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

#141

Post by tcj_phx » Mon, Sep 26, 2016, 5:01 PM UTC

pixl97 wrote: post #58

gjolund wrote: post #29

Most doctors will also tell an alchoholic to stop drinking.

Actually they won't. You can very quickly kill a dependent alcoholic without special treatments. Going cold turkey has a risk of sudden death. Quickly losing a massive amount of weight has risks too. That said, if a doctor says you have a condition that is being exacerbated by obesity, the patient should be sent to a weight specialist.

> You can very quickly kill a dependent alcoholic without special treatments. Going cold turkey has a risk of sudden death.

My girlfriend became profoundly psychotic when she ran out of alcohol. She was taken to the hospital, who didn't care that she had been drinking, and didn't include on their 'petition for court-ordered evaluation' that their initial blood work found cocaine metabolites. The psychiatrists at the county's behavioral health center also didn't care that their patient told them she'd been drinking heavily.

Modern Medicine does some things quite well. Weight loss and addiction are two areas where conventional medicine is inadequate.

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

#142

Post by imagist » Mon, Sep 26, 2016, 5:03 PM UTC

lsy wrote: post #79

imagist wrote: post #33

Earlier quoted context omitted.

> Denial of care, or dangerously mismeasured care, is not acceptable simply based on BMI (a non-scientific measure invented in the early 1800s). How did you conclude that BMI is non-scientific? Did you know that Centigrade was invented in the early 1800s, and the first realization of the metric system was in 1799? BMI definitely isn't accurate for people with high lean body mass, but the patients in this article aren…

Do you have resources on the scientific basis for BMI's efficacy as a health indicator? Comparing to linear measurements like temperature and distance seems a little apples-and-oranges when BMI is attempting to do something different, which is to reduce a fairly complex system to a single number. > I'd like to see those statistics. https://www.ncbi.nlm.nih.gov/pubmed/10449014 "Data from the scientific community indic…

> Do you have resources on the scientific basis for BMI's efficacy as a health indicator?

http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/ind...

> > > 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 tantamount to outright denial of care.

> > I'd like to see those statistics.

> "Data from the scientific community indicate that a 15-wk diet or diet plus exercise program produces a weight loss of about 11 kg with a 60-80% maintenance after 1 yr. Although long-term follow-up data are meager, the data that do exist suggest almost complete relapse after 3-5 yr."

This in no way indicates how many patients with knee and hip issues are able to solve those knee and hip issues simply by losing weight.

> And that's 11kg… the situation described above is 90kg. You're essentially telling someone to go away and come back after 2+years of dieting to get medical care. Don't you think that seems unrealistic?

No, I'm not telling someone to go away and come back after 2+ years to get medical care, I'm prescribing medical care that will take 2+ years.

Weight loss isn't denial of care; weight loss is the care.

There are plenty of forms of treatment that take a long time. If a doctor prescribes a course of medication that takes 2 years before trying surgery because it will solve the problem for most people and is lower-risk, you wouldn't complain about that, or call it denial of care. But in fact, weight loss is safer than most medicines--weight loss for an obese person has almost no negatives.

I posit that the only reason you're objecting to weight loss as treatment is that you've formed your opinion based on identity politics rather than medical efficacy.

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

#143

Post by jakebasile » Mon, Sep 26, 2016, 5:03 PM UTC

ivraatiems wrote: post #65

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…

In fairness to HN, this is a societal problem, not an HN problem. It's a viewpoint issue that affects lots of people.

That's true. I think I'm just especially aghast at the comments here because I generally enjoy this community and figured there would be more empathy.

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

#144

Post by dragonwriter » Mon, Sep 26, 2016, 5:04 PM UTC

adrr wrote: post #94

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…

Article doesn't mention who pays for the increased cost to serve the morbidly obese. Replacing all the MRIs, Xray machines etc would be very expensive. Also added malpractice insurance as morbidly obese have more complications especially when it comes to anesthesiology as dosing is extremely hard to to get correct.

Reducing the malpractice currently occurring in the treatment of the morbidly obese should reduce the needed malpractice insurance. (The problem may be that the malpractice that the article documents isn't being prosecuted sufficiently by its victims; if it was, the behavior would probably change.)

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

#145

Post by hasenj » Mon, Sep 26, 2016, 5:06 PM UTC

tcj_phx wrote: post #137

speeder wrote: post #132

Earlier quoted context omitted.

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.

Citation needed.

