They agreed to a compromise - an unusual one, but a compromise nevertheless. That sounds a lot more mature than the explosive negative comments that followed on BOTH sides of the aisle.



I don't think my expectations of women are low. I certainly don't regard the women I've encountered as "crappy". Judging a man by his earning capacity is just standard behavior for most women - I see nothing crappy about that. Earning capacity is important to providing for children, among other things. To my thinking this is at least a notch or two above the male habit of judging a woman by her looks - although, to be fair, an attractive woman has a somewhat better chance of having sex, and hence, having children and a spouse to care for them.

Nor is having an emotional outburst necessarily a bad thing. Although outbursts are unsettling when they occur, they can start a process of self-reflection that can lead to positive results if one can swallow one's pride enough to consider making improvements. Besides, a woman without passion is like an amusement park without a roller-coaster: bor-ing.

I believe that emotions drive all our choices regardless of how rational we try to be. It is easier to rationalize an emotional choice than to dredge up an emotion to drive a rational choice.

Do I get what I expect? Hardly.

Example 1: I'm not a jealous person - I've never understood the feeling. I certainly don't expect it in a relationship. Of the 6 women I've been in long-term relationships with, 4 were not jealous types, but the other 2 became insanely, violently jealous for no reason they could explain. I sure didn't sign up for that!

Example 2: Do I expect a woman I'm with to gain 100 lbs in a year? Nope, but it happened (and no pregnancy or other medical condition was involved).

I don't think my understanding of women or experiences with women translates into low expectations of women. I expect women to be smart, honest, sexual, and reasonable - silly me, I know, but I'm an idealist at heart. It has been my experiences that have been low sometimes, not my expectations. I still hope though reason tells me that my hope should grow thin.

But I also find, in the light of experience, that I'm growing more content being single. While most of my mid-40-ish male contemporaries are struggling with marriage and/or divorce, I'm seeing smart, beautiful women in their mid-20s. Does wonders for the insecurities, among other things.

Just to keep the record straight, that t'warnt my post....

Kay

oops. Sorry. Fixed it.

Regarding the idea that it's better for one spouse to take on a parental role with the other in regards to losing weight (or any other problem for that matter), I personally feel that it's much wiser to encourage and/or wait for that person to take ownership of their own problem rather than trying to deal with it for them unless their actions are putting their health and safety or that of someone in the immediate vicinity in immediate danger (ie, becoming physically or verbally abusive, about to go out driving while intoxicated, etc...).
Those who take ownership of their own problems and issues are generally far more successful in solving them than those who are being forced to through external means and this applies to addictions as well as weight loss. My DH works with addicts and without exception, those that come to their program voluntarily are more successful than those who are forced into the program through the court system or a family member, even when failure means a return to jail or an ended marriage/relationship. Why? Those that admit themselves into the program voluntarily have taken ownership of the fact that they have a problem (addiction) that they must do something about and are internally motivated to overcome it. Those that don't have not taken ownership of the problem and are only doing something about it because they are being forced to (hey, it's better than sitting in jail!) or someone else thinks they have a problem. One of the primary objectives, as a matter of fact, is getting the addict to a point where they can say (and believe), "I am an addict and I must do something to overcome this addiction because if I don't, it will ruin my life or kill me.", not "I have to be here because the judge/my wife/my parents/my (fill in the blank) thinks I have a problem."

I had a conversation with a neighbor today, who's in a similar, though not identical situation...

Her husband is morbidly obese, and comes from a family where every member is obese, most have multiple medical conditions related to it. He's made an attempt of two at Atkins, but always has a "reason" to quit. She (and she's thin, BTW) goes out of her way to cook healthy foods for him, encourage him, even inviting his whole family to their home every holiday so he can have control over the menu.

She expressed her frustration to me today, since she's tried everything she can think of. She flat-out told him she's scared he won't be alive to walk their baby daughter down the aisle someday.

He's agreed to look into a different diet plan, and wants to borrow my CAD book, since it sounds like a plan he can stick with.

What struck me was having this thread in the back of my mind. Never ONCE did she resort to humiliation, or consider leaving if he didn't lose weight. He went from "I can't" to "I'll try" just because she shared her fears with him, and he doesn't want her to be afraid, nor to leave the kids fatherless.

That's not saying he'll succeed, but to me, it was a great example of how it "should" be.

this is correct psychology 101, although it took me a long time to accept it - LOL. a person is not gonna change, until he wants to change. this desire, as previously mentioned, must come from within.

the very best psychologist ever, was a man named Aesop - boy did he ever understand people. the fable that represents this situation happens to be my favorite - "mr. sun and mr. wind". if you have not read it before, it makes for good reading.

Wow, this thread is a fun read.
/sarcasm

I'm appalled at the opinions some have expressed toward women in blanket generalizations. I suppose they have their reasons for it from previous experience, but unless you've been with all of the women on the planet, you can't honestly make those kind of generalized statements.

Likewise I don't think humiliation is ever called for in a marriage. If your spouse's fat is something you can't live with, and you've discussed the issue like reasonable people, then leave. If you use tactics like that, the marriage is already over, in soul if not legality.

