Melissa writes:
I was reading your website and have a story that I think is important to share with physicians (if they are reading) and overweight patients who may, like me, have the cause of an illness missed because the first assumption is to blame the fat.
In my 20s I developed depression and was prescribed a popular but relatively new drug treatment. The medication was at least partially successful in treating the symptoms of depression but I gained a great deal of weight (which everyone assumed to be associated with the depression) and developed high blood pressure (which everyone including my doctor assumed to be associated with the weight gain). I was encouraged to work on improving my diet and exercise, which I did, but I struggled to lose any weight. My doctor talked about putting me on another drug (beta blockers) to deal with the high blood pressure. I resisted this as a side effect of these drugs is to increase lethargy which makes it harder to exercise and was likely to see me gain even more weight.
My doctor was very reluctant for me to go off the antidepressant medication for fear that I would spiral back into my depression – and this did happen the first two times I did this. Last year, as I wished to try and get pregnant, I went off the antidepressant medication for a third time and have now been off it for more than a year. It’s been tough but I’ve coped. I lost a few kilos but am still very overweight. Recently I was hospitalised for an unrelated issue. During a week of constant monitoring it emerged that my blood pressure had reverted to a very healthy normal range. I was delighted but puzzled. Everyone claimed that this was probably due to the fact that I had lost some weight and was regularly exercising. I thought that this was unlikely to be the case as I am still about 10-15 kilograms heavier than when I was first diagnosed with high blood pressure.
I started researching the antidepressant drug I had been on for the best part of a decade and discovered that a known possible side-effect was hypertension (high blood pressure) along with weight gain. In other words, it was the prescribed drug that caused the high blood pressure, rather than the fat (and in fact a fair bit of the weight gain may have also been due to this drug). And this was never picked up because everyone, including the medical profession, assumed that the fat was the cause of the problem rather than a symptom of the problem (that I was experiencing dangerous side effects from a popular drug and should probably not be taking it).
I am trying not to be angry about the fact that for 10 years I experienced a condition that in the long-term can be life-threatening due to the doctors’ misguided assumptions about the cause of my high blood pressure. I would rather people, especially GPs, learn from my experience. My doctor is a good and experience practitioner who I know has my welfare at heart – but he made a mistake that could have had a major impact on my health and I’m sure there are many other doctors and patients in the same situation.
I urge anyone who has been diagnosed with a medical condition such as high blood pressure to seek a second opinion as to its cause and to specifically request a review of any prescribed or over-the-counter medication they are taking (there are pharmacists and other specialists who are particularly good at the latter). Even the best doctors can make mistakes or be unknowing victims of fat prejudice.
First, Do No Harm 
ReginaE
/ June 19, 2009Actually, I would bet money that the doctor knew that hypertension was a possible side effect of the antidepressant, but decided that it was more important to treat the depression at that time, and just didn’t want to explain/discuss any of this with Melissa for fear of scaring her off the antidepressant.
MDs do this all the time– adopt this patronizing attitude where they’ve done the thinking, and feel they don’t have to explain their chain of logic to the patient. (In fact, many seem to think they’re doing their patients a favor by adopting this way of doing things… they don’t recognize that it’s patronizing, and then get upset when their patient continues to ask questions to try to figure out what the doc is thinking!)
sannanina
/ June 20, 2009ReginaE – I get were you are coming from and I think you are right that many doctors show this kind of behavior (which is in itself unacceptable). But then her physician shouldn’t have told her that her high blood pressure was caused by her weight gain.
I had high blood pressure a few years back – actually I probably developed it while losing weight (I hadn’t checked it a for a few months before starting to diet). My GP send me to a cardiologist who was pretty awsome until the point that he told me that losing weight would normalize my blood pressure. I told him that I had just lost 15 to 20% of my body weight. His response? “Lose some more.”
