What always gets me about "let me tell you about my diet" is how little training most medical professionals get in nutrition and the full mechanics of weight regulation. (Especially nutrition, ouch.) Those who are trained know enough that one person's diet is not always right for everyone or anyone else, whether they're chasing after weight loss or just trying to eat "healthier." Even for diabetes, there's no "one size fits all" food plan.
As someone else once said, "Thinking that losing weight makes you an expert in weight and nutrition is like thinking that surviving cancer makes you a cancer expert." Even for doctors and other medical professionals, someone is not an expert just from personal experience. This is just perception bias at play.
There are always multiple factors in play. If I eat bread, potatoes, or even cookies, cake, or ice cream, I inject a certain number of insulin units according to how many grams of carboyhydrates those items have, and it keeps my blood sugar in check. However, if I eat rice, I have to inject more than I normally would for the number of carbohydrate grams contained in rice, because for some reason rice blows up my blood glucose readings in a way that bread, potatoes, or cookies and cake don't. I don't know why this happens, and neither does my PA.
It happens because... you're not a clone! I ran a mailing list for fat diabetics (almost all type 2) for many years, and one of the things people discovered is that what one person can eat with lesser effect is another person's 'problem food.' Someone said they could eat ice cream with no issue and I thought they were going to get strangled. :-)
But, seriously, this is very common. I cannot eat a half a bagel without needing extra insulin but I know people who can eat a whole one with no issue. I'm the same as you with rice (white OR brown) but I have no problem with potatoes at all. It's just a mechanism of how our bodies and our metabolisms are all different.
Not sure if you remember me but I was the ED of meda when you came to speak there many years ago . I just want to express my gratitude for all you are doing to help people understand fat phobia and lack of access to appropriate services. So.. you are greatly appreciated and respected and I am so glad i I get to read your newsletter
Of course I remember you! I remember you inviting me to come back and do a keynote even though my breakout talk was controversial, I remember you coming up on stage after my keynote and telling a room full of people that this message needed to be heard, I will never forget that. Thank you for all of your work and for your relentless support of both me and this message, I'm so glad and grateful to know you!
I am so grateful for your concise, clear & informed emails. I look forward to not very much but definitely this is my outlier. Thank you for re-teaching me and for supporting the community. Do you do any podcasts?
Thanks so much Michelle, your comment made my day! I don't produce any podcasts (except the podcast that is just the audio files from this substack!) If you are looking for podcast interviews, you can scroll down on this page to link to past interviews I've done. http://www.sizedforsuccess.com/press.html
Hi Ragen. Thanks for all that you do. I think I know the answer to this, but I was wondering what your take is on Dr Fatima Stanford, and her insistence on treating ob*sity with medication. She was on the well-respected NYT podcast First Person, and she made some cogent and intelligent sounding arguments related to medical improvements. I just would like another opinion, namely yours. I know the damage that fat shaming by the medical community does to people in larger sized bodies, but she seemed to be saying something different, about medical outcomes. Thanks again.
I'm sure that Dr. Stanford is well-meaning, but she has pinned her career to this body-size-as-disease model and is also absolutely a mouthpiece for the weight loss industry (she takes a ton of pharmaceutical payments.) She is adopting their talking points of being "anti-weight-stigma" but only in the service of pushing more dangerous (and expensive/profitable) drugs and surgeries. I talk about this phenomenon in this article if it helps: https://weightandhealthcare.substack.com/p/gina-kolata-and-the-nyt-lobby-for
This article has so many points that are familiar throughout my entire life, to varying degrees. At this time in my life it seems to all becoming to a head.
Always there are the frustrating weigh-ins, and the blood pressure cuffs. Many offices lately are coming around with the cuffs issue, at least where I live. I also have become assertive and sassy in the way I handle it. I pro-actively start out with something that keeps me feeling better before the MA starts fumbling and attempts to find a way to get my bp - somehow. About then I start with: “girl, we both know that is not going to work, go ahead and find the Big Girl Cuff, I’m not going anywhere.” This works much of the time. If they don’t have one, I let the Dr. know that I am sure I am not their only fat patient, maybe they could work with us that are, by simply buying a few. That same general approach has worked with chairs and with gowns. I have followed it up on one occasion with a letter to the head of the company.
My major heartbreak of recent is the need for a full spinal and full brain mri.
Two failed, embarrassing, and horrific attempts at trying, when it was clear at the second facility it wasn’t going to be successful . I tried being stuffed into the tube, which left me shaking and bruised from equipment on the entrance to the tube.
Third attempt was after I called all over the region to find who had the machine with the largest bore.
