insulin circulating in their bodies for years before they even become prediabetic. One of the other functions of insulin in the body is to promote the storage of excess energy as fat. So, insulin makes people fat, and keeps people fat (makes it harder to lose weight).
Can you see where I’m going with this? The question now becomes, are people diabetic because they are fat? Or are they fat because they are diabetic? This is an extremely important distinction to make.
When I see a diabetic person, fat or not, I tell them to make sure they get plenty of exercise and to watch what they eat to control their carbohydrate intake. What does this sound like? “Diet and exercise.” The difference is that I don’t tell people to lose weight. Many of my patients who follow this advice do in fact lose weight, and that is fine. Many of my patients do not. That is also fine. They all have better control of their sugars, and in most cases, to similar degrees. I fail to see how not insisting on losing weight is “doing harm.”
There are times when a person’s weight turns out to be a factor in their illness and where weight loss may help in treating it. In those cases, I do suggest some weight loss. But in NO case is it ever necessary for someone to get to their “ideal body weight” to help their condition.
Finally, let’s look at the idea of “doing harm.” Did you know that studies (link and link) have shown that the medical profession as a whole is biased against fat people? That there are countless stories about people having serious illnesses going undiagnosed because they are fat and doctors refuse to look beyond that? That fat patients stop going to their doctors after being repeatedly made to feel ashamed for being fat by their doctors? For trying so hard to lose weight but not being “successful?” That, to me is the real harm that is done. The psychological harm. The physical harm that results from not going to the doctor for a serious problem because the doctor will either ignore it or just embarrass them again.
Are you aware that the vast majority of people who lose weight are not able to maintain that weight loss over the long term? And that people can end up far fatter than they would have become otherwise due to the lose-gain cycle. That that cycle can also cause serious harm to a person?
I care about each and every one of my patients whether they are fat or not. Whether they are healthy or not. Fat patients get the same consideration given to their concerns as thin people. I don’t simply dismiss things because a person is fat or tell them that losing weight is the ultimate answer. If my medical work up indicates that losing a small amount of weight may help, then I suggest it. Otherwise, it is not necessary.
Finally, before you try to tell me about all the research that shows being fat is unhealthy, I have a few of links to lots of evidence-based medical research that shows that being fat does not necessarily make one unhealthy.
Serious question? Serious answer.
The doctor is fucking IN
I just read this whole thing and it was worth it
Europe at ‘polio risk’ from Syria
Europe could be at risk from polio following a recent outbreak in Syria, infectious disease experts say.
In the Lancet journal, two doctors in Germany say the cases in Syria - which had been free of wild poliovirus since 1999 - could endanger nearby regions.
They say because only one in 200 people infected develops paralysis it could take a year of “silent transmission” before an outbreak is detected.
In that time hundreds of individuals could be carrying the infection.
Prof Martin Eichner, of the University of Tubingen and Stefan Brockmann, of Reutlingen Regional Public Health Office explain that most European countries use inactivated polio vaccine (IPV) rather than the live oral polio vaccine (OPV), because the latter can, in rare cases, lead to cases of acute flaccid paralysis, the main symptom of polio.
Whilst IPV is highly effective at preventing polio disease, it does not give the same level of protection against the virus as the oral drops, so vaccination coverage needs to be very high. The doctors say that countries with low coverage such as Austria (83%) and Ukraine (74%) risk a sustained outbreak should the virus be introduced via refugees fleeing Syria. Polio vaccine coverage in the UK is at 95%.
The doctors said Israel could also pose a potential polio threat.
Prof Eichner told me: “Wild poliovirus has also been found in sewage in Israel and from samples taken from some symptom-free individuals since February 2013. Although there have been no cases of polio in Israel, tourists could risk bringing the infection to other countries.”
Dr Benjamin Neuman, a virologist at the University of Reading, said: “The Syrian outbreak puts Europe at risk because of the way we give vaccines. In parts of the world where it is still possible to catch a wild strain of poliovirus, children are usually vaccinated with a live but genetically weakened poliovirus which gives excellent protection but has a tiny risk of changing back to the more dangerous form.
"However, in parts of the world where polio has been eradicated, like the UK, children are usually given a killed vaccine. It doesn’t protect quite as well but it cannot mutate, so it protects reasonably well while preventing polio from being accidentally reintroduced to a country.
He added: “Vaccination is never perfect, so despite being vaccinated, a small percentage of children in the UK would be at risk of contracting polio if they were exposed to the virus. Until the virus is completely extinct, it is essential that we continue to vaccinate our children.”
The Department of Health Director of Immunisation, Professor David Salisbury said:
"The UK is well defended against the possibility of importation of polio from outbreaks such as the present one in Syria. Our population has very high coverage of polio vaccination with more than 95% of young children being vaccinated. We have WHO-approved surveillance in place so we can pick up polio if it does start to circulate in the UK."
(From BBC News - by Fergus Walsh)
Hi sorry for the late reply!!