This is somewhat of a personal issue for me, not because I've been in the situation, but because I've been constantly trying to lose about 20 lbs my entire adult life. I couldn't lose an ounce, but it wasn't for lack of effort and heartache. I would think on an enlightened LC forum like this, people would realize that sometimes it's now how hard you're working, it's *what* you're doing. My low-cal, low-fat diet was getting me nowhere. Finding out about low-carb dieting was like a light bulb going on over my head. I'm finally making progress. Unfortunately, the word isn't out yet, and the LC thing isn't mainstream (yet). Some people are quite literally stuck in their fat.

I think we'd all like to know that our spouse is in it for the long haul, fat or not. Because no one stays like they were on their wedding day for long. Waistlines grow, hairlines receede, wrinkles and stretch marks form. Hopefully it's the person beneath that matters. Is that too much to ask?

Likewise, I'm appalled that no one has found a counterexample: a wife who doesn't freak when her husband brings up the subject of her weight. Just one documented case would prove me wrong, absolutely. You'd think in a world of billions of wives at least one could react "reasonably".

Candy? Most believe her case was a hoax.

Wanda Barzee? Maybe; I mean, DAMN, that woman agreed to some outrageous things, but we have no evidence her weight ever came up as a subject of discussion.

Terri Schiavo? The whole state gov't exploded for her.



What relationships ever start without a physical chemistry of some sort? Why should they persist without it? Most don't. Acknowledging that reality would go a long way towards stabilizing marriages - one worthy goal I think we can agree on.

I don't think anyone is denying that marriages start out with physical chemistry - it's the expectation of maintaining the unrealistic that was originally in debate here. That gal on the website is at a pretty normal "pushing-30" weight, up from "skinny teenager". What kind of Michael-Jacksonian measures is the average wife supposed to undertake to keep looking like she did when she was 20? I hate to repeat myself, but female weight gain is normal and pretty much equivalent to male pattern baldness and impotency. It's natural aging - sorry if it doesn't fit in to what Hollywood and Madison Avenue dictates...

On the humiliation issue, Sango said it perfectly: there's no excuse for humiliation. If you've tried everything and you can not live with his/her fatness, it's time to walk away.

A "documented case"? Haha. Of interperonal relationships? I'll have to ask some of my married friends to tape-record something. Right.

No one is arguing that physical chemistry isn't absolutely necessary in the beginning. But it's inversely proportional to the length of the relationship, I think...how much "physical" chemisty is there between two shrunken octagenarians? As time progress I would think the person inside is what becomes beautiful. It's not realistic to expect anyone to forever hold onto what they had in their 20's. The most romantic couple I've ever seen was on TV one day, in their eighties, still sitting together and holding hands like teenagers. He said that she was "more beautiful today than the day I met her." No one else might agree with him, but when he looks at her, every wrinkle and age spot is a reminder of the happy years they've spent together, a visible and concrete marker of a half-century of marriage.

As for women and their knee-jerk reactions to comments on their weight from the men they love...can't blame most of them, as they're taught all of their lives that if they aren't beautiful, they're nothing. Which you, gotbeer, seem to verify. "You might be the most wonderful, loving, caring and supportive wife [and the mother of my children] but you're fat and they physical chemistry is gone, so I'm out of here if you don't lose the weight, [insert humiliating insult here]."

Is it crazy that we'd like to hope there are more reasons to stay?

I suppose that depends on what you define "freak" as. I get the impression that any dissent at all, no matter how it is expressed, with the husband's express opinion you consider "freaking" on the part of the wife. No matter how good the relationship between two people, there are going to be things that you don't agree on. How you handle those disagreements is a good indication of how solid your relationship is.




Frienship. My husband and I started out as friends in the 8th grade and didn't become lovers until 9 years later. Now, after 18 years of marriage, we're both and will continue to be both long after the "physical chemistry" is gone. Marriages that make it through the long haul and the tough times are based on far more than physical attraction and physical chemistry.
Do many marriages start because of physical chemistry? Yup. Do many of them fail because that's all the marriage was based on? Yup.

By "freaking", I mean, acting out in a panic, or fear, or rage, whether or not they believe that they are being abused. A calm, reasoned dissent, with no lingering implications, is what I believe does not exist.

Here's an interesting article on what constitutes abuse, and how different people perceive it.

BECAUSE I SAID SO!!

A new study says that yelling at your children -- even if you're trying to protect them -- is "psychological aggression."

- - - - - - - - - - - -
By Christopher Healy Dec. 11, 2003 |

link to article

The day my daughter was born changed me profoundly. The first time -- when, in her toddlerhood, I saw her squeezing Legos through a heating vent into our furnace -- I screamed "Stop that!" after more gently spoken pleas went ignored was also a pivotal day in my life. According to renowned sociologist Murray Straus, that was the day I became an "abusive" parent.

Needless to say, it came as quite a shock to find out there were bona fide family experts who would consider my behavior toward my daughter, the most important person in my life, cruel. Yet according to Straus, yelling at my daughter even that one time was "abuse the moment it [was] done."

A few weeks ago, the respected Journal of Marriage and Family published a study by Straus and his colleague Carolyn Field that reports that "psychological aggression" toward children is "so prevalent as to be just about universal." This is the result of a telephone survey of 991 parents, 98 percent of whom admitted to using "psychological aggression" against their child by age 7. While the researchers' definition of "psychological aggression" includes such inarguably objectionable acts as calling your children obscene names and threatening to throw them out of the house, it also includes actions that most parents regard as a normal part of raising kids -- shouting and yelling. In fact, the 2 percent who came off completely clean in the study probably either lied or have nannies who do the hollering for them.

