doctors

Got a lot to say but I'll keep it brief-ish. Corporations love unhealthy people. They will artificially celebrate this and reinforce unhealthy lifestyles. This extends beyond weight.
Once entrapped, escape is hard. Some are passive and depressed. Some are dismissive and defensive. No matter which cycle you are in, it's unhealthy.
I think smoking is bad like I think being overweight is bad. If a doctor says alcohol is killing you, it probably is. I don't think hatred is deserved, but don't expect any validation for those choices.
- Surely no coincidence that being obese is a gateway to hyperconsumerism anyway. Sugary, fatty, processed snack foods are way more profitable than healthy meals.
  Walking around town is free, can't have that. Sit at this computer chair, watch advertisements and play video games instead.
  Heart disease at 26? That'll be $2k/month until you die.
  Get depressed, buy the meds, never leave your couch, don't fight back, you're the evolution of humanity and - most of all - you are beautiful.
- I am down 50+ pounds, and have another 20 to go. This is new to me, but I absolutely agree with everything you said.
  
  Congratulations, that's really impressive!
- The meme isn't about that, I've read stories of some doctors refusing to perform surguries to overweight people, but other doctors doing the surgery anyway.
  The same way a lot of women get told stuff is just from their period by doctors.
  
  I'm a medical student and I have some direct experience with this. Sometimes, the difference between the surgeon who will do the procedure versus the surgeon that won't do the procedure is the availability of specialized facilities and equipment that they have access to. An elective surgery (i.e. not an emergency surgery) can go from routine to very high risk depending on the amount of adipose tissue the patient has.
  And it's not just a matter of the fat tissue overlying the surgical site. Morbidly obese patients are much more likely to have things like sleep apnea which can make anesthesia more risky and might require more specialized equipment than a particular surgeon/hospital/anesthesiologist might have access to. The "morbid" part of "morbid obesity" also refers to the fact that people above a certain threshold of weight are much more likely to have other health conditions like heart disease that make anesthesia more risky.
  
  The reason for that is that surgeons are rated based on their success percentages meaning they'll recommend against risky surgeries.
  The upside of this is that surgeons aren't operating willy-nilly on people and will make a proper risk assessment. The downside is that overweight people have an inherently higher risk of complications from surgery, so some surgeons will pass.
  It's not because they think these people don't need it, it's because they think it's too risky. They're usually not wrong about that, you just need to find a surgeon willing to take the risk or, if possible, reduce the risk by losing weight.
  
  Look. Shitty doctors exist, but when 1/3 of the US is overweight, there are underlying issues that need addressing. I only hear horror stories when an addict, alcoholic, or overweight individual in my life is feeling insecure or defensive about a prognosis. Too many people deflect and it's enabling a much larger issues. Our basic instincts are being exploited.
  
  When talking about obese individuals, the fat very easily gets in the way of surgery. Compared to a healthy patient the risk of complications during surgery is much greater and really not worth chancing it (most if the time)
  
  Similarly - if you are trans and on HRT, every problem is due to your hormones.
  
  My mother had a doctor that refused to move forward with knee surgery because she was so depressed and refused to do therapy because it hurt her knee so much to move around.
  I guess I understand, why go through the trouble of surgery if she's just going to be a bummer couch potato afterwards and never change her ways?
  But at least she'd be a bummer couch potato whose knee didn't threaten to give out on her whenever she tried to do laundry in the basement.
  If I take my car in for new brake pads, don't refuse me service because the transmission is on its way out.
  
  I’m guessing that’s under the US health system, where doctors are incentivised to only perform surgeries with a low risk of complications
- I'm just sitting here waiting for the point of what you said. 60 people upvoted, but you didn't say anything.
  The phrase of the day (which you should Google of you downvote this) is pseudo-profound bullshit.
  
  You count just say you disagree and explain why it upset you.
  
  I think their point is that doctors don't want their patients to become entrapped by obesity into lifelong poor health, which also traps them as sources of revenue for corporations that profit from sickness and fat: pharma, companies that sell fad diet and/or exercise plans, etc. So if your doctor tells you to lose weight, it's probably coming from a good place, regardless of what else might be going on with your health.
  (And just in anticipation of some replies I might get: yes, it's absolutely a real and shitty thing when doctors only see the fat and assume it's the cause of all the patient's problems. You deserve better healthcare than that. But also recognize that while the fat might not be the cause of a given problem, it might be exacerbating that problem.)
- You are ignorant of the genetic factors at play here and I think you need to realize that your rhetoric is identical to victim blaming eugenics ideology. You sound like RFK Jr. and I'm guessing you would want me dead if you could have things that way. It's honestly despicable and I don't know how people like you sleep at night.
  
