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How do we tell them that they are fat???

Discussion in 'General Issues and Discussion Forum' started by footdrcb, Feb 6, 2011.

  1. footdrcb

    footdrcb Active Member

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    Hi all. I just treated a patient this morning with bilateral calcaneal spurs, plantarfasciitis and associated aches and pains blah blah. After many years in practice I still stumble for words when asked by that patient "why is this happening ?" . The answer is so simple "You are too fat" . I still stumble around for a non offensive answer. Im sure these people "know" the answer themselves. In my younger days I used to tell patients that they were overweight and hey presto, never saw them again . :bash:

    Look forward to hearing your own experiences.

  2. fatboy

    fatboy Active Member

    i merely state Newtons' 2nd: F=ma

    then ask them how fast they run...
  3. drsarbes

    drsarbes Well-Known Member

    This is what I do;

    I tell any obese patient to purchase one of those talking scales, the ones that "tells" you how much you weigh.

    If they step on it and it says "one at a time, please" I think they'll get the message.

  4. footdrcb

    footdrcb Active Member

    Mate, that is very funny . 10 out of 10
  5. Or if it says "no coach parties please"...

    Explain the frog in boiling water concept. Give them a 20 kilo weight and ask them to walk up and down with it. Ask them if it felt difficult. When they say yes explain that this is exactly what their body is doing now, its just it happened slowly so they didn't notice. Tell them as much easier as it got when they put the weight down is how much easier their feet will feel if they lost weight.

    This is arrant nonsense of course but its a nice example.
  6. footdrcb

    footdrcb Active Member

    Excellent , I tried that myself once...a 20 kg back pack...on a bushwalk. Hard yakka . :boohoo:
  7. joejared

    joejared Active Member

    Sometimes people need to be offended. "You're not big boned; you're just boned. if you were big boned, your arches wouldn't have collapsed due to exceeding the load capacity of your foot structure. Please take the freight elevator on the way out.". Realistically, no amount of therapy will help them unless they're willing to take a couple steps away from the twinkies and towards normalcy anyway.

    A few months ago, a friend asked me about his feet, which were horribly damaged by obesity and diabetes, and the fact that he doesn't take care of himself and continued to drink knowing full well he's an alcoholic and 100+ lbs overweight. I actually did scan his feet, but due to the restrictions of his range of motion had to literally tilt the scanner because he couldn't center his foot on the scanner window. Recently, his wounds finally closed up and he's got about another 70 lbs to go. Being nice about his condition wouldn't have done anything and his podiatrist was just as blunt about his condition.
  8. Catfoot

    Catfoot Well-Known Member


    but I am rather concerned about this part


    I have never heard of this and wonder if it is another animal welfare issue I need to be concerned about ?


    PS Still doing research about the whitebait.

  9. LMAO!!

    Those poor lil' fish (sniff).

    Old story. The concept is that if you drop a frog into boiling water it will jump out. If you put it in cold water and heat it gradually it will stay put until the water boils and it dies. The point being that small incremental changes (like putting on weight) are harder to detect and more likely to be accepted than the same change administered all at once.

    The frog in boiling water concept has been studied. Apparently several experiments showed that the frog will indeed not jump out of a pan of water until it boils to death provided the water is heated slowly enough. It seems that provided the temperature increase is less than 0.002°C per second the frog will remain in the water until it dies. Some modern commentators have disputed this, however the experiment has not to my knowledge been repeated recently. However there is good deductive evidence that at least half of the story is untrue as we DO know that if you drop a frog into boiling water it won't jump out, it will die instantly. Much like shellfish. Yummy, yummy shellfish. Jellied eels yesterday, my favourite thing. *

    Evidence is a wonderful thing.


    PS. No frogs were harmed in the writing of this post.

    *Yes I know they're not shellfish.
  10. Loved the article!!

    Hurt trout behaved differently
    You know, I think you can tell! Poor little trout. Poor, tasty, little trout.
  11. footdrcb

    footdrcb Active Member

  12. W J Liggins

    W J Liggins Well-Known Member

    Just to get serious a moment...

    Have copies of the BMI scales handy and dish them out with their weight, and ideal weight marked on.

    All the best

  13. Catfoot

    Catfoot Well-Known Member

    Back to the topic of this thread.

    IMO there is no easy way to tell someone they are overweight and you should certainly never tell someone they are "fat", that's just plain rude and not professional.

    In the States patients are registering complaints about doctors who are telling them that they are "obese", so physicians over the pond have to say that a patient has "excessive calorie stores" or are "adiposially gifted". Airlines talk about a "person of size" who takes up two seats on an aircraft (and therefore has to buy 2 tickets).
    To me this is political correctness gone barmy.

    If you have a good relationship with a patient who develops weight-related problems, you might be able to gently suggest that "I think your weight might be a factor in your foot problems - what do you think?".

    Most people who are overweight know that they are. If they are in denial about it or don't want to take responsibility for it then there's not a lot you can do.

