How do I get my doctor to stop lecturing me about my weight?

June 29, 2006 6:27 PM

How do I get my doctor to stop lecturing me about my weight?

First, the background: I am fat. I'm not hugely fat, but I'm definitely a big guy. At 6 feet tall, I weigh 242lbs, putting me at a BMI of about 33. I am aware that I am fat, and I am also aware of the health risks of being fat, having not lived in a cave for my entire life. I also choose to accept those risks, rather than make the lifestyle changes necessary to not be fat.

The problem I have is this: Every time I go to the doctor, I get "the lecture". If you've ever been overweight, you know what I'm talking about - my doctor insists on going through the entire schpiel about how fat I am and how fat is bad, and I'm getting quite sick of hearing about it. It doesn't matter what I go see the doctor for, whether it can even remotely be connected to my being overweight or not, I still get the lecture. I've given my doctor the counter-lecture ("Thank you for bringing my weight to my attention, doctor. I am aware of the problem, and I couldn't possibly care less"), but he still insists on lecturing me on every visit. Making it worse is that my doctor once weighed about 300 pounds, a fact that he reminds me of each time he's delivering his lecture.

I'm finding myself not going to the doctor when I probably should, simply to avoid the BS that goes with it. So, here's my question: How do I convince my doctor to lay off the lectures? Is this just a "doctor thing", and will I just have to get used to tuning them out?

posted by deadmessenger to health & fitness (49 comments total)

Find one who doesn't care about your well being. Seriously.
posted by Loto at 6:31 PM on June 29, 2006

Could you change doctors? And then make sure you send a politely worded letter to your lecturing doctor to tell him why you did so. Maybe he'll take it to heart and you'll save someone else the trouble in the future.
posted by chiababe at 6:33 PM on June 29, 2006

Can you change doctors? Can you tell your doctor that he's made his point, but if he continues to lecture you, you will be switching doctors? There's no reason for a doctor to be condescending.

Previous thread from a woman's perspective. (Hurf durf butter eater!)
posted by occhiblu at 6:34 PM on June 29, 2006

Yes, this is a "doctor thing." When a patient is harming his or her health, the doctor has an ethical duty to discuss it with the patient. If you weren't taking your meds, surely the doctor would say to you on each visit "you really need to take your meds, this is a very serious transgression."
posted by GIRLesq at 6:37 PM on June 29, 2006

occhiblu writes "(Hurf durf butter eater!)"

Completely off-topic, but I use that phrase on a regular basis since I read it here. Say it out loud. You'll love it too.
posted by chiababe at 6:43 PM on June 29, 2006

If he gives you the full drawn-out lecture every time, let him know you're not coming back.

Any doctor who still cares about their patients will likely make a small note of losing weight on any given visit. You mentioned you're not willing to change your lifestyle for that. So, you can take Loto's advice and find a doctor who doesn't care, or you can stop going to the doctor's office altogether.

If being lectured is enough of an annoyance to keep you away from the doctor when you know you ought to go, then you either aren't worried about your health enough to bother with regular medical checkups, or there's issues that you have to face on your own. Either way, dump the doc. Being reminded you're fat obviously won't do you any good. You won't waste your time with lectures, and your doc won't waste his breath.
posted by Saydur at 6:50 PM on June 29, 2006

I don't mean to be an ass (although god knows I have a gift in that direction) but this is a bit like bitching because your doctor tells you that cigarettes, heroin and a daily bottle of scotch are bad for you. He's doing his job.

On the other hand, the fact that he's an ex-fatass himself does suggest there's a bit of the zealotry of the born again going on there. And that's a pain every time. Still, he doesn't sound as bad as the typical reformed alcoholic.
posted by Decani at 6:57 PM on June 29, 2006

Hey man, first off, it's his/her job. They would be remiss not to. However, obviously, it doesn't need to be mentioned every time you visit. So just tell that person that it's a done deal for you and please don't mention it again.

You probably woudn't dump a girl friend over something you havn't even discussed. Also, it's really good to have an honest open relationship with your Doc. So talk about it.

I had a Doc once who used to piss me off. Always with the blood pressure. Finally I told him that I was just a pissed off high-strung guy. He had an epiphany and said, "Yea, I guess you are." He gave me some cool low-grade pills that really helped and we were friends until he got promoted and left.

