Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

nytimes.com

Post reply on HN
Print view View original

221–230 of 239 posts

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

#221

Post by imagist »

jakebasile wrote: post #197
imagist wrote: post #192

Earlier quoted context omitted.

I think that big people are discriminated against. I've experienced this in the workplace firsthand, where people were not hired for positions where their weight had no bearing on their ability to perform the job. However, obesity does have real health implications, and as such, weight loss is an effective treatment for obese people presenting with a wide variety of health problems. Recommending weight loss when weig…

I agree that recommending weight loss is not discrimination in and of itself. I think that refusing to explore other treatment options in tandem is wrong, and I think that the comments in here blaming big people for being big as if it's a moral failing are discriminatory and ignorant.

> I think that refusing to explore other treatment options in tandem is wrong,

"Exploring other treatment options in tandem" in this case means cutting someone open and possibly killing them, in tandem with helping them lose weight, which would likely solve the problem by itself.

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

#222

Post by AstralStorm »

jimmywanger wrote: post #102

It reminds me of the Anna Karenia (sp?) principle. Happy families are all alike, every unhappy family is unhappy in its own way. Most fit people are fit the same way. They have the same body proportions, respond the same to anesthesia, and can be maneuvered into the same positions that doctors train for and are used to. If you're obese, you accumulate fat in different ways, you respond differently to medication and a…

The real question then is why. It is certainly not just access to abundant cheap food - otherwise you would see more rich fat people in the past. There is probably more than factor and actual epidemiologists should be able to disentangle and find most of them, especially as records are available.

It is either something tied to methods of agriculture and farming or appearance of some sort of endocrine disruptor that is nowadays abundant.

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

#223

Post by AstralStorm »

imagist wrote: post #219
AstralStorm wrote: post #214

Earlier quoted context omitted.

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.

Well, I know a few people with damaged joints. Weight loss helps but does not fix the problem. The main thing is if your joint are damaged due to overload and not some other issue, surgery may be less effective or only temporarily effective.

The joints can and do regenerate except from chronic problems. Unfortunately, obesity is one, just losing weight does not fix joints as quite a few long time former weight lifters can attest.

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

#224

Post by AstralStorm »

hourislate wrote: post #131
dclowd9901 wrote: post #26

Earlier quoted context omitted.

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 m…

He's right, but those are not "choices". Few people I know choose to be fat consciously. As opposed to drug users and smokers.

This kind of language is part of the problem, shifting blame onto actual patients.

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

#225

Post by AstralStorm »

vonmoltke wrote: post #220
AstralStorm wrote: post #211

Earlier quoted context omitted.

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.

You would need a large group of people with regular and often made metabolic (extended, incl. thyroid, cortisol, liver hormones; urine NH to check protein catabolism...) panels during a strict diet. Probably also direct BMR measurements. I am not aware of such studies and not for lack of effort to find them.

I only have my own metabolic panels taken at my expense weekly during a vegan diet (vetted by a dietician) attempt. A failed one to boot. From correct baseline to borderline hypothyroidism in a matter of weeks. Quick rebound when the attempt was stopped.

The study would have to be careful to exclude people with known preexisting conditions that cause obesity and only take in "idiopathic" subjects.

The most interesting related study I found is the Right Track long-term study of adolescent health related behaviour and total factors. It is currently in progress. Hopefully it won't disappear.

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

#226

Post by Sir_Substance »

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.

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

Actually there's a good chance that's not true. My experience with specialist equipment suppliers is that they _will not_ sell single units to individuals who don't work in the field, because civilian customers are annoying as fuck, and they choose to keep a clean battle front by refusing to sell to them regardless of circumstance.

Your clean view of capitalism is as irrelevant to wholesale as it is to medicine, I'm afraid.

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

#227

Post by imagist »

AstralStorm wrote: post #223
imagist wrote: post #219

Earlier quoted context omitted.

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.

