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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

#51

Post by whamlastxmas »

imagist wrote: post #28
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…

So, I'm in strong agreement that it's reasonable to have weight cutoffs as requirements for surgery, but let's make that argument based on facts, please. You said: > This survey doesn't confirm that surgeries are refused for the fear of lower ratings. The articles says: > And 42 percent who picked a body mass index cutoff said they had done so because they were worried about their performance score or that of their h…

How convenient they don't mention the name of that survey, who conducted it, how it was formed, or link to the actual survey itself. The idea that nearly half of doctors would outright say "we do this to cover our ass" is laughable. That sentence from the article would also be "technically true" is they gave a checkbox of options for factors in that BMI cutoff, one of of which could be "concerns over the overall success rate of surgeries for myself or my employer" which is totally founded and reasonable and could have nothing to do with having some egotistical or financial stake in ratings.

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

#52

Post by vonmoltke »

ivraatiems wrote: post #36
joenot443 wrote: post #32

Earlier quoted context omitted.

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, fe…

> Plus, you suggest that because the way to lose weight is clear (it is), that makes it easy.

> > There are safe, reliable, and well-understood ways to lose weight. They're not easy

The poster you are replying to specifically said it wasn't easy.

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

#54

Post by [deleted] »

jakebasile wrote: post #42
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?

[deleted]

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

#55

Post by jakebasile »

jlarocco wrote: post #17
et2o wrote: post #12

Earlier quoted context omitted.

Doctors take care of people who don't take care of themselves all the time, everyday. It's part of being a doctor.

And when those people go to the doctor with complaints related to not taking care of themselves, the doctors tell them they need to stop drinking, smoking, or whatever. Why would obesity be any different?

Telling them to correct the initial cause is wholly different than not treating the symptoms or not mitigating damage because "they don't deserve it" or "they can't even take care of themselves".

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

#56

Post by lsy »

whamlastxmas wrote: post #40
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…

>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…

BMI can definitely be a starting point for a discussion with the patient about elevated risks, etc. But there's never a point where "other things become irrelevant", which is exactly the point of this article—doctors regularly refuse to provide basic medical treatment beyond a certain BMI point. If someone is experiencing e.g. chest pain, it's deeply unethical and unprofessional to refuse consideration of any other cause than obesity, and to limit treatment to a scolding about dieting—no matter how high a person's BMI is.

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

#57

Post by JackFr »

dclowd9901 wrote: post #26
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…

But therein lies the problem: being overweight is so _unbelievably_ unhealthy that most problems would be resolved simply by losing the weight. And conversely, I don't think any doctor out there is refusing to treat a sinus infection because a patient is overweight.

As reported in the article, a patient who over the course of a week became unable to walk at all without shortness of breath. Her doctor told her to lose weight. The cause of the shortness of breath was blood clots on the lungs.

And in my personal experience, my mother experienced precisely what you don't think ever happens. A sinus infection went untreated for weeks after repeated doctor visits.

It is not that the doctor won't treat a sinus infection, it's that he won't _diagnose_ a sinus infection because the level of care drops when a patient is obviously overweight.

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

#58

Post by pixl97 »

gjolund wrote: post #29

Most doctors will also tell an alchoholic to stop drinking.

Actually they won't.

You can very quickly kill a dependent alcoholic without special treatments. Going cold turkey has a risk of sudden death.

Quickly losing a massive amount of weight has risks too. That said, if a doctor says you have a condition that is being exacerbated by obesity, the patient should be sent to a weight specialist.

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

#59

Post by dragonwriter »

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…

> There are safe, reliable, and well-understood ways to lose weight.

Which ways to lose weight are most safe, reliable, and effective is well-understood to actually be quite dependent on personal factors which are exactly the things that will not be properly assessed if doctors are less likely to order appropriate diagnostic tests for people that are overweight.

> They're not easy, enjoyable, or fast

They are often at least one of those (most often the last) if the appropriate method is chosen for the person, though its true that this is not always the case.

> but they're almost certain to work, excluding other medical conditions.

"Excluding other medical conditions" is exactly the problem, since comorbidities with obesity are not at all rare, and many of them are directly relevant to weight-loss strategies.

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

#60

Post by fjjrxcbdhx »

nugget wrote: post #21
fjjrxcbdhx wrote: post #8

Earlier quoted context omitted.

I don't even work in software, but it just makes sense considering most of what they do is looking up factoids in a textbook. They frequently misdiagnose or let things slip by because there's just no way for humans to memorize that many books.

That's a little like saying software developers spend all day googling for syntax. The "factoids" aren't very useful unless you know how to put them together and what to do with them.

It's a very different kind of knowledge retrieval, i.e. knowledge about something as opposed how to do something. Your example doesn't really fit.
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