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

nytimes.com

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

#41

Post by ivraatiems »

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…

This isn't about what I'd expect a doctor to do. Of course I'd expect a doctor to say "lose weight." What I am taking issue with is the way commenters here are treating that imperative, "lose weight," as though it is some very simple thing for severely obese people. It isn't.

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

#42

Post by jakebasile »

diyseguy wrote: post #14

Obesity is deeply repulsive on two levels. People who get to these extreme levels of obesity are basically suicidal. Aside from the obvious revolting physical appearance, there's an underlying message of "might as well die". Their chosen method of suicide is death by uninhibited indulgence in food.

How is it acceptable to call big people revolting and wave off their condition as "suicidal"? You know nothing of these people, or why they are big. They aren't here to look pleasing to you, they just want to live their lives. People are not always big by choice. Do you blame all alcoholics for their condition?

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

#43

Post by csydas »

csours wrote: post #23

There is something similar in IT operations/support. Many companies refuse to investigate an issue until you are on the latest versions of software and firmware. There are good reasons for each of these checkpoints: there may be a real issue not caused by obesity/old firmware, but it is really hard to tell until you get past that.

Well, working support for software company where we often do just that sometimes, the reasoning is different. Often times update to latest version is simply the fastest and safest solution to many problems, since why bother with fixes and workarounds when the underlying bug has been properly resolved elsewhere? We still are required first to identify that upgrade is the right path

Software support isn't exactly analogous to healthcare since the upgrade requirement often is trivial and troubleshooting past that checkpoint is instantaneous. It's also generally not potentially life threatening, despite what angry DBAs might threaten

I would say that weight as a checkpoint for some things is mildly arbitrary and not nearly as useful as most recent patch. With most recent patch, you at least can see what fixes have been incorporated. Losing weight doesn't have the capacity to immediately resolve the underlying issue like a patch does.

I do agree that obesity is a personal thing, but a patient being obese is just part of the considerations as they troubleshoot. It's a major problem but it's also integrated into the patient, and it's the unfortunate reality of what doctors need to deal with.

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

#44

Post by CalRobert »

My experience, having been both a very obese person (100 lbs overweight) an an almost normal-weight person (10ish pounds overweight) is that obese people get worse _everything_.

I expected to have an easier time talking to the opposite sex when I lost weight, and this ended up being true. I had no idea how much better talking to everyone else would be. In customer-business interactions, job interviews, and really every interaction you have with other people it made a remarkable difference. I was an avid cyclist before I lost weight, and I still am now, but people are nowhere near as dismissive when I tell them I rode a half-century the previous weekend, even though I did so before as well (riding a recumbent helps a lot).

This is anecdotal inasmuch as it was just me, but over the course of my life thousands and thousands of data points suggested the idea that people are just extremely prejudiced against fat people.

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

#45

Post by lsy »

graeme wrote: post #37
lsy wrote: post #20

Earlier quoted context omitted.

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…

From the article:

"But there should not be blanket refusals to operate on fat people, the committee wrote. Those with a body mass index over 40 — like a 5-foot-5-inch woman weighing 250 pounds or a 6-foot man weighing 300 — and who cannot lose weight should be informed that their risks are greater, but they should not be categorically dismissed, the group concluded."

It's really simple. You can inform people of the increased risks and possible outcomes and let them make their own decisions about their bodies. The article here is not saying that doctors should ignore weight as a factor, but that they shouldn't make decisions to deny or provide care based solely on BMI.

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

#46

Post by speeder »

I didn't read the article yet, since I opened the comments first... and was shocked by them.

I have a thyroid problem, the first symptons started to show up when I was 13 or 14, including my hair starting to get white.

I didn't knew, it was a thyroid problem, my mom, for some reason (that back then offended me, I told her I didn't wanted to go to a "fat people doctor") took me to a endocrinologist, suspecting something was wrong.

The endocrinologist made no tests, only said I was fat, and dismissed me.

