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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

#131

Post by hourislate »

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.

My neighbor is Head of Emergency for one of the largest hospitals in my city. He has said that a large part of Emergency Room cases are due to lifestyle choices whether it is Drugs, Alcohol or being Over Weight. Problems related to being over weight from Heart conditions, Diabetes, High Blood Pressure account for the largest portion of visits. He said the single most important thing you can do for your health is to maintain a healthy weight. It will prevent many ailments later in life.

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

#132

Post by speeder »

hasenj wrote: post #92
speeder wrote: post #46

I didn't read the article yet, since I opened the comments first... and was shocked by them. I have a thyroid problem, the first symptons started to show up when I was 13 or 14, including my hair starting to get white. I didn't knew, it was a thyroid problem, my mom, for some reason (that back then offended me, I told her I didn't wanted to go to a "fat people doctor") took me to a endocrinologist, suspecting somethi…

Whatever condition you had didn't cause you to gain weight. You can't defy physics. If you control your caloric intake, your body /will/ lose fat. Your story is anecdotal so I'll response with an anecdote as well: I've seen more than one person with a "thyroid condition" who were in good shape.

You just forget the body is made of more than fat.

Yes, eating less calories than I use will make me lose weight, but where that weight will come from? Nothing guarantees it will be from fat.

For example right now my hair, nails and skin is breaking, and I am losing muscle. But when I raise my food intake, I get an increase in fat, and my nails, hair, muscle and so on continue fucked up. But when I cut calories, they get worse faster, but the fat remains.

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

#133

Post by rangibaby »

maxerickson wrote: post #122
rangibaby wrote: post #108

Earlier quoted context omitted.

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 strat…

> 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.

My wife had a good idea and she has got me eating a big bowl of high-fiber vegetable (cabbage etc) soup before whatever silly main I want to eat. It's very filling and I believe the same strategy as yours.

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

#134

Post by tcj_phx »

hasenj wrote: post #92
speeder wrote: post #46

I didn't read the article yet, since I opened the comments first... and was shocked by them. I have a thyroid problem, the first symptons started to show up when I was 13 or 14, including my hair starting to get white. I didn't knew, it was a thyroid problem, my mom, for some reason (that back then offended me, I told her I didn't wanted to go to a "fat people doctor") took me to a endocrinologist, suspecting somethi…

Whatever condition you had didn't cause you to gain weight. You can't defy physics. If you control your caloric intake, your body /will/ lose fat. Your story is anecdotal so I'll response with an anecdote as well: I've seen more than one person with a "thyroid condition" who were in good shape.

> You can't defy physics. If you control your caloric intake, your body /will/ lose fat.

People whose bodies go into starvation mode in the absence of starvation can't lose weight.

Dietary goitrogens and excess polyunsaturated oils are very hard on the metabolism.

> I'll response with an anecdote as well: I've seen more than one person with a "thyroid condition" who were in good shape.

Being in 'good shape' is about more than excess weight. I've started to fix my metabolism, and I'm not so anorexic-looking anymore.

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

#135

Post by dragonwriter »

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.

> The whole point of the majority of the conversation here is that there isn't systemic discrimination happening.

Yes, the article links to research showing systematic discrimination here, and many people here are dismissing the possibility without addressing the research, acknowledging it is even referenced, or doing anything more than stating their firm belief that discrimination is not occurring.

> People like to feel victimized and are claiming discrimination

With, you know, actual research backing them up.

> when it's overwhelmingly not the case

[citation needed]

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

#137

Post by tcj_phx »

speeder wrote: post #132
hasenj wrote: post #92

Earlier quoted context omitted.

Whatever condition you had didn't cause you to gain weight. You can't defy physics. If you control your caloric intake, your body /will/ lose fat. Your story is anecdotal so I'll response with an anecdote as well: I've seen more than one person with a "thyroid condition" who were in good shape.

You just forget the body is made of more than fat. Yes, eating less calories than I use will make me lose weight, but where that weight will come from? Nothing guarantees it will be from fat. For example right now my hair, nails and skin is breaking, and I am losing muscle. But when I raise my food intake, I get an increase in fat, and my nails, hair, muscle and so on continue fucked up. But when I cut calories, they…

When under conditions of low blood sugar, muscles are the easiest source of sugar. Low blood sugar -> Cortisol release -> muscle destruction. If you search for 'cortisol muscles', I'm sure you'll find something helpful.

Fruit juice is one of the best sources of sugar - many fruits are good sources of potassium, which helps the body burn sugar instead of store it. Milk is also a good source of potassium.

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

#138

Post by hasenj »

speeder wrote: post #132
hasenj wrote: post #92

Earlier quoted context omitted.

Whatever condition you had didn't cause you to gain weight. You can't defy physics. If you control your caloric intake, your body /will/ lose fat. Your story is anecdotal so I'll response with an anecdote as well: I've seen more than one person with a "thyroid condition" who were in good shape.

You just forget the body is made of more than fat. Yes, eating less calories than I use will make me lose weight, but where that weight will come from? Nothing guarantees it will be from fat. For example right now my hair, nails and skin is breaking, and I am losing muscle. But when I raise my food intake, I get an increase in fat, and my nails, hair, muscle and so on continue fucked up. But when I cut calories, they…

There's hardly any calories in your nails.

You can supplement with specific vitamins and minerals for your nails and skin. You can supplement with protein and perform basic exercises to protect muscles (pushups, beginner level).

Protecting hair is not a good excuse to not lose weight.

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

#139

Post by throwanem »

lsy wrote: post #119
whamlastxmas wrote: post #85

Earlier quoted context omitted.

> 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 diagnost…

The study you cite does not seem to support your contention in so doing:

> Comparisons of recommendation categories for shortness of breath by condition revealed that students were more likely to recommend lifestyle changes when the patient was obese than when she was not obese, χ2 (1, N =76) =14.6, p<.0001. They were less likely to recommend symptom management (i.e., bronchodilator prescription) for shortness of breath when the patient was obese, χ2 (1, N =76) =4.8, p<.05. There was, however, no significant difference in recommendation rates for diagnostic tests.

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

#140

Post by hasenj »

tcj_phx wrote: post #134
hasenj wrote: post #92

Earlier quoted context omitted.

Whatever condition you had didn't cause you to gain weight. You can't defy physics. If you control your caloric intake, your body /will/ lose fat. Your story is anecdotal so I'll response with an anecdote as well: I've seen more than one person with a "thyroid condition" who were in good shape.

> You can't defy physics. If you control your caloric intake, your body /will/ lose fat. People whose bodies go into starvation mode in the absence of starvation can't lose weight. Dietary goitrogens and excess polyunsaturated oils are very hard on the metabolism. > I'll response with an anecdote as well: I've seen more than one person with a "thyroid condition" who were in good shape. Being in 'good shape' is about…

Starvation mode is not really a thing. At worst, your daily caloric output will drop by a hundred or two hundred calories. It's not going to drop by a thousand calories.

Obese people have specially high caloric requirements per day. A normal size person might require 2000 calories a day to maintain weight, but an obese person could require 3500 per day (or even more).

Limiting your daily intake to 1600 calories as an obese person absolutely will cause your body to burn fat.

Consistently so.

All you have to do is endure the hunger.

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