The tone of Straus and Field's report is unrelenting. They do not distinguish between different forms of communication -- harmful invective like "I wish you had never been born!" as opposed to "Do your homework now!" pleas. In their view, it also doesn't seem to make a difference if parents scream at their children constantly, or just get loud once in a while. They say, "We believe it should be never." While admitting that even the best of parents can sometimes lose their temper and get a bit snappish, they are sure to add, "This provides an explanation for some psychological aggression, not a justification."

Upon first reading the study, I was incredulous; could the authors truly believe that occasional yelling would damage my child? I contacted Straus in Belgium, where he is currently teaching, in hopes of getting some clarification. "Any yelling or screaming is bad parenting," he said, quite clearly. "It is not, in my opinion, a humane mode of family relationship." So now not only was I "psychologically aggressive" toward my daughter, but I was also "inhumane" -- a term I'd always associated with POW camps and cockfights.

I kept searching for some kind of caveat to Straus' all-out ban on shouting but never found one. Not even motivation seems to matter. Couldn't you get a free pass for yelling at your children out of frustration or concern as opposed to assaulting them with a malicious verbal attack that is intended to berate and belittle? "Because it is the lesser of two evils," Straus told me, "does not make it not an evil."

And yet, resolute as he is in his thesis, he admits there is still research to be done. "There is no empirical evidence," he told me, "to support either my hypothesis or the view of critics." But we're still supposed to feel guilty about it.

In the study itself, the researchers admit their reluctance to label psychological aggression as "abuse" -- mostly because there are legal definitions of abuse that some psychological aggression would not fit into -- but Straus didn't shy away from that word in the accompanying press release or in his interview with me. He also told me he "would not see any downsides" to future laws against psychological aggression. Such forms of discipline are tolerated right now, he says, because they are society's norm (and certainly anything done by 98 percent of the population qualifies as a "norm"). "The expansion of humanitarian rights that has occurred in respect to other areas of childhood, such as child labor," he said, "suggests that it is possible that the norms will change."

And there you have it. Shouting "How many times have we told you to stop eating Mommy's lipstick?" is on a par with manacling your kindergartner to a rusty antique Singer in the basement of a factory and forcing her to stitch up knockoff D&G handbags for 18 hours a day.

While Straus and Field certainly didn't create the blame-the-parents-first atmosphere that has begun to blanket our country, with this study they've supplied a diaper's load of fodder for all those people suffering from concerned-neighbor syndrome, the ones who seem to believe that the nation's children should be raised by an army of omnipotent Stepford parents, and who are ready to call in a SWAT team if they spot a mother who hasn't wiped her son's runny nose quickly enough.

There's not much a parent can do these days that doesn't bring on an onslaught of societal guilt. Letting kids cry is neglectful, letting them glimpse even a nanosecond of television is irresponsible, and putting them in day care is so awful the Brothers Grimm wouldn't use it as a plot device. You would think there's enough genuine abuse in the world that we could cut some slack to a father who accidentally lets his vocabulary lapse into PG-13 as the stroller rolls over his toe, but apparently not.

I can't count the number of times my wife was reprimanded, while our daughter was still in utero, for not exhibiting the mental tranquility of a Zen monk. "Stress can do horrible things to your baby," was the constant refrain -- one backed up by hordes of obstetricians across the nation. That, of course, only led her to become stressed out about becoming stressed out. When caring, responsible, attentive mothers can be made to feel like lousy parents before their children are even born, things have gone too far. It's as if the best caregivers would have to be unfeeling, unemotional automatons. Mr. Spock has replaced Dr. Spock, and an impossible standard is being set.

Raising a child is pressure enough without having to suddenly worry about your decibel level as your 2-year-old decides that the keyboard of your iMac might like a drink of milk. You don't need to curse at her, or berate her, or threaten to kick her out of the house (which would be a pretty nasty thing to do to a toddler). You may even admire her compassion with regard to your computer's thirst. But you also might shout at her -- intentionally or not -- to get her attention, to make sure she stops, and to underscore the message that mixing dairy products and expensive technology is a no-no. And even if the tone of your voice temporarily upsets her, chances are she'll get over it rather quickly. You don't need to start worrying that you've just crossed the line into Joan Crawford territory. And if anyone tells you that you should, well, I think that's psychological aggression.

Incidentally, after I yelled at my daughter that first time, she flashed me a big smile and giggled as if I had just put on an Elmo costume and done a headstand. Then she handed me back the Legos.

salon.com

- - - - - - - - - - - -

About the writer
Christopher Healy's writing has appeared in the Washington Post, Teen People, and "Out of the Ordinary: Essays on Growing Up With Gay, Lesbian and Transgender Parents."

From previous conversations, gotbeer, I know you do not believe it exists, and you don't believe anyone else who claim (as I do) that I have had calm, reasoned discussions, with no lingering ill feelings.

I can only conclude that:

You are basing this on your personal barometer, which is so exquisitely sensitive you make The Princess & The Pea look like a WWF wrestler...

AND/OR

Your personal relationships really suck.

Sorry to hear that there is no one in your life you can have a calm, reasoned, dissent with.
Heck, my Dad is a concrete Republican, and I am certainly not. We discuss political things quite a bit, and while we are convinced the other is missing brain cells on certain issues, it does not affect the rest of our good relationship one bit.

I should clarify: only on the point of her weight have I experienced this universal lack of a calm, reasoned dissent.