  Hear me out. You're villainizing me because what I said struck a nerve. You don't actually believe I want you dead. You're just upset that I pointed out a deep flaw. Maybe it's an insecurity, or cognitive dissonance, or whatever. I'm very familiar with this type of response. Whatever it is, realize that someone likely depends on you and that an unhealthy lifestyle is not good for them. I'm encouraging you to do better, if not for yourself, the people in your life you care for. I recognize my ignorance. I'm not a therapist. I'm just stating something I've personally observed.
  
  Buddy, you're over stating the importance of genetics. Time and time again it shows that getting bigger is more nurture than nature. Papers and research retounely come out saying its a two-sides of the same coin issue, but then fail to support their nature/genetics claims, which are often refuted. Slender families get children who end up obese because of lifestyle, and their children become obese. That's not genetics. The grandchildren end up obese because obese parents place their lifestyle and diets onto their children.
  Claiming something is victim blaming is insanely disrespectful to the people who actually get blamed for things out of their control. Your weight is in your control for the vast, VAST majority of people.
  People with disabilities who can't get an opportunity to do something about it? Sure. Can that disability come from genetics, sure. But that's a small minority of people who are overweight.
  
  Used to see the odd "genetics" fat person and they'd just be built a bit bigger. Now I'm seeing fucking waddling planetoids and that's not genetics man. Part of that blame belongs to individuals but part of it belongs to the food lobbyists and their quest to add sugar and corn syrup to everything.
  Incentivise people to grow their own vegetables (or source them locally from those who already are) and disincentivise the purchase of processed and sweetened food. Have our agencies promote healthy recipes using weight rather than volume measurements and show people how to use scales to properly weigh ingredients and help make it as easy as possible to count calories.
  
  And you sound like a moron. OP didn't say anything and you said even less.

I can't blame doctors for letting obesity color their opinion. Look around your doctor's waiting room. Everyone is fat. Imagine the suffering and illness they see daily due to fat. How can those observations not color their general attitude?
- Look around your doctor’s waiting room. Everyone is fat.
  Lots of people are old and age correlates with weight gain. But the volleyball player who blew out her ACL isn't fat. Neither is the chemo patient who is back for a final round.
  How can those observations not color their general attitude?
  Doctor: "Feels like everyone I see is either sick or injured"
  Nurse: "Try spending less time in the ER"
  
  I'm not sure your second point works, or maybe I just don't understand it. It's not like the doctor is making judgements that people are fat outside a hospital- they're doing their job. You've got a car and it's starter goes out every year, last time being a year ago. Your car wont start. Whats the first assumption?
  It's not ableist or bias to assume that the most common issue is the most likely issue. They see a ton of people whos problems are irrefutably due to their weight. It's not the doctors job to make judgement calls on whether that person is wholly responsible for their situation, it's their job to doagnose the problem and help take steps to fix it. The problem being their weight, the steps include: burn down capitalism and replace it with a system that doesnt incentivise companies to use the cheapest least healthy ingredients, or tell the patient unless they lose weight they're going to die. One of these is completely pointless to tell the patient, the other gives them an unfair opportunity to potentially save themselves.
  
  Lots of people are old and age correlates with weight gain.
  Only in the US and countries with similar shitty feeding habits.
- Everyone is fat
  Exactly, which points squarely at an environmental cause, not at individual sloth/gluttony or some shit like that.
  The conclusion you're saying doctors arrive at—which I don't doubt you're correct about—is actually completely fucking backwards.
  
  Yeah but your doctor cant prescribe you burning down capitalism, they can prescribe you lower your caloric intake.
  
  which points squarely at an environmental cause
  No, it points to people eating processed food and other shit. Guess what, you can still be healthy if you eat healthy.
  
