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

#101

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

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…

"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."

And here I was, thinking it was just that you love constantly stuffing large amounts of high-calorie foods down your throats.

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

#102

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

It reminds me of the Anna Karenia (sp?) principle.

Happy families are all alike, every unhappy family is unhappy in its own way.

Most fit people are fit the same way. They have the same body proportions, respond the same to anesthesia, and can be maneuvered into the same positions that doctors train for and are used to.

If you're obese, you accumulate fat in different ways, you respond differently to medication and anesthesia, because you just accumulate in different patterns.

Doctors don't train on obese patients because they're all different, so it's hard to get a standard operating procedure. They also don't train on obese patients because until now, they've been a vanishingly small proportional of the population.

Take a look at vintage photographs of "fat men" in carnivals in the beginning of the 1900s. You see people like that all over the place these days. Cheap abundant food and obesity has only recently been a problem.

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

#103

Post by vonmoltke » Mon, Sep 26, 2016, 4:27 PM UTC

dragonwriter wrote: post #59

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…

> 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 a…

> 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.

Other than a few anecdotes, one of which comes from an urgent care center[1], the article provides no evidence of categorically denying diagnostic tests, only surgeries.

> "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.

I have yet to encounter a doctor whose response to my weight is just, "Hi! Lose weight! TTFN!" It's hard to tell with the kind of surveys presented in this article if people are really being brushed off or if they are just being told things they don't want to hear.

[1] Relevant because urgent care centers tend towards shitty experiences regardless of your weight or medical problems. Especially the ones not affiliated with a hospital system.

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

#104

Post by whamlastxmas » Mon, Sep 26, 2016, 4:28 PM UTC

jakebasile wrote: post #50

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, ignori…

The whole point of the majority of the conversation here is that there isn't systemic discrimination happening. People like to feel victimized and are claiming discrimination when it's overwhelmingly not the case, and dishonest articles like this do a huge disservice to the real, legitimate discrimination that does happen.

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

#105

Post by lsy » Mon, Sep 26, 2016, 4:29 PM UTC

asynchronous13 wrote: post #74

lsy wrote: post #45

Earlier quoted context omitted.

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 i…

"But there should not be blanket refusals to operate on fat people" I don't know anyone who would disagree with this sentiment. And the article doesn't present any evidence that there are blanket refusals. Sure, the article presents a few anecdotes, but that's not enough to show that blanket refusals are happening on a larger scale. > You can inform people of the increased risks and possible outcomes and let them mak…

From the article:

"A recent survey of more than 700 hip and knee surgeons confirmed Dr. Yates’s impressions. Sixty-two percent said they used body mass index scores as cutoffs for requiring weight loss before offering surgery."

It sounds to me like "cutoffs" and "requiring" would indicate a blanket refusal, and 62% seems like a fairly large scale to me. What evidence are you looking for?

Other common conditions can also increase risks of complications, and patients are routinely given opportunities to weigh those risks before deciding on surgeries. My suggestion isn't that the doctor throw his duties out the window, but that with high-BMI patients, those duties should not suddenly become more dictatorial than with other patients.

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

#106

Post by AstralStorm » Mon, Sep 26, 2016, 4:29 PM UTC

hasenj wrote: post #70

jakebasile wrote: post #42

Earlier quoted context omitted.

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?

> They aren't here to look pleasing to you So? GP is not here to indulge them either. To each his own. They can choose to indulge on food, it's their freedom, and he can choose to ignore them, it's his freedom.

Another person who thinks obesity is caused by solely overindulgence.

Maybe next you would claim that people with movement disorders (e.g. in wheelchairs) are overweight because of overindulgence. Or maybe you will shift the blame to lack of exercise, not considering they would need multiple times more. Our maybe you will start designing diets for everyone that are trivial to adhere to and make millions as a life coach.

GP is there to treat, not indulge. If they are unable to treat obesity, they are to blame, not the patient. Obesity is extremely hard to treat even when there is will to change. Heck, the causes of it are not yet well understood. Something goes wrong with the feedback system of satiety and energy expenditure, which is evolutionarily stacked to accumulate calories.

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

#107

Post by dragonwriter » Mon, Sep 26, 2016, 4:30 PM UTC

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.

> But therein lies the problem: being overweight is so _unbelievably_ unhealthy that most problems would be resolved simply by losing the weight.

Failure to properly diagnose the actual problems makes it harder for the doctor to assist the patient in actually losing weight. "Lose weight" is an outcome, not a course of action, and choosing the most medically appropriate course of action to achieve that outcome is down to coincidence if you decide to skimp on proper diagnosis just because you think that the patient needs to lose weight.

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

#108

Post by rangibaby » Mon, Sep 26, 2016, 4:31 PM UTC

Sir_Substance wrote: post #31

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…

There was about a 11 year period (first US cases in 1981, "Gay-Related Immune Deficiency" in 1982, Magic Johnson got HIV in 1992) where an HIV/AIDS diagnosis was a certain death sentence. I think there was more of a stigma against gays from politicians and their constituents than doctors, which contributed to it's spread too. It was recognised as early as 1983 that GRID wasn't a gay disease, hence AIDS.

If you would like to read more I believe the definitive history of the early days of the AIDS epidemic is "And the band played on" by Randy Shilts.

I honestly think that if the governments of the world stopped allowing corporations to put sugar in everything then the problem of obesity will fix itself. I'm not going to promote a low-carb diet or whatever, but it is not a disputed fact that sugar makes anything taste better and is addictive, which is why companies add it to everything. People will complain, but it's not really "personal choice" when you are literally choosing food spiked with a drug to make it more addictive.

A lot of people who overeat do it for a number of reasons. I know I like eating a lot now because I was poor once and had to eat as much as possible of whatever was available. I lift 3-4 times a week and bike daily, but am still obese according to my BMI and was recommended against having surgery for appendicitis last year (it fixed itself with a hospital stay and IV antibiotics which was lucky).

I think that for a lot of people counselling would be a good start instead of "eat less". If it were that simple then there wouldn't be fat people, would there? One problem is that some people are just bullies and like to put down others to make themselves feel superior. Then there are things like the "fat acceptance movement". I will never understand that either.

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

#109

Post by [deleted] » Mon, Sep 26, 2016, 4:31 PM UTC

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.

[deleted]

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

#110

Post by ivraatiems » Mon, Sep 26, 2016, 4:32 PM UTC

QSIITurbo wrote: post #101

ivraatiems wrote: post #36

Earlier quoted context omitted.

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…

"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." And here I was, thinking it was just that you love constantly stuffing large amounts of high-calorie foods down your throats.

Imagine how pleased I am to see you've changed that perception.