Everybody is different. Tell your Doc your happy being you and to skip the spiel.
posted by snsranch at 6:58 PM on June 29, 2006

He's doing his job. He should and will keep doing it. You could always tell him what you're telling us, but otherwise, and perhaps even despite that, you can expect to keep hearing it. If you don't want to hear about cavities or gum disease, don't go to the dentist. Likewise here.

Go see a carpenter if you don't want to hear about health issues. Seeing a health guy, you're going to hear about health stuff. It's not just some politically correct, sanctimonious posturing. If you had diabetes or sickle cell, you'd expect him to tell you about it and counsel you, because you could die. I mean, Jesus, obesity kills people, a lot of people. (Technical "obesity" is a lot lighter than most people think). You write it off as just some ho hum slight inconvenience, but it's real and it's a major health risk. High blood pressure, high cholesterol, diabetes, heart disease, stroke, CANCER, yes, cancer, you name it.

You really can request exactly what you want, and maybe even get a result. I know how you feel, I need to lose about 20 lbs but am kind of apathetic about it, but you're not being realistic when it comes to a doctor's duties. He's not passing moral judgement, just trying to extend your life. Just ignore it if you don't believe it.

Good luck.
posted by kookoobirdz at 7:00 PM on June 29, 2006

Hey man, first off, it's his/her job. They would be remiss not to.

no doctor should lecture anybody. there is such a thing called bedside manner, or even tactfulness. you are not a child. i would not stand for such treatment. i would simply find another doctor, one with manners.
posted by brandz at 7:05 PM on June 29, 2006

No, actually your doctor is not doing a very good job of looking out for your health. In fact, he might be so blinded by your weight that he could overlook or misdiagnose a serious illness. Case in point. If he refuses to respect your wishes, then it is time to find a new doctor, one that will help keep you healthy at your current weight. This is a concept called Health At Every Size.

One place to start is this site which also includes a list of fat friendly doctors. There are other resources and discussion groups that might be of help to you. E-mail me at my profile address if you want more info.
posted by kimdog at 7:08 PM on June 29, 2006 [1 favorite has favorites]

If you've made your wishes about how to be treated clear, and your doctor disregards those wishes, find another doctor. You may find the Fat-Friendly Health Professionals site helpful in finding one who will treat you as an adult.
posted by bac at 7:08 PM on June 29, 2006

Why do you go to the doctor??
I am curious...
I go for a physical every few years but other than that I don't see my doctor.

What is the reason you have to even see him more than ever 4 years or so??
posted by beccaj at 7:10 PM on June 29, 2006

If it's during your physical or a problem that could be exacerbated by your weight, I don't think you're going to find a doctor who is going to stay quiet on the weight issue.

But if he is railing on about your weight when you come in for, say, an ear infection, then I would seriously consider switching doctors. I've had some doctors who I absolutely hated (i.e. a gynocologist who told me - at 22 - that if I were her daughter she would tell me I was too young for birth control pills), and while the issue is very different, when you have a doctor who is an ass and who doesn't respect your lifestyle, then you can't change that. You just have to find a doctor who doesn't make you uncomfortable.
posted by tastybrains at 7:15 PM on June 29, 2006

"...and I couldn't possibly care less."

Sounds like you are challenging him to further lecture you with that type of response. Doctors can feel insulted too -- lord knows that put up with more than you and I deal with every day.

Bottom line: You need a new doctor -- threatening him that you'll leave will only make your relationship with him that much worse. (You might also skip over transfering your patient records a la Elaine's doc episode on Seinfeld. :)
posted by jca at 7:23 PM on June 29, 2006

Move to a country where you wouldn't win a lawsuit if after falling ill with a weight related illness you sued your Doc for not reminding you every visit that you were at risk of said illness.

Otherwise, ask your doctor about signing a waiver that explicitly states you understand the risks involved with being overweight and do not wish to be further advised of them. It may be your doctor is showing perfectly normal concern, for his/her malpractice insurance rant.
posted by tiamat at 8:03 PM on June 29, 2006

There was an article in several newspapers in Feb 2006 predicting your odds of dying in the next 4 years from a medical condition. The newspaper article was based on a JAMA paper Development and Validation of a Prognostic Index for 4-Year Mortality in Older Adults. In it, if all other medical tests showed good results, a BMI>25 was better than a BMI less than 25. If you doctor demonstrates that you have diabetes or high blood sugar, or a heart condition, then let him go to work on those issues. If his only complaint is a high BMI in the absence of other factors, show him this paper, and tell him to shut up and keep his advice medically-based.

