Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat • Hacker News Board

Re: Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat

#31

Post by Sir_Substance » Mon, Sep 26, 2016, 3:55 PM UTC

NDizzle wrote: post #3

The article starts out talking about a woman who is 502 lbs. Why wouldn't "lose weight" be the best suggestion? You're 500 lbs!

>The doctor’s scale went up to 350 pounds, and she was heavier than that. If she did not know the number, how would she know if the diet was working?

The important bit of that anecdote that you skipped over. Every doctor will tell overweight people to lose weight, but they also tell them not to lose it too fast, or it can lead to liver and kidney problems.

If a doctor says "lose weight", but can't actually assist you in doing that in a safe, controlled and sustainable fashion because he doesn't have the equipment, he's actually not very useful. My grandmother could tell a 500lb woman to lose weight, but I wouldn't pay her $200,000 a year to do so.

However, the key allegation of this article isn't just that doctors don't have the equipment to give first-world-quality health care to overweight people, it's that they have biases that cause them to not want to rectify that problem, even though that's as simple as buying a sturdier scale.

That's a much more serious issue. It's one of the key reasons AIDS was such a problem 30 years ago. No one wanted to treat ~~the gays~~ in the 70's, and so HIV was allowed to run rampant rather than be treated. Within a handful of years of our society realizing it didn't actually give a shit about whether people like butt stuff or not, HIV went from a terminal diagnosis to a manageable condition, because /doctors actually started taking the people it affected seriously/.

Re: Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat

#32

Post by joenot443 » Mon, Sep 26, 2016, 3:55 PM UTC

ivraatiems wrote: post #22

I'm disappointed by the lack of empathy in these comments. While I agree that yes, an obese person needs to lose weight, telling them that and offering no other help is like telling someone with depression "why don't you just cheer up?" It's totally unuseful advice that incorporate all sorts of gross value judgments about the person. It doesn't solve problems. I've been overweight - not obese, but close at times - al…

I would say that your depression comparison isn't totally accurate.

There are safe, reliable, and well-understood ways to lose weight. They're not easy, enjoyable, or fast, but they're almost certain to work, excluding other medical conditions.

Depression on the other hand, is far less well understood. It's also far more more difficult to treat and fight, and while weight loss has an effective general solution of eating less and exercising more, no such general solution exists for depression. Plenty of people spend their lives chronically depressed with little to no improvement, despite trying countless medications, forms of therapy, and lifestyle adjustments. The same can't really be said for weight loss.

Re: Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat

#33

Post by imagist » Mon, Sep 26, 2016, 3:56 PM UTC

lsy wrote: post #20

whamlastxmas wrote: post #5

Let me save you the time: it's an article pandering to fat people without any substance and really dishonest arguments. The complaint is that doctors tell fat people to lose weight when they come in with symptoms that match the symptoms of being very overweight. If you go to the doctor with knee pain and you are drastically overweight, the most likely answer is that the knee pain is from being overweight. The doctor…

This seems like an unfair characterization of the article. Denial of care, or dangerously mismeasured care, is not acceptable simply based on BMI (a non-scientific measure invented in the early 1800s). If you look at the statistics on weight loss success rates, asking a 500lbs person to lose 200+lbs before you're willing to treat their disease with actual evidence-based medicine—looking at symptoms, pathology, etc—is…

> Denial of care, or dangerously mismeasured care, is not acceptable simply based on BMI (a non-scientific measure invented in the early 1800s).

How did you conclude that BMI is non-scientific? Did you know that Centigrade was invented in the early 1800s, and the first realization of the metric system was in 1799?

BMI definitely isn't accurate for people with high lean body mass, but the patients in this article aren't bodybuilders whose muscle mass drives up their BMI--people with high lean body mass are less likely to need hip and knee surgery. Sure, BMI is an approximation with some well-known cases where it's inaccurate, but doctors are well aware of this fact.

> If you look at the statistics on weight loss success rates, asking a 500lbs person to lose 200+lbs before you're willing to treat their disease with actual evidence-based medicine—looking at symptoms, pathology, etc—is tantamount to outright denial of care.

I'd like to see those statistics.

