In Credibility 

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“I want to lose weight.”

“How are you doing on your diet and exercise?” 

“Well, Doc, I do have a Fitbit,” she offered, then shrugged.

“Are you using it?”

“Sure! I do challenges all the time,” she said enthusiastically. “My friends and family all do it.”

“How many steps are you averaging per day?”

“Well, I don’t know actually…” Her voice trailed off. Then she brightened. “Sometimes I get in 10,000 steps, though!”

Ah, that magic number….

“Are you counting calories? Eating plenty of fruits/veggies? Decreasing portion sizes?”

“Nah. That’s waaaaaayyyyyy too much work. Don’t you have a pill you can give me?”

“You know, we are going to have to work on the diet portion of things. The weight isn’t going to come off without it.”

She looked me up and down critically, then glared. “Whatever, Doc. What do you know? You’re already skinny. I can’t lose weight.”

Skinny?

I get this all of the time. I just sighed.

Just so you know, I am not a wisp of a woman. I have hips. And a butt. Some might call it a large butt. AND she has no idea what I have looked like in the past, no idea how hard I work to keep my size where it is. I count calories obsessively. I exercise daily. It is incredibly hard. I come from a long line of morbidly obese people and it is a daily fight. It doesn’t come easy.

I understand more than my patients realize.

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114 thoughts on “In Credibility 

  1. How you manage to bite your tongue sometimes I just don’t know. The assumption that you cannot advise on weight because you are not obese. Surely that makes you the ideal person to advise?! Very angry on your behalf! 😀

    Liked by 3 people

      • I get it too – I have people say to me ‘oh, but you don’t have to worry about your weight.’ No – because for years I have eaten sensibly and taken exercise. That’s why I look like this. It isn’t difficult, but it doesn’t happen by magic either. Still – I don’t wish to make light of weight issues, some people really do struggle and I know it can be awful for many people who are doing everything they can.

        Liked by 2 people

  2. Could you say to her, “I have struggled with my weight all my life, so I do understand how hard it is?”
    Would this be helpful to her? Would it cement your bond a bit and help her see as understanding? Or would it be problematic?
    I used to train interns that they could briefly share a limited detail of their life IF it would be helpful to the client, not if it was for their benefit.

    Liked by 1 person

  3. It’s really, really tough to teach yourself to find pleasure in life outside of eating. And to enjoy kicking your butt with exercise. But once you get a routine of kick-your-butt exercise AND portion control, that’s when the magic happens.

    I would also recommend using something like My Fitness Pal to track calories at least for a couple days. I hate doing it (so I don’t anymore), but I did just for a couple days to get a general understanding of how many calories I was eating and then I went from there.

    Stress is also super effective for losing weight, but I wouldn’t recommend it because: 1) it’s not healthy weight loss; and 2) you’ll lose handfuls of your thick, magnificent curls and have to get a haircut when it starts looking thin and gross …. oh sorry I must be projecting again. 🙂

    Liked by 1 person

  4. One of the things about SW is that our consultant is following the plan herself, and is not a skinny Liz. It gave me immedaite confidence, and her encouragement is bottomless (excuse pun). Finally I’ve found something that is working for me, so I’m sticking with it! I get tired of people who think it doesn’t take effort or change in food habits, as if you want the weight to stay off, you have to change the way you look at. cook, and portion your food. 🙂

    Liked by 1 person

  5. She won’t listen to you anyway. I think there’s a lot to do with portion size. The hot dogs of today are the equivalent of 2 hot dogs, not so long ago. They’ve supper sized our food portions and in so doing they have supper sized us.
    Leslie

    Liked by 2 people

      • Part of me thinks it isn’t just marketing of what we eat and how much. It’s Americans being obsessed with value and low cost(Thanks Wal-Mart), people having to be obsessed with amount and value (Thanks poverty and the struggle), and more than anything the philosophy of how we eat and when. Instead of eating smaller meals throughout the day we eat like, at least in the U.S, like we’re a nation of farmers still. I find smaller meals throughout the day is good for decreasing how much I eat, and it means I can structure what when I do need a bigger meal better. Plenty of large people eat relatively healthy but don’t or can’t do exercise. For some people their neighborhoods aren’t safe to jog in and they don’t have grocery stores of any kind. We have to change how we eat philosophically and find ways to make healthier foods and snacks available. Smaller portions can’t equal less value to people and we have to push smaller meals and snacks as superior to 3 square massive meals. It’s just very hard to change our whole approach to food.