(Oops, the JAMA link was previously available, now it seems to be restricted. Your email address is not in your profile, otherwise I could link you up with a copy.)
posted by mediaddict at 8:03 PM on June 29, 2006

People change doctors over personality incompatibility issues all the time. In fact, some doctors fire patients that they feel they can't get along with. All of this is legal, expected, and normal. If you are not getting medical care when you feel like you need to, because you're insecure with this doctor but won't change to another, man, that's pretty dysfunctional.

That being said every doctor (except perhaps Dr. Nick) is going to view your weight as a health issue and have the moral, medical, and legal obligation to note it and bring it to your attention. Same as if you had a big black cancerous looking mole on your face, not to make fun of you. But a doctor who's more attuned to your state of readiness for change will say something like "By the way, I know you've heard the lectures before but I just had to mention once again, your weight may be a health issue for you in the future and if you are ever ready for a change, please let me know. It's not my job to bully you into anything." Your current doc sounds like a zealot.
posted by Slarty Bartfast at 8:20 PM on June 29, 2006

I have a great doctor in Atlanta, with the Emory clinical group, and I know it.

When I smoked, he questioned me about it, and I didn't like it much. When I weighed 120 pounds more than I do now, he was generally worried that I was headed for short term diabetic problems, and I didn't like hearing about that, either. But he didn't rant, and he saw me immediately whenever I needed to see him, and he just kept looking over the top of his glasses, with a wrinkled brow, as if it might be the last time he was going to see me, and he wasn't quite sure what tone to take. He took thorough history, did thorough exams, told me when test results were being obscured by my weight issues to the point he wasn't going to be able to get much useful information from doing them, etc. But he kept doctoring, and I kept being a patient.

Doctors see those of us with bad habits as the walking dead, because the percentages in clinical practice don't get waived just because we patients think they don't apply to us. They don't want to be officiating in a hopeless cause anymore than anyone else we deal with does. When I came in and didn't smell like smoke, and was wearing pants 8 sizes smaller, he quit looking over his glasses, smiled, and we talked about his new Land Rover and the Braves, and how I lost the weight, and my new foolish dog.

Seemed pretty human to me. I can make a recommendation if you're doctor shopping in northern Gwinnett County, but I can't guarantee this good man won't be looking over his glasses at you...
posted by paulsc at 8:20 PM on June 29, 2006

A lot of interesting responses here - thanks to all of you (except the jerk who made the "tree doctor" comment)

chiababe: Could you change doctors?

I can, and it looks like I'll probably have to. I would have preferred not to - the doctor I see is unique in that I don't recall ever having been seen later than my actual appointment time. Doctors who keep patients cooling their heels in the waiting room are a MAJOR peeve of mine, and this one has been pretty good about not doing it.

occhiblu: (Hurf durf butter eater!)

OMG that rocks - love it. I might just get that on a tattoo.

kookoobirdz: High blood pressure, high cholesterol, diabetes, heart disease, stroke, CANCER.

Thank you so much! In my original post, I said: "I am also aware of the health risks of being fat, having not lived in a cave for my entire life." I had no idea that my weight puts me at higher risk of any of *those* things, though! Or not. Sarcasm aside, you've actually done a wonderful job of demonstrating exactly what my doctor does to piss me off.


beccaj: What is the reason you have to even see him more than ever 4 years or so??

tastybrains: But if he is railing on about your weight when you come in for, say, an ear infection

Let's see - In the last 6 years, I've been to the doctor 4 times. I've had a sprained wrist, conjunctivitis, a pretty nasty case of strep throat, and some moderate depression. Of those, the only one that could have been legitimately related to my weight was the depression - there is a known link between the 2.
posted by deadmessenger at 8:26 PM on June 29, 2006

When a patient comes into a doctor’s office with a complaint, that chief complaint must be addressed. After that, it is the doctor’s job and duty to address other health concerns. To not do so would be a violation of what it means to be a doctor.

A few examples:
- A person coming into the doctor’s office complaining of frequent nosebleeds can be easily treated by cauderizing an artery. But if the reason the person gets nosebleeds is because they are snorting cocaine frequently, well, there are bigger issues that need to be addressed. Should the doctor treat the nosebleeds? Yes. Should the drug addiction be left untreated, or glossed over if the patient understands what they are doing to themselves and is okay with it? I’d say no. (Do you say yes?)