Well, I know a few people with damaged joints. Weight loss helps but does not fix the problem. The main thing is if your joint are damaged due to overload and not some other issue, surgery may be less effective or only temporarily effective. The joints can and do regenerate except from chronic problems . Unfortunately, obesity is one, just losing weight does not fix joints as quite a few long time former weight lifte…

From the article: "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." (emphasis mine)

I don't have any reason to disbelieve you about your friends, but your friends do not represent all obese people, and in losing weight does fix joints some percentage of the time. Given the alternative is surgery, which kills the patient some percentage of the time, I don't think there's a lot of debate to be had here.

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

#228

Post by jimmywanger »

AstralStorm wrote: post #222
jimmywanger wrote: post #102

It reminds me of the Anna Karenia (sp?) principle. Happy families are all alike, every unhappy family is unhappy in its own way. Most fit people are fit the same way. They have the same body proportions, respond the same to anesthesia, and can be maneuvered into the same positions that doctors train for and are used to. If you're obese, you accumulate fat in different ways, you respond differently to medication and a…

The real question then is why. It is certainly not just access to abundant cheap food - otherwise you would see more rich fat people in the past. There is probably more than factor and actual epidemiologists should be able to disentangle and find most of them, especially as records are available. It is either something tied to methods of agriculture and farming or appearance of some sort of endocrine disruptor that i…

I'm pretty sure it's access to abundant cheap food. With a few exceptions (ahem, Mexico) most obesity crises are in well developed countries.

Even so, cheap abundant food is definitely much more of a thing in Central/Latin/South America than it used to be.

Also, a lot of corporation have spent a lot of time and energy dressing up cheap ingredients to directly stimulate our pleasure sensors.

In the past sweet, salt, and fatty food were hard to come by and rather expensive, so you'd gorge when you could. These days, the cheapest procesed foods are saltier, sweeter, and fattier than anything in the 1800s.

It's doubtful that it's tied to methods of farming or an endocrine disruptor. Unless you're talking about food subsidies for cheap grains. We just like salty, greasy, sweet food cause it used to be rare, and now it's not.

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

#229

Post by asynchronous13 »

lsy wrote: post #105
asynchronous13 wrote: post #74

Earlier quoted context omitted.

"But there should not be blanket refusals to operate on fat people" I don't know anyone who would disagree with this sentiment. And the article doesn't present any evidence that there are blanket refusals. Sure, the article presents a few anecdotes, but that's not enough to show that blanket refusals are happening on a larger scale. > You can inform people of the increased risks and possible outcomes and let them mak…

From the article: "A recent survey of more than 700 hip and knee surgeons confirmed Dr. Yates’s impressions. Sixty-two percent said they used body mass index scores as cutoffs for requiring weight loss before offering surgery." It sounds to me like "cutoffs" and "requiring" would indicate a blanket refusal, and 62% seems like a fairly large scale to me. What evidence are you looking for? Other common conditions can a…

There's a difference between saying "You're fat, so we won't operate on you." versus "The pain that you hope to fix will become worse if we perform surgery on you." Surgeries that involve weight-bearing joints and bones are particularly sensitive to the mass of the patient (like the hip and knee surgeons surveyed). For heavier patients, the healing time is longer and the risk of additional pain after surgery is much much higher.

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

#230

Post by AstralStorm »

imagist wrote: post #227
AstralStorm wrote: post #223

Earlier quoted context omitted.

Well, I know a few people with damaged joints. Weight loss helps but does not fix the problem. The main thing is if your joint are damaged due to overload and not some other issue, surgery may be less effective or only temporarily effective. The joints can and do regenerate except from chronic problems . Unfortunately, obesity is one, just losing weight does not fix joints as quite a few long time former weight lifte…

From the article: "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 ." (emphasis mine) I don't have any reason to disbelieve you about your friends, but your friends do not represent all obese people, and in losing weight does fix joints some percentage of the time. Given the alternative is surge…

It is true. Counselling is not good enough though. Given how ineffective it is, it is essentially permanent denial.

Moreover, there are other issues to verify, say, a person born with hip dysplasia should be treated regardless of weight as weight loss will never fix the underlying problem.

Also aching hip joints quite effectively prevent many kinds of exercise, which does not help with weight loss at all.

Without an effective alternative course of action, the surgery may be the one remaining effective measure.

Post reply on HN