The government is into preventative medicine or something like that these days, so if you go to your friendly local orthopod's office, they have to ask you about your most recent mammogram, your sexual history, and your vaccination status. Technically they don't, but the way funding is set up, they get reimbursed more if it looks like they care about the patient as a whole. In addition, we are now giving out what we refer to as the "you are fat" handout. The "you are fat" handout goes to anyone with a BMI>25, which is technically overweight going by the BMI calculator (as in, not taking muscle mass into account, etc) but it's not fat. Or at least, it doesn't have to be. Not only that, but you have to give it to a patient each time he/she comes to your office. I guess to make sure they know they're still fat. There's a second "you are fat" handout that you get if your BMI is over 30, which I believe is "obese" if we use the BMI scale. Your office gets reimbursed more if you show you're giving out the "you are fat" handout so we're all doing it these days.
For obvious reasons, I am not a fan of the "you are fat" handout. I mean, I feel like I wouldn't go back to a doctor if the first thing he did was give me the "you are fat" handout. From what I hear, I am not alone in this regard. Apparently there was a 20 year old who started crying hysterically upon being presented with the "you are fat" handout. They haven't seen her since. Also, most of the attendings are really not all that thin. Dr. Orthoking Jr probably weight around 300lbs, so I can't imagine anyone would take the "you are fat" handout seriously if it came from him. He's probably the fattest, but there's a whole pile of them who really aren't so thin. So I'm not sure how seriously I would take the "you are fat" handout if it was coming from someone who was, uh, fat.
Also, the "you are fat" handout is causing me some distress and I haven't even gotten it. The other day in the OR, Dr. Chatterbox was talking about it and he said "I bet everyone in this room has a BMI over 25!" That seems like the wrong thing to say in a room full of women. He then said 'I think everyone in my office has a BMI over 25...well...maybe not the new girl." So I had to calculate my BMI after the case to see if I was, in fact, over 25. I am not. I calculated what my weight would have to be for me to be 25 and I am below that by a wide enough margin that I could go to the all you can eat buffet tonight and then I could still be under 25 tomorrow morning. (I do not think I could do that more than once, however) But still, I don't want my attending to think I need the "you are fat" handout because, like I said, I'm a little bit touchy about it.
Today the "you are fat" handout was mentioned again and I said I had calculated my BMI and I was definitely not over 25 and Dr. Chatterbox said "oh, so what are you? #?"
...and...I got a great evaluation today in the OR. And it has nothing to do with Dr. Chatterbox feeling bad about overestimating my weight by the time I was done. I totally deserved all those "excellents."
And this is why it's nice to work in a mixed gender environment.ReplyDelete
My daughter has been getting the 'BMI notice' for years. In 6th grade the school nurse gave it to her; this after taking her in to see the dr who said she was 'growing normally and within normal ranges.'ReplyDelete
Finally, I explained how the massive calf she has on each leg, mixed with the fact that she needs a 8 or 8 1/2 inch bracelet and a size 10 ring means she may actually be the rumored 'big-boned-girl.'
Last year, she went for her sports physical / yearly physical and two Twiggy sized girls (PA & Intern) announced that her BMI was worrisome, and told her she needed to exercise. (um, that is basketball paperwork in your hand sweetie, what do you think she is doing. Couple that with the dance team discussion you just had and the comments about extra classes and rural areas and tell me what and when you want her to do? My guess, gym membership. 45 minutes each way)
I watch her skip meals and foods to bring her weight down, which leaves her hungry because she is active and too busy to cut up fruit and veggies at 9pm so she grabs a granola bar or some other junk. I see what the problem is. She makes healthy, ill-advised choices at dinner (try two helpings of the veggie heavy stir-fry? Nope, I each too much) followed by desperate choices later on.
Her BMI? Well, she is 5-8 and 170. She'd have an hourglass figure if she had any weight at all on her hips. Her pants fall down because we need to fit them over a crazy inseam and calves. I can't recall the actual number, but they said if she was an ADULT, she'd be ok, but they want it lower for teens. She is 17 folks.
Oh and changing doctors.
If my physician (or any other health care provider) kept giving me a "you are fat" note, without any degree of sincerity or expressed concern for my welfare plus an action plan to NOT get a "you are fat" note the next time, I would politely tell that person where they could file that note and then find another provider of healthcare.ReplyDelete
As for commenting or quizzing colleagues on what their BMI is, one could consider that workplace harassment. It seems fat folks are the last group acceptable to ridicule or otherwise denigrate.
Keep trying anon 0942. However in a couple of years you'll have no doctor at all unless you go to one that doesn't take insurance as it is a mandate of the government to ask. I think BMI is a bunch of bunk. Doesn't matter. If I want to accept insurance, it will be required.Delete
It seems fat folks are the last group acceptable to ridicule or otherwise denigrate.ReplyDelete
Actually, I think the last group may be thin folks. I admit I'm biased as even I can't believe the number of strangers from all walks of life and professions, including patients and even a man who interviewed me, who have seen fit to guess my weight. I'm slender with reasonable muscle mass and body fat but since I'm both short & small-boned, I'm a small person and don't weigh a lot.
Other than in a medical setting, I can't think of a situation where it's ok to comment about how fat someone is, but people feel free to talk about my body at totally inappropriate times.
I agree. I feel like other nurses especially feel like it's ok to ridicule me for my food choices (veggies/fruits) and exercise habits (running). I don't get it.Delete
I disagree. I'm also very slender, and I do get lots of comments from co-workers, patients and even strangers. But I think that hardly compares with what someone who is overweight/obese goes through on a daily basis. I also think that "thin privilege" exists; I get advantages because of my body shape.Delete
Liana, thanks for being the voice of reason here. I agree that no one should be critiqued for being either "too fat" or "too thin," but thin people are not automatically considered lazy/stupid/slovenly etc. etc. etc. It is by far a bigger stigma to be "fat" than it is to be "thin."Delete
I agree with liana. Even though I do get a lot of Annoying comments about being too thin, I know people who are overweight get comments too, and those comments are probably a lot more insulting than what I get.Delete
I wonder how many people now avoid seeking any kind of medical care at all because they know they are going to get one of these handouts each and every time they see a health care professional?ReplyDelete
Probably the same amount that avoid seeking medical care because they are tired of being harassed about smoking or drinking.Delete
Obesity (and its comorbidities) needs to be addressed every time, every visit (as well as smoking and drinking!).
Sorry, just my .02.
I find myself thinking "I need to lose at least 10 pounds first" instead of going in to talk about menopause and weight gain...Delete
I've gotten the "your are fat note". I KNOW I'M FAT!!! That's why I've been working with a personal trainer and increasing my physical activity. I recently went back to the doctor and got the "you are still fat note". It would be nice if they acknowledged that my BMI went from 33 to 27. Fuckers.ReplyDelete
Can I just say, congratulations? That is quite an improvement in your BMI and I know from experience how hard it is to do what you have accomplished.Delete
I am also sick of what I call "food shaming". I was walking down the hall at work after heating up some left over pizza for lunch. A complete stranger comments " that's no healthy you know". God forbid an adult wants to eat a piece of pizza without defending their choice to every person they pass on the street.ReplyDelete
Kind of weird tho, parents brings kids in to see me all the time because they are "too thin" and there must be "something wrong with them". But I see plenty of obese kids and the parents don't think there is anything wrong with that. No one ever brings their child in to see me because they're overweight. Ever.ReplyDelete