The thing is: according to BMI, I was only slightly overweight, not even really "fat" yet.

But I worsened over the years, and became obese, no matter how hard I tried to not to (including having strict diet and going to the gym, and having medical help from cardiologist, physiotherapist and nutrition).

A random friend of my mother then commented I had obvious thyroid problems symptons, including a obviously enlarged neck.

My mother started to take me to endrocrinologists again... and again, they just kept telling me I was fat, and refusing to help.

I ended researching my own problem, figuring on my own what I needed to have tested, and spending lots of money and time looking for a decent endocrionologist.

I found one that is half-decent, and started at 25 years old my treatment finally... and only then, the treatment is kinda half-assed, my current endocrinologist mostly don't believe me, and don't really want to help, in fact I ended mostly treating myself by myself, buying whatever medicine I wanted, and informing the medic after the fact (where if I made the right choice, the medic would inform me that I made the right choice, so far I always made the right choice, according to improvement in symptons and blood tests results).

I am currently trying to drop my weight until I get obviously "not fat" so I can then save some money, and go to a expensive endocrionologist and hope he will treat me correctly, instead of telling me I am fat.

I even tried to go to the most famous endocrinologist in my country, I spent a entire month salary in one single visit, and the guy just told me I was fat and refused to ask for any tests, despite tests being kinda straightforward (I have a autoimmune disease, a test to see if I have anti-thyroid antibodies would already be enough to diagnose me, yet not a single doctor ever wanted to test that, the single one that did, was a doctor that was going to retire, and that I was very "persuasive" in convincing her to ask for the test, that indeed proved I was correct, and indeed I had a huge amount of anti-thyroid antibodies destroying my thyroid).

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

#47

Post by drzaiusapelord »

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've noticed the liberal media is pretty big on the 'fat rights' bandwagon right now. I imagine its profitable considering the number of fat people in the US and fits in with the largely SJW editorial narrative bias the press is fond of.

As a chronically 25-50lbs overweight person with knee problems, just dropping 10lbs was like night and day for me. Suddenly my feet and knees didn't hurt as much and I felt and slept so much better. There's an ugly narrative here that few press outlets want to sell because I imagine fat rights groups will be offended, but there's a real personal responsibility argument with weight that too often gets brushed under the carpet. Victimization naratives are popular now and get significant ad impressions. Consider the two headlines, which one will get you more clicks? "Doctors biased against the fat patients; thin patients treated better" or "Losing weight is your responsibility when it comes to your health." Obviously, the former will get all the clicks.

I really hope fat rights groups and the liberal media stop with these narratives. Losing weight isn't terribly difficult if you actually care about your health. Its a small investment that significantly pays off. Yes, I get a little offended when my doctor brings it up, but he's right every time. When my weight hits a certain number, my body just falls apart. Suddenly sleep apnea kicks in, I'm sore all the time, I get winded easily, and my back and knees hurt. We shouldn't be fighting against this kind of advice. Its still good and often life-changing advice.

Sadly, this forum being mostly millennials means the comment section is leftist victimization responses straight out of /r/fatlogic. I pity the generation growing up with a 'no one is ever at fault' and 'personal responsibility doesn't exist' philosophy. Its a disservice to them and ruins lives.

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

#49

Post by roflchoppa »

everyone wrote: post #34
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.

Idk why this is being downvoted, its Cal-in,Cal-out... this should have been taught in that health class we took in highschool. I'd argue it should be taught in elementary.

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

#50

Post by jakebasile »

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…

It's infuriating. HN commenters will fall over themselves to rail against discrimination, real or imagined, against women and minorities, but it's perfectly OK to insult, demean, and minimize the problems of big people.

They know nothing about their lives, why they are big, what their health problems come from, what they've tried to lose weight. It's easy to dismiss them as weak willed disgusting blobs of fat, ignoring the human being underneath that is trying to live their life as best they can.

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