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

#146

Post by speeder » Mon, Sep 26, 2016, 5:07 PM UTC

hasenj wrote: post #138

speeder wrote: post #132

Earlier quoted context omitted.

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.

Are proteins calorieless?

Right now my diet is already protein heavy.

There is a way to force all my protein eaten to do protein job without a single bit of it being turned into calories for other purposes?

EDIT: my questions were rethorical. I know proteins have calories, that is my whole point. even with a diet where I get only the macronutrients I need, my calorie intake is too high. Right now my lifestyle consists of switching periods of losing weight woth periods of fixing the damage. so far lost 30kg from my peak weight, still need to lose more 30kg to doctors stop telling me I am fat and start helping me.

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

#147

Post by hasenj » Mon, Sep 26, 2016, 5:07 PM UTC

AstralStorm wrote: post #106

hasenj wrote: post #70

Earlier quoted context omitted.

> 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 coa…

I used to be obese.

I know what causes obesity.

It basically does boil down to over indulgence.

If you're in denial about that, I can see why you would be. It's no different than religious people denying science to protect their egos.

However, your sensitivity does not warrant that others should indulge your delusions and fantasies.

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

#148

Post by jakebasile » Mon, Sep 26, 2016, 5:08 PM UTC

hasenj wrote: post #112

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…

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

Because she is paying the doctor for medical care, either directly or indirectly through insurance. Because the doctor has taken some form of oath to do no harm, and to take every measure necessary to treat a patient, and to have empathy and sympathy for the sick. Because she is a human being who deserves medical care.

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

#149

Post by imagist » Mon, Sep 26, 2016, 5:08 PM UTC

whamlastxmas wrote: post #51

imagist wrote: post #28

Earlier quoted context omitted.

So, I'm in strong agreement that it's reasonable to have weight cutoffs as requirements for surgery, but let's make that argument based on facts, please. You said: > This survey doesn't confirm that surgeries are refused for the fear of lower ratings. The articles says: > And 42 percent who picked a body mass index cutoff said they had done so because they were worried about their performance score or that of their h…

How convenient they don't mention the name of that survey, who conducted it, how it was formed, or link to the actual survey itself. The idea that nearly half of doctors would outright say "we do this to cover our ass" is laughable. That sentence from the article would also be "technically true" is they gave a checkbox of options for factors in that BMI cutoff, one of of which could be "concerns over the overall succ…

> How convenient they don't mention the name of that survey, who conducted it, how it was formed, or link to the actual survey itself.

Ugh, you're just wrong, and I can only conclude you didn't read the article. They mentioned who conducted it and linked the actual survey, which has all the information you mention.

From the article:

> "There is a perception among some surgeons that it is more difficult, and certainly some felt it was an added risk,” to operate on very obese people, Dr. Yates said. He was a member of a committee that reviewed[1] the risks and benefits of joint replacement in obese patients for the American Association of Hip and Knee Surgeons. The group concluded that heavy patients should first be counseled to lose weight because a lower weight reduces stress on the joints and can alleviate pain without surgery."

> 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.

Again, I think that it's reasonable to have BMI cutoffs as a requirement for surgery, but let's make that argument based on facts, please.

[1] https://www.researchgate.net/publication/278060582_Obesity_a...

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

#150

Post by JoeAltmaier » Mon, Sep 26, 2016, 5:10 PM UTC

AstralStorm wrote: post #69

JoeAltmaier wrote: post #6

Life is hard when you have worked yourself into a health hole. Getting out will require treating a cluster of issues. Obesity is trivial to diagnose. So the rest get little attention until that one is dealt with. Occams razor says don't spend a moment more figuring out probable cause than is necessary.

Except medicine works on different principles than Ockham razor. Such as the Hippocrates oath some doctors selectively forget. (2nd and 4th verse of modern version) A doctor is not supposed to stop or not attempt treatment because a person is fat... which is a kind of sickness, not really a choice. Not should they stop at the most obvious issue, especially when it takes years to fix.

Diagnosis works on Occam's razor most of the time. Yes it could be a tumor or degenerative bone disease, but its probably just a sprain (because you twisted it hard while playing basketball). In fact Occam's razor describes medicine perfectly.

As for the 2nd part - my back hurts and I'm fat - weight-related for 99% of the patients. Fixing weight fixes the back (and the feet and the knees and on and on). Any other treatment is palliative but doesn't address the fundamental cause. It would be irresponsible to keep giving obese patients 'crutches' (treating the complaint) when the cure is weight control.