    At the end of the day they have the right of self determination and if they want to be obese that is their choice. However, they should also be aware that this choice will have a negative effect on their treatment plan. Therefore, this must be explained to them at the first consultation, if you think their weigh is an issue. If they choose to go away and not come back then, again, that's their choice.

  14. Good points.

    Especially this one. We have a duty to inform, but that is all.
  15. Catfoot

    Catfoot Well-Known Member

    As a postscript to this, I am sure we are all familiar with the very similar problem of unsutable footwear.

    The same principles apply but patients can make up better excuses like, "oh no, I don't normally wear these shoes, but the others are in the cobblers". Now, although we know the only cobblers in the equation are what they are talking, we can't do a lot about it.

    At least obese people can't say " oh no, I'm not normally like this, but I decided to put on 150lbs of adipose tissue today for a change ........":D


  16. footsiegirl

    footsiegirl Active Member

    CF is right, of course. To say bluntly that someone is "fat" is just rude. Its not that much of a delicate subject is it?!

    I would say that "just as excessive weight can contribute to/cause serious health issues, it can also be responsible for your foot health too." It is your responsibility to inform individuals about such matters, although it wont necessarily make any difference. People give all kinds of excuses, if they are not ready to accept that only they can make the necessary changes. I cant count how many times I have heard someone say "its not what I eat - I hardly eat anything" (!!) Then they go on the describe their diet in detail, and it plainly IS what they eat!
  17. RobinP

    RobinP Well-Known Member

    Just to go back to the funnies for a minute. One of my favourite Garfield cartoons was when Jon bought Garfield a set of talking scales. I cannot find the comic strip for it but the dialogue for it is as follows.

    Garfield steps on to the talking bathroom scales

    Scale: Let me put it this way... Have you ever considered a career as a river barge?
    Garfield: Your mother was a blender!
    Scale: That hurt.

    On the serious note, I usually give all the risk factors, as there are generally more than one. Second on the list is always being overweight, rather euphamistically said thus, " your weight is clearly a major contributory factor". Always go for weight 2nd. It's not first so it doesn't sound like you are picking on their weight. It's also early enough on the list for them still to be listening and to make an impact.

    Two thing really irritate me about patients attitude towards weight issues.

    1. The complaint that their weight gain is a viscious cycle. They can't exercise so they can't lose weight. I don't do any exercise but I can lose weight, I just eat smaller portions more regularly.

    2. I don't understand because I am slim, so I don't know anything about being overweight. How do you know if I have been fat or slim before. To be honest, I get the same thing when talking in paediatrics about getting appropriate footwear for childrens feet. There seems to be an assumption that, just because I am not the mum, I don't take my kids to buy their shoes or look after them on a daily basis so I don't understand the problems. My wife and I share childcare duties so I know exactly how difficult it can be.

    ....and breathe! Retiring my soap box for the evening now.

  18. Boots n all

    Boots n all Well-Known Member

    To be delicate yet make your point is an art in its self and worth practicing, dont worry you will get plenty of opportunity to practice.

    When faced with these clients we say.

    "You do realize its your structure that is causing these problems, have you consulted a dietitian to help you"

    At this point they either look at you with a blank face, the whats he talking about look, change the subject or as one client told me late last year "Yer, l have cut down on my Cola in take by about 4 liters a day, its hard!"
  19. footdrcb

    footdrcb Active Member

    I find that very clever. And yes, Cola is a common thread in most patients that are overweight (to quote a dietitian friend of mine) :wacko:
  20. I just tell them that it's not their fault, but they simply have a hyper-intense gravitational field around their body at all times. Couldn't possibly be their own fault....now could it?:rolleyes::cool::eek:
  21. Boots n all

    Boots n all Well-Known Member

    LOL, Star Tek fan are we Kevin?
    Sounds something like Dr Spock would say
  22. footdrcb

    footdrcb Active Member

    Like it Like it
    FDCB :santa2::drinks:good:
  23. footdrcb

    footdrcb Active Member

    Here in Australia we call them BFDA'S BIG FAT DUMPY ARSE...

    Catfoot... Maybe i should be more candid .....thanks for your well informed advice....


    Fat FDCB ... can someone pass me the chocolate????
  24. Peter

    Peter Well-Known Member

    my approach has always been to eliminate the forces, where practically possible causing the pathology using our array of orthoses/splints/FW advice, and if said pt is still symptomatic, tell the parents you have eliminated all the forces within your capabilities, but ask them if THEY think there is still something contributing to continued symptomology?

    Sometimes the penny drops.............:bang:
  25. Heard a good one today...

    "You're fat. I'm not going to sugar coat it for you because then you'd just eat that as well. "
  26. Peter

    Peter Well-Known Member

  27. peace

    peace Member

    Quote from another thread regarding prejudice

    'I find that deeply embarrassing, both as a Podiatrist AND as a Christian. Some people just don't get it'

    Being offensive to overweight people is just as bad as being offensive and prejudice to any other section of society.

    I applaud those who have posted and attemped to address this with sensitivity, and hope that those who have not may at least consider what they have posted
    Last edited: Feb 8, 2011
  28. My deepest apologies to any overweight people who found this joke offensive.