Other touchy subjects (her lack and/or excess of sexual skills, the size of her shoe collection, her taste in movies, his or her cheating, etc.) do not seem to reflect freakish responses universally. Unlike weight, counterexamples to these are easy to find and verify.

And my relationships are fine, thanks, now that I know to avoid discussing my girlfrends' weight in anything except the most glowing, positive way.

Her: "Honey, does this make me look fat?"

Me: "NOTHING could make you look fat!"

You know, I can't honestly say I've never yelled at either of my kids, but it's generally been in the context of their being in immediate danger (like about to walk into the street or get burned on the stove).
Our general rule in our house is that there had better not be any yelling unless the house/a person is on fire or terribly injured or there is a tornado coming.

As for discussing weight loss in a calm, reasoned manner. Sure, it's possible. But at the same sime you have to admit that personal criticism (and telling your SO that you believe that they need to lose weight is a personal criticism no matter how nicely you phrase it) is in and of itself an emotional topic and expecting complete emotional detachment from such a topic is unreasonable unless, of course, you happen to have Vulcan ancestry. :rolleyes: Disagreement does not have to be done at high decibel levels. I can think of two times where my DH and I have actually raised our voices to each other. Once when the oven was on fire and once when I was about to deliver a baby without pain medication or an epidural. As for lingering implications, it's a rare person indeed (female OR male) who can have their feelings hurt and just forget about it. Unless, of course, you didn't have any feelings to hurt in the first place. One mark of maturity is to be able to forgive and move on even IF your feelings have been hurt. Again, a rare attribute in today's society I'm afraid.

I find myself wondering how many men could discuss the topic of their spouse wanting them to undergo penile enlargement surgery with the same degree of emotional detachment and calmness that we women are expected to discuss something equally personal (and often just as difficult to do something about) as our body size/shape.

Another good question is: Is it even realistic to expect/demand that your SO lose weight considering that 95% of such attempts fail. Granted many of us here have finally (after decades of trying other methods in some cases) found something that is working for us, but we are still very much a minority. How many women are trying to lose weight using the traditional methods of low fat/high carb/eat less/excercise more only to find themselves gaining still more weight despite their best efforts? How frustrating and humiliating it must be for those women who are honestly trying and failing to be berated by those that should love them for that failure with the message that if they only tried harder or "if you really loved me", they'd be successful.

Well, gotbeer, I'm glad to hear it. Sorry if I've been a bit tough on you. Nor are women to the only ones with touchy subjects IMHO.

I like my husband's approach: Once, while looking at our wedding photographs, but before embarking on this WOE, I mentioned, "I think I've lost weight since the wedding."
He said, "I'm taking the fifth."
I laughed and said, "I guess you're right. There is no good answer to that remark."
He said, "Either I agree, in which case you were fat at the wedding. Or I disagree, in which case you are still fat, to your way of thinking, so I'm taking the Fifth."

Indeed, a male friend of mine, "Don" I'll call him, will be having urethral reconstructive surgery next month (a childhood injury has caused extensive scarring). An earlier surgery cost him both length and girth, prompting his wife to complain to him. He handled it quite well then, and now, facing even more erosion, he's speaking with her again quite calmly and rationally.

Oh, and you guessed it. 4 months ago he told her she had a choice: lose weight, or go back to work. Kaboom! She's now claiming a mysterious back injury prevents her from doing either.

They've been married about 24 years: 6 kids, 1 grandkid.


That's one wise man.

(For those outside the US: "taking the fifth" is a legal phrase that means "to invoke one's right not to testify against oneself", a right guaranteed by the 5th amendment to the US Constitution. In everyday speech it means: "I see no good answer, so I'm shutting up rather than trying to wriggle my way out of this".)

I'm glad your friend took it so calmly. It didn't work out that well for someone I know who made a similar request/complaint to her husband. He screamed at her for 15 minutes, hit her and then left her. If that's not a "kaboom", I don't know what is. Both are examples of reactions at the extreme ends of the spectrum (total calm vs. total rage) and I suspect that the reaction that would be more representative of males in general would likely be somewhere in the middle as are the reactions of most women.
As I said before, it's a rare person who can handle criticism of something very personal like the length of one's penis or the amount of body fat you have without at least some degree of emotion and/or hurt feelings. It baffles me a bit how you could reasonably expect otherwise. Keep in mind also that when someone is relating a story to you intended to elicit sympathy, they rarely, if ever, tell it in a manner that puts them in a bad light. Someone I know once said, "There's three sides to every story; your side, their side and the truth". ;) It's certainly no well-kept secret that your body size is a somewhat sensitive topic and this applies to men as well as women. Perhaps the difference is that women in general are more vocal in expressing their reactions to such criticism than men are.



LOL. Mine just makes the sounds and motions of a rifle being cocked (implication being that's a loaded question) and then we both laugh. :lol: Even though he knows that I wouldn't ask the question without being prepared to hear an honest answer even if I didn't like it.

My ex wife told me before our wedding that she felt like she was marrying the michelin man.
She also told me that I physically repelled her.
I still married her. She still married me. I guess that says a lot about BOTH of our states of mind ;)

Wow. I tried to read this whole thread, really I did. Started skipping around by page 6.

