Hi Penny, I have had two ACL knee constructions, so I get knee problems. In my adult life, I have struggled with both my weight and my knee. Happily, I now have both sorted via an improved diet. The best book I have read on the topic of diet and nutrition science is the fascinating Good Calories, Bad Calories - a.k.a. “Good Science, Bad Science” – by former The New York Times science reporter Gary Taubes. And I plan to give away a copy of his book each week until Christmas: http://www.australianparadox.com/

I was recently diagnosed with high blood glucose, commonly referred to as "Type 2 diabetes", which in medical terms means high blood glucose. Yes, the diagnosis is a description of the symptom, and nothing else.

I was put on a course of medication to lower my blood glucose, and sent to a dietician, who advised me about what I should eat, and how much exercise I need to do to stay healthy, and that being overweight is a risk factor for Type 2 Diabetes, and especially weight around the abdomen is really bad.

The only problem with all this useful information is, I am not even close to being overweight. I am smack in the middle of the (questionably useful) BMI range for my height, my waist measurement is below average for my BMI, I don't eat a lot of sugary foods or drinks, I walk everywhere, as I have no car. I was a vegetarian for fifteen years, and still have a predominantly vegetarian diet with lots of vegetables, pulses and whole grains and some, generally lean, meat and seafood.

They have nothing else to offer, basically.

It's an instant and easy response for a doctor, I suppose, a useless repeated mantra, and I feel many patients are missing out on actual diagnostic medicine, as doctors simply decide their problems arise from their weight without actually checking for genuine medical problems.

There are issues associated with excess weight, but doctors should confirm that patients are actually unfit before assuming they are unhealthy just because of their waist measurement.

The underlying assumption often seems to be that being overweight is a "choice", thus overweight people are "wrong". It's really not helpful. A person's weight (whatever it is) is always part of the complex constellation of that person's personality and life. Maybe having a GP blurt something at a patient as part of a 7 minute consultation might "work" in a rare case ("I'm fat? really? I had no idea. Better rush off and get thin then.") but it doesn't seem likely.

Hi Penny, I know how you feel - I manage to stay at a "reasonable" weight through a lap band, lots of exercise and sometimes using those horrible highly processed meal replacements. I have broken both my legs including my knee, and need to keep my weight down for many reasons. I have been lucky enough recently to have found a couple of doctors who say "It's not your fault" - i.e. that I eat less than 1200 calories a day and have done for many years and still remain overweight; that to lose weight I need to eat about 6-700 calories plus an hours exercise a day. One doctor who is an obestity expert has told me that if it's any consolation (it isn't) then my extremely efficient metabolism is much healthier than those people who can eat whatever they want and remain thin. I just wish more people (including those so called fitness experts in the media) would realise how hard it is for many of us to keep our weight down and that many of us in fact eat better and exercise more than most.

Hi Penny, you have hit the nail very squarely on the head with this one, I too had a doctors visit, just for a referral mind you, and he preceded to tell me I needed to loose weight..... Oh derrr, didn't know that at all!!!! I walked out of his surgery with a perscription for weight loss pills, duromine think it was, never got it filled.... after checking with Dr google realised far too many side affects for me. On my next visit to MY Dr, mentioned to her how my weight had slowly increased over the years without any significant change to my diet, she did a full blood workup and..... showed I had a Non Alcoholic Fatty Liver..... didn't matter what I did I was never going to loose weight till I fixed my Liver!! If only the first Dr had bothered to look beyond my weight problem to see if maybe there was a reason for it!! I've since been to a dietican who said my diet was fine, lots of healthy foods, just portion size issues..... Well have a follow up every fortnight she said...... not heard back from her since!! Thank goodness for my local nutritionist that does kineseology,Facebook and the world that is BLOGS!!! I found 'sweet poison' by David Gillespe and the rest as they say is history, I am slowly turning the weight graph upside down. Bring on summer and a much slimmer healthier ME :)

Building muscle is the key to losing fat. Weightlifting is the best way to build muscle. Many aerobic exercises, while very good for you, can actually reduce muscle mass. Greater muscle mass means faster metabolic rate which means more calories burned even when resting.
It's not about losing weight, it's about losing fat. Weightlifting also has benefits for bone density and joint strength in preventing injuries.

Good article - thanks! You obviously know lots about nutrition, diet and are most likely very healthy despite dodgy knees!

Making judgements about people is always fraught with danger, but what am I supposed to think about overweight families I see in the supermarkets, loading up their trollies with the most amazing amounts of processed junk? Or the pudgy children who come to school with a typical lunch-box: small packet of high-sugar fruit bites, small packet of BBQ shapes, tub of low-fat, high-sugar yoghurt, chocolate bar, white bread sandwich with processed cheese, and possibly a strawberry or two. Throw in an energy drink, and it's impossible not to make a private judgement about that family's attitude to food and nutrition!

The people who comment on and read The Conversation are well educated, and interested in their own lives and wider issues. The challenge is to change the attitudes of the majority of people who find it too hard to change, don't really think about it, don't want to be told what to do.

A local Kinder has just started a 'nude food' policy, with bans on pre-packaged food, highly processed foods, sweet things (including biscuits, cakes, muffins, whether home made or not), rice-crackers etc. New rules allow for kids to bring a sandwich, fresh fruit and vegetables, dips, cheese and yoghurt. Sounds pretty sensible to me, but there has been a big backlash from parents who find it hard to deal with the new plan.

It seems essential to start good eating really early - how do we tactfully deal with that?

Great article. I research type 2 diabetes and obesity. This whole demonisation of people who are obese is enormous problem. It's going to take a lot to turn this around, but articles like this can only help.

If you have access to the International Journal of Obesity there's actually an article out today you'd find interesting:
International Journal of Obesity (2012) 36, 1332–1333; doi:10.1038/ijo.2012.100
When commonsense does not make sense
N V Dhurandhar
http://www.nature.com/ijo/journal/v36/n10/full/ijo2012100a.html?WT.ec_id=IJO-201210

Just to pick up on a specific point raised by your doctor - coconut oil doesn't appear to influence blood lipid levels as badly as other saturated fats. It contains a lot of a specific saturated fatty acid 'myristic acid', which influences blood lipids differently than fatty acids with a longer carbon chain. (here's a few refs):

Effects of coconut oil, butter, and safflower oil on lipids and lipoproteins in persons with moderately elevated cholesterol levels.
Cox C, Mann J, Sutherland W, Chisholm A, Skeaff M.
J Lipid Res. 1995 Aug;36(8):1787-95.

The chain length of dietary saturated fatty acids affects human postprandial lipemia.
Karupaiah T, Tan CH, Chinna K, Sundram K.
J Am Coll Nutr. 2011 Dec;30(6):511-21.

Thanks for this article Penny.
I read that the main thing here is the assumptions. It could have been about anything; judgements are quickly made based on people's appearance or little pieces of information without an understanding of context. I understand that GPs work very hard and are under a lot of pressure from a variety of sources but it is so important to talk to your patient and recognise that each presentation is a unique person in a unique situation. Assumptions can be dangerous on a number of levels.
I fear that many GPs are like this (but acknowledge that many are not) and worry that there is an evolving primary health care system that has the general practitioner at the centre, making assumptions, and not the people that have the health need.