2. Obesity can be the marker for other things as well. (And Orange, yah, hope you find a better doctor. How many instances of classic thyroidal symptoms do you have to list before they listen?)

3. Exercise with fun stuff like belly dance and hiking and eat reasonable amounts of delicious food. Life is too short to eat crap. Works for me!

I’m not aware of any reputable doctor/nutritionist who would suggest a caloric intake more than 500 calories below your BMR.

all epidemiologists and medical professionals know that you cannot always compare directly between different countries and indeed it is unscientific to do so.

My point, in the examples in the original post, was that the teaching about obesity in medical school is rife with unsupported facts, and that evidence-based medicine goes out the window when we are talking about the evils of being fat. Whether or not you believe that a reputable medical professional would say these things is irrelevant: they were explicitly taught, in lecture, to my medical school class. These attitudes, I believe, are part of the reasons why fat people are so marginalized by physicians.

Let me respond to a few strawmen

“. Or lecturers who tell us that 1200 kCal per day is a reasonable weight-loss diet to recommend to patients”

Uh, given we’re talking about a medstudent talking about their own lecturers, and given I have encountered medical professionals who recommend this level of calorie intake as reasonable, I’m not sure strawman means what you think it means. Whether or not you believe doctors who advocate this are ‘quacks’ doesn’t change that there are a sizeable number of doctors who *do* advocate this, and many of them, wait for it, went to medical school. Which indicates that perhaps it’s not so unbelievable that there are lecturers in medical schools who are teaching that this is reasonable.

I’ve not heard before that excess GH leads to obesity or that obesity is a symptom of acromegaly. So no, its not a symptom, nor is extreme hunger for that matter.

You’ve not heard of it before, so it’s not true? Are you really stooping to that level, considering I’m not seeing your medical credentials? Obviously the reports of people with these conditions is completely irrelevant. Not to mention that the human body has a tendency to, well, do wacky things.

Of course, what you’re missing is that there *are* conditions where obesity is a symptom. PCOS is one that hasn’t been mentioned, but many of the women I know who have it start by going to the doctor about no or infrequent periods, and got met with the dismissal that it was because they were overweight, even if they’d maintained the same size for some time and the period problem was more recent.

That such conditions are rare doesn’t make them not worth considering. If anything, if one wants to quickly get back to telling one’s patient how fat and horrible they are, they should be the first things to rule out, since the quicker you do that, the quicker you can go back to being an insulting ass.

For the vast majority of obese people, its lack of exercise and caloric excess that leads to obesity. That was the case for me !!

Yes, one generally needs a genetic predisposition to be obese. But thats irrelevant. Nature is not going to give you a pass just because you drew a gene that gave you this disposition and more than you get a pass on the harmful effects of blood pressure just because you inherited a genetic tendency to get high BP.

If every physician I’ve ever had hadn’t viewed the weight as the primary problem, instead of a possible symptom (in the process completely disbelieving my reports), it’s possible I could have been diagnosed a decade ago

I’ve not heard before that excess GH leads to obesity or that obesity is a symptom of acromegaly. So no, its not a symptom, nor is extreme hunger for that matter.

Unfortunately most GPs rarely deal with very rare conditions such as acromegaly so the doctors probably missed it.

During each of my two pregnancies I gained 40+ pounds, and then only lost 15. I was completely unable to lose more weight than that no matter what I did, even though when not pregnant my weight is extremely stable. My foot size grew, and my ring size grew. During pregnancy I was hungry to the point that I could not get full, no matter how much I ate (literally, at one point I was so hungry that I decided to screw watching what I ate, and went to an all-you-can eat Chinese buffet. After four full plates, I gave up. I was still as hungry as when I had gone in.) None of this set off any alarm bells in anyone.

Fast forward six years - I’ve just been diagnosed with a pituitary tumor. I’ve had it in my skull for at least nine years, and pregnancy hormones make it (and me) grow. If I weren’t related to an excellent neurologist who noticed the hand growth and forehead growth, and ran me through an MRI, I still wouldn’t know. I likely wouldn’t have found out until the tumor started squeezing my optic nerves (which it’s resting against). If I had developed diabetes (common with acromegaly), it would probably have been chalked up to my obesity, despite my generally good diet, and excellent physical condition.

If every physician I’ve ever had hadn’t viewed the weight as the primary problem, instead of a possible symptom (in the process completely disbelieving my reports), it’s possible I could have been diagnosed a decade ago. As it is, I have to feel incredibly lucky that I was diagnosed after only a decade or so, instead of when I went blind.

Yeah. Correlation does not equal causation, especially if the correlation is not true in all cases.

