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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

#121

Post by vonmoltke »

AstralStorm wrote: post #93
hasenj wrote: post #64

Earlier quoted context omitted.

Having been obese in the past as well, I can confirm some of your experience. However, to be honest, I don't see it as a form of negative prejudice. It's a completely reasonable prejudice. You can only become obese due to some very critical character flaw. For example: inability to delay gratification, lusting over immediate pleasures, inability to make plans and stick to them, inability to read social cues telling y…

> 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.

> - untreated hypothyroidism (even low grade) > > - certain autoimmune diseases including type 1 diabetes > > - inborn errors of metabolism

None of those conditions is sufficient to push you above borderline obesity (~30 BMI). To get beyond that requires something else. I will not subscribe to the GP's notion that "something else" is necessarily a "very critical character flaw", but I also will not accept that it is out of the control of the person in question.

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

#122

Post by maxerickson »

rangibaby wrote: post #108
Sir_Substance wrote: post #31

Earlier quoted context omitted.

>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…

Yeah, it was for sure recognized as a public health problem in 1981.

https://www.aids.gov/hiv-aids-basics/hiv-aids-101/aids-timel...

AZT was approved by the FDA in 1987, with some federal funding to pay for it. Which is the real story of why people survive it today, drugs were developed to treat it. But the attitudes of front line doctors in 1990 wouldn't have much to do with the development of those drugs.

One strategy I've used against my poor eating habits is to eat something like broccoli when I want a large serving. A huge serving with a modest amount of butter is ~200 calories.

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

#123

Post by AstralStorm »

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.

Good luck handling first three with discipline. Make sure to run a placebo controlled trial of "discipline" and compare to results of insulin and thyroid hormones. You won't be able to, because it is considered unethical for a good reason.

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

#124

Post by whamlastxmas »

jakebasile wrote: post #111
whamlastxmas wrote: post #104

Earlier quoted context omitted.

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.

I would if it wasn't the equivalent of talking to a child with hands over their ears yelling "LALALALALLALA"

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

#125

Post by vonmoltke »

speeder wrote: post #120
jtuente wrote: post #99

Earlier quoted context omitted.

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?

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

The treatment is taking the appropriate dose of levothyroxine. It's very unfortunate that you have had a string of shitty GPs and endos, but to treat it you need someone to measure your T3 and TSH levels while gradually ratcheting up the synthetic hormone dose until your numbers are in the acceptable range.

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

#126

Post by speeder »

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.

I am exceedingly unlucky then, the tens of doctors I visited so far since I was 13 years old looking for help with my symptoms (that now I know is hashimoto disease) all refused to do any tests and just told me I was fat. Seemly all few shitheads were met by me.

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

#127

Post by jtuente »

AstralStorm wrote: post #123
jtuente wrote: post #99

Earlier quoted context omitted.

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

Good luck handling first three with discipline. Make sure to run a placebo controlled trial of "discipline" and compare to results of insulin and thyroid hormones. You won't be able to, because it is considered unethical for a good reason.

None of them cause weight gain, which is explicitly was the original comment was about, not disease treatment.

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

#128

Post by jtuente »

speeder wrote: post #120
jtuente wrote: post #99

Earlier quoted context omitted.

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?

None of them cause weight gain, which is explicitly was the original comment was about, not disease treatment.

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

#129

Post by ivraatiems »

whamlastxmas wrote: post #124
jakebasile wrote: post #111

Earlier quoted context omitted.

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.

I would if it wasn't the equivalent of talking to a child with hands over their ears yelling "LALALALALLALA"

Insulting parent commenter for asking you to support your arguments makes me feel that the child here is you.

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

#130

Post by dragonwriter »

jtuente wrote: post #127
AstralStorm wrote: post #123

Earlier quoted context omitted.

Good luck handling first three with discipline. Make sure to run a placebo controlled trial of "discipline" and compare to results of insulin and thyroid hormones. You won't be able to, because it is considered unethical for a good reason.

None of them cause weight gain, which is explicitly was the original comment was about, not disease treatment.

> None of them cause weight gain

All three of them do cause weight gain, actually; that is, any medical treatment of them will list something like "weight gain or increased difficulty losing weight" as a symptom.

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