What about an issue that is not directly (causally) related?
- A woman comes into the doctor’s office for her annual ob/gyn check. But she has a black eye, bruises on her arm and breasts, and indications of forced sexual intercourse. When the doctor suspects domestic abuse, the woman responds “oh my husband just gets a little rough at times, it’s nothing”, should the doctor simply let it go? The woman is not crazy, she understands what is going on, but makes it clear that she doesn’t want to be lectured about abuse. Should the doctor simply drop the subject and not lecture her because if the woman hasn’t done something by now, she never will? (Like you and your weight?) I think we will all agree that it would be very wrong for a doctor not to discuss or document it. (In some states, failure to document abuse is illegal. Ethically, not discussing your patients weight is also not right.)

Now you’re thinking: I’m fat, I like to eat, big deal. I’m okay with being fat, I’m not in terrible health. I’m not doing drugs, and I’m not getting abused (hopefully). This may be true, and you can be assured that I’ve thought of all these things myself. Now what’s your doctor supposed to think? Should I lay off this guy because he knows what he’s doing to himself? Or should I continue to lecture him, and hope that this might be time I get through, and he finally does something and at least tries to lose weight?

You sound like a smart guy, and I’m sure you know what obesity does to you. It pretty much puts you at risk for every medical condition ever. (Obviously that’s an overstatement, but not by too much.) Hypertension, heart disease, cancer, depression, sleep apnea, diabetes, the list never ends. Now if this doctor didn’t care about you, he would stop lecturing you because as you develop (some of) these problems, you’ll continue to visit him and he’ll make more money. But doctors would much prefer you to be healthy and stay out of their offices.

Honestly, if you (and me, because I’m in you’re same boat) keep up this lifestyle, we’re going to get sick. We’re going to get some of those diseases. That is going to absolutely suck. I don’t even want to think about being a type II diabetic – that itself scares me. I am trying. It is so damn hard, but I am trying. I urge you to try. This is what your doctor is doing too. He is trying to get you to see what he saw and lose some weight. He obviously saw what he was doing to himself at 300lbs, and if he doesn’t tell you, he is in fact harming you.

If you don’t want the lecture, change doctors. I’m sure you’ll find one who ignores the main issue in your life and only treats your bumps and bruises. This will also be the doctor you spend the rest of our life visiting as you get hit by the multitude of diseases that accompany obesity. Your health will plummet, and the doctor will get rich.

I hope you realize that this little comment doesn’t come lightheartedly. Re-reading it, I say some harsh things, but I have been harsher on myself, believe me. I am beginning to see that what I am doing is killing myself slowly (I sadly never got the lecture from my doctor). I refuse to let that happen to myself, and I hope that you will to.
posted by ruwan at 8:34 PM on June 29, 2006

tiamat: Move to a country where you wouldn't win a lawsuit if after falling ill with a weight related illness you sued your Doc for not reminding you every visit that you were at risk of said illness.

That never occurred to me, and it makes a ton of sense. My doctor's nagging may very well be CYA on his part.
posted by deadmessenger at 8:35 PM on June 29, 2006

Doctors are funny, I've gone in with a suspected broken pinkie-toe (dropped a bottle on it) and got the usual "... I see your are over weight..."

Hell, even with the language barrier in Japan I still get it... Long string of Japanese, when I don't follow he goes "Cholesterol.. wakatta?". ("understand?")

Now it's tradition!
posted by lundman at 8:44 PM on June 29, 2006

i can see people are responding to this post in a lecturing mode.
posted by brandz at 8:56 PM on June 29, 2006

Have ANY of you people read "The Obesity Myth"? Give it a look-through. It will calm your hysteria.

I am a fat woman myself, and my doctor never lectures me about my weight. I do go in for annual physicals, with blood work, which always show that my cholesterol, blood sugar, blood pressure, and so on are fine (cholesterol actually better than average), and she is happy about that. She asks me some questions about my diet and is generally happy about that, too. She asks me about how much I exercise; she was really happy when I was walking 10-14 miles a week, and we both wished I had been able to keep that up over the winter. When I recently lost about 25 pounds, she asked what I had been doing differently, partly because unexplained weight loss can be a sign of illness.

I have never had a doctor who lectured me about my weight. There are lots of doctors who DO care about their patients' health who nonetheless do not hector them. You should be able to find one. Whether you can find one who also sticks to his schedule is another question entirely, alas.