Re: Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat

#34

Post by everyone » Mon, Sep 26, 2016, 3:57 PM UTC

whamlastxmas wrote: post #5

Let me save you the time: it's an article pandering to fat people without any substance and really dishonest arguments. The complaint is that doctors tell fat people to lose weight when they come in with symptoms that match the symptoms of being very overweight. If you go to the doctor with knee pain and you are drastically overweight, the most likely answer is that the knee pain is from being overweight. The doctor…

I agree. The example in the start where the patient asks how will they know if theyre losing weight as theyre off the scale does not make any convincing point. If they actually ate 1200 kcals a day they would definitely be losing weight. It wouldnt be necessary to confirm via weighing.

Re: Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat

#35

Post by bkor » Mon, Sep 26, 2016, 3:57 PM UTC

ivraatiems wrote: post #22

I'm disappointed by the lack of empathy in these comments. While I agree that yes, an obese person needs to lose weight, telling them that and offering no other help is like telling someone with depression "why don't you just cheer up?" It's totally unuseful advice that incorporate all sorts of gross value judgments about the person. It doesn't solve problems. I've been overweight - not obese, but close at times - al…

Disagreeing with the article and agreeing with that they lose weight does NOT imply lacking empathy. Then entire article states some ridiculous claims. If you're obese, it is a danger to your health. If go then go to a doctor what do you expect the doctor to do? Ignore this because the person might not want to hear it?

You're rephrasing things with "just lose weight": nobody said it is easy to lose weight. But if you're obese, you're in the danger zone.

Re: Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat

#36

Post by ivraatiems » Mon, Sep 26, 2016, 3:58 PM UTC

joenot443 wrote: post #32

ivraatiems wrote: post #22

I'm disappointed by the lack of empathy in these comments. While I agree that yes, an obese person needs to lose weight, telling them that and offering no other help is like telling someone with depression "why don't you just cheer up?" It's totally unuseful advice that incorporate all sorts of gross value judgments about the person. It doesn't solve problems. I've been overweight - not obese, but close at times - al…

I would say that your depression comparison isn't totally accurate. There are safe, reliable, and well-understood ways to lose weight. They're not easy, enjoyable, or fast, but they're almost certain to work, excluding other medical conditions. Depression on the other hand, is far less well understood. It's also far more more difficult to treat and fight, and while weight loss has an effective general solution of eat…

That's not quite the point I am making. The point is that taking either condition at its most surface level and just saying "why don't you just fix it?" is unhelpful.

The fact that there are known ways to help solve weight loss isn't the problem. Obese people know there are ways to lose weight. The issue is psychological - not believing one can achieve the goal, not being ready/willing to fully commit to the goal, feeling too ashamed of oneself to believe one can improve one's situation, and on and on.

Plus, you suggest that because the way to lose weight is clear (it is), that makes it easy. That's a false equivocation. I'm speaking from experience when I say it's simple, but quite challenging. That's like saying "winning the Olympic 100m sprint is easy, just be faster than everyone else." (No, I don't think my weight loss is an Olympian effort, but I am exaggerating for effect.)

Re: Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat

#37

Post by graeme » Mon, Sep 26, 2016, 3:59 PM UTC

lsy wrote: post #20

whamlastxmas wrote: post #5

Let me save you the time: it's an article pandering to fat people without any substance and really dishonest arguments. The complaint is that doctors tell fat people to lose weight when they come in with symptoms that match the symptoms of being very overweight. If you go to the doctor with knee pain and you are drastically overweight, the most likely answer is that the knee pain is from being overweight. The doctor…

This seems like an unfair characterization of the article. Denial of care, or dangerously mismeasured care, is not acceptable simply based on BMI (a non-scientific measure invented in the early 1800s). If you look at the statistics on weight loss success rates, asking a 500lbs person to lose 200+lbs before you're willing to treat their disease with actual evidence-based medicine—looking at symptoms, pathology, etc—is…

Surgery isn't riskless. This source shows knee surgery has serious complications in 2% of cases.

That's for all patients. But it states the risk of knee fracture is higher for overweight patients.

http://www.zimmer.com/patients-caregivers/article/knee/knee-...

Here's a source specific to overweight patients. Obesity is often comorbid with conditions that make it harder to heal and increase the risk of infection, such as diabetes.

http://orthoinfo.org/topic.cfm?topic=A00745

Here's a crucial section:

"However, if you have obesity, you may never achieve the increased mobility and range of motion experienced by a patient of normal weight.