I got some not quite strong enough tranquilizers from my neurologist. I am a terrified, claustrophobic in the least scary situations. Got on my third table, third facility.
Larger table but still going to be tight. I started trembling, and then my head had to be locked into a tight cage that added another layer and tighter, closer, and terrifying Sound of it brushing against the literally inch to the top, as my hips started to get squeezed tightly going in for what was going to be a forty minute procedure. I squeezed my rescue button and frantically let them know I needed out, now! By the time I got completely out, I was weeping and humiliated. On the way home, I got a migraine. Thankfully, my wife was driving.
I need the brain mri! I have begged to be anesthetized, but that will require more people in order to accomplish it, and nobody wants to pay for it, I cannot. I am now set to go to an “upright mri”, that I went to a long time back. I do not believe I will fit. I told the woman that when we ultimately made the appointment. I told her of my fear, gave her my height and weight. Her response, meant to be kind, was “I see other large patients, shorter than you but the same wight or more, and they fit into it.” thanks, I think? Of course post pandemic everyone books months out. Consequently, my possible condition cannot yet be verified or treated because of this. Each and every appointment is at least 4-6 weeks out, at least! It is something I have tried to handle, but not to an end. I maybe needed to start medication months ago. All because I couldn’t even handle being in the “biggest” mri in town! ( why on earth didn’t we at least start with that one?) by the way, the biggest bore table is 77cm, or about 30 inches. Add pad, bolsters and the dreaded head cage, it all makes it smaller.
Anyway, I needed to just share as the story was so on point for me right now.
These are good tips for healthcare workers who are receptive to change. In my experience as a nurse in a primary care clinic environment, some providers would prefer that patients that make the clinic workflow difficult (thus affecting smooth schedule operation, and possibly RVUs, if more time accommodation is necessary) not return to their practice. Do you have recommendations for patients who suspect that this is the case?
Yes, definitely. I should have put "difficult" in quotes to indicate my disapproval of this tactic. I know that physician burnout and decision fatigue contributes to discrimination against patients, and makes providers less compassionate. I see the perverse incentives and systemic problems of the healthcare system, but recognizing these problems is kind of a patient advocacy dead-end. I'm very interested in your expertise on effective self-advocacy within a problematic practice/healthcare system.
What always gets me about "let me tell you about my diet" is how little training most medical professionals get in nutrition and the full mechanics of weight regulation. (Especially nutrition, ouch.) Those who are trained know enough that one person's diet is not always right for everyone or anyone else, whether they're chasing after weight loss or just trying to eat "healthier." Even for diabetes, there's no "one size fits all" food plan.
As someone else once said, "Thinking that losing weight makes you an expert in weight and nutrition is like thinking that surviving cancer makes you a cancer expert." Even for doctors and other medical professionals, someone is not an expert just from personal experience. This is just perception bias at play.
There are always multiple factors in play. If I eat bread, potatoes, or even cookies, cake, or ice cream, I inject a certain number of insulin units according to how many grams of carboyhydrates those items have, and it keeps my blood sugar in check. However, if I eat rice, I have to inject more than I normally would for the number of carbohydrate grams contained in rice, because for some reason rice blows up my blood glucose readings in a way that bread, potatoes, or cookies and cake don't. I don't know why this happens, and neither does my PA.
It happens because... you're not a clone! I ran a mailing list for fat diabetics (almost all type 2) for many years, and one of the things people discovered is that what one person can eat with lesser effect is another person's 'problem food.' Someone said they could eat ice cream with no issue and I thought they were going to get strangled. :-)
But, seriously, this is very common. I cannot eat a half a bagel without needing extra insulin but I know people who can eat a whole one with no issue. I'm the same as you with rice (white OR brown) but I have no problem with potatoes at all. It's just a mechanism of how our bodies and our metabolisms are all different.
Ragen
Not sure if you remember me but I was the ED of meda when you came to speak there many years ago . I just want to express my gratitude for all you are doing to help people understand fat phobia and lack of access to appropriate services. So.. you are greatly appreciated and respected and I am so glad i I get to read your newsletter
Hi Beth,
Of course I remember you! I remember you inviting me to come back and do a keynote even though my breakout talk was controversial, I remember you coming up on stage after my keynote and telling a room full of people that this message needed to be heard, I will never forget that. Thank you for all of your work and for your relentless support of both me and this message, I'm so glad and grateful to know you!
I am so grateful for your concise, clear & informed emails. I look forward to not very much but definitely this is my outlier. Thank you for re-teaching me and for supporting the community. Do you do any podcasts?