Yes, I’m currently working on my MPH (Masters in Public Health) and have 1.5 yrs until graduation to decide what I actually want to do. I may re-apply to med school or stay within the field of public health as a healthcare administrator. Time will tell. :-)
Thanks for the question!
I’m sorry I don’t post much/at all here anymore. I just… stopped caring. I don’t feel the need to share everything about my life on here. I’ve also been ridiculously busy with moving and switching to full-time at work aaaaand being a full-time student. So for being forever absent, I’m sorry to all my followers. I hope you still love me. ;-)
I was riding in a van with a television crew who was doing a piece on HONY. The cameraman, Duane, was behind the wheel. At one point he casually remarked on how bad the traffic was in Ethiopia.
"Ethiopia?" I asked. "What story were you working on there?"
"It wasn’t a story," he replied. "We were picking up our daughter.
He then told me the most amazing story. He told me that he and his wife were not able to conceive. “But I’d always resisted the idea of adoption,” he said. “My wife wanted to adopt right away, but I was just never sure if I’d be able to fully love a child that wasn’t my blood.” So time went on, and they remained childless.
Then one evening Duane was watching a television show with his wife. The show was about aid work in Ethiopia. “They were showing before-and-after photos,” he explained. “I remember this one girl. She was skin and bones. But she still had this amazing smile and spirit in her eyes. The aid workers rehabilitated her, and six months later, she looked like a normal little girl. Right then, I turned to my wife, and said: ‘I’m ready to adopt.’”
But it wasn’t as easy as he’d hoped. “At first I thought we needed an infant,” Duane explained. “I just couldn’t imagine missing out on all those early moments of our child’s life.” But for healthy infants, the waiting list was years. “So then we went we moved up to three or four year olds.” But still, the waiting list was one to two years. “The only children you could get immediately were seven and up, and who had physical handicaps of some sort. I just didn’t think I was ready for it.”
But then Duane and his wife went on vacation. And toward the end of the trip, “after a few drinks,” Duane’s wife brought out a brochure from the adoption agency. One of the pictures showed an unsmiling seven year old girl, standing against the pink wall of an orphanage. She had been blinded in one eye. “That’s our daughter,” Duane said.
Three years later after the Watkins adopted her, Chaltu has blossomed. She has grown over one foot, is fluent in English, and although blind in one eye, plays soccer, gymnastics, and basketball. She’s doing great at school, and has tons of friends. “She is the greatest daughter in the world,” Duane said.
“That’s an unbelievable story,” I told Duane. “Can I share it on HONY?”
“That’s fine with me,” he answered. Then he sort of stared at the ground for a second, shuffled his feet, and asked: “Would there be any possibility that you could help us raise the adoption fees to get her a brother? We’ve already found him, but aren’t financially ready yet.”
LET’S BRING RICHARD HOME: Click here to donate!
Beautiful. Over $50,000 has been raised in less than an hour. In a world full of chemical weapons, murders and school shootings,this just makes me believe in the genuine good of people again.
This mugging victim had a six inch knife plunged deep into her back — and she didn’t even feel it. The shocking picture shows the blade sticking out just above Julia Popova’s shoulders and blood pouring from the wound. Incredibly the 22-year-old, who was knifed by a mugger on her way home from work, failed to notice the appalling injury and managed to calmly stroll to safety. The office worker had grappled with her attacker when he snatched her handbag as she walked to her parents’ house in the Russian capital Moscow. But she was so shocked by the ordeal she didn’t know that the thug had buried a kitchen knife in her neck just fractions of an inch from her spinal cord.
When she got home her horrified parents rushed her to hospital where surgeons managed to remove the blade without damaging Julia’s spine. One medic said: “Shock had kicked in and her body prevented her from feeling any pain. She simply walked home without feeling the knife in her back.”
Along with being the worst built website in history, Healthcare.gov also appears to be the most expensive, and we get stuck with the bill. How lovely…
Via Digital Journal:
It’s been one full week since the flagship technology portion of the Affordable Care Act (Obamacare) went live….
Best & Worst Places to Practice 2013 [infographic]
Check out this infographic detailing the best and worst places for physicians to practice. Each region of the US is represented with some interesting positive and negative facts. The data comes from a survey of more than 1,000 physicians.
Where does your state match up?
The Miniature Earth ::: What if the world’s population were reduced to 100 people community?
This really puts things in perspective. I wish every person in the US alone could watch this; I think it could make a world of difference. So many people in our country are materialistic and care about money, money, money… There’s more to life than objects and money. And we’re all here at the same time, together. Let’s make it a better world and work as a team.
The far left shows a normal liver, the centre fatty liver disease which results from excess accumulation of fat in the liver which can lead to inflammation and liver damage. The right shows cirrhosis, where a toxic agent (alcohol, viruses) causes scarring of the liver and it therefore cannot carry out its usually functions causing liver damage and failure.
Time for a transplant