        Culture, ethnicity, childhood memory, and just having it as a hobby make it hard to control. The reality of it is exercise is unnatural, but it is something necessary and something people have to make fun. Some people will never be thin. Some people don’t want to be. But everyone should work towards the best diet and exercise possible…there’s just a lot to consider and work on both individually and as a society before we get to where its a lot easier. But that’s my two cents

        Liked by 2 people

      • Thank you! Ya know I wish weight wasn’t so complicated. People make all kinds of excuses that are insincere, but at the same time there are a lot of things that really fuel people. The problem is just unpacking that and making sure you have what you need to support it. I gained back all the weight I lost a few years ago because I lost financial support for the diet that worked for me and then just got depressed. That sort of thing really hurts people. Best thing I ever did was stop caring about a size. I just do my best to eat and be healthy. I hope your patient eventually learns that for herself!

        Liked by 1 person

  6. I’ve always been fairly skinny, with a nice rounded tummy. Now my tummy is getting bigger…. The fat always goes in my middle it never settles where I want it to. My weight fluctuates… etc.. But it must be frustrating for you, sadly some folks can’t be helped however hard you try. It has to come from them – the intention to do something to change their situation. I like to eat that’s my excuse, and friends keep on asking me out for lunch! Eating is such a social activity, and luckily I can get away with it for now….

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    • Your comment ended up in the spam folder so I apologize for only just now getting to it! I hate that we are genetically programmed for our body shape. I would like to be able to exercise to target the parts that are bad and skip the rest, you know? Gah.

      Liked by 1 person

    • Your comment ended up in my spam folder so I am sorry I am only just now getting to it. I do tell people that if they are going to exercise they have GOT to pay attention to the calories and diet part of it, particularly when studies show that exercise itself does not fix obesity.

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  7. It can be a huge struggle to keep a certain weight or to lose weight. For sure. Dealing with my own weight issues has been a journey of my life. My own emotional connections to food were what I can categorize as an addiction. Hang tight. People will do what they can do. If it becomes more urgent, they’ll either take action or crumble. Neither is on you.

    Liked by 1 person

  8. A huge part of the problem is that many do not/do not know how to cook. Restaurant portions are ridiculous and unhealthy, but are expected by diners. Salt and fat content of fast food is equally dangerous. And the lack of nutrition leads to snacking. It’s a vicious circle. I watched my mother suffer with obesity, mostly caused by emotional issues. It’s always a lot more complex than diet and exercise, and that’s the real problem, Doc. I don’t envy your position with patients who judge you. Stay strong.

    Liked by 2 people

  9. As an obese provider- I find it insanely difficult to talk to my patients about weight loss. I don’t know how to tell them I understand and I struggle too. (Although, let’s be real. The struggle is painfully visible.)

    I struggle with this because the problem is so multifaceted. It’s physical and psychological. How do I offer them help without making them feel judged? I know what a trap that is … because for so many years I felt judged.

    I also fell into the trap of feeling that every person who was not obese was silently (or vocally) judging me. Turns out- they have the same body issues I do. Good post Doc!

    Liked by 1 person

    • I have made it a point to do the things I tell my patients to do. My current run on My Fitness Pal is 580 consecutive days. Even when I’m not blogging, I’m logging my calories. I run almost every day. When you are overweight, though, patients act like they don’t believe you can help. When you have a healthier weight, they still don’t believe you! 😉

      Liked by 2 people

  10. No one believes that at one point, I was 53 pounds heavier than I am today. After yo-yo dieting and binge exercising and realizing that it was pointless if I was only doing these things to look good for some social event in college, etc., I stopped caring about “looking good” and what other people might think. I lost it in a little more than two years, but it was worth it. But no one would guess that from looking at me now…

    Liked by 2 people

  11. Ok…. I HATE that we are a society that allows the persecution, prejudice and bullying of people of size. No one knows what someone struggles with. But it is perfectly ok for others to sit in judgement and criticize someone just because they/we are not meeting THEIR expectation of what is an acceptable size. And we do it to ourselves, for example: you DOC… do you really feel your bottom is too big, that it impedes you in anyway,it changes your health situation or are you just satisfying someone’s criteria???
    We, especially women, are expected to live in a state of deprivation in order to meet acceptable proportions based on myths, No one really looks like the media portrays. So we starve ourselves and in most cases rebound over and over. Which, by the way is more unhealthy than staying at one weight. We now feel that surgery is an acceptable method of weight reduction. I know many people who went under the knife, lost significant weight and then put it all back on and then some and had chronic health issues from the surgery to boot. I know one lady who died from the surgery and left two young kids behind. We do not have a safe method to help the morbidly obese but we expect them to surrender to methods that are not proven safe. Example: Fenfluramine or fen phen…
    We conclude that people of size are unhealthy, but that too is a falsehood. It is just as true there are unhealthy fat people just as there are unhealthy skinny people. But our media and society has dictated that automatically people of size are: lazy, unhealthy, unmotivated, not athletic, eat too much or eat unhealthy, It is so not true. And if this was based on ethnic background, this type of discrimination would be racist. But this behavior, this small minded prejudice, is tolerated, exonerated and accepted.