Can you speak plainly to this doctor? Can you just say, "I have heard your lecture about this before, and I do not need to hear it again. I will let you know if I change my mind about losing weight and need your help." My not-lecturing-about-weight doctor tried to give me a lecture at my 5-year-old's last appointment about giving him the "stranger danger" talk. I just said, "I've made my decision, I don't need to hear this, and we should move on." She desisted.
posted by not that girl at 8:57 PM on June 29, 2006

"I know doc, I know, I hear you. Can we can the lecture though? When and if I'm ready to do something about it I'll let you know, thanks. My toe hurts right now."
posted by Divine_Wino at 9:16 PM on June 29, 2006

Now that I read the thread, exactly what Not That Girl said. In the phrase Health Professional, both words have equal weight.
posted by Divine_Wino at 9:17 PM on June 29, 2006

Tell the doctor you're a smoker. It won't stop the doctor lecturing you, but in my experience, it will get the doctor to shut up about your weight.
posted by beniamino at 9:26 PM on June 29, 2006

"I am aware that I am fat, and I am also aware of the health risks of being fat, having not lived in a cave for my entire life. I also choose to accept those risks, rather than make the lifestyle changes necessary to not be fat."

One of the attendant risks of being fat, doing drugs, smoking or drinking heavily (While I do not presume to say any of the afformentioned are safe or unsafe, they are considered to be as such by many in and outside the medical profession.) is having people recommend that you stop doing what you are doing and the discomfort that can come with that. In fact, this is a risk with most any activity.

Perhaps you should find a doctor not concerned with your weight, perhaps you should take your doctors concern as a good sign about him as a doctor and just ignore his fat lecture.

Your doctor seems to be good for you in general, except this one thing which bothers you. Is it really so bad to hear a viewpoint that conflicts with your lifestyle as to discard him? Good doctors can be very hard to find.
posted by Matt Oneiros at 9:31 PM on June 29, 2006

notthatgirl: The Obesity Myth is written by Paul Campos. Mr. Campos is a lawyer (albeit, one with great credentials). Would you encourage people here to pay more attention to his ideas or the NIH, the AMA, the Surgeon general, and the American Academy of Pediatrics combined?

Just sayin'.
posted by ruwan at 9:34 PM on June 29, 2006

I have a great doctor in Atlanta, with the Emory clinical group, and I know it.

When I smoked, he questioned me about it, and I didn't like it much. When I weighed 120 pounds more than I do now, he was generally worried that I was headed for short term diabetic problems, and I didn't like hearing about that, either. But he didn't rant, and he saw me immediately whenever I needed to see him, and he just kept looking over the top of his glasses, with a wrinkled brow, as if it might be the last time he was going to see me, and he wasn't quite sure what tone to take. He took thorough history, did thorough exams, told me when test results were being obscured by my weight issues to the point he wasn't going to be able to get much useful information from doing them, etc. But he kept doctoring, and I kept being a patient.

Doctors see those of us with bad habits as the walking dead, because the percentages in clinical practice don't get waived just because we patients think they don't apply to us. They don't want to be officiating in a hopeless cause anymore than anyone else we deal with does. When I came in and didn't smell like smoke, and was wearing pants 8 sizes smaller, he quit looking over his glasses, smiled, and we talked about his new Land Rover and the Braves, and how I lost the weight, and my new foolish dog.

Seemed pretty human to me. I can make a recommendation if you're doctor shopping in northern Gwinnett County, but I can't guarantee this good man won't be looking over his glasses at you...

That was incredibly eloquent.

Tell the doctor you're a smoker. It won't stop the doctor lecturing you, but in my experience, it will get the doctor to shut up about your weight.

No, the obese have a world of hell awaiting them that surpasses smokers anyday. Caring for emphysema is pretty simple. Managing diabetes is like trying to train a herd of cats to walk a tightrope.

