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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

#171

Post by hasenj »

jakebasile wrote: post #164
hasenj wrote: post #163

Earlier quoted context omitted.

Did she pay the doctor for an extra extra extra large scale?

What the fuck does that have to do with receiving medical care? A heart patient pays for medical care and gets the use of an EKG. An obese patient deserves the same level of care. I guess the oath to heal the sick doesn't matter if that person happens to be big. They don't really deserve to live anyways, they're just weak, right?

If the scale exists in the market, there's no reason why she can't buy it.

If it doesn't exist, it can't be that doctor's fault.

Shifting the blame from oneself into the doctor doesn't do anyone any good.

It just wasted everyone's time and makes people less willing to tolerate your bullshit.

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

#172

Post by botfly »

scarface74 wrote: post #162
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…

When I was in the best shape of my adult life, I weighed 175, with 10% body fat (measured with calipers) and a size 30 waist. I wasn't overly into lifting weights but did a lot of cardio. My BMI was 30 - obese. 5 years later. I do about 3 hours of cardio a week, I weigh 185 and my waist is about 32. My BMI is 31.8. No doctor has ever looked at me and said I need to lose weight. BMI is completely bunk in my case.

You're 5'3" and weighed 175? You must be built like a tank

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

#173

Post by ivraatiems »

forgottenpass wrote: post #160
ivraatiems wrote: post #98

Earlier quoted context omitted.

> I actually sort of resent the comparison between "why don't you just cheer up?" and "oh, just lose weight." Everyone understands that weight loss is diet and exercise, even if they've never have to do it. Most people don't understand that depression isn't just an extra long bit of being bummed out, let alone the resources a person might need to overcome depression. > I am empathetic, what I am NOT is sympathetic. I…

The people we need to have sympathy/empathy for, though, are the people who haven't gotten there yet. Why though? Isn't sympathy towards people who "haven't gotten there yet" really fucking patronizing? I'm not on this "empathy" bandwagon that has gotten popular in the last few years. It's really good at being unemphatic towards people the group has already decided not to like, so the whole thing reads as a sham. I i…

I'm not sure you understand what sympathy and empathy in this context are, or what the difference between them is.

Sympathy is effectively just compassion. False "sympathy" like pity isn't what I'm asking for. Sympathy isn't a bad thing; treating someone with sympathy but not also with respect is a bad thing.

Empathy is about putting yourself in somebody else's shoes. It's about asking yourself "how would I feel if I had to deal with the things this person deals with?" and then evaluating your answer against that person's behavior until you understand them. Empathy is not a "fad," empathy is a basic human societal construct and a fundamental psychological building block. It's decency. I don't know what bandwagon you refer to, but it's not one I'm aware of or what I'm discussing here.

So when I say "treat people with empathy and sympathy," what I am saying is "don't judge them too harshly for not being as capable in this area as you, and think about how it would feel for you if you yourself had to struggle with that incapability." To be frank, I think that that is part of the civility with which we should treat everyone. Admittedly, it's a difficult part and I'm not there 100% myself, but it's valuable.

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

#174

Post by vonmoltke »

tcj_phx wrote: post #117
roflchoppa wrote: post #49

Earlier quoted context omitted.

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_foo…

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

To be at that level of starvation would require the person's body fat percentage to drop to essential levels. "Starvation mode" in normal weight and overweight people is a pernicious myth.

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

#175

Post by hasenj »

jakebasile wrote: post #165
hasenj wrote: post #159

Earlier quoted context omitted.

I'm only dismissing the fat logic that's being despersed everywhere here. Losing weight is hard but that does not entitle obese people to special treatment. The thing is, no one can help you lose weight. Only you can help you do it. Unless you make a decision to endure hunger everyday, it will not happen.

"The thing is, no one can help people through bipolar disorder. Only you can help you do it. Unless you make a decision to endure suicidal ideation everyday, it will not happen." I'm not asking for special treatment, I'm asking to be treated like a human being who deserves dignity and life.

Then ask the doctor to help you lose weight, instead of complaining that the doctor shouldn't advice you to lose weight.

If a cure for bipolar disorder exist but a bipolar patient refused to take it because it hurts their self image, what do you presume the doctor should do?

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

#176

Post by imagist »

halostatue wrote: post #167
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…

Most of the people that I know who have needed hip or knee surgery are thinner people. One’s occupation and/or recreation activities are far more likely to have an impact on whether you need knee surgery than one’s mass (one gentleman I know who had to have both knees replaced was at most 65 kilo and about 165cm—140lb and 5'5"—but had played tennis all his life and had a job which required using his knees often). I k…

> Most of the people that I know who have needed hip or knee surgery are thinner people.

I'm proposing that weight loss is an effective and reasonable treatment for hip or knee problems in obese people, so this observation is consistent with my proposition.

> I know, anecdotes are not data, but there is essentially no data that supports the claims made about BMI, and there are known measurements that are more effective than this grossly ineffective ratio that is loved pretty much only by insurance underwriters.

People are focusing in on BMI as being an inaccurate measurement of fatness, but notably all the cases noted where people treated with weight loss instead of surgery are people who are fat by any measurement you want to pick. Look at the pictures, or read how the person interviewed says, "Do you think I don't know I'm fat?" Can you point to cases where someone who isn't fat was denied surgery due to their BMI?

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

#177

Post by jakebasile »

hasenj wrote: post #171
jakebasile wrote: post #164

Earlier quoted context omitted.

What the fuck does that have to do with receiving medical care? A heart patient pays for medical care and gets the use of an EKG. An obese patient deserves the same level of care. I guess the oath to heal the sick doesn't matter if that person happens to be big. They don't really deserve to live anyways, they're just weak, right?

If the scale exists in the market, there's no reason why she can't buy it. If it doesn't exist, it can't be that doctor's fault. Shifting the blame from oneself into the doctor doesn't do anyone any good. It just wasted everyone's time and makes people less willing to tolerate your bullshit.

Wanting to receive medical care is bullshit? You are all over this thread throwing around vile "aphorisms" about big people being moral failures and that they "just need to eat less!", as if it was so simple. Your casual dismissal of people's lives is appalling, and your ability to dehumanize others is sickening.

I do not blame doctors for my weight. I do blame doctors that do not give adequate medical care to people because of weight.

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

#178

Post by jakebasile »

jlarocco wrote: post #166
jakebasile wrote: post #55

Earlier quoted context omitted.

Telling them to correct the initial cause is wholly different than not treating the symptoms or not mitigating damage because "they don't deserve it" or "they can't even take care of themselves".

I'm not sure it has anything to do with the patient "deserving it" or not. Nobody wants to put effort into something when somebody else is actively working against it.

Big people do not want to be obese, and doctors are paid for their efforts. Nobody sets out with the life goal of being fat.

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

#179

Post by vonmoltke »

dragonwriter wrote: post #114
vonmoltke wrote: post #103

Earlier quoted context omitted.

> 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

I see a lot of discussion in that paper about stigmatization, "bedside manner" type stuff, and other things that understandably affect outcomes because it puts the doctor-patient relationship on a negative footing. I'm in complete agreement with that being a problem. However, it provides no evidence that diagnostic tests or any other care are categorically denied.

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

#180

Post by [deleted] »

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…

[deleted]
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