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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

#111

Post by jakebasile »

whamlastxmas wrote: post #104
jakebasile wrote: post #50

Earlier quoted context omitted.

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.

Yes, the majority has investigated the majority and found the majority not guilty of discrimination. Please tell me more about how you know that big people aren't discriminated against.

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

#112

Post by hasenj »

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…

Why is it the doctor's obligation to provide her with a scale for her size? Why can't she buy one herself?

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

#113

Post by Avshalom »

Constantly ignored is that medical problems are a huge source of weight gain. The arrow of causality is frequently diabetes-> weight or sleep apnea-> weight or sciatica-> weight or asthma -> weight or joint problems -> weight

Not the other way around. A constant thread in the dismissal here and across culture is that the only way you could possibly weigh more that 200lbs is pure weakness of character.

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

#114

Post by dragonwriter »

vonmoltke wrote: post #103
dragonwriter wrote: post #59

Earlier quoted context omitted.

> 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 categori…

> Other than a few anecdotes [...] the article provides no evidence of categorically denying diagnostic tests, only surgeries.

That's not true; besides the anecdotes, there is, for example, the research review linked from the sentence noting that "Research has shown...". [0]

[0] direct link: http://onlinelibrary.wiley.com/doi/10.1111/obr.12266/full

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

#115

Post by jakebasile »

dragonwriter wrote: post #73
jakebasile wrote: post #50

Earlier quoted context omitted.

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…

> 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. I don't think that's true at all. The people that are most described by the latter are also, often, the HN posters most opposed to the former. THere's, obviously, some differences here, but not to t…

My issue is that if comments like this happened on an article about another class of people, it simply wouldn't be acceptable here.

Imagine an article about African American men getting poorer care for heart disease because they are more susceptible to it, and the comments claiming that it's perfectly reasonable and they should just exercise more to compensate for it.

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

#116

Post by dragonwriter »

whamlastxmas wrote: post #85
lsy wrote: post #56

Earlier quoted context omitted.

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.

> 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.

The article links to research showing that it is a wide-spread problem. There may be valid criticism of that research, but your flat unsupported denial is not that criticism.

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

#117

Post by tcj_phx »

roflchoppa wrote: post #49
everyone wrote: post #34

Earlier quoted context omitted.

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.

> Idk why this is being downvoted, its Cal-in,Cal-out...

Calories-in vs. Calories-out is not helpful advice. A person's metabolism can slow to a crawl if the person is starving.

It's much better to fix the metabolism, and remove metabolism-destroying foods from the diet. Many common foods should not be eaten (tofu), or only eaten when well-cooked (kale) [1].

[1] https://en.wikipedia.org/wiki/Goitrogen#Goitrogenic_foods

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

#118

Post by dragonwriter »

jakebasile wrote: post #115
dragonwriter wrote: post #73

Earlier quoted context omitted.

> 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. I don't think that's true at all. The people that are most described by the latter are also, often, the HN posters most opposed to the former. THere's, obviously, some differences here, but not to t…

My issue is that if comments like this happened on an article about another class of people, it simply wouldn't be acceptable here. Imagine an article about African American men getting poorer care for heart disease because they are more susceptible to it, and the comments claiming that it's perfectly reasonable and they should just exercise more to compensate for it.

> My issue is that if comments like this happened on an article about another class of people, it simply wouldn't be acceptable here.

Comments like this happen on articles about the poor, blacks, and women, among others, here, with pretty much similar debate on both sides. So, I think that you're just, factually, wrong.

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

#119

Post by lsy »

whamlastxmas wrote: post #85
lsy wrote: post #56

Earlier quoted context omitted.

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.

Aside from the actual example cited in the article which would appear to contravene "never", as well as plenty of reports from actual obese people, there's a linked study with research on the various ways obesity can cause lower quality of care:

http://onlinelibrary.wiley.com/doi/10.1111/obr.12266/full

"Finally, physicians may over-attribute symptoms and problems to obesity, and fail to refer the patient for diagnostic testing or to consider treatment options beyond advising the patient to lose weight. In one study involving medical students, virtual patients with shortness of breath were more likely to receive lifestyle change recommendations if they were obese (54% vs. 13%), and more likely to receive medication to manage symptoms if they were normal weight (23% vs. 5%)."

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

#120

Post by speeder »

jtuente wrote: post #99
AstralStorm wrote: post #93

Earlier quoted context omitted.

> You can only become obese due to some very critical character flaw. Maybe in some alternate universe. In this universe, you can get obese by, among other things: - untreated hypothyroidism (even low grade) - certain autoimmune diseases including type 1 diabetes - inborn errors of metabolism - having parents consistently overfeed you at youth None of the above is a character flaw.

The first 3 examples you give can all be handled with self-discipline. Only the 4th must be learned.

I have autoimmune hypothyroidism and didn't found yet a good treatment.

Tell me, how I fix it with self-discipline? currently I am using discipline to lose weight, but my hair is falling, my feet skin is splitting open, my nails are breaking, and I am losing muscle faster than I lose fat.

Any suggestions on what I should disciplined about?

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