Doctor Visits

[Guest slugowl]

Just out of curiosity for the other gainers here -- when you have doctor appointments and know you're going to be weighed and then lectured by your doctor, do you just interrupt them and tell them you're intentionally gaining weight or do you just sorta nod and keep quiet and let them do their spiel every single time? Has anyone actually just told their doctor point-blank "I'm actually trying to get fat/stay fat. I'd rather not discuss your want for me to lose weight."? Or should I just not bother being that blunt with my health care person?

 

Just wondered if any of you had ever gotten sick of hearing it enough to set the record straight. Or if it's even worth doing.

[dania201]

Most people let them do their spiel. If you engage them too much, they try to get you to do WLS (they get a commission if you do it). Most gainers I've known have just taken the "I'm okay with my weight right now" approach in order to diffuse the conversation and get back to whatever real issue is at hand. 

[extra_m13]

a polite and clear answer may be the best

[Guest hhh]

I know this thread is kind of old, but I do love this topic.  My gf is new to the gaining world so it's only recently that her doctor has mentioned it once or twice.  It's exciting to hear that her weight was finally brought up, after maintaining a skinny body her whole life and then suddenly gaining the "freshman 15" several semesters in a row!  She's apparently pretty close to the overweight line, so she was warned about that.  Luckily she just brushed it off like it's nothing, which was great!

[le_gone]

I remember some years ago, I attended my wife's visit to the doctor, she was not yet that fat but had gain some weight and her doctor mentionned it, saying the usual comments about weight gain. She swept his comments, saying "you know, I love so much food at this time and too bad for my weight"

[Guest hhh]

1 hour ago, le_gone said:

I remember some years ago, I attended my wife's visit to the doctor, she was not yet that fat but had gain some weight and her doctor mentionned it, saying the usual comments about weight gain. She swept his comments, saying "you know, I love so much food at this time and too bad for my weight"

Haha, nice.  I wonder if my gf will be saying that one day?  When she was skinnier, she would have fell over backwards if you told her she would some day be overweight.  And yet here she is, only like 8 lbs away from overweight, and she doesn't seem to care one bit!  Her doctor advised her to start exercising and cut back on her drinking. She told him she would, but I'm pretty sure neither of those is going to happen any time soon!

[Guest billow]

On 4/6/2017 at 11:24 AM, hhh said:

I know this thread is kind of old, but I do love this topic.  My gf is new to the gaining world so it's only recently that her doctor has mentioned it once or twice.  It's exciting to hear that her weight was finally brought up, after maintaining a skinny body her whole life and then suddenly gaining the "freshman 15" several semesters in a row!  She's apparently pretty close to the overweight line, so she was warned about that.  Luckily she just brushed it off like it's nothing, which was great!

Her doctor brought up her weight even when she only has a BMI of 23.3?  Wow, he/she must really be anti-fat/a health fanatic!

Technically, she was rather underweight at first, and she's still 10 pounds away from being overweight.

[Guest hhh]

25 minutes ago, billow said:

Her doctor brought up her weight even when she only has a BMI of 23.3?  Wow, he/she must really be anti-fat/a health fanatic!

Technically, she was rather underweight at first, and she's still 10 pounds away from being overweight.

It was less the weight, and more the rapid gain.  To stay a steady, skinny weight your whole life and then gain 40 pounds in a relatively short span is unusual.  I like how they ask if she was feeling depressed, when it's actually quite the opposite!

[Dr. Feeder]

I think ideally she should tell her doctor so he can keep track of her risk factors. Some doctors probably can't handle this and will read her the riot act for even thinking of gaining, but others may help her figure out if she's becoming pre-diabetic etc. and should cut back on the Twinkies or whatever.

If that's too hard: there's an in-between thing she can say (that may even be true): "I've tried dieting and find that I'm happier eating what I want."  I advised a woman who wanted to figure out how to talk to her mother about this stuff. She tried that line and it worked out: http://askdrfeeder.dyndns.org/letters.html#Amanda

I have not heard of anyone trying this stuff on an actual physician though.

[Guest hhh]

On 4/8/2017 at 6:20 PM, Dr. Feeder said:

I think ideally she should tell her doctor so he can keep track of her risk factors.

True, at some point I'm sure she'll give up on the whole "Okay I'll try to eat healthier and get fit" thing, when she knows perfectly well she's gonna go home and sit on the couch, eat some chips, and down a few beers, and fall asleep.  She even has a Fitbit that her mother got her for Christmas.  She wears it all the time, but I'm guessing it's mostly for show since she never ever checks it.  I'm sure her doctor would LOVE to hear that, haha!

