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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

#211

Post by AstralStorm »

vonmoltke wrote: post #174
tcj_phx wrote: post #117

Earlier quoted context omitted.

> 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.

Not true about body fat levels. Metabolism is not quite regulated in this way. Otherwise those people would get hot before they get fat, as their metabolism would speed up.

Metabolism control seems to be based of medium term intake rather than fat stores. Either that or there is a set point which is quite hard to move. Or both. Handling the fat does increase basal metabolic rate to an extent. But only so far. The abovementioned slowdown starts with mild thyroid suppression and shows up in bloodwork. This can cut BMR by up to half without starvation. (25% calorie cut from high levels is nowhere near enough)

The problem is, this reduces will to both diet and exercise and induces a low grade depression.

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

#212

Post by AstralStorm »

hasenj wrote: post #206
jakebasile wrote: post #200

Earlier quoted context omitted.

Find another way to help the patient.

Would you be open to possibly having to restrain the patient and force them to take the medicine? Would you be open to shaming then into taking it? Would it be wrong to say that unless they want to be cured, no one can help them?

Yes, it is wrong. Forced treatment has a pretty long tradition. The problem is, unlike alcoholism there is no way to abstain from food other than being immobilised and fed IV or enteric. There are no good way to fake satiety yet. For alcoholics, there are drugs that will make one retch when they imbibe. For some narcotics, there are strict blockers.

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

#213

Post by AstralStorm »

JoeAltmaier wrote: post #150
AstralStorm wrote: post #69

Earlier quoted context omitted.

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 tre…

This applies only for movement disorders (e.g. joint damage) directly caused by obesity, maybe. Which the doctor gets to prove by excluding other reasonable causes existing in non-obese people. No shortcuts.

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

#214

Post by AstralStorm »

imagist wrote: post #142
lsy wrote: post #79

Earlier quoted context omitted.

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... 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 sympt…

Weight loss is a result of a proper treatment. A result.

Care is getting the obese person to lose weight. Which is hard, harder than dealing with hard drugs. Dieteticians, who are supposed to be specialists, fail hard at care. GP doesn't even know where to start.

So let's fix what is broken. If a person cannot eat, they are fed, right? That is a task for a properly trained nurse.

But I don't know of a doctor who wants to provide essentially more than daily care and effective one to begin with.

And doctors do not like to feel like failures.

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

#215

Post by AstralStorm »

voidtype wrote: post #208
tcj_phx wrote: post #117

Earlier quoted context omitted.

> 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…

CICO is incredibly helpful advice, and should be the main piece of advice given to anyone wanting to lose weight. I wish someone told me when I was starting out. Eating healthy and working out doesn't mean anything if you're not counting your calories and making sure CI "You don't need to exercise, you don't even need to eat healthy. Eat less than your BMR and you WILL lose weight." Your claims of a metabolism slowin…

Even counting calories, as laborious as it is, has its limits. Weight loss takes a long time for an obese person. A diet has to be also healthy and possible to follow long term.

Personally I have been through 6 different kinds of diet, calorie counting or not. The only thing to put in a dent long term was a very low carb high protein ketogenic diet (but it broke liver enzymes and cholesterol long term, took it 2 years. Exactly at the point where I achieved the right weight too. Yes, it was nutritionally verified.) and a hardcore CR diet which was terrible to adhere to. (essentially hungry all time after two weeks, preoccupied with food enough to be distracting at work. Also nutritionally verified.)

And in our culture you get to tell everyone you will not partake in their food which is extra torture on top.

So yes, the advice is garbage, does not work in general long term in my long and varied personal experience.

Also, obesity is a syndrome. There are many causes and diet is probably very ineffective for most. At best a symptomatic treatment.

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

#216

Post by AstralStorm »

hasenj wrote: post #156
dragonwriter wrote: post #130

Earlier quoted context omitted.

> 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.

Weight gain cannot occur without consuming excess calories. Your body cannot defy physics. Your body cannot create energy out of thin air.

Do you want to be hungry all the time? Because that is the result of the required diet (close to hardcore 1200 kcal CR bottom limit) to compensate for hypothyroidism. Essentially starvation. It is worse than drug cravings which tend to disappear after a short time. I wouldn't wish that on anyone.

The body sadly seems to sense lack of input/output balance, not current energy state.

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

#217

Post by AstralStorm »

hasenj wrote: post #161
jtuente wrote: post #95

Earlier quoted context omitted.

> inability to read social cues telling you to stop gaining weight This one is going the way of the dodo of late, especially for females. Articles like this one are a symptom of the normalization of obesity.

Which further proves how common this character flaw is.

If it is common, maybe it is not character. Somehow people hundred years back did not have the problem and they had just as many character flaws.

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

#218

Post by imagist »

jakebasile wrote: post #201
imagist wrote: post #190

Earlier quoted context omitted.

The study did not show systematic discrimination. It showed that obese patients presenting with hip and knee problems were systematically denied surgery in favor of weight loss as a treatment. There is a strong case to be made that weight loss is the proper treatment for those patients, given that weight loss is a much less risky treatment, and has positive side effects beyond treating the condition at hand. For me t…

And of course it is impossible to find other avenues of treatment if one doesn't work for the patient.

I don't see any evidence that patients whose knee and hip issues weren't fixed by weight loss are unable to get surgery.

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

#219

Post by imagist »

AstralStorm wrote: post #214
imagist wrote: post #142

Earlier quoted context omitted.

> 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... 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 sympt…

Weight loss is a result of a proper treatment. A result. Care is getting the obese person to lose weight. Which is hard, harder than dealing with hard drugs. Dieteticians, who are supposed to be specialists, fail hard at care. GP doesn't even know where to start. So let's fix what is broken. If a person cannot eat, they are fed, right? That is a task for a properly trained nurse. But I don't know of a doctor who want…

I agree, we need better help for weight loss.

However, that's not what most people here are arguing for. The specific case here is a complaint that people are denied surgery, and people feel that this is denial of care; that is, people are arguing that we should perform knee and hip surgeries on obese people, even though weight loss would be a much safer treatment.

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

#220

Post by vonmoltke »

AstralStorm wrote: post #211
vonmoltke wrote: post #174

Earlier quoted context omitted.

> 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.

Not true about body fat levels. Metabolism is not quite regulated in this way. Otherwise those people would get hot before they get fat, as their metabolism would speed up. Metabolism control seems to be based of medium term intake rather than fat stores. Either that or there is a set point which is quite hard to move. Or both. Handling the fat does increase basal metabolic rate to an extent. But only so far. The abo…

There is no scientific evidence of this. No study that has tried to demonstrate this effect has done so.
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