Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

nytimes.com

Post reply on HN
Print view View original

81–90 of 239 posts

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

#81

Post by shortformblog »

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…

This is pretty much how I felt when I read these comments. The argument being made by the piece is that weight is treated as a binary issue, without nuance. Yes, the problem is there—it's apparent, they see it right in front of them, thanks for noticing—but that doesn't mean that other issues should be looked over in diagnosis.

Some doctor choosing not to even consider a patient's medical problem without looking past a single issue—especially when that patient is actually seeing some success in dealing with that issue on their own, as seen in the Patty Nece example highlighted by the Times—is a waste of everyone's time.

From a purely economic perspective, a patient who is paying thousands of dollars for insurance and not-insignificant copays is not getting what they paid for if the doctor treats their patients in this way.

Yes, weight loss solves a lot of problems, but the complication of losing weight for the myriad metabolism types out there makes the solution a challenging one for many types of people. For all the doctors know, their patients could be walking five miles a day and eating a 1,500-calorie vegan diet, but finding their success rate doesn't match the amount of work they're putting in. Their weight may yo-yo in a dramatic way that can make sustaining a healthy weight very challenging.

Weight loss is not like aspirin. It doesn't work exactly the same for everyone. (And there are bad ways of losing weight, of course.)

This Times article from May, while it obviously highlights extreme cases (Biggest Loser contestants), is worth bringing up in the context of this conversation: http://www.nytimes.com/2016/05/02/health/biggest-loser-weigh...

Obesity is a hard problem to solve as a society. To solve that problem, we have to consider the issue thoughtfully, from all sides.

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

#82

Post by ivraatiems »

RyanOD wrote: post #71

Curious...have any individuals ever found the reverse to be true? Doctor takes a look at patient (who presumably appears to be in very good shape) and quickly draws the conclusion, "You're working/training too hard. Just take a break." No real diagnosis, just a quick assumption that, "Hey, this person looks like they're in great shape. They'll get better one way of the other. I have bigger fish to fry." Just curious.

Oh, yeah, that definitely happens. It happens to young people, too. They come in with X symptom and doctors are like "nah, you're so young, you're just fine." Then it turns out you are not fine. This also negatively effects people who have unusual or hard-to-diagnose conditions that exhibit symptoms similar to those of other conditions.

Doctors apply 90%-suitable heuristics to 100% of candidates too often, in my opinion.

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

#83

Post by ivraatiems »

hasenj wrote: post #76
RyanOD wrote: post #71

Curious...have any individuals ever found the reverse to be true? Doctor takes a look at patient (who presumably appears to be in very good shape) and quickly draws the conclusion, "You're working/training too hard. Just take a break." No real diagnosis, just a quick assumption that, "Hey, this person looks like they're in great shape. They'll get better one way of the other. I have bigger fish to fry." Just curious.

Obesity is an actual condition. Being athletic is not a medical condition.

Obesity is a descriptor of somebody's physical state. It's not technically a disease. Your physical state is your medical condition. So, being athletic is an important piece of medical information. Athletes are at risk for some things that non-athletic people are not.

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

#84

Post by Avshalom »

echlebek wrote: post #67
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 don't think the message is "just lose weight". It's "before we can treat this knee problem, we need to deal with your weight problem". Being obese is a critical health problem. It's not wrong for doctors to prioritize it, and I don't think it belies a lack of empathy to agree with them. I say this as a person with a weight control problem.

"Before we fix your knee we're gonna need you to start running more"

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

#85

Post by whamlastxmas »

lsy wrote: post #56
whamlastxmas wrote: post #40

Earlier quoted context omitted.

>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 c…

> 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

It would be if this was actually happening, which is never. Maybe there's like a handful of shitheads out there doing it, but this isn't a wide-spread problem.

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

#86

Post by BlackjackCF »

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 is the sentiment that I hear from my friends who are doctors.

And it's not that they're trying to be disparaging or mean. It's very frustrating for doctors who have to explain to patients repeatedly the root cause of their issues, and that there is no "fast fix" or medicine that will fix their problems until they lose weight.

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

#87

Post by forgottenpass »

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…

Don't assume that because it's easy for you to be fit and skinny, it's easy for everyone.

I'm neither fit nor skinny.

I am empathetic, what I am NOT is sympathetic. I have a problem, and I need to fix it.

I'm working on it. But even when I'm not, I understand that my health problems are and will be primarily weight related.

I actually sort of resent the comparison between "why don't you just cheer up?" and "oh, just lose weight." Everyone understands that weight loss is diet and exercise, even if they've never have to do it. Most people don't understand that depression isn't just an extra long bit of being bummed out, let alone know what the resources a person might need to overcome depression are or how much more complicated it can be. Sure, they both have an initial inertia that needs to be overcome to get started on fixing it, but I'm much more sympathetic to the depressed.

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

#89

Post by ivraatiems »

vonmoltke wrote: post #77
ivraatiems wrote: post #63

Earlier quoted context omitted.

Yes, but then he goes on to suggest that it IS easier than dealing with depression. I think that while that is probably true, it is not true by much, and not true enough to make a distinction here.

As someone who has dealt with both, I personally think weight is far easier to deal with than depression, specifically because I know what to do about weight. Neither is "easy" in the absolute sense, though.

That's fair. I don't mean to judge your specific experience.

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

#90

Post by whamlastxmas »

JackFr wrote: post #57
dclowd9901 wrote: post #26

Earlier quoted context omitted.

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 d…

What her doctor actually probably said was "the limits of what I can diagnose show that you would most likely see a great improvement with weight loss. I can refer you to a specialist who can conduct more tests (MRI etc) but those tend to be very expensive. I wouldn't recommend it without trying weight loss first, which is very important beyond the symptoms you came in for today".
Post reply on HN