You have every reason to get a different doctor. You really would get along better with someone that really doesn't care whether you do anything about your weight. Every practice has plenty of people that want help changing that it's not too hard to look past the ones that could care less about their health.
posted by docpops at 9:56 PM on June 29, 2006

You told him that you couldn't care less, did you tell him not to tell you about it again? If you didn't, do so. Then he'll tell you whether he feels its his ethical obligation as a physician to warn you about your preventable health risks, even if you don't wish to hear those warnings. Then look for a new doctor, and when you meet them for the first time tell them that you are fully aware of the health risks of being overweight, you don't plan to do anything about it, and you do not wish to be given medical advice about your weight. Repeat as needed. I think the characterization that the only kind of doctor who will pass this test will be one who does not care about your health is probably unfair, but I haven't known that many doctors.
posted by nanojath at 10:07 PM on June 29, 2006

Loose weight??? It's his professional duty to warn you about something that is a risk to your health. If you had cancer and he omitted to tell you, you'd probably sue him, same goes for being overweight...
posted by MrC at 10:13 PM on June 29, 2006

there are lots of ways to be healthy at whatever size you are. here's an interesting study on diet vs. body acceptance practices. losing weight may or may not end up being a side-effect of healthier living choices, but you may find it more appealing to focus on being kind and good to yourself vs. punishing yourself.
posted by judith at 11:41 PM on June 29, 2006 [1 favorite has favorites]

Oh, as for motivational speeches to help you get about and shedding some of those pounds, I always enjoyed my father's line: Just because you have a crack in your ass doesn't mean your legs are broken.
posted by furtive at 4:22 AM on June 30, 2006

if a doctor is making a patient feel uncomfortable, even if the diagnosis is correct, why should the patient shut up and take it?
Especially if the patient is aware of the diagnosis, and the doctor does nothing except lecture? It doesn't sound like the doctor is doing anything to help deadmessenger lose weight except tell him to do so. As we can see from the responses here, you don't need a medical degree for that. However, training and understanding go a lot farther, and perhaps a better doctor could motivate more gently and effectively. Also, perhaps the reason the doctor is always on time is because he's not such a great doctor and doesn't have too many other patients to see.
posted by chelseagirl at 4:54 AM on June 30, 2006

Get your weight down from 242 to 220 and tell him/her to feck off. Seriously.

That's exactly my plan. 220 would put you at 29.8 BMI and at the very top end of the overweight rather than obese category. For me the magic number is 250kg and I intend to hit it specifically to annoy my doctor.

The other option is to go in there and tell them that the BMI system is all bollocks because the system uses height squared when the body increases by a cubed relationship when you get taller. That argument (while slightly flawed) is highly amusing.

The final possibility is to discover one of their health secrets. My old doctor never said a word about my weight after I met him at a party smoking like a chimney. :)
posted by twine42 at 5:31 AM on June 30, 2006

You feel nagged which in my book is pretty counterproductive to you deciding to try any weight loss.

I'd switch docs. Mine is pretty chubby herself and has never lectured me about weight. Funny that all by myself I lost 35 pounds.

If you do decide to do something can I just recommend you exercise? Even if you didn't lose any weight you would be going a long way toward avoiding any longterm health issues.

I bet that if you find a doc that respects your choices you may actually feel more inclined to take some steps to be healthier, because you want to and not because a doc is being a pain in the posterior.
posted by konolia at 5:35 AM on June 30, 2006

C'mon, folks, there's "mentioning the weight as your physician" and then there's lecturing. I'm not even fat and I know "the lecture" that he's talking about.

But the "couldn't care less" part of your counter-lecture is undermining your counter-lecture. Yes, you should warn him before you find a new doctor -- tell him that the full-blown lecture is not helping, and that he needs to take it down a notch.
posted by desuetude at 6:14 AM on June 30, 2006

I am very familiar with this lecture. Went in for allergies? Got the lecture. Went in with a broken foot? Got the lecture. Went in for xanax because I hate flying? Got the lecture.

None of these have anything to do with my weight, which is why the lectures always bothered me. Treat what I'm here for doc, please. Lecturing me about my weight isn't going to make my foot heal any faster.

I switched doctors.
posted by misanthropicsarah at 6:56 AM on June 30, 2006

[a few comments removed, there is metatalk for any future HURF DURFery]
posted by jessamyn at 7:05 AM on June 30, 2006

I don't think that any doctor that intentionally, willfully, repeatedly agitates and infuriates a patient by treating him with disrespect is worth his time, but you clearly need a bit more convincing to make a break, so try this:

Ask him if he has some special knowledge that will make you one of the 3-5% of people who lose any significant amount of weight permanently, since being one of the 95-97% of people who gain back everything they lose is something you've done before (I'm guessing) and don't wish to do again. (Especially seeing as how such weight cycling has been shown to have a more harmful affect on the metabolism, blood pressure, cholesterol levels, and gall bladder than maintaining weight, even a clinically obese weight)