One thing that struck me was the point made earlier that it isn't always what you say but how you say it. This seems to apply more to women than men for reasons it would give me a brain cramp to come up with. Having a friend or loved one tell ME they were concerned that I'd gained so much weight would have went a lot further than to hear someone tell me I was repulsive/fat/gross/most oft heard put down. A confrontation is one thing, abuse is another.

A little "interpersonal communication" 101 lesson..
 

Whether people want to admit to this or believe it or not is up to them, but...when you are in a discussion with someone, particularly if that discussion involves a sensitive topic, what we hear and how we interpret it is based on the fact that it first passes through something similar to a filter in our brains; a "decoder", if you will. That filter/decoder (for lack of a better word) is composed of past experiences with that topic or situation as well as our own personal thoughts and feelings attached to that particular topic or situation. It does actually influence not only what you hear, but how you interpret what is being said to you (motives, implied meaning, etc...). When communicating with someone else, especially on a sensitive issue such as body image and weight gain/loss, it's important to remember that often what you said isn't nearly as important as what the other person "heard" and keep that in mind when the reaction you get isn't in line with what you actually said. In such a situation, ask them to repeat back to you what they heard. If you can manage to do this, I'd be willing to bet that what is repeated back to you isn't exactly what you said OR how you meant it if the reaction is a negative one. Doing this also gives a chance to clarify and correct the other person's interpretation.
On the other hand, if you find yourself getting upset by something that another person is saying to you, it might also help to step back and ask yourself if you are interpreting what they said correctly and first ask for clarification before blowing an O-ring on them.
"I" messages are also less likely to elicit hostility than "you" messages. For example: "I think that your health is in danger or will be soon if some changes aren't made" vs. "You're eating yourself into an early grave if you don't stop stuffing yourself and lose some weight". See the difference? One is an expression of concern (and how can you reasonably get angry with someone for expressing concern about your health?), the other would most likely be interpreted as a personal attack requiring defense...the infamous "kaboom".
Often it's not what you say, guys and gals, it's how you say it that matters.

Well, I promised myself I wouldn't step back into this fray......but some interesting ideas have come up quite aside from Andy and Candy. So I return to comment upon the idea that couples never get together for reasons other than physical attractiveness/sexual desire.

Hello? Love can evolve from a meeting of the minds, as well as meeting of the libidos. Years ago, someone asked what first attracted me to my present husband and my immediate, unthinking, response was "He's happy being who he is, and he makes me laugh."

And I am not by any means an asexual person. Although I may well have worn out that side of myself in my younger years. The sixties were a weird and crazy time.

But for longevity in a relationship? Go for the fun and companionship, rather than the lust. I've done both, been married twice. Second time around, I had grown up.

Kay

No, that's merely the normative way. I concede exceptions are possible - Anna Nicole Smith, for example, married for money.



I believe the reactions are more complex (exist in more dimensions) than a "calm to rage" scale can measure.

For example, male human abusers adopt one of two main strategies - call them "ogres" and "cobras".

"Ogres" are loud, overtly physically violent but not terribly clever. As their rage builds, their hearts race, and they lose their calm and become fidgety. Ogres often strike their wives but rarely kill them. (For example, the abusive husband of Don Corleone's daughter in "The Godfather" or the hotheaded "Sonny" Corleone whom he betrayed.)

Contrast that with "cobras", who have a cold violence that is less overt but yet more chilling than the overt physicality of the ogre. As their rage builds, cobras become quieter, not louder. Their heart and pulse slows down; they become focused, still, calm and relaxed. As their anger crests their words drop to a whisper. Cobra's rarely strike their wives, but are much more likely to eventually murder them. (Think of the savage calmness of Michael Corleone, or of Hannibal Lector, or of the abuser [played by Patrick Bergin] in the movie "Sleeping With the Enemy".)

In one study, after a couple years of abuse, most Ogre-marriages had ended (over 60%), but NO Cobra marriages had ended. The explanation proposed in the study was that the wives of the Cobras were too terrified to attempt to escape. About 20% of abusers can be classified as Cobras; 80% are Ogres.

In light of this, it should be clear why a "total calm to total rage" scale can be inadequate to capture all the nuances of a reaction to a loaded emotional question.



Um, he not only admitted that his penis had shrunk, but also that his wife complained, and that yet another shrunkage operation was coming. I'd say any one of those would tend to put him in a poor light - one can't get much more exposed than that. And, he told the story before both me and a woman friend we work with. If he had any serious degree of embarrassment or anger he never would have opened up like that - after all, we are buddies, not group therapy members.

Of course I expect weight to be an issue, especially with women. What I find exceptional is the degree of uncontrolled reaction when it involves a husband raising the subject with his wife. I've never even heard of a "Cobra female" in this situation - angry yet calm. The reaction seem to be 100% "Ogre female".

For Medicine, a Growing Problem
Doctors, Hospitals, ERs Struggle to Handle Wave of Obese Patients

By Ranit Mishori
Special to The Washington Post
Tuesday, September 23, 2003; Page HE01

http://www.washingtonpost.com/ac2/w...2&notFound=true

On a chilly October day a few years ago, a 44-year-old woman lay in the internal medicine ward at Georgetown University Hospital. Pockets of infection were breaking through the skin on her abdomen as she received an intravenous drip of powerful antibiotics for her chronic non-healing wounds.

I was a third-year medical student, and she was now my patient.

After reviewing her medical history, I went to order a magnetic resonance image (MRI) to give me more information. There was only one problem. She was what we call "morbidly obese," weighing more than 350 pounds. The hospital's MRI machine was state-of-the-art, but my patient was too big to fit inside.

