totally screwed. These examples are legion. Patients either don’t want to get better or don’t want to do the things to get them better, regardless of how simple.
And what is the policy solution to this? To punish physicians and other healthcare providers for not providing “value” as if any amount of healthcare service can fix this.
flocking into concierge? My brother works in Chicago and his group is losing internists to concierge medicine left and right. Some work in groups, others on their own. No insurance. Basically rich cash paying clientele where they act as basically doctor and patient advocate. One guy he knows on his own only has 150 patients and charges $30K a year (one of his clients is a very famous old British rock star living now in LA). My brother thinks the urban centers will be devoid of GPs and internists in 10+ years as they all go concierge. Thinks transition will take longer in suburbs because life better for doctors in suburbs. But sees cities as devolving into rich (concierge) and poor (hospital affiliated internist groups - basically cattle calls with long wait times).
Said he's even seeing concierge enter specialists. He would go concierge but within 5 years of retirement and feels conflicted about it morally. He may become a concierge vacation fill-in doc PT as a way to stay in the game.
They're a married couple who are both internists and they have a concierge practice in a strip mall in our local community.
They do really well and I know several people who go to them. My current insurance is really good, so haven't needed to so far, but might consider it in the future. Although I don't really want my neighbor squeezing my testicles or exploring my various orifices.
There just aren’t enough people out here with enough money to have a patient panel like that. The cities are seeing a few here and there go this route but nothing major. We have seen another surge of docs getting out of Medicare though.
He said none of the concierge docs take Medicare.
I think the notion that Americans (women or men) live under unusual expectations to be thin is questionable. Most or all of western European countries of obesity levels less than the US. Outside of Polynesia, the US has the highest obesity rate in the world.
It is possible that our unusually high obesity rate is caused by unusually high pressure to be thin, but I don't believe it. If Sole-Smith were serious, she'd have addressed the inconvenient fact that despite our uniquely American obsession with thinness, we have the highest obesity rate of any country not located in the Polynesian triangle.
'hey we have unrealistic expectations about saving for college, so let's go to the casino with our credit card and go full tilt borderline bankrupt.'
It's alarming how what used to work now just... doesn't anymore. Not to mention the fun insomnia, night sweats, and all the other weird shit shifting hormones is doing to me.
I do have to disagree with her on the "oh, high cholesterol? I'll just take meds!" High cholesterol runs in my family, so when I got the inevitable "you have a stick of butter in your veins" result, I went hard at it with diet -oatmeal with blueberries every morning, an apple and a handful of almonds every day for a snack, try to keep things a mix of high protein and high fiber otherwise. Brought those numbers down. But weight? It feels like a losing battle.
It sounds awful and demoralizing. Seriously. For men TRT is getting traction - is there a similar course of treatment for women? I have only heard horror stories of women starving themselves to hope to maintain fitness.
My response above was more geared towards the author who has not gone through menopause and espouses a position that basically says give up and give up super hard.
The secret to eating almost anything you want is to not be sedentary.
The problem is this person will have plenty of cheer leaders because she is likely an influencer and people are sheep. (Sadly, influencers aren't even the top 20 stupidest things to happen in the last 20 years.)
plastic surgery.
What passive voice bullshit. For the vast majority who are overweight, we made those bodies with our own choices, day after day. We didn't wake up trapped in someone else's. And the only way out is to change those choices, day after day.
"Through her father, Sole-Smith belongs to the family that founded H.D. Smith, a national pharmaceutical wholesaler acquired in 2018 by AmerisourceBergen. “It was the back story of my life, and it does shape my life,” Sole-Smith said. “It provides a lot of financial security for my family,” she added. “It is not a privilege I earned, and it is an enormous privilege.”"
So she has a profit motive to sell drugs, which will be more necessary when all those issues correlating with obesity become more and more common.
And I'm gay
My favorite SNL sketch that has ever been and will ever be
The Eating Instinct (her first book), a "quiet" book with a more balanced message about intuitive eating - 2,000 copies sold
Fat Talk (her second book), a noisy book with an extremist message - New York Times best seller that then provided the platform for a $200K per year Substack
I'd suggest that Sole-Smith apply her capitalist critique to her own output.
and ~1,600 calorie days without a break.
Damn it, I could have had an Ozempic. It's like the new V-8.
..."Coulda had a V-8" was a nice marketing campaign for what is mostly plain old tomato juice. I've been having some almost every morning for the last year or so. Wie so:
Several splashes of Tabasco
Several shakes of ground comino
Several shakes of chipotle molido
Lemon juice
Low sodium V-8
No vodka, except maybe on a Sunday morning.
Once again, Bill Burr nails it (NSFW): https://youtu.be/pznB7WP4P1o?si=TKsDGZ3lvnTsSVvn
Kid is under-dressed for the weather, but rather than telling her to dress appropriately, she gives the girl's dinner to the dog.
I'm sorry, that person is mentally unwell.
just as we would do a lot better to be less afraid of being fat." What a load of crap. The template is sort of fun, though. "We would all do a lot better to be less afraid of being squeezed to death by a giant anaconda, just as we would do a lot better to be less afraid of death by ebola." "We would all do a lot better to be less afraid of being eaten alive by a shark..." I think an entire thread of these things would be fun.
There are many causes for divorce, and I know as well as anyone the benefits that are possible from them. But while often complicated subjects, even when both blame the other, not all parties are as well equipped for critical self-examination. Here, the portrait of the individual painted in the article is not a flattering one. It’s hard not to see her cause as motivated at its root by self-centeredness and resentment that she should have to change to accommodate others irrespective of the virtue of the requested change. It’s hard not to conjecture that this hurts her ability to maintain rewarding and sustainable relationships.
