Yesterday I discussed my first visit with Debra Horne and I thought it went well. When I walked into the room for the second visit, she took one look at me and started crying. When a woman looks at you and immediately starts crying I have learned through hard experience that is not good. I was really baffled.
“Oh no, what’s wrong? Are you ok?” was all I could think to ask. It turned out everything was better than ok. She said, “For the first time I have hope!” The tears were tears of happiness. “I have been to many doctors in the last few years, and it was always the same. I could see it in their eyes. Here comes the fat girl. There is nothing that I can do to help her!” They would tell me to lose weight, like I didn’t know. They would tell me to go on a diet, and I have done that but I only got bigger. You were the first one who did not judge me and helped me understand how I could help myself.
Of course, I was relieved but saddened at the same time. Her story underscored the failure of our current system for most people like her. I could not have been more sympathetic. I am an internal medicine doctor and I had weighed 307 pounds myself. Like her, I did not want to be sick or fat, but the prevailing dogma and interventions were no help. To make it worse, doctors were prescribing medications that cause weight gain, and then dismissing her because she was “noncompliant”. We should never prescribe medications that cause weight gain for a patient who has a weight-related illness unless our backs are just up against the wall.
Weight is like any other medical problem. Success requires root cause analysis. Too many Americans take medications that cause weight gain. Processed foods combining fat, salt, sugars, and carbs are irresistible for many of us like me and Debra. Excess weight is mostly about addictive food.
Durable success for us required changing what we eat for all but one meal a week-lean meat, eggs, low-fat dairy, seafood, fruits, vegetables, beans, peas, and nuts-real whole foods. This lady lost 150 pounds 13 years ago and she is still slender. Three others lost over 100. I lost 60. Sixty percent of my diabetic patients lost weight while achieving better glucose control. In usual care, diabetic patients achieving better control gain weight because of ineffective dietary advice and medications that cause weight gain.
As with blood pressure and blood sugar treatment, weight management success must meet the same criteria. Do you help your patients lower their blood pressure and keep it down. Do the people you are seeing lose weight and keep it off? That is the critical question. Americans spend billions on weight loss and they don’t get much for it. If you cannot find out how many patients lose weight and keep it off, save your money. If you see an overweight person coming in your room and you think “ Here comes the fat girl, there is nothing I can can do to help her”, it is time for serious self examination. We have the tools now to help patients with diabetes live longer healthier lives. Eat real food. Avoid medicines that cause weight gain.
I will take Christmas Eve and Christmas off. Happy holidays.
You're a great mentor. Thank you for continue to inform/educate us. Merry Christmas!
Love this! I love our Internal Medicine doctor but when I go I feel like I am a hamster on a wheel. I know that the administrators are dictating how much time they can spend with each patient and they're hands are tied but that is not benefiting the patients. Your patients were so lucky to have a physician who cares for the patient not the dollar. Merry Christmas to you and Bari!