To be blunt — this is just pure denial. There are a vast number of medical conditions and recommendations that are based on statistical data. You will almost never find a medical correlation that is true in all cases. AThere will always be people who smoke 5 packets a day and spend their nights in a radon filled basement and never get lung cancer. There are people with Type 2 diabetes who do not control their diet at all, and never suffer from kidney, heart, eye or nerve disease. But we know from strong statistical evidence that smoking vastly increases the risk of lung cancer or that diabetes vastly increases risk of a dozen types of damage to your body.

if you wanted 100 % correlation, you would never take a medication, never get vaccinated, since no medication or vaccine works for everyone. Equally, there are many drugs or diseases for which we don’t know the exact pathology. B

And while we don’t know the exact mechanism yet, there are many theories, with some evidence as to why obesity is a strong risk factor for diabetes. Obesity is a cause/symptom of insulin resistance, which is almost always required for type II diabetes. Also, the fat reserves in our body are known to release various inflammatory hormones and free fatty acids that possibly kill pancreatic insulin secreting beta-cells.

No, we don’t know for sure, but there is lots about diabetes (and indeed many diseases) that we don’t know for sure. I’m sure we will know more in the future, just as we will know more about heart disease, stroke, Alzheimers and so on.

Not all people with type 2 diabetes are obese, not all obese people get diabetes. But we do know is that obesity is a huge risk factor for diabetes.

Obesity does not cause diabetes. However, it is a very strong risk factor. The scientific evidence for that is undeniable. There is also strong evidence that diet, exercise and relative modest weight reduction can delay or prevent the onset of diabetes (see the reports of the DPP studies). It is unscientific to deny that.

Now, I don’t know what charts were being referred to here, but all epidemiologists and medical professionals know that you cannot always compare directly between different countries and indeed it is unscientific to do so. Data from developing countries is often poor and out-of-date. The average age in different countries tends to vary a lot, and older populations are more likely to have higher incidence rates of disease. Finally, ethnic stock, lifetstyle and diet tends to vary a lot (there is some evidence that the Med diet may be protective).

Furthermore it is also true that the BMI calculations and definition of “obesity” may not be completely valid for different ethnicities. Indeed, there is plenty of evidence that Asian and South Asian first generation immigrants in the US have considerably higher risks than Caucasian Americans with the same BMI (or the same blood pressure or cholestrol for that matter). All of this would be an argument for trying to use different metrics for people with different ethnic backgrounds (lower BP, lower BMI, lower LDL targets). Not for saying that such tables aren’t useful !!

The so-called diseases of affluence (diabetes, obesity, heart disease) are exploding in China and India, and yes there is evidence that obesity is increasing in these countries. There was a report just a few days back that incidence of obesity had increased in India (so equally unfortunately, had the rate of malnutrition). I would suggest reading the WHO reports on diabetes in this case.

“. Or lecturers who tell us that 1200 kCal per day is a reasonable weight-loss diet to recommend to patients”

I’m not aware of any reputable doctor/nutritionist who would suggest a caloric intake more than 500 calories below your BMR. For most adult males, that would be much higher. When I was diagnosed with diabetes, the dietitian recommended a 2300-2400 cal a day diet, saying that diet, with exercise would make me loose a pound a week, which she said was a safe weight loss. In general, very low calorie diets are the prerogative of quack doctors.

I know what I speak of. I’ve been obese for years, when I went to doctors for a yearly checkup, they would just gently suggest that I should loose weight with diet and exercise. I never paid much attention, and I had no family history of heart disease, hypertension, diabetes. Then, last year, I was diagnosed with diabetes at such a checkup.

I did a lot of research after that and learned that fasting blood sugar (the criterion used for diagnosis) is practically the last indice to deterioriate. You could run high postprandial blood sugars for years and have a normal blood sugar, as I did, with final deterioration coming on over a year or so. But a lot of the damage has already been done — FBS deterioration is a fairly advanced stage of the disease.

So yes, obesity is a huge risk factor for diabetes. You can roll the dice and assume your genes will protect you (as I thought). You can deny that — its your own pancreas, heart, limbs, kidney and eyes. But any health care provider who soft pedals your risk is not doing you a favor, but the greatest disservice of your life. I wish my doctors had been more insistent (although to be honest, I would probably have ignored them anyway).

Also, try to get tested when the symptoms are at their worse (if there is a worse).

My family has a history of Grave’s disease (hyperthyroidism), but with an odd presentation. The thyroid does not fail completely–it cycles. If the person is tested at the right time (while the thyroid is in a hyper state) they are diagnosed. If not, the levels may be normal, or even low (hypothyroidism). Not all doctors know that this can be an abnormal Grave’s presentation. A lot of doctors–especially GPs–operate under the idea that the thyroid rarely changes state, and that thyroid diseases are either all or nothing. This is not always true.

And to everyone else: I can’t tell you how much I appreciate hearing that other people have gone through the same struggles and come out better on the other side. I will take your advice.

NO doctor with half a brain rules out thyroid problems just because a patient is fat.

But also know that being treated for hypothyroid in no means reduces your weight! It makes you feel better, but I can attest to the fact that weight gain is quite possible while being treated. :)

Good luck!

oh, when getting tested, always ask for the full thyroid panel, with all the bells and whistles. Check T4, T3, etc.

Orange, I hope you find a reasonable doctor soon. And please don’t forget to report to EVERYONE why you’re leaving the old one. Doctors who don’t treat their patients well should go into labratory research, or surveys. I’ve more experience with docs who treat women badly for their reproductive choices. Good luck.