  The environmental causes are availability of options we crave but are still not forced into, so individual responsibility is absolutely a thing.
  I was obese and it sucked but I got down to a healthy weight, and keeping it off kind of still sucks but it doesn't take a lot of time or money, in fact it's generally cheaper.
  Fast food is constantly highlighted as an impossibly unhealthy reality, the nicer places cost more and take too much time. Except you can choose passable choices in fast food.
  If you can freely pick, there are fast food places that offer salads with maybe some grilled chicken, which can be healthy unless you opt to drown it in ranch.
  But let's say you are in a group and they pick a restaurant without an option like salad. Just asking for water instead of a big sugary drink gets you so much closer to healthy. Skip the fries, skip the mayo, get a smaller burger. All these things are cheaper and friendlier to a reasonable caloric budget.
  It sucks because it means eating to feeling "ok" while skipping the most awesome foods and rarely getting to feel just utterly full, but that was just life when people had healthier weight.
  Similarly on activity. It does suck that work has people sedentary, but our idle pursuits are similar. When I was a kid, TV was stuck on a schedule and video games were only so engaging, so we would get bored and want to do something. Maybe it was walk amongst some trees to see if anytime interesting was around. Maybe do something with a ball. Nowadays we can get endless engagement from streaming, video games, and Internet. So tempting to just be on the couch. We can still choose those more active things, but we don't want to.
  Note all this awesome stuff is still great in moderation. I just went full on gorging at a restaurant a week ago on pretty much whatever I wanted. The thing is this is maybe like once every 2 or 3 weeks, not daily like we really want to.
  
  That's the trick!
  They believe everyone is gluttonous and slothful because they're misanthropic.

Have you tried not being fat?
reminder: shitpost
- I've not not tried it
- I can't believe it took me 45 years to try that but man am I happy I did. Well, I'm almost there. None of my clothes fit anymore though.

Me: "I've tried everything I am physically capable of trying short of anorexia. Ive tried to walk. Ive tried lifting weights. I've even starved myself. 200 calories every other day for 3 months. Nothing works. I think I may have a legitimate medical issue"
Doctor: "Drink water and walk. Thatll be $250."
Me:
- It's important to notice that while an underlying medical issue is certainly likely in your situation, and that's hard to work against... There's no physical way you were actually ingesting 200 daily calories and didn't lose weight.
  This is beyond biology, it's physical. You were either consuming way more than that, or you were actually losing weight and just didn't notice. There's no alternative.
  
  I mean they said every other day, if one day they get 200 and the next they get 5000 they ain't losing weight...
  
  I think the alternative is that it was a joke
- 200 calories every other day
  Forgot to mention the 8000 calories on the alternating days but I’m sure that’s fine
  
  Yeah, they tend to forget about those.
- None of that is what you should be doing. I mean yes you should be exercising. But not the way you are going about it. For context, I just lost 50 pounds, and have another 20 to go. I got a scary liver diagnosis due to a lifetime of overeating.
  Download a calorie tracker and be super honest with it. At first don't be as concerned with staying within your calories as you are about building the habit to ALWAYS log everything. Seeing it laid out has more impact than anything else in changing your daily habits. Don't be tempted to skip little tastes, licks, and bites.
  Additionally, do not starve yourself! Slowly change your habits and your body will do the rest. Starving yourself will only trigger your body into gaining weight by holding onto everything it gets. It will also make just about everyone quit within a few weeks. If you are finding yourself constantly starving (as opposed to occasionally hungry) then you need to make adjustments to what you are eating. Swap foods for better options. I swapped my late night chips, which kept me awake while driving trains at 3 am with no sleep for two days, with baby carrots I bought at the gas station. I found potatoes helpful in keeping full in the past, but had to avoid them for the liver. Potatoes aren't super high in calories, but sour cream, bacon, cheese, and/or deep frying them is.
  Remember that your body adapts to the foods you regularly eat in about 4-6 weeks. So if you start eating healthy foods you hate, like a salad with tuna and sliced beets, you will start to crave it in about a month and a half. (Tuna has fish oils and beets are chock full of antioxidants). I have hated oatmeal for 40+ years, and now that is my preferred breakfast. I tried to make myself like it over and over but this time I stuck with it long enough to actually get my body hooked on that particular set of nutrients.
  Oh, and if you set your home address to Europe in My Fitness Pal, it gives you some of the premium features, like the barcode scanner.
  Absolutely quit soda and energy drinks. That one is just hard and there really isn't an easy answer for it. Sparkling water helps a bit, but really just plain water is the best at satisfying those cravings. Oh, and you will develop a massive sweet tooth when you quit soda. But if you try to stay within calories and drink a Mt Dew you will be starving by the end of the day. Diet soda is NOT better just because it doesn't have calories. It messes with the way your body processes and stores everything else it gets making it just as bad (worse) than the regular stuff. Stevia is ok for a lot of things, but getting your tastes used to less sugar is a huge step in losing weight and getting healthier.
- What were you eating 6000 calories every other day too? No wonder doctors don't believe their patients.
- You would be stufied because it's impressive that your body can just grab calories out of thin air. Obese people lie about what they eat, it's really simple. That's why doctors don't take these people serios.
  