I explained the situation to my superiors and asked for advice. Their answer startled me: Call the National Zoo and schedule a session with the zoo's MRI.

Some of my fellow students snickered. I felt protective -- embarrassed, actually, for my patient. I wasn't sure I should take this instruction seriously. And if so, how was I supposed to tell my patient she might have to wait in line behind an elephant or a panda for her turn at the MRI?

No room for the obese -- to a lot of heavy Americans, that seems to be a slogan for the entire American health care system. And this is no minor issue: According to the National Institutes of Health, nearly two-thirds of the population is overweight or obese.

About 9 million Americans are "extremely obese," with a body mass index, or BMI, over 40; they have a substantially increased risk for illness and premature death.

These are people who should be going to the doctor more often than others, but in many cases they are not. Studies suggest this is because they believe the health system doesn't want to deal with them, or is out to humiliate them.

Here is what they experience: gowns that are too small; waiting room chairs they cannot squeeze into; scales placed in public view; exam tables that tip over; procedures (such as pelvic exams) that turn embarrassing when extra staff is required to lift the patient's middle.

And always there is The Lecture: being told, repeatedly, that "all you need to do is lose weight, and only then can we get a handle on your other health issues."

Hally Mahler, a public health expert specializing in HIV and AIDS, remembers getting The Lecture for the first time when she was 8. "He would say to me, 'You're getting too fat, you have to lose weight, it's now or never.' It was embarrassing. It became embarrassing going to the doctor."

Today Mahler is 35 and still big. But that childhood memory lingers. "As a child it was terrible, I resisted it, I did not want to go to the doctor, ever," she says.

Even as an adult, she has found medical personnel not only unsympathetic, but sometimes manifestly hostile. During one recent visit to the doctor's office, she recalls, "I walked in, and the nurse looked me up and down, saying, 'You're too heavy for this table. How much do you weigh?' And she looked me up and down again, in a really nasty way, and she just stormed off."

'Repulsive' Patients

If overweight patients like Mahler sometimes suspect that practitioners dislike them because of their condition, perhaps they are not being paranoid. Rebecca Puhl and Kelly D. Brownell of Yale University reviewed the literature about doctors' attitudes toward obese patients and published their findings in the journal Obesity Research in 2001. They discovered a whole collection of studies that suggest doctors and nurses do harbor negative feelings about obese patients.

For example, in one nationwide study of 400 physicians that appeared in the Journal of Family Practice in the 1980s, one-third included the obese among patients who cause them feelings of "discomfort, reluctance or dislike." (Other groups provoking such feelings included drug addicts and alcoholics.)

Studies on nurses' attitudes found similar results. In one, a study of Canadian nurses that appeared in the journal Perceptual and Motor Skills in 1989, nearly a third of those queried said they prefer not to care for the obese at all -- 24 percent labeled the obese "repulsive."

Other studies suggest that doctors see obese people as lacking in self-control, or as just plain lazy.

Uri Barzel, an endocrinology and metabolism expert at Montefiore Medical Center and the Albert Einstein College of Medicine in New York, admits that the overweight patients he sees in his practice frustrate him.

"Because the patient does not take charge of himself," he says, "they do not let me practice the best medicine. And the best medicine is [for these patients] to have a weight which is appropriate for their height."

"What I face as a physician when I see a patient like that is a mixture of feelings. I feel pity for the patient, because I know this patient is not going to end well. I know the person will need to take medications for diabetes, hypertension, for cholesterol, and will probably need to have knee replacement, hip replacement, because their joints cannot withstand the weight."

This is frustrating, says Barzel, "because we as a society and we as medical professionals are unable to bring about any reduction in weight."

After years of handing out diet sheets and dispensing advice to patients who, in his view, were not making enough of an effort to reduce their weight, Barzel simply says, "I'm not trying anymore."

In listening to doctors describe treating obese patients, I have heard a litany of tales that explain physicians' frustrations as well as patients' feelings of humiliation:

• The man who came to the hospital with shortness of breath. Doctors suspected he had a pulmonary embolism. At 402 pounds, he was two pounds over the weight limit for the CAT scan machine, so they pumped him full of a diuretic, hoping to shrink him down to treatable size -- but it didn't work. He left the hospital against medical advice and without a diagnosis.

• The patient who was taken down to the loading dock to be weighed like a piece of freight before being admitted to the hospital.

• The patient who was so heavy that the ER staff had to call the fire department to lift him onto a stretcher with hoisting equipment.

• The patient who died in bed. Five nurses tried to pick up the body and failed. Finally, they left the corpse, covered with a sheet, until more help was found.

The Impact of Obesity

So it is something of a standoff: Patients say doctors are hostile, and doctors say the patients are not doing enough to help themselves. In the meantime, the nation keeps gaining weight and overweight people keep getting sicker.

The list of conditions associated with excessive weight is long: diabetes, hypertension, heart disease, arthritis, sleep apnea and cancers of the breast, uterus, kidney, gallbladder, colon and rectum. Obesity is also associated with high blood cholesterol, complications of pregnancy, surgical complications and dementia.

It's evident that seriously overweight people should be seeking medical treatment. And yet many are shying away from the system.

"We are not going after preventive care," says Lynn McAfee, who, at 425 pounds, has experience as both a patient and a patient advocate for the Council on Size & Weight Discrimination, a nonprofit based in Mount Marion, N.Y. "We're not getting ourselves diagnosed with a lot of conditions that could be fixed."