    If I refused to see overweight patients, work with overweight podiatrists or walk out of a course because the tutor is overweight then this would indeed be comparable. But this is a different thing. This is humour. Its offensiveness is entirely subjective and in the mind of the offendee.

    I don't get pissy when people rip it out of me for any of my many flaws or opinions. I know a soliciter (poker buddy) with a HUGE selection of lawyer jokes. Ireland has yet to invade over the irish jokes and I'm not aware that I've successfully offended any blonds with jokes about them (although its possible they just did not understand):rolleyes:. I don't like the life of brian but I don't get pissy about it or people who do, I just chose not to watch it. Garfield has had fat jokes as a staple for decades and the PC lobby have not yet shut him down. Dilbert pokes fun at managers and most managers I know love it.

    There is a rather large difference between situational humour and discrimination or prejudice. But if you find this thread offensive, instead go have a look at Godhatesshrimp.com. Its a website parodying the more excentric aspects of christians. Its a hoot. Don't worry, I said its ok.

    Have a nice day.

    PS, Simon, Tim ian and Del, I'll need your BMIs immediately so I know if I can still work with you.
  29. blinda

    blinda MVP

    Never :rolleyes::empathy:
  30. Peter

    Peter Well-Known Member


    I saw it as a joke

    not an intentional act to discriminate.

    If we were to be discriminatory on this site, we could fill our boots with a dig at Aussies, Brits, Irish, Pod surgeons, educationalists, Canadians,Belgians (or as Monty Python would put it, lousy fat belgian bastards), Americans, people from Stoke, women etc.
    But we don't, we have a lighthearted look at life and the people that colour our lives daily.
  31. Peter

    Peter Well-Known Member


    As Robert did ask a relevant question in his OP, perhaps you care enough about the sensitivity of the issue to furnish his question with an erudite response?
  32. Well, we try...:rolleyes:

    Actually, when you think of it, I believe all of those groups, and a few more, are represented here. Its probably the most diverse set any of us will ever get to enjoy. For example I have personnally met at least 3 people who live north of watford gap services from this site and almost 2 of them are almost normal!!* Who knew!?


    *(chill, peace, that was another joke.)**

    ** (they were actually properly weird!!)
  33. footsiegirl

    footsiegirl Active Member

    I think that, this, like a lot of other threads, has been subject to the usual sprinkling of humour - and there is certainly nothing wrong with that. I guess, though, if an over weight Pod Arena member was to read this, then they may be sensitive to the issue...However, I certainly do not think this is a case of prejudice of any kind...mountains and molehills spring to mind here.
  34. Peter

    Peter Well-Known Member

    im overweight, no qualms from me, BMI about 30
  35. Peace:

    You have a good point, obesity is a very serious health issue for many of our patients. Of course I never tell patients that they have a "hyperintense gravitional acceleration" around their body, that was obviously a joke. However, I do have a number of ways I handle this common problem.

    Typically, for women, I will say something like, "Mrs. Smith, you are carrying around some extra pounds that is affecting the amount of force going through your foot with each step you take. I know it is difficult to lose weight, but if there is anything you can do to shed some of those extra pounds, then your feet would greatly appreciate it, with each and every step."

    For men, I often say, "Mr. Jones, you know, you aren't built exactly like a marathon runner. If you could lose some of that extra weight then your feet would feel much better and you would heal much faster."

    Often times, to make it a little more real for them, I ask them, "How much did you weigh when you were 25 years old?" Then when they answer I might say, "You can probably assume that what you weighed at age 25 is close to your ideal weight and the extra weight that your carrying now is largely responsible for your pain and disability."

    I have many other favorite ways of conveying this sensitive issue to my obese patients but, in nearly all cases, people already know that they are heavy, and you don't need to rub it in. What you do need is to be sympathetic with them and emphasize how they will have more energy, less pain, look better and feel better when they start to lose weight. Some of my nicest patients are those that are, unfortunately, also obese.
  36. Peter, I can't believe I even spoke to you!

    27.9 here.
  37. Peter

    Peter Well-Known Member

    took some Mackems to the Stoke-Sunderland match on saturday. We went to a traditional oatcake shop for breakfast. Think oatmeal pancake, think of bacon and cheese dripping in the middle, think of why Stoke people were called "lardies" in the past, then you realise its all in the genes!
  38. Think you're making me hungry!!

    Sadly my lardies tend to bulge over my genes these days. Oh well. Compulsary diet on the way soon.
  39. W J Liggins

    W J Liggins Well-Known Member

    In relation to Isacc's hurtful comments about those who live north of Watford Gap (to put this in perspective for Canuks and Aussies who live in large countries, this is about 50 miles north of London), I would like to repeat a Bob Monkhouse saying - he came from the same county as Isaccs.

    He said that when he was on stage he was always surprised that so many of them knew he came from Kent - they kept saying so. Would that be fat Kent now?

  40. I can't help it, I get a nosebleed when I go above the thames!! ;)

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