I actually DID lose more weight at the time – but my blood pressure normalized only later on. And it did not go back up when I gained back the weight plus some (although yoyo dieting is a factor that was found to cause high blood pressure in animal experiments). Looking back I think that my high blood pressure was probably at least partially caused by being really stressed at the time – yet none of my doctors ever asked me about that. I don’t even doubt that being fat is a risk factor for high blood pressure – the problem is, though, that there is evidence that yoyo dieting is an even stronger risk factor and most people who lose weight will gain it back. Plus, it is irresponsible to tell a patient that his or her high blood pressure is cause by being fat without ever checking for things like stress (or in the case above medications that can cause high blood pressure). And I haven’t even gotten into how hard it is to even GET a correct blood pressure measurement at most doctors’ offices – up to now I ALWAYS had to remind the nurses and doctors that I need a bigger sized cuff, and in about 50% of the cases they did not have one available. Just like Melissa I don’t think these things happen because of malicious intent – however, that does not mean it is okay that they do happen.
Christina
/ June 21, 2009I’m on three medications for high blood pressure, and it will NOT come down. I am trying to get my doctor to do some tests to figure out why, after a beta-blocker, a calcium channel blocker, and a vasodilator, it’s not happening. Hypertension runs in my family, we ALL have it.
ReginaE
/ June 22, 2009sannanina: of course the doc shouldn’t have blamed it on her fat. I totally agree.
BMW
/ August 21, 2009Thought I’d let you gals know, The high blood pressure someone whose obese/overweight gets IS NOT the same kind someone who is thin-“normal” sized does. High blood pressure in the over weight is due to higher blood volume and stroke volume. This is much less dangerous than high blood pressure due to hardening arteries(which is what is automatically assumed in the obese). Make sure you’re doctor tests the flexibility of your arteries before you get on beta-blockers or the like that can kill your liver. If the cause is just higher stroke volume, then weight loss will “cure” it, but if you actually have hardened arteries, no amount of weight loss will help you, and you need actual help(meds.). If your arteries are still supple there is little need to worry unless your BP is well (30+ points) above normal.
lauredhel
/ August 22, 2009It’s amazing how many pressures drop to normal or low-normal just by using the appropriate equipment for the task. Even name-brand “large” cuffs are very, very cheap – maybe around the price of a box of syringes and a kidney dish.
Yet they’re still not available in many doctors’ offices. I can’t help wondering if this is because they don’t like the idea of being deprived of the opportunity for a DeathFat! lecture.
G.
/ September 10, 2012It reminds me a very similar story, but not with the high BP side effect.
I was prescribed Zyprexa to deal with my outbursts preventing me to function (it was found later that those outbursts were linked to my ADHD. This is not a small detail for the follow-up).
I slept 13 to 15 hours a day, unable to do anything, and I gained a mere 12 kilos. The mere 12 kilos made my mom worry, instead I was more worried about the sleeping 13 to 15 hours a day and being told by psychiatrist that I can get my driving license if I want.
No way I can get my driving license with a medicine who makes me sleep 13 to 15 hours a day !!
The psychiatrist was firm on the fact that I was sleepy due to depression !!
It was only after I stopped the medicine and start to throw a fit in her office that she started to consider “maybe changing the medicine” (she was extremely reluctant because she feared other worse side effects. It could not be worse than sleeping 13 to 15 hours a day, at least for me).
Needless to say, the first day of med change made a whole difference. Still the wrong class of medicine, but having a diagnosis for ADHD and being prescribed the right medicine (a stimulant) is basically another story (stimulants are considered a medicine to drug patients because their parents didn’t want to take their responsibilities, and that CPS would had never allowed such a failure to happen. Especially by doctors, especially by psychiatrists, BTW).
She recognized that she made a huge mistake and that indeed, the Zyprexa she prescribed was the wrong medicine to give me.
She explained her mistake that “on the paper, Zyprexa looked perfect for you. But in the reality, it was the wrong medicine because it had too many side effects”.
Also, after I printed a guidebook from a French charity aimed at road safety, she recognized that of course, by sleeping 13 to 15 hours a day will not make someone pass the license.
At least, she recognized her mistakes, which was at least something ! Because making a doctor to recognize his mistakes is as hard as teaching an elephant to climb on a tree….
Last but not least, years later after I started taking the right medicine for my ADHD, I made a Google research about hypersomnia and Zyprexa.
The amazing thing is that the European Medicines Agency released a complete facts sheet about Zyprexa, and side effects include : “somnolence can leading to the point of hypersomnia” (I quote it from memory, and it was from French, so may not be the exact translation. The essential is that they recognize that Zyprexa can lead to hypersomnia).