"It is killing us," she adds.

Research demonstrates that the overweight are under-served. Puhl and Brownell cite a 1993 study in Women's Health that showed that the heavier a woman is, the less likely she is to undergo a pelvic examination. Another, a 1998 study in the Archives of Family Medicine, concluded that higher BMI measurements were associated with fewer preventive procedures like Pap smears and breast examinations. Yet another, published in 1994 in the Archives of Family Medicine, demonstrated that the higher a woman's BMI, the more likely she is to delay or cancel a visit to the doctor.

It is not a matter of the system refusing to treat the obese. It is the obese choosing not to use the system, because they feel put down by it, constantly reminded that they should do what so many of them seem unable to do: lose weight.

"I am just not sure it is the best use of a doctor's time to lecture somebody who's nearly in tears, somebody who could barely get themselves to the doctor for treatment and will probably not come back when they should," says McAfee. "Yelling at us louder is really not that effective. We heard you the first time."

Something needs to change, and McAfee, Mahler and others argue that it is the system.

'I Know That I Am Overweight'

A recent article in the Archives of Family Medicine, "The Sensitive Treatment of the Obese Patient," is one of the first to offer recommendations to doctors about the medical interaction itself. The article discusses how to improve the office space -- armless seats, large speculums for gynecologic exams, a scale with a wide base located in a private area. The article also advises that practitioners display the right attitude: "avoid any display of frustration or distaste when doing a difficult examination."

Some practices and hospitals are making efforts to accommodate large patients. The emergency room at the Montefiore Medical Center in New York just purchased some double-size stretchers, extra-large wheelchairs and oversize gowns.

While McAfee applauds such efforts, she would make one further change, simple but radical: Ditch the scale.

"Fear of the scale," as she puts it, is a huge barrier to care. "You internalize that fear so much. And even if the doctor says nothing about your weight, sometimes just getting weighed in that setting is so traumatic that people avoid doctor visits."

Hally Mahler simply refuses to be weighed. "The first thing that I did to empower myself as an adult, when I went looking for my first doctor . . . was to tell them that they couldn't weigh me. I know that I am overweight, we can see that. But it is my business."

And how did the nurses react? "Most were so taken aback that they'd say, 'Oh, okay,' " Mahler says. But not always. "Some have tried hard to convince me to get on the scale. Some have said. 'You can't do that.' I just try to be firm and say, 'Talk to the doctor if you have a problem with that.' "

Mahler is the kind of patient McAfee seeks to develop -- the empowered patient.

"I suggest people get a health partner," McAfee says. "In case you are very ill or in the hospital, someone who would come in and advocate for [you]. Put things in writing: Have a form that is basically a patient history form, with bullet points for what you want out of the visit."

McAfee's own health form has the following statement: "Lectures on the dangers of obesity and the value of weight reduction are not appreciated."

Better than The Lecture, McAfee argues, is a doctor who focuses on treating the conditions associated with the patient's obesity.

She believes in telling doctors to "spend your energy being creative about how to help me right now. What can you do if I can't get imaging right now; if we're dealing with my diabetes right now and I can't lose weight?" Or as the authors of the article about the sensitive treatment of obese patients recommend, "Focus on the person, not the obesity."

There is just one problem with this reasoning, according to Caroline Wellbery, a family physician from the District. "Preventive care includes treating obesity," she says, "and obesity is the underlying problem."

Asking doctors to accommodate obesity is one thing. Asking them to look past it is something else entirely, and goes against every aspect of their training.

In courses on obesity, doctors are urged to bring the subject up even during appointments unrelated to weight problems. To do otherwise is, according to many doctors, to fail the patient.

"I see these people marching into terrible dependency," says Barzel. "They are not going to be able to take care of themselves. The care that they require is huge. The drain on society is going to be much, much bigger than lung cancer was. . . . Just like smokers, overweight and obese patients do not seem to recognize -- or they deny and suppress the notion -- that they are likely to end up in a state of serious ill health and a lifelong dependency on others."

If anything, the medical establishment worries that overweight patients aren't hearing the "you-need-to-lose-weight" message often enough. A study of more than 1,200 physicians that appeared in the journal Preventive Medicine in 1997 found that doctors dealing with obese patients "did not intervene as much as they should, were ambivalent about how to manage obese patients and were unlikely to formally refer a client to a weight loss program."

It is not clear where the happy medium is. On the one hand, you have patients like Mahler, who demand that the system change to fit her: "You need to have a table that can hold somebody, even somebody who weighs 500 pounds." On the other hand, you have doctors like Wellbery, who suspect that accepting the fat may actually contribute to the problem. "Think of smoking," she says. "The negative connotation helped curb the habit."

And yet everyone agrees something is wrong. "When occasionally I have a patient who lost a lot of weight," says Barzel, "I am happy like a kid who has found a toy. But it is so rare. The fact is, we all talk about it, but while we all talk about it, society gets heavier and heavier."

Giving Doctors a Hand

That last point is indisputable. And so is the reality that even the most sensitive doctoring is not going to solve America's obesity problem. Solutions, many experts believe, will also have to come from outside.

Barzel, for example, having all but given up his own efforts to cajole patients into losing weight, says that doesn't mean there aren't other ways to get through to those patients. "The only things that work, at least partially," he says, "are programs like Overeaters Anonymous or Weight Watchers. But these are not medical interventions."

