Friday, May 09, 2008

What I Hate Even Worse

But you know what I hate even worse? It's when somebody describes pain in their feet, or their knees, or their back, and then quickly says, "I know what I really need to do is lose some weight." As if to say, "I know this is really self-inflicted, sorry to bother you with it, really I deserve to be in pain."

No. No, you don't deserve to be in pain. And an extra twenty or thirty pounds probably has nothing to do with it; an extra hundred pounds probably has nothing to do with it. (Except that you may have put on weight because moving around hurts). Skinny people have plenty of foot and knee and back trouble, trust me.

Doctors, who are generally ignorant about the causes of myofascial pain and how to deal with it*, advise people to lose weight all the time, despite the fact that nobody has a method for losing weight, in the real world, for the long term, that's very effective. It's just silly to go around saying that people ought to be able to lose weight when obviously, in the long term, most of them can't. It's not only silly, it's cruel. So you have a metaphysical doctrine that says people can control what they eat by the exertion of will power. Bully for you; you can believe whatever you like to believe; but what right have you to lay your bizarre religious doctrines on other people? People come to you for help, not for preaching. Prescribing cures that have a 5% to 10% effectiveness, at best, and then blaming people when they don't work, is not good medical practice.

There are millions of people who are suffering daily pain, sometimes excruciating, sometimes disabling pain, and doing nothing about it (except guiltily taking some pain medications and compromising their livers), because they've been told that it's their own fault, and that the only real thing they could do about would be to exert their will power and lose weight.

It's not true. None of it is true. There's nothing wrong with your will power; it works about the same as everyone else's.** Your pain isn't caused by being overweight. It isn't caused (not directly, anyway) by stress. It's caused by purely mechanical problems that have mechanical fixes: fascia that's stuck, unresolved trigger points in the muscles, bad ergonomics at work or at home, insufficient rest, nutritional deficiencies. The weight is the least of your troubles: if you miraculously dropped to your recommended weight overnight, your pain might become a bit easier to work around, but it would not go away.

* I'm sorry to keep dissing doctors. I have great respect for medical doctors; what they're good at they're very good at. But I work in a field that makes their deficiencies rather glaringly obvious. People come to me with pain that's been diagnosed as arthritic, that can't possibly be arthritic; they come to me diagnosed (correctly) with plantar fasciitis, without having been told about the most elementary stretching exercises for alleviating it. These things aren't rocket science. They're just things that doctors aren't taught to take very seriously: lives are made miserable by them, but people don't die of knee pain or plantar fasciitis.

** Nobody -- nobody -- resists overwhelming, omnipresent temptation, in the long-term. Most people who are fat are tempted to overeat that way. Most people who aren't fat aren't. I think it's likely that when we really understand the metabolic mechanisms of appetite, we'll work out how most people can live in the normal state of mild, passing, intermittent tempation, and most of us won't overeat. Heroic exertions of the will, and shame at their failure, are dear to the traditions of revealed religion, but they're not a good basis for public health.

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