Yeah, on this matter, last week I had a private patient sent to me (somewhat incorrectly, since I am a surgeon) for neuropathy, her PT wanted to know if there was an underlying vascular condition. 43 years old, barely walking, came in a wheelchair, with her 13 years old daughter pushing her, around 130 kg/155 cm, had 7 (SEVEN!!!!) spinal surgeries for back pain (caused by her status as an obeast, since it was specified in her chart that she had been obese since childhood), ended up losing sensibility in her lower limbs. Still, it is obvious that, since she still has full motor function, she could live an almost normal life just by losing weight. I listened to her story, read her chart, and I judged that talking about losing weight would be a complete waste of my time. So I did my consult, ruled out vascular problems, and said farewell. I wrote in the chart that she had to lose weight, but I avoided any confrontation. It would have been useless, they don't believe us and we are not that invested anymore in their health, since they clearly don't give a crap. It is sad, but true. Doctors just do not have the time and energy to build with every patient that kind of relationship that would lead to meaningful change in life choices: it was possible in the past, when about 20% of patients needed it, and on average patients trusted doctors, but it is impossible now, when 70% of patients come in spouting nonsense read on the internet, and are arrogant and vocal and often violent if you try and contraddict them. And fats are the absolute worse.