You may also experience more implant and prosthesis complications after surgery, including:

    Component loosening and failure
    Dislocation of the replacement joint, especially in the hip

In some cases, a second "revision" surgery may be necessary to remove failed implants and replace them with new ones. "

That section would be based almost purely on weight. Certainly, BMI is a crude measure, and it doesn't work well for weight lifters and athletes. But that's mostly an issue an issue for people near the "overweight" cutoff at 25. The more obese someone gets, the less false positives BMI has.

There's clearly an issue where past a certain level of adiposity, knee surgery is not sensible: the risks become high, and the outcomes become poor.

What would you do instead? To operate with the expectation of poor outcomes is not good medicine.

Re: Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat

#38

Post by [deleted] » Mon, Sep 26, 2016, 3:59 PM UTC

bkor wrote: post #35

ivraatiems wrote: post #22

I'm disappointed by the lack of empathy in these comments. While I agree that yes, an obese person needs to lose weight, telling them that and offering no other help is like telling someone with depression "why don't you just cheer up?" It's totally unuseful advice that incorporate all sorts of gross value judgments about the person. It doesn't solve problems. I've been overweight - not obese, but close at times - al…

Disagreeing with the article and agreeing with that they lose weight does NOT imply lacking empathy. Then entire article states some ridiculous claims. If you're obese, it is a danger to your health. If go then go to a doctor what do you expect the doctor to do? Ignore this because the person might not want to hear it? You're rephrasing things with "just lose weight": nobody said it is easy to lose weight. But if you…

[deleted]

Re: Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat

#39

Post by __jal » Mon, Sep 26, 2016, 3:59 PM UTC

wyager wrote: post #7

To be a bit blunt, the doctors are probably thinking "if you won't take care of your body, why should I?" If someone is so massively overweight that they need to use equipment intended for large animals or industrial scrap, they are putting themselves in an extremely precarious health situation.

So they don't prescribe statins, and just tell people to change their diets, yes? Hold back on insulin until those nasty diabetics stop gulping soda, even the thin ones? They tell people who do physical work to suck up the back pain, because they should have taken care of their body?

Your needlessly weird comments about equipment betray your bias, as does your implicit belief that everyone who has a weight issue can do something about it. But even if you can't get past your personal feelings, I'd hope you can see that the rather nasty condemnation and moral judgement implicit in how this line of thinking runs looks pretty awful when applied to other medical conditions.

Re: Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat

#40

Post by whamlastxmas » Mon, Sep 26, 2016, 4:00 PM UTC

lsy wrote: post #20

whamlastxmas wrote: post #5

Let me save you the time: it's an article pandering to fat people without any substance and really dishonest arguments. The complaint is that doctors tell fat people to lose weight when they come in with symptoms that match the symptoms of being very overweight. If you go to the doctor with knee pain and you are drastically overweight, the most likely answer is that the knee pain is from being overweight. The doctor…

This seems like an unfair characterization of the article. Denial of care, or dangerously mismeasured care, is not acceptable simply based on BMI (a non-scientific measure invented in the early 1800s). If you look at the statistics on weight loss success rates, asking a 500lbs person to lose 200+lbs before you're willing to treat their disease with actual evidence-based medicine—looking at symptoms, pathology, etc—is…

>not acceptable simply based on BMI

It's not simply based on BMI. It's based a lot of things, but at some point the BMI will be bad enough that the other things become irrelevant.

>asking a 500lbs person to lose 200+lbs before you're willing to treat their disease with actual evidence-based medicine—looking at symptoms, pathology, etc—is tantamount to outright denial of care.

It would be if that actually happened in any systemic manner. And even in the cases where it does happen, it has less to do with whether the doctor is willing and more to do with whether the doctor is able to diagnose.

> But just saying "we have a BMI cutoff" is pretty much discrimination masquerading as medicine.

It's discrimination in the same way that saying people under a certain height can't ride rollercoasters. There isn't some conspiracy amongst theme parks to alienate short people. It's dangerous, and it's nothing to do with prejudice against short people.

And in reality, it's not "we have a BMI cutoff" as the only criteria. It's "we have an extensive and exhaustive list of things we look for before we recommend surgery to patients, since surgery is a dangerous and often life threatening procedure. One of those criteria is a BMI that doesn't cause undue risk to the life of the patient".