  the thing is, people SEVERELY underestimate how many calories are in what they're eating. Ask any fat person how many calories a chocolate bar has, and they'll say something like "50?"
- Nothing you said makes any sense at all

quality rage bait 👏👏👏
- I'm not rage baiting, its a shitpost, in the community for shitposts.
  
  You sound distressed, you should lose some weight.

I've had almost exclusively military doctors for nearly two decades, and I can tell you they aren't trying to respect your feelings (not that they're dicks). If your tests come back with high cholesterol, they aren't jumping to Lipitor or some shit, they'll refer you to a nutritionist and tell you to exercise more. They have no problems telling you that your health troubles come from that weight crushing your organs and joints.
And that's as a person in the military, who has to maintain a certain level if fitness to keep my job.

shoutout to my current PCP for actually listening to my symptoms and (most importantly) when they started/worsened and treating them and/or the cause while also reminding me I still need to keep working on my weight
gonna miss her when I move towns :[

Also if they're dentists (suddenly teeth become "bones to smile with").
- You're going to need a root canal, not because its the best procedure for the job, but because its more expensive.
  
  I had a dentist give me an unnecessary root canal when a filling broke and they didn't even do it right. I'm still pretty salty about it. I'll always get a second opinion moving forward.
- I did notice my dentist's office is decorated with various posters and such that say "smile" and none of them say "chew"

What part of the Hippocratic Oath does this refer to? If anything, the Oath specifies "us[ing] those dietary regimens which will benefit my patients according to my greatest ability and judgment".
- I heard Dr Mike saying the other day that as a doctor he admits prescription drugs suck. End of the day, they have serious risks vs benefit. But the one thing known to give you the benefit of drugs without the risk is lowering your weight. Like across the board it improves so many things. I don't envy doctors who know what the answer is but are told they're assholes for trying to help
- I'm consistently 20-30 kilo above what was considered ideal weight for my height. It took 10 different visits to 10 different doctors to find my life-altering disease that was caused by basically a slow acting infection. 9 of them attributed my very real and severe symptoms to "well, what do you want from me, you're a fatty fat fat and until you fix this you will be bad and miserable and actually deserve it, and did I mentioned you're fat?". All of them were as smug as you are right now, all of them presumably thought that they're helping.
  Now that that shit is fixed, I'm still the same weight, but weirdly enough, no symptoms and I am feeling good. Almost like my body type has nothing to do with anything.
  And that's what the meme is referring to.
- This is a joke, in a community for jokes.

Now we have weight loss drugs, though. Those are apparently unbelievably effective
- Sort of. We have drugs that can help you lose weight, but they come with their own challenges and risks, and you still need to eat right and exercise. And even then, it's prescribed and covered for diagnosed diabetes. If you want it to lose weight, you probably have to pay for it.
  Eating right is much more difficult than people pretend it is, and exercise is simply not possible for a lot of overweight people. You might as well say "don't be poor, and also don't be poor."
  So when you say on top of that, "we've made it easier for you to lose weight with this new drug, as long as you aren't poor," that's not really helpful.
  
  My parents and my fiancee have gotten on an equivalent of Ozempic specifically for weight loss and covered by insurance. It seems to be easier now than it was, because if my fiancee wasn't covered we absolutely couldn't afford it.
  