    Liked by 1 person

  12. Have I mentioned I really need to lay off the soda? This is my #1 hang up, the #1 thing I can do to improve my health and my waistline. I struggle. Food, easy peasy. Exercise, not too bad. Soda? OMG. I want to drink soda until I’m bloated with the love of carbonation! I want to drown in soda!
    I know some people who look fit and don’t even work at it, and I know some people who work at it and don’t look fit — I am neither of those. I have to battle the soda and move my body.
    (I haven’t had a soda today, and it’s killing me. lol)
    I hate pills. Like even if you told me there was a pill I could take and drink all the soda I wanted, I’d be like, “Nah, pills are scary.”
    Humans don’t make a lot of sense, huh, Doc? 😛

    Liked by 1 person

    • I started drinking mineral water for the carbonation when I needed a fix. That helped. After a few months of no cokes, when I tried one again I wanted to puke. The withdrawal can be very physical, though. I love that you would rather drink soda than take a pill! 🙂 Soooo many of my patients have similar hang ups over pills!

      Liked by 1 person

      • Exactly that. LaCroix is my friend. It is. Also herbal tea and decaf coffee. It’s easier when it’s cooler weather. A few months without Coke you say? Wow, okay, I’ll try harder.

        Liked by 1 person

  13. Being ready to lose weight is similar to bring ready to quit smoking, or drinking. Literally, in your mind you have to be ready. And changing one’s diet is hard if financially you can’t afford the healthiest food. It’s all a struggle to be healthier and not feel deprived. All the while you’re racing a clock, where instead of numbers, you see hypertension, diabetes, high cholesterol, stroke. The whole world focused on being skinny, and the truth is skinny people die of the above listed ailments. Healthier and active should be the goal. If we can stop fat shaming as a society and focus on healthier as opposed to skinnier, I think that could be a vital first step for us all.

    Liked by 1 person

  14. That’s a tough row to hoe. The culture and food industry doesn’t help.
    I lost 20# this spring, down to my young adult weight, feeling the best in years, yet the pushback I get is astounding. ‘Too skinny.” “Are you sick? (i.e. dying)” With 2/3 of the country overweight, I’m an anomaly.

    Liked by 2 people

  15. I really struggle with diet. I am “lucky”, I can eat half a pizza or full restaurant portion (as a petite 5’4″ woman I surprise a lot of people with how much I eat) and not gain weight. I know that isn’t a healthy source of calories, but frankly current diet recommendations don’t provide enough calories for me… I tried really hard several times to follow portion, calorie and exercise guidelines. I lost so much weight in a few months it wasn’t healthy. I eat a lot of fruits and vegetables, but also a lot of high calorie meat and dairy just to maintain my weight. And then get harassed by well meaning relatives that are gluten free or vegetarian or following some other diet for not eating healthy. I just try not to say anything because my issues are so different.
    And now I have two children, one with my metabolism (I have to take in her leggings because they don’t make any slim enough) and another with Down Syndrome and a tendency to gain weight. We eat meals as a family, but it takes a lot of planning to make and serve meals that are healthy for everyone!

    Liked by 1 person

    • There are conditions that cause difficulty gaining weight (celiac and such) and people who are blessed with a great metabolism. They are judged as harshly as overweight people. They must have an eating disorder, right? If you need to eat more calories to maintain a healthy weight, then you are doing the right thing. It is choosing junk to do that that would be the problem. 🙂

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  16. I don’t know why I’ve gained 30 lbs…puts cookie in mouth, grabs bag of Doritos…but really this is all I’ve eaten all day! I have no idea how you do it!!! Comparing to you…I really like the age as an excuse which I hear all the time when my husband is a beast of a muscular specimen at 45 years old and I hear guys saying, well you know your metabolism slows after 30. Whatever excuse you can come up with buddy! “Wisp of a woman” made me laugh!

    Liked by 1 person

    • Genes play a large part in our body types and metabolism. I will always have a Kardashian butt. Coming to terms with that fact help me not feel like being healthy was impossible. Aging does slow metabolism and that is an added challenge for me, personally.