[Guest MUSEic]

I understand that this is sort of a safe space for everyone, but honestly doctors are counseling their patients on weight loss for good reason. Obesity is second only to smoking when it comes to risk factors for comorbidities. If that's a risk that you're willing to take, then so be it, but a doctor has no way of knowing that, and to assume otherwise would be akin to malpractice in the profession's eyes.

Moreover, there are very specific ways in which obesity can be directly harmful to the body outside of cardiovascular health which people seem to focus on. This includes greater risk of joint degradation, back pain, breast cancer and endometrial cancer, colon cancer, blood clots, sleep apnea, liver disease, infertility, pregnancy risks, hernias, high risk anesthesia, surgical complications. Obesity touches literally every aspect of health in one manner or another. Things may be fine now, and a person can live their entire life without obesity harming their life, but should something go wrong (accident, cancer, illness, etc), obesity complicates almost every single aspect of your medical care.

Yes, the lifestyle is comfortable, and for BBW's and FA's, it's extra enjoyable, but people need to be aware that generally speaking doctors don't have a vendetta against fat people. There are in fact risks, and if you were exposed to the number of people in incredibly morbid conditions due to their lifestyle choices, you would be as frustrated as a doctor when they have to manage a patient who has no interest in losing weight.

[Guest hhh]

11 hours ago, MUSEic said:

I understand that this is sort of a safe space for everyone, but honestly doctors are counseling their patients on weight loss for good reason. Obesity is second only to smoking when it comes to risk factors for comorbidities. If that's a risk that you're willing to take, then so be it, but a doctor has no way of knowing that, and to assume otherwise would be akin to malpractice in the profession's eyes.

Moreover, there are very specific ways in which obesity can be directly harmful to the body outside of cardiovascular health which people seem to focus on. This includes greater risk of joint degradation, back pain, breast cancer and endometrial cancer, colon cancer, blood clots, sleep apnea, liver disease, infertility, pregnancy risks, hernias, high risk anesthesia, surgical complications. Obesity touches literally every aspect of health in one manner or another. Things may be fine now, and a person can live their entire life without obesity harming their life, but should something go wrong (accident, cancer, illness, etc), obesity complicates almost every single aspect of your medical care.

Yes, the lifestyle is comfortable, and for BBW's and FA's, it's extra enjoyable, but people need to be aware that generally speaking doctors don't have a vendetta against fat people. There are in fact risks, and if you were exposed to the number of people in incredibly morbid conditions due to their lifestyle choices, you would be as frustrated as a doctor when they have to manage a patient who has no interest in losing weight.

I'm pretty sure everybody knows all of this already.  Nobody here is under the impression that being fat is healthy, or that doctors have anything personal against fat people.  We get it, there's no need to be that "Well, actually..." guy and rain on everyone's parade.  Also, you keep referencing obesity, which is an extreme category that only covers a certain portion of the girls on this site (certainly not my girlfriend, for instance.) 

[scissortooth]

The only problem I have with docs is that when they see a fat person, they assume in most cases that they feed on McD, lard sweets and cookies and spend most of the day sedentary. And often when the patient claims otherwise, they don't believe them. And some consider fatness an explanation of half the conditions you can have. High cholesterol? You're fat. Irregular periods? You're fat. Heart problems? You're fat. And unless you have a battery of tests proving that um, no, it's not because I'm fat, they tend to follow this simplest route.

Yeah, obesity is a risk, but how much of a risk it is depends on a huge deal of factors. And many people tend to assume a very direct relationship between obesity and being unhealthy. Nope, that ain't that simple.

[Guest wtfmate85]

What I'm about to post ignores comorbidities and jumps to years of life lost (YLLs) for the most part. Oh, and if your goal is to be above 350 pounds at any point in your life, you're going to be past the point of this post.

 The obesity paradox, for those unfamiliar, is the paradox that even though comorbidity is highly correlated in obesity, when compared to individuals with healthy weight BMI (18.5-24.99) with the same weight-related comorbidities ("skinny fat," normal-weight type 2 diabetes, obesity correlated cancers, CVD) overweight and obese class I and sometimes class II (rarely class III) have better health outcomes than normal weight individuals.