  Now it is also prescribed for obesity, not just diabetes. And I think very much worth it from a societal perspective, as the healthcare costs of obesity are extreme.
  
  exercise is simply not possible for a lot of overweight people.
  I'm not fat, but that seems simply untrue unless the person is fat due to a serious disability in the first place. Maybe doing intense exercise isn't possible, but fat people can absolutely start with small, little exercises and work their way up over months or years.
- And unbelievably expensive, and unbelievably good at regulating an A1C.
  Now if you excuse me, I am gonna go and break down crying to the insurance rep about how Ozempic is way better than metformin at not making me shit my pants. I swear I am not making excuses just to lose weight. (Please someone, stop the madness, if I can get semiglutides that doesn’t make you lose weight but regulates my A1C I would be so happy)
  
  Another option for diabetes are the SGLT-2 inhibitors like Jardiance. They work by making you pee out all the excess sugar. You won't have the diarrhea issues, but you will be peeing a lot. (It's basically a special diuretic, so it's also really good for blood pressure.) Bonus: they've also gained approval for slowing the progression of diabetic nephropathy (kidney disease), so if that's something you have any trouble with, it can help get it covered.
  
  I hope you get the care you deserve.
  Until then talk to your doctor about:
  if you can adjust dosage yourself so that you only take metformin in amounts or at times/circumstances that won't make you sick
  if you can try the extended release (or vice versa) formulation of metformin
  talk to your doctor/dietician about when you should take it during a meal to minimize side effects.
- They are, and they absolutely changed my life. I was never obese, but almost always overweight since childhood.
  As an adult, I used Saxenda (liraglutide) for almost 3 years, prescribed by my gastro doc. I lost 25 kgs with it, out of which only 3 was muscle mass. I only needed half the max dose, and now they even have a newer and more effective formula.
  I was afraid I would gain it back after stopping, as I was warned, but I stopped half a year ago, and I lost 5 kg more with only diet since then. And by diet I don’t mean starving myself, just switching to super healthy and natural stuff, and staying away from processed food.
  Before this med, I ate too much, and even though I tried to stay away from stuff with added sugar or too much fat, it just added up. The drug took away my excessive hunger, and at the beginning I just ate less, but after a few months I also changed my diet to be more fresh and healthy, and the fat just kept melting away.
  Now I’m in my mid 30s, and look better then ever, and also got rid of health conditions (like minor high blood pressure) that would cause a mess later. And again, I was never obese, only overweight, so I can’t even imagine the impact this would have on dangerously obese people.
  Incredible technology, I think a lot of people will take these in the future. And my case shows that it’s not true that you have to take it forever: if you can adjust your diet and life over a period of a few years, your body will “heal” and help you to keep the fat down later.
- Friend of mine has been on wegovy and has lost almost 40 pounds in 4-5 months. It was almost discouraging to hear that as it has taken me two years to set the correct habits to lose almost 35 pounds (and keep it off).
  The side effects of those drugs are real though. My friend says she constantly feels nausea and it's weird to see her eat so little... When we go out I would be surprised if she even eats half her plate, if that.
  It's been a long journey for me personally to lose weight. I had to teach myself how to use gym equipment, cut out all sodas, and to suppress my cravings. To see people take what looks like "the easy way out" can sting... but in the end, I feel better then ever.
- I'd there's one thing I've learned in all my studies, it's that weight los drugs are shiiiiiit
  Not because they don't work, but because a general effect like "weight loss" usually comes with more than a few downsides
  
  One of the biggest problems with the GLP-1's (Ozempic, etc) is the fact that people lose weight by just not eating as much, and the things they do eat aren't likely to be very nutritious. Protein malnutrition and muscle wasting are very common sources of weight loss on Ozempic. That's why it's standard of care to get your patient to a licensed dietician before starting them on one of those drugs if at all possible.

Or a mentally troubled patient. Or a black patient. Or a woman.
- Yeah. I've a friend who kept getting dismissed by the doctors when they came with worries about their heart, because they were diagnosed with generalised anxiety. Apparently if you're living with anxiety you're also immune to heart problems!
  Doesn't help that someone close to them died because of late medical intervention, which only happened because the person's partner insisted that they fake a fainting episode as the medical system had repeatedly dismissed them when previously asking for help with their problem. Everything was fine and dandy until they didn't pass out, then oops, too late to treat the cancer, have a nice rest of your life.
  Can't even blame individual doctors though, I think it has a lot to do with understaffing and overworking. The people who matter aren't cared for and thus can't properly care for the people they are obliged to care for. It all serves the bottom line of the elite because they can pocket more money.
- If you say so

The patient is a women, in poverty, disabled, mentally ill…
Medical culture is unbelievably bigoted.
- And all of that would be made worse if she was fat as well. Being fat is unhealthy. I was a medically obese child. 250lbs at 12. Losing 80lbs is one of the greatest changes I've ever made in my life, if not the best, for my daily quality of life.
  