...is the person who said that we should treat people who have obesity with respect, as we would people with other health issues; but that we can still recognize the health issues.
This lady has every right to eat and be merry as she likes. However, rather than dwell on how she feels about her body at 42, she might consider what it would be like to have a BMI of, say, 40 at age 72.
We can acknowledge each person’s dignity and not be ugly or callous to our fellow man/woman.
But it is essential that we be honest about the myriad structural and physiological harms to which chronic severe obesity (BMI > 35) leads. It’s a chronic inflammatory state.
We shouldn’t shame, but we sure as hell shouldn’t be spouting lies in a specious effort to buoy self-esteems.
Cash
Some people can keep thin throughout life without trying. Some people gain weight by looking at a donut. So many factors play a part.
Can we all agree obesity is a health issue with massive implications to society, that we should be addressing it, but that not everyone is obese because they (as the person in this article is doing) chow down unrepentantly?
Some people need the extra push - ozempic and wegovy aren't magic bullets - they suppress hunger cravings and make you want to barf if you eat too much. I don't know anyone who would be on it if it didn't help or work when nothing else does.
Above all else, I am very angry at the person in the article because they're a borderline caricature of real life weight struggles of people who are not pompous idiots.
I am proud to be down 45 pounds from 5 years ago thanks to diet and exercise, but I still deal with the effects of carrying too much weightt for too long. I feel for her children.
What a fat idiot and drain on our resources.
never figure out how to eat according to their bodies’ own needs, she explained.” This was her explanation for letting her kids eat as many Oreos as they want.
At some point, people will realize this and something will happen. What, I don't know. It just feels like as the costs associated with obesity/ unhealthy living increase, society is going to push back.
One example is the insurance surcharge associated with smoking. Perhaps something similar will occur with BMI, cholesterol, weight, etc.
I feel for people that try and lose weight, while losing out to genetics. I'm struggling to feel for someone that ignores reality and lives on a YOLO diet.
But Sole-Smith is committed to her stance. At her last checkup, her blood work showed high cholesterol for the first time, and her doctor suggested she limit saturated fats and start baking cookies with margarine. She’s waiting to see her results “in a year when I’m not launching a book and getting divorced,” she said, with a small laugh. If her cholesterol warrants medication at her next visit, “then great. Medication,” she said. “But no. I will not pursue intentional weight loss to manage a cholesterol level.” As she sees it, the risks to her mental health by restricting her diet outweigh whatever other benefit she might gain.
Andy having a dr in front of your name doesn’t immunize you from bad advice. Med mal wouldn’t exist if that were the case. This is a perfect example. Margarine is straight up fucking poison.
Is familiar with her and is trying to fund something she might do. Kind of lick a doctor dealing with an opioid addiction who has no interest in quitting might advise them on using safe needles or avoiding fentanyl.
The thinking being that she'll have more time to snap out of this bizarre midlife crisis before she croaks from a heart attack if they can get her cholesterol in a better place.
For another that has been known to be carcinogenic when it was laden with trans fats strikes me as malpractice.
Butter per 100 g and margarine per 100 g are both 717 calories
Butter has 51 g of saturated fat vs 15 g for margarine
On a calories in and out basis they’re the same thing. This fucking about the margins is how people don’t lose fat and give up.
mental health.
And if they have the older bags vs the newer design at the store, get the older one!
Those bastards at corporate cut the amount in the bag and kept the price the same.
#makechocolategreatagain
You’re in luck!
They are legit, and you don't crush a box since your molars get glued together for three hours.
Now, Good'n'Plenty, I'll get the pitchforks if you get the torches.
not have deleted. It was A+ (chuckle)
choice of dog’s name. But hey, let them eat cake!
to make it through the entire article. Every word of it. Go!
I’m gonna read an article that says it’s okay to promote being fat.
Nobody got fat overnight. I don’t know why people get away with acting like that shit just came out of nowhere.
I mean I do know why; but it’s not polite discussion.
Suffice it say that it -should- require you and does require you to put in an equal amount of time getting rid of said fat.
If you could learn to love shoveling your face you can learn to love lifting weights and having a McSalad.
This whole business in both directions is just ridiculous. I'm not telling my 80 year old dad to bench press, and the woman in this article is toxic.
All or nothing; balance is boring.
By the way, Molly is spot on with respect to resistance training being even more important in the elderly, and yes doing it safely is crucial.
He’s doing machines at planet fitness twice a week.
And that’s just perfect.
Weightlifting becomes even more important as you get older. Nobody wants them under a barbell.
But the benefits of resistance training are crucial for the elderly.
I also don’t give a fuck about being “shredded” - I just wanna look good and be healthy.
Eating sensibly? Lose weight and keep it off. Drink too much or hit a buffet? Hey, there it goes, right to the ass. You can work out obsessively and it will have minimal effect if you don't eat right.
I should probably do some pushups or something but other than my noodle arms I don't really want a ton of muscle.
As far as old people, keep moving. My dad walks around the home. Mobility is a huge issue for older people so staving that off as long as possible is key.
You should, however, be as strong as you can be at all times. Future you thanks you.
Present me probably owes himself some better endurance, too. After I dropped 50 lbs I could better keep up with the chainsmoking 20 year olds, but they still have better stamina.
Nothing will fix my wrister, though.