      Liked by 1 person

  17. As a physician you MUST model good diet and exercise for your patients. An extra burden. Ach! the old weight problem. I waffle ten pounds up and down but have never been able to get close to what I was in high school. Of course, given what I was doing physically then, I can understand why. You are a great role model!

    Liked by 1 person

  18. This time last year I was five feet six inches and weighed in at 93 kilo I told my GP I was going on a diet – we discussed it and he approved of the plan. Before the operation on my knee I was still the same height but I weighed 81 kilo. I was pleased with that. Howeffer!!! since the operation on my knee I have put on weight and last week I weighed 84 kilo – a gain of 3 kilo. I am not best pleased. But the lack of diet and exercise and walking the dog, recovering from surgery and unable to keep up an average of 14,000 steps per day have all gone to pot for the moment.I needs to get out again soon.

    Liked by 1 person

    • Good for you losing the weight! Surgery throws everyone if there is a long recovery period. To address the now sedentary lifestyle a decrease in calorie intake is necessary but who thinks of that ahead of time? Not me. Not anyone. Maybe it should be part of the preop discussion. You sound like you are going stir crazy!

      Liked by 1 person

  19. Doesn’t it just drive you nuts? I was once 50 pounds heavier and work like a dog to keep my current level of fitness and weight. Then everyone says that I am just naturally slim. I’ve learned to just let it go. (cue music from Frozen)

    Liked by 2 people

  20. If I didn’t know any better I’d swear this post was about me 😉. Until very recently I really lost all control of my eating habits. Always had a sugar addiction but it reached the point where I knew I had to make a change (this isn’t the first time I’ve been here). So about a month ago I went cold turkey on going without sweets and substituted them with fruit. It’s going well but I know if the tip of my tongue even touches a piece of candy I’ll be done. Even though I remind myself to make healthier choices I wish there was something I could do about this awful addiction.

    Liked by 1 person

  21. When someone says I’m skinny or thin, I feel like looking around to see if they are talking about someone else. Years ago I stopped sugar cold turkey and had mood swings for a couple months, but it worked. Now that I allow myself occasional sugar, the addiction creeps up on me. So the new rule is I can only have sweets that contain nuts or dark chocolate. Sometimes it works.

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  22. I once had a colleague who told me she wanted to lose weight. No excessive diet and she was active in general. Our workplace being in the centre of Amsterdam I asked how far she lived from the city she told me “about 20 minutes by public transport.”

    I advised her to go to work on the bicycle. She looked at me funny and I thought “oh that is too much effort for you? Time to ignore you…” and she never bicycled to work. Some people really do not like it when you tell them that losing weight requires effort, even when it requires little to no budget.

    Liked by 1 person

      • Actually, it could be worse. Amsterdam is organised and there are rules. You can cruise on your bike and safely get from A to B and back home again. Being alert is necessary though.

        What is worse is when there is no organisation, no rules and pure chaos remains. At worst you have to deal with people on bike or in cars with no understanding of the traffic rules and who treat the roads like a playground.

        Amsterdam traffic looks scary but really is not. No one wants to get hurt so most people follow the rules. Look at Top Gear in India or Vietnam and you understand how it can be worse…

        Liked by 1 person

  23. It’s hard .I never used to struggle when I was younger. Now in my mid 40s I’m as heavy as when I’m heavily pregnant and I can’t shake it off .
    I only want to lose a few kilos yet it’s very hard with my love for KFC and ice cream combined with my loath for exercise. Still I get comments like oh you’re tiny what have you got to worry about? But tiny comes with a tiny frame and my body can’t handle the extra weight.

    Liked by 1 person

  24. Holey moley, you do know how to pull them out of the wood work. (more than 100 comments). A touchy subject and one that so many can relate to. I had best not write very much since I see that a few folks are quite touchy. I feel it is one’s prerogative to choose if they want to look and feel un-healthy. It’s all about where one put his/her emphasis.

    Some over weight people might live longer but the ones that I have seen are all suffering the consequences with diabetes, heart disease and, or worse. It just leads to so many health problems. I see it in the grocery store- I saw it in the hospital. Folks riding in carts with O2 tanks and looking miserable. And they or not what I consider old people.

    Look for NYDJ at a reputable store. Get a sales clerk to help you. They are made to fit any butt. Not sure if they make pants other than jeans but they are high quality and will look good on you. They are about $120 per pair but last a long time. Levi also makes a good fitting jean but the NYDJ is the best. I’m sure you are not allowed to wear jeans to work but I have a pair that don’t really look like jeans. Under a lab coat you might be ok but I thinking you’d not want to wear them to work- principle and otherwise. 🙂

    Liked by 1 person

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