  Being fat is unhealthy
  It's funny, because the metrics we use to declare an individual "fat" loops in quite a few professional athletes.

they must harm the fat in order to save the patient
/s
- The patient needs fat to live.

Obesity is a disease, so it should be treated as such. It’s not more of a personal failure then getting lung cancer from smoking.
Yet tobacco companies are shamed and taxed, while the sellers of addictive junk foods and sugary waters are thrivingcand marketing for children.
And at the end, people are dying, and taxpayers are paying the cost for capitalist greed.
- There's a saying: "it's not your fault, but you are the only person who can solve it".
  Only you can reduce your calories, only you can stop smoking and only you can quit alcohol. That's shitty that you have to, and in an ideal world it wouldn't be like this, but it is.
- Nobody blames the patient for getting lung cancer, they blame the patient for smoking for years knowing the risks.
  Same thing with obesity related heart issues. You aren't being blamed for the heart issues, you are being blamed for eating yourself into obesity.

More like as soon as they leave medical school in my experience.

What harm is the doctor doing to fat people in your opinion?
- People love to claim that doctors don't take fat patients seriously and complain when they tell them to loose weight.
  In the Fediverse there are also some Nutjobs who will claim that being morbidly obese isn't unhealthy and that those doctors just don't have a clue if they think it is unhealthy
  
  #loose
  Fat people can lose weight. Loose people... are more fun I presume.
- Isn't it well-known that doctors frequently dismiss health concerns with "have you tried losing weight?"
  
  When you look at how strongly obesity correlates with everything from back- and knee pains to weakened immune response to sleep issues and cardiovascular disease...
  When a severely obese person has any of the above, it's reasonable, scientifically backed diagnosis/prescription to say "these issues will probably go away by themselves if you lose weight". This is about treating the cause and not the symptoms: When severely obese people are heavily over-represented among those with a certain disease or problem, you can try treating the symptoms, but should expect that they return rather quickly.
  Of course, there are cases where the issues come from something else, but no matter who goes to the doctor with health issues, their first response will be to try to treat the post probable cause.
  
  Weight gain can turn a small thing into a bigger thing. A outpatient procedure is more likely to turn inpatient if the patient is over 300lbs.
  
  Because in many cases, the weight is the problem.
  Being obese has so many related sicknesses. From having sleeping problems to back pain to knee pain to more serious stuff like cardiac arrests - being fat brings so many health problems.
  
  While I have no doubt there are doctors like that, they are the exception.
  Every profession has it's idiots...
  
  First I'm ever hearing about it.
- There is a fat acceptance movement that says you can’t control your wight, and also the only healthy way to eat is to eat whatever you want whenever you want, and if doctors want to weigh their patients or inform them of the health risks of being overweight or not do operations where excess fat would create complications, the only possible explanation for any of that is fatphobia.
  
  That's not what that is.
  Its more just not going out of your way to be an asshole to fat people.
- Denying care until an arbitrary amount of weight is lost.
  Maybe there's sound science behind it, such as the procedures not having been tested on larger patients (if that's the case why don't they just say), but mostly it just looks like a waiting list hack.
  
  Risk/benefit ratio.
  The benefit is X the risk is Y, but the risk increases with excess weight, at some point Y exceeds X. Once the risk exceeds the benefit, it no-longer makes sense to perform the procedure.
  From the patient point of view, the likelihood of a bad outcome is above the likelihood of a good outcome. They would be worse off getting the procedure; but likely they are only considering the good outcome and wishing away any bad outcome.
  From the doctors point of view, they are considering both outcomes and trying to communicate to the patient that it's not a good option for them. There is also the opportunity cost to consider, they could be helping someone else that is more likely to have a good outcome.

Or lgbtq

it's 100% true, I am treated as less than human because high BMI.

Doctors will be the first AI replacement