Thanks so much Michelle, your comment made my day! I don't produce any podcasts (except the podcast that is just the audio files from this substack!) If you are looking for podcast interviews, you can scroll down on this page to link to past interviews I've done. http://www.sizedforsuccess.com/press.html
Thank you Ragen!
Hi Ragen. Thanks for all that you do. I think I know the answer to this, but I was wondering what your take is on Dr Fatima Stanford, and her insistence on treating ob*sity with medication. She was on the well-respected NYT podcast First Person, and she made some cogent and intelligent sounding arguments related to medical improvements. I just would like another opinion, namely yours. I know the damage that fat shaming by the medical community does to people in larger sized bodies, but she seemed to be saying something different, about medical outcomes. Thanks again.
I'm sure that Dr. Stanford is well-meaning, but she has pinned her career to this body-size-as-disease model and is also absolutely a mouthpiece for the weight loss industry (she takes a ton of pharmaceutical payments.) She is adopting their talking points of being "anti-weight-stigma" but only in the service of pushing more dangerous (and expensive/profitable) drugs and surgeries. I talk about this phenomenon in this article if it helps: https://weightandhealthcare.substack.com/p/gina-kolata-and-the-nyt-lobby-for
Does that help? Is there something I'm missing?
This article has so many points that are familiar throughout my entire life, to varying degrees. At this time in my life it seems to all becoming to a head.
Always there are the frustrating weigh-ins, and the blood pressure cuffs. Many offices lately are coming around with the cuffs issue, at least where I live. I also have become assertive and sassy in the way I handle it. I pro-actively start out with something that keeps me feeling better before the MA starts fumbling and attempts to find a way to get my bp - somehow. About then I start with: “girl, we both know that is not going to work, go ahead and find the Big Girl Cuff, I’m not going anywhere.” This works much of the time. If they don’t have one, I let the Dr. know that I am sure I am not their only fat patient, maybe they could work with us that are, by simply buying a few. That same general approach has worked with chairs and with gowns. I have followed it up on one occasion with a letter to the head of the company.
My major heartbreak of recent is the need for a full spinal and full brain mri.
Two failed, embarrassing, and horrific attempts at trying, when it was clear at the second facility it wasn’t going to be successful . I tried being stuffed into the tube, which left me shaking and bruised from equipment on the entrance to the tube.
Third attempt was after I called all over the region to find who had the machine with the largest bore.
I got some not quite strong enough tranquilizers from my neurologist. I am a terrified, claustrophobic in the least scary situations. Got on my third table, third facility.
Larger table but still going to be tight. I started trembling, and then my head had to be locked into a tight cage that added another layer and tighter, closer, and terrifying Sound of it brushing against the literally inch to the top, as my hips started to get squeezed tightly going in for what was going to be a forty minute procedure. I squeezed my rescue button and frantically let them know I needed out, now! By the time I got completely out, I was weeping and humiliated. On the way home, I got a migraine. Thankfully, my wife was driving.
I need the brain mri! I have begged to be anesthetized, but that will require more people in order to accomplish it, and nobody wants to pay for it, I cannot. I am now set to go to an “upright mri”, that I went to a long time back. I do not believe I will fit. I told the woman that when we ultimately made the appointment. I told her of my fear, gave her my height and weight. Her response, meant to be kind, was “I see other large patients, shorter than you but the same wight or more, and they fit into it.” thanks, I think? Of course post pandemic everyone books months out. Consequently, my possible condition cannot yet be verified or treated because of this. Each and every appointment is at least 4-6 weeks out, at least! It is something I have tried to handle, but not to an end. I maybe needed to start medication months ago. All because I couldn’t even handle being in the “biggest” mri in town! ( why on earth didn’t we at least start with that one?) by the way, the biggest bore table is 77cm, or about 30 inches. Add pad, bolsters and the dreaded head cage, it all makes it smaller.
Anyway, I needed to just share as the story was so on point for me right now.
These are good tips for healthcare workers who are receptive to change. In my experience as a nurse in a primary care clinic environment, some providers would prefer that patients that make the clinic workflow difficult (thus affecting smooth schedule operation, and possibly RVUs, if more time accommodation is necessary) not return to their practice. Do you have recommendations for patients who suspect that this is the case?
Thanks for pointing this out Claire, I want to give it some thought and I'll create a separate newsletter about it if that's ok?
Yes, definitely. I should have put "difficult" in quotes to indicate my disapproval of this tactic. I know that physician burnout and decision fatigue contributes to discrimination against patients, and makes providers less compassionate. I see the perverse incentives and systemic problems of the healthcare system, but recognizing these problems is kind of a patient advocacy dead-end. I'm very interested in your expertise on effective self-advocacy within a problematic practice/healthcare system.