When he has no good answer for that (because if he did, he'd be a multitrillionaire doing a book tour, not looking after your strep throat) ask him what recommendations he has toward improving your fitness in the here and now, as a fat person who will have different considerations about moving your body than a thin person. If he doesn't have any, tell him that he's clearly not interested in your health, just in making you thin regardless of the method (especially true if his next recommendation is mutilation gastric bypass) and walk away with a clean conscience. Use the resources mentioned above to find a doctor who wants you to be healthy and has meaningful advice toward that end, not just empty screeding.
posted by Dreama at 7:09 AM on June 30, 2006

You can try beginning your next appointment with him by saying, "Doctor, there's something that has been bothering me about the care I'm receiving in this office. The last four times I've been here, you have given me what I regard as a lecture about my being overweight. I am aware that I am overweight, and I appreciate your concern about this issue. However, the repeated lectures feel to me like nagging, which makes me very uncomfortable. Frankly, I was reluctant to come in to the office today for that very reason; I didn't want to be nagged like a misbehaving child."

Either the doctor will stop "lecturing" you, in which case you stay with him, or else he will continue, in which case you find another physician.

Briefly then: tell him what he's doing that you don't like, and ask him to stop. Don't wait for him to guess how you're feeling.
posted by La Cieca at 7:17 AM on June 30, 2006

what La Cieca said
posted by matteo at 7:45 AM on June 30, 2006

When he starts in with "the lecture," interrupt him and give it yourself. "At my BMI of 33, I'm at an X-fold increased risk for diabetes, which in turn can potentially lead to blindness, nerve damage, and even limb amputation. I also have a Y% increased risk for cardiovascular problems, including heart attack and stroke. My life expectancy is shortened by Z years. [and so forth.] Now, is there anything else you wanted to add to that?"
posted by DevilsAdvocate at 7:47 AM on June 30, 2006

Just wanted to jump in and thank kimdog and bac for posting the physician resource. My ob/gyn has retired, and I admit -- I've been putting off finding a new one because it took me eight years of switching before I found her.

Anyone who thinks this issue is overblown should read some of the commentaries in the listings.
posted by gnomeloaf at 9:29 AM on June 30, 2006

The other option is to go in there and tell them that the BMI system is all bollocks because the system uses height squared when the body increases by a cubed relationship when you get taller.

Maybe that's why I always found it messed up. I'm around the top end of "normal" and I look at the cutoff for "overweight" and I think "Yeah, that's slightly overweight, I guess" and then I look at the cutoff for "underweight" and I think "OMG how can someone that skinny be alive?"
posted by dagnyscott at 9:38 AM on June 30, 2006

judith: there are lots of ways to be healthy at whatever size you are.

Well, there are lots of ways to be healthier at whatever size you are. But mainstream scientists are fairly united in their collective position that obesity itself is decidedly unhealthy. If you're significantly overweight, the best thing you can do to improve your overall health is to lose some weight.

As a consumer, you have every right to find a doctor you like, as this one clearly rubs you the wrong way. I left an orthodontist once because he insisted on lecturing me about biblical prophecy. You could head him off by saying, at the start of your visit, something brief like "I know you're going to bring up my weight, but I'm working on it, so please don't." Remember that, from your doctor's perspective, your willingness to ignore a known health problem could be a sign of depression or other emotional trouble. So, while it's a philosophical decision for you, it's probably just another symptom, for him.

And not to be a prick, but have you considered that perhaps you don't like "the lecture" because you realize--on some level and despite your cavalier attitude--there's truth to it and that the truth hurts?

Full disclosure: By BMI numbers, I was obese for about seven years. At my peak, I was the same BMI as you (33). Now, I'm just barely in the overweight category (26.5) and aspire to "normal weight" (<24.9). I feel better now and all of the objective parameters that can be checked say I am healthier. Just another data point for you.
posted by wheat at 12:56 PM on June 30, 2006

dagnyscott: "OMG how can someone that skinny be alive?"

My brother lost a ton of weight while going through a pretty nasty post-divorce depression a few years back. He's 6'5", and at his lowest weighed 140 pounds, which would put him at a BMI of about 17. He looked like a walking skeleton - sunken cheeks and eyes, ribs sticking out and everything else - my sweetie started crying when she saw him, and then promptly started feeding him - he's up to a much more reasonable 200 now.
posted by deadmessenger at 1:18 PM on June 30, 2006