Additionally, in many meta-analyses, there is the appearance of a u-shaped distribution with regards to relative risk of mortality that tends to show, even in younger populations sometimes, that being mildly overweight (around 27 BMI) is strongly correlated with having the lowest risk of mortality. Of course, BMI is a population-model tool that ignores many variables. Which is why I'm also bringing this link http://www.absicalculator.eu/ which is a statistical model that graphs relative risk with BMI combined with ABSI. The on-its-way-to-becoming a theory behind this lesser risk associated with even obese BMIs is the developing hypothesis behind being "metabolically healthy obese." Which probably comprises only between 20%-33% of the obese population, and is strongly related to their overall physical activity level and the level of visceral adipose tissue (VAT) in relation to subcutaneous adipose tissue (SAT).

Fortunately, for most of us I believe, SAT is the far better fat to have. It is generally associated with increased insulin sensitivity and improved glycemic control, whereas VAT (for all us men who like to die young) is strongly associated with all obesity-related comorbidities.

That all being said. Here's some fun graphs. Sorry for the long post, but part of coming to terms with my attraction to fat chicks at one point included a period of trying to rationalize and see what would even be possible for my partner to achieve and still remain (relatively) healthy. We all trade our vices for lesser life. I'm working on a literature review that compares lifestyle factors and their hazard ratios with respect to YLLs and mortality. From the review so far, I think a fair thing to be able to say would be some examples like the following of people with equal longevity or cases where the overweight/obese person in the example is better off. Lastly, fun graphs at the bottom for interest.

Example 1: I'm going to use ACG's generously provided measurements in her thread to compare herself to herself lol @AnonymousCollegeGainer Thanks for your information.

ACG in 2010: 138 pounds, 65" tall, 28" waist. BMI: 23. "Health Weight BMI"
ACG in 2014: 170 pounds, 65" tall, 34" waist. BMI: 28.3 "Overweight"

From what my current look at the existing literature (probably gotten through about 24 different studies that would qualify for this type of analysis), if ACG, in 2010, ate a 6 oz steak 3x a week, ate <3 servings of fruit a day, drank more than a moderate amount (>3 14g servings per day), and didn't exercise at moderate intensity for 30 minutes a day, 4-5x a week, then she would be more at risk of mortality and even more at risk of some obesity-related comorbidities (at the normal weight) than her 2014 self 32 pounds heavier with 6 more inches on the waist. Even, ACG in Dec 2016 at 186 pounds with a 36" waist (a BMI of 31 "obese class 1") would be of similar or possibly better health than her 2010 self provided she practiced much better health practices than her 2010 self. 

Understanding that all of this is a trade-off of health choices. Clearly, if you were shooting for longest living woman, you would just stay at around 130 and practice all the good health practices imaginable, but everyone has their vice. The hypothesis behind the existence of the obesity paradox at all (look at the two U-shape graphs I've attached to see it), lower BMIs have a higher mortality likely because smokers are confounding that data along with the fact that persons who live with terminal disease for any significant length of time generally get to a low BMI prior to death.

So, the science is definitely not "in" and in favor of packing on the pounds by any means, but if you're not trying to be the longest lived person and just looking to get your kink on and remaining pretty healthy without actually losing a bunch of your life, it seems that's a fairly attainable goal if you trade off some bad habits with some good habits.

Speaking of which, don't take crap from a smoker if they want to talk about obesity being unhealthy. A fun thing to identify is where the line would be with regards to how fat you would have to actually get to match the YLLs when compared to smokers
 

Here's a YLL graph from the 2003 study titled "Years of life lost due to obesity" (http://jamanetwork.com/journals/jama/fullarticle/195748)
 

In this graph, you can see for white women and men (african-americans have a separate graph), that you have to be pretty hefty before you'd match the risks a normal-weight smoker encounters simply by being a smoker (10 YLLs). Being a class III obese smoker spends 21 years of your life (takes your LE to 60 years roughly). You can see on the graph that for white women, there is not a point in this study where being any weight (bear in mind that the population in these studies of individuals in the >45 BMI group is low) ever approaches more than 9 YLLs. The average american woman is 5'4" tall. You'd have to be 262 pounds at that height at 20 years old before you approach the risk a normal-weight smoker sees.

Going to continue on to the next post. You asked for it. You're browsing lifestyle discussion just like me.

 

[Guest wtfmate85]

I have attached the remaining graphs I've saved for this post. If you need me to look them up (just trying to finish my diatribe here), I can do that, but I assure you I didn't make these myself.

