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Oct 11, 2012

Doctor, don’t make assumptions about your fat patients

Penny Wilson, PhD Researcher at the Australian National University writes: A couple of weeks back I awoke with a swollen and painful knee. I’ve had problem knees s

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Penny Wilson, PhD Researcher at the Australian National University writes:

A couple of weeks back I awoke with a swollen and painful knee. I’ve had problem knees since high school and figured that this was just another chapter in the saga. Some days later I was fed up – my knee was preventing me from getting around and was keeping me awake. Time, I thought, for a quick trip to the doctor followed by targeted sessions with the physiotherapist.

My regular doctors weren’t available so I made an appointment with a GP I see occasionally. “I’ve had problems all my life,” I said. “I was seeing physiotherapists when I was 13 and have had aches and pains intermittently forever.”

She poked and prodded, discovered the bits that hurt most and determined that all the bits that should be there in my knee were still there. I suggested that physio might be the next step and she suggested an X-ray, just for a closer look.

At this point, I must have temporarily lost my mind, for in a completely unguarded moment, I said, “Of course, I know that I should lose a few kilos. I haven’t been this heavy for some time now.” Which, I discovered, was the catalyst that magically transformed me from an intelligent adult to a stupid and ignorant child who needed a good talking to.

But a little background: I was fat through childhood and on my first diet when I was four years old. I was transformed through my teenage years to a very curvy adolescent, before becoming grossly overweight in my 20s. I’ve spent my entire life dieting to become merely overweight, before gaining weight to become grossly overweight, then dieting again and so on. I managed to maintain my latest “thinner” state for a decade but the past two years have seen me heading back to a size I hoped I’d never achieve again. The doctor knows nothing of this and didn’t ask.

Instead, I got a lecture. “You shouldn’t eat processed food,” she said (I don’t eat processed food), adding “what I do to lose a bit of weight is to use a diet supplement instead of a meal once a day”. Hold on, aren’t they products of highly processed stuff blended and whisked to make a sickly shake?

“What do you eat for dinner?” she asked. “What, whole grains and veggies?!” she screwed up her face. “Whole grains are carbs and full of calories!” she exclaimed, horrified. Doesn’t she realise that one gram of complex carbohydrate has around the same number of calories as one gram of protein? Yes, proteins can be satisfying over a longer period of time but environmentally, going with the grains is a sound decision and is recommended by the Dietary Guidelines for Australian Adults.

She went on. “You eat curry? Coconut milk is really bad for you… You use kefir in your curries? Oh, I’ve never heard of that. You should get yourself a good cookbook and make meals with protein according to the recipes in the book. Start the day with a good breakfast: I eat porridge.” If she’d asked, I would have been happy to tell her I eat fresh fruit and plain, unprocessed, unsweetened yoghurt made with milk straight from a sheep. But she didn’t ask.

Naturally, I had turned off. I felt resentful and unhappy. I cook meals, lately with little protein, with the flavours from many countries that surround the Mediterranean and beyond. I eat Indian curries, Mexican salsas, fiery Moroccan tagines, dishes with brown rice and stir fried veggies, kamut and spelt pasta with fresh tomatoes and eggplants. I eat vast quantities of leafy greens as well as fresh peas, zucchinis, multi-coloured carrots, rainbow chard and kale – from my veggie patch. And fruit: berries, mangoes, whatever’s in season; plus apples, hazelnuts and persimmons from my fruit trees. I don’t eat takeaways, although my partner and I enjoy dinner in a nice restaurant when we can.

Why did I just sit and listen, and get angry? Why didn’t I interject, cite references to journal articles about diet and weight; to the fact that, sadly, according to the literature, most fat teenagers grow into fat adults; that after dieting, according to some of the literature, most people put the weight they lost back on plus a bit extra each time?

Why didn’t I say that actually, my diet doesn’t contain processed foods, sugary drinks, trans fats, biscuits, pizzas and fries?

Why didn’t I say that if losing weight was so easy, I really would not be fat, I would be slim. And certain television personalities would not spend years in very public attempts to be and stay slim.

So how did I feel when I hobbled out of the surgery? I swore that I would never again look for empathy from my doctor. I reflected on the growing number of desperate fatties trying to manage their weight in an obesogenic environment and pondered on how sad and pathetic their doctors have made them feel.

Why didn’t I protest? I’ve been pondering that question myself. I can only think that I was simply rendered dumb by the implication that because I am overweight, my knowledge is therefore inadequate; my intelligence limited and my food choices unhealthy.

Don’t assume that the fat person in front of you eats rubbish food and relishes takeaways, chips and chocolate. Most fatties know more about diet that any thin person who’s never tried to diet. Why don’t we succeed? Why can’t we manage the weight loss and maintain a sensible weight? That’s a problem we’re all trying to resolve, trust me on that.

A person whose addiction is for one more serving of dinner, one more bite of dessert, cannot give up food for life. Eating is a social act, much like drinking alcohol. And through each painful period of dieting, denial becomes a permanent state of being. “I’m sorry, I can’t meet for dinner, I’m on a diet and one indulgent meal means no weight loss this week.”

My message to doctors? If you want to provide positive support to those patients who battle to maintain their weight, treat them with respect and know that many have detailed knowledge of food choices and diet plans. Don’t assume that they live on junk food and, unless you’re up to date with the healthy food guidelines, don’t preach.

The doctors’ practice I attend calls itself a community medical practice and it occupies a spacious airy building. Perhaps inviting community members to attend a weekly support group would open the food and diet conversation up to both the community and to the doctors within the practice. But most of all, it would teach you not to judge us.

By the way, the physio is wonderful. I should be able to restore my knee to usefulness in time and the strapping and sticky bandages have stopped the excruciating pain. And most importantly, I can walk around campus again.

* Penny Wilson is a PhD researcher at ANU and an educational consultant specialising in curriculum design and development.

This article was first published by The Conversation. A reminder to Croakey readers that TC articles are freely available for republishing under a creative commons licence.

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