Indeed, some in the medical profession say doctors should recognize that counseling patients on obesity is not a burden they need to shoulder alone. Susan Yanovski, who directs the obesity and eating disorders program at the National Institute of Diabetes and Digestive and Kidney Diseases, contends that many physicians may not have the necessary expertise anyway. She suggests that many physicians would be wise to refer obese patients to programs that emphasize nutrition and physical activity.

"I don't think physicians need to do it all," she argues. "Not every physician is going to be an expert in counseling their patients in weight management. I think what every physician and health care provider can do is serve as a resource and coordinator of care. I don't see anything wrong with physicians referring their patients out to other programs."

Still, because obese people need to see doctors and because doctors will continue to worry about the weight of those patients, ways are being sought to improve interactions between the two groups.

For frustrated patients, there are support groups -- "fat-friendly" organizations like the National Association to Advance Fat Acceptance, which has urged doctors treat obese patients "with gentleness, tact and concern. Remember that many fat people have had years of negative experiences with health care providers, and some have been denied treatment, or given inappropriate treatment, because they are fat."

For frustrated doctors, the National Institutes of Health has issued a handbook for clinicians that covers everything from how to diagnose diseases associated with obesity to ways of getting their patients help outside the medical system. (And yes, there is advice on being more sensitive to their patients.)

"All physicians are now treating obese patients, from the pediatrician to the geriatrician," Yanovski says. "More education will come through workshops by professional societies, articles in medical journals, Web-based continuing education and training for clinic staff -- from the doctor to the receptionist."

Yanovski cites a study from 1998 and a more recent, not-yet-published one by Tom Wadden, an obesity expert from the University of Pennsylvania, showing that obese patients are beginning to report increased satisfaction with their medical care. The preliminary findings, she says, show that "fewer patients have been reporting negative interactions with their doctors regarding their weight than had been reported in previous studies."

This change, she says, may be partly a product of new discoveries that point to biological and genetic causes for obesity. "There is less of a perception that this is just a matter of willpower," Yanovski says.

And that, in a sense, is all that patients like Mahler are asking for. "People who are obese crave what anybody else craves," she declares, "which is just respect and dignity."

Meanwhile, Back at the Zoo . . .

Respect and dignity. It sounds straightforward, but not when you're being told to call the zoo to book an MRI for a patient. I later learned that I would not have been the first to do so. Sharon Deem, a veterinarian at the National Zoo, says she receives calls from doctors all the time trying to get humans in the animals' MRI.

It turns out, however, that the zoo's MRI is not large enough to accommodate humans or other large animals.

The better option is an open MRI, a relatively new type of imaging machine that does not include the narrow, enclosed tunnel of other models. Designed primarily for children and patients who are extremely claustrophobic, the open MRI can also solve the size issue for obese patients, although the image it delivers provides generally lower resolution. Open MRIs are becoming more available, especially in and around major metropolitan centers.

As for my own patient who would not fit: Her condition improved quickly enough that she no longer needed that MRI, so I never did call the zoo on her behalf.

The truth is, I'm not sure how I would have told her she needed to go to the zoo.

They just don't teach you that one in medical school.•

Ranit Mishori last wrote for Health about the care that patients receive in teaching hospital in July, when new residents arrive.

Well...I was talking about normal, non-abusive, non-pathological personalities here as far as range of reactions go and I'd also like to point out that the above (true abuse) is an action, not a reaction. Abusers don't need a reason to abuse, nor do they usually do it in response to some aggrivation (although they may claim one, either real or imagined, as justification for their abuse) they do it because they find pleasure or a thrill or some other form of gratification from it such as a feeling of control over the victim. They have pathological pesonalities and as such, I wouldn't consider them the norm as far as range of reactions goes.




Put him in a poor light? I fail to see how, other than as a male being open about something very personal (something that in a male could be interpreted as a weakness in this society). All of those items he "shared" make him appear the victim and his wife the victimizer; "poor me...I had a childhood injury and needed surgery to correct it and now my penis is smaller and my wife is complaining about it and that with more surgery coming up!" Nor is his wife being given any chance to correct his version of the story...you only get his side (remember what I said earlier about there being 3 sides to every story?).

Interesting article, although it has been posted before in the Research/Media Watch forum. It seems to underscore everything that a lot of us have already said: lecturing and belittling don't work even when they come from someone whose advice and opinion most people respect and should be objective: their own physicians. Instead of motivating people to lose the weight, it causes them to avoid the doctor completely to avoid the humiliation that they have come to expect from such visits and because of that their health suffers.

I agree. Not that there isn't any place for lust and libido in a good marriage or that there is anything wrong with either of those, but what are you left with after the passion fades if that's all you had to begin with? If all you had was lust to begin with, the marriage won't last long after that lust wanes because then you will have to deal with the real person underneath it all and you may not find that as attractive as their body once you get past the lust and start relating to the person underneath.

Ya know, Gotbeer, I've really tried to be reasonable. And non kaboomish. But I'm having some problems understanding why you seem to get so much pleasure out of insulting people.

Kay

Okay Sinbad, can you tell me what is so wrong about the "michelin man"? Cause I am really not getting it :-)

The Michelin Man.

Hey baby! I'm liking those rolls.

Tarheel - no insult was intended. Indeed, I was agreeing with you.