WHtR = Waist-to-Height Ratio. Your waist circumference (WC) divided by your height. WHtR has also been positively and strongly correlated with different weight-related comorbidities and mortality. Shown here in YLLs, as well. I think YLLs is one of the easiest ways to grasp the risks. That and annual incident mortality. When they say your risk of death at 30 from being morbidly obese is 4x greater (made up statistic, probably) than a normal weight individual, well, if mortality at 30 for your population is .8 individuals per thousand individuals. Well, then your risk is not the .08% that your average, normal-weight buddy has. Your risk is now .32%. Now, granted, not something to scoff at. If I was forced to play a death lottery, and you could buy extra tickets, I suppose I wouldn't be clamoring to better my odds, but the facts are that pretty much everyone has a bad health choice they partake in regularly. I, for one (if you couldn't tell), am a little annoyed at the DRAMATIC difference in the amount of judgment that a fat person gets for simply being overweight or obese when compared to a smoker. You would think people were worried about second-hand or third-hand obesity. Just being near a fat person talking won't hurt you in the least (don't be a technical timmy and point out that a larger person is going to put off more residual radiation), but being near a smoker with any regularity is demonstrably bad for you. From what I can tell, I'd put a guess that if you had to choose which would be more harmful between being 20 pounds overweight from 25 on and having a best friend you hung out with regularly (while they smoked) who was your friend for 30 years, being 20 pounds overweight would probably be considered a wash at that point.

Also of interest in these YLLs graphs is how the obesity paradox is represented. And I believe this study adjusted for factors such as smoking, socioeconomic status, etc. So, this data here strongly suggests that the obesity paradox does exist and isn't just confounding variables. Still, of note is that a white woman with a BMI of 20 seems to have a higher YLLs than a white female with a BMI of 31. In other words, if your average height american woman weighed 116 pounds, under the graph shown here, have a lesser life expectancy than a woman of the same height who weighed 181 pounds.

*******NOTE! These two YLLs graphs are for WHITE WOMEN (sorry, I'm married, and I selfishly only concerned myself with her health based on her demographics, this information is out there for other ethnicities).

I know they were long posts, but it's interesting and useful for me, and I assume others like me. My preference for women (now, my wife) is around 31 to 32 BMI, it's nice to know that provided there isn't something hidden in her genetics that causes her to have higher than normal triglycerides, insulin levels, LDL or VLDL, or decreased glycemic control (metabolic syndrome symptoms), then she could actually reach what I think would be an amazing goal (if she wanted to reach it, all women should get to feel beautiful at whatever weight if you're the one telling them you love them) and remain relatively healthy. We do like food, but we like hiking, too. So, you can live an even more healthy life than a thin person who just works a desk job and parties on the weekend at low-grade obesity and walking the woods...even if you will sweat a good bit more...

[AnonymousCollegeGainer]

Fascinating! 

[Guest MUSEic]

15 hours ago, hhh said:

I'm pretty sure everybody knows all of this already.  Nobody here is under the impression that being fat is healthy, or that doctors have anything personal against fat people.  We get it, there's no need to be that "Well, actually..." guy and rain on everyone's parade.  Also, you keep referencing obesity, which is an extreme category that only covers a certain portion of the girls on this site (certainly not my girlfriend, for instance.) 

"Nobody": clearly not or these threads wouldn't exist. And they're fairly common posts  and themes on other FA websites.

If everybody is already aware, then I'm not raining on everyone's parade. Just because coffee is hot, doesn't mean I shouldn't remind someone that is and to be careful.

I also reference obesity specifically and with purpose. It covers the vast majority of active women on this site, and  a fair proportion of men, and is therefore directly relevant to this site. Furthermore, obesity is not an extreme. Approximately 1/3 of all people in western developed countries are obese. It is very common place.

[Guest MUSEic]

12 hours ago, scissortooth said:

The only problem I have with docs is that when they see a fat person, they assume in most cases that they feed on McD, lard sweets and cookies and spend most of the day sedentary. And often when the patient claims otherwise, they don't believe them. And some consider fatness an explanation of half the conditions you can have. High cholesterol? You're fat. Irregular periods? You're fat. Heart problems? You're fat. And unless you have a battery of tests proving that um, no, it's not because I'm fat, they tend to follow this simplest route.

Yeah, obesity is a risk, but how much of a risk it is depends on a huge deal of factors. And many people tend to assume a very direct relationship between obesity and being unhealthy. Nope, that ain't that simple.

And you know what? That's a fair criticism. Doctor's shouldn't assume anything. But the flip side of that applies as well. Doctor's shouldn't assume that a person who walks into their office is active and eats right regardless of their size. The fact of the matter is that most people in western society, skinny or fat, are not as active or eat as well as they ought to be.

