hissing meerkat

Sorry, “moral hazard” is a term-of-art (something that doesn’t mean what it says on its face but is used in some particular way in some fields or professions). In this case by “moral hazard” I meant the idea that if you reduce the harm of some course of action there’s a chance that people will engage in it more because it’s less harmful now. It usually is applied to risky-yet-beneficial behaviours like injury from sports or from outdoor pursuits. It’s ridiculous in that context (I don’t think we should make things worse just so they don’t get better) and doubly or triply ridiculous when the risky behaviour isn’t beneficial or also isn’t effectively voluntary.

analyzed in depth under the lens of how that would actually effect reality

You are implying you imagine some moral hazard where their provider minimizes the risk of the conditions the patient has, and as a result the patient stops seeking treatment. What you’re talking about in reality is shame. “Should a patient feel shame talking to their provider”?, and the answer to that is resoundingly “no”. Shame is a powerful demotivator, it’s function is to stop a person from doing something that threatens their relationships with others or the society they depend on. Trying to motivate someone with shame is counter-productive. All shame in a patient care setting can do is demotivate the patient from seeking care.

Mental illnesses are absolutely medical conditions. Many of them have physical origins; your brain is a physical organ in your body. Mental illnesses with social or experiential origins are also medical conditions that can demand both physical and mental care. The brain can have a physical impact on the body that also need care. Your brain is the main organ in your body that predicts what will happen in the future, and other parts of your body respond to it to regulate biological functions, as famously demonstrated by Pavlov’s experiments with conditioning dogs by experience to get a response from their digestive (salivary) glands.

Medical care for obesity is currently in most cases like telling someone with a broken starter that they need to run their car more instead of replacing the starter.

If eating too much compared to energy usage is unhealthy then there’s already something wrong with the patient that’s causing them to eat too much or expend too little energy. Telling them to lose weight might be the only thing within a provider’s abilities to do, but it’s equivalent to telling someone with a broken starter to leave the engine running.

It is abelist and biased to pass judgement on ones patients for having symptoms of physical, mental, social, or environmental ailments. When a symptom is already socially stigmatized a provider has a responsibility to care for the social impacts of that stigmatization as well, at the bare minimum in one’s own dealings with the patient.

People “eat too much” because there’s something that’s already wrong with them that causes them to eat too much.

I hope you get the care you deserve.

Until then talk to your doctor about:

• if you can adjust dosage yourself so that you only take metformin in amounts or at times/circumstances that won’t make you sick
• if you can try the extended release (or vice versa) formulation of metformin
• talk to your doctor/dietician about when you should take it during a meal to minimize side effects.

I’m going to let you in on a little secret. Obesity is almost always caused by other medical conditions, not the other way around.