And you know what, obesity is NOT the cause of all of these problems. That doesn't however mean that weight loss doesn't often help. The simple act of losing 15 lbs, whether it's due to exercise, eating, loss of adiposity, or a combination of above, often has tremendous health benefits. More than lifestyle modifications alone. And If I recall correctly, your wife has PCOS, correct? Fat does not cause PCOS. But PCOS causes hyperestrogen and hyperinsulinemia. The most effective means of reducing those is by losing weight.

[Guest hhh]

9 minutes ago, MUSEic said:

"Nobody": clearly not or these threads wouldn't exist. And they're fairly common posts  and themes on other FA websites.

Are you under the impression that these threads are people saying their doctors are wrong?  I don't know about you, but I don't think I've ever seen a single post saying that.  The point here is people knowing the risks, and still being willing to take that risk to enjoy what they love in life, even when the risks are repeated ad nauseam by people such as doctors and yourself.

12 minutes ago, MUSEic said:

Just because coffee is hot, doesn't mean I shouldn't remind someone that is and to be careful.

Yes, it does.  That is also an inane thing to do.  It doesn't surprise me that you're the kind of person who'll walk up to a stranger with a coffee and go "Careful, that's hot! You could seriously burn yourself! 36% of burns occur when..."  Leaving the person to look at you like, no shit it's hot, I specifically ordered it that way.  And just like the gaining on this site, it's a conscious choice regardless of the risks.

Now can we please get this thread back on the rails?  

[Guest MUSEic]

8 minutes ago, hhh said:

 

No, I'm trying to explain to people that's literally a doctor's legal and ethical obligation to make these facts known and it's never going to end, so that way I don't have to hear about dinguses like you gripe about it all the time.

[scissortooth]

7 hours ago, MUSEic said:

And you know what? That's a fair criticism. Doctor's shouldn't assume anything. But the flip side of that applies as well. Doctor's shouldn't assume that a person who walks into their office is active and eats right regardless of their size. The fact of the matter is that most people in western society, skinny or fat, are not as active or eat as well as they ought to be.

And you know what, obesity is NOT the cause of all of these problems. That doesn't however mean that weight loss doesn't often help. The simple act of losing 15 lbs, whether it's due to exercise, eating, loss of adiposity, or a combination of above, often has tremendous health benefits. More than lifestyle modifications alone. And If I recall correctly, your wife has PCOS, correct? Fat does not cause PCOS. But PCOS causes hyperestrogen and hyperinsulinemia. The most effective means of reducing those is by losing weight.

Actually, PCOS was one of the diagnoses on the way (with recommendation to lose weight, obviously), but it turned out that basically the mother of all problems were her overactive adrenals. Idiopathic, because she had them examined and there are no lesions of any kind. Might run in the family, considering her dad has the same problems and her mom had some issues that can be attributed to hormonal balance as well (and she is slim). Anyway, it was probably like that - excess cortisol messed up her insulin levels and overactive adrenals produced excess weak androgens, messing up her period and some other stuff on the way. Plus, either that cortisol thing or some other event caused her immune system to get a bit overzealous and made her thyroid self-destruct to some point, which messed up the situation further due to a degree of hypothyroidism. All in all, all these things contributed to her getting fat, not the other way round. Now on metformin + dexamethasone + thyroxine she is almost A-ok, the only problem being that her periods are still somewhat irregular due to prolonged follicular phase, but other than causing some problems with getting pregnant (which can be easily fixed by a competent gyn it seem, and in the long run might even have the benefit of us being able to have sex without protection (which we both like - she likes it even more than me) without her having to use any birth control - which is good because BC is totally un-recommended for her) she has no problems now. Normal sugar, normal insulin, normal lipids, normal mood. And currently at her fattest or near that.

But in order to reach that point we had to visit a doc on the other side of our country and pay twice the usual price for visit (not to mention devoting a whole day to that journey). And then, suddenly, instead of "it's just you hormonal profile" or "it's because you're fat" we heard - "ok, so according to these results and your history shit A caused shit B and that's why you are where you are; take this and this, check your blood in 2 months and tell me if it worked". It did. Hooray for competence. The fun part is that I actually knew what the diagnosis would be before we got there, after reading a couple of abstracts and studies at NCBI. It was not exactly rocket science, it just required to have general knowledge in fields other than a single specialization and a bit of creative thinking. But it's not really possible if a doc devotes to you only those 10 mins you spend in their office. The lady doc who provided us with that final diagnosis actually exchanged e-mails with me prior to visit and after she received the history of previous test results she gave me a list of blood tests my wife should do before we went to see her. Seriously, too many people consider themselves experts these days, but this means we only should value the true experts more.