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

#231

Post by AstralStorm » Wed, Sep 28, 2016, 5:49 AM UTC

jimmywanger wrote: post #228

AstralStorm wrote: post #222

Earlier quoted context omitted.

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, a…

I am pretty sure access to food is a prerequisite, but not a direct causative agent. Otherwise everyone in the West would be obese today, not 1 in 5.

And yes, manufacturing practices may be truly causing this, coupled with more hectic but sedentary lifestyle preventing people from cooking properly (it takes time and care), compounded by lower quality of basic ingredients and higher levels of stress.

It is highly unfair and unjust to throw it also onto a single person to invert, especially a sufferer.

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

#232

Post by AstralStorm » Wed, Sep 28, 2016, 5:52 AM UTC

hart_russell wrote: post #30

csours wrote: post #23

There is something similar in IT operations/support. Many companies refuse to investigate an issue until you are on the latest versions of software and firmware. There are good reasons for each of these checkpoints: there may be a real issue not caused by obesity/old firmware, but it is really hard to tell until you get past that.

Great analogy

If an upgrade took years to apply, this wouldn't be a standard operating practice.

Such as in high risk environments with certification requirements. You wouldn't tell a bank or military "upgrade it".

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

#233

Post by AstralStorm » Wed, Sep 28, 2016, 5:56 AM UTC

ivraatiems wrote: post #82

RyanOD wrote: post #71

Curious...have any individuals ever found the reverse to be true? Doctor takes a look at patient (who presumably appears to be in very good shape) and quickly draws the conclusion, "You're working/training too hard. Just take a break." No real diagnosis, just a quick assumption that, "Hey, this person looks like they're in great shape. They'll get better one way of the other. I have bigger fish to fry." Just curious.

Oh, yeah, that definitely happens. It happens to young people, too. They come in with X symptom and doctors are like "nah, you're so young, you're just fine." Then it turns out you are not fine. This also negatively effects people who have unusual or hard-to-diagnose conditions that exhibit symptoms similar to those of other conditions. Doctors apply 90%-suitable heuristics to 100% of candidates too often, in my opin…

If it were 90% applicable if would be good. These are not validated and are likely much less accurate.

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

#234

Post by AstralStorm » Wed, Sep 28, 2016, 6:01 AM UTC

hasenj wrote: post #140

tcj_phx wrote: post #134

Earlier quoted context omitted.

> 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…

Ever tried enduring hunger on a starvation level diet? If not, please do not say "all you have to do", because you have no idea how impossible it is.

CR people who are reducing calories count to what you propose from healthy levels almost never go to maximum restriction immediately exactly because of this problem. And those diets are extremely precise and meticulous. A minor deviation is enough to cause long term health problems.

And even at 50% caloric restriction it will take years to lose a large amount of weight.

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

#235

Post by AstralStorm » Wed, Sep 28, 2016, 6:33 AM UTC

hasenj wrote: post #153

speeder wrote: post #146

Earlier quoted context omitted.

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 consist…

Combine it with healthy fats and healthy carbs. Muscle loss is unavoidable. But you can't use it as an excuse to not lose weight. You just try to minimize it by having a balanced diet and performing some basic exercises.

Another platitude of a "balanced" diet. Not even dieteticians know what that means for purposes of weight loss. Muscle loss is a major problem for people who fail diets and bounce back. Muscle once lost is very hard to regain. Lack thereof will also reduce energy output making further attempts harder.

Even a vegan or near vegan diet easily exceeds required caloric intake for weight loss. Going for healthy foods is no good if caloric input is too high.

Protein has a star quality in that it suppresses hunger directly. The trouble is finding sources not also laden in fat and also making it palatable.

What you need is a highly unbalanced diet, but one that will not damage your health. It is very tricky to set up.

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

#236

Post by AstralStorm » Wed, Sep 28, 2016, 6:57 AM UTC

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.

I have a few small ones to show:

https://www.ncbi.nlm.nih.gov/pubmed/8772559

https://www.ncbi.nlm.nih.gov/pubmed/2185664

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

#237

Post by jimmywanger » Wed, Sep 28, 2016, 3:15 PM UTC

AstralStorm wrote: post #231

jimmywanger wrote: post #228

Earlier quoted context omitted.

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, a…

I am pretty sure access to food is a prerequisite, but not a direct causative agent. Otherwise everyone in the West would be obese today, not 1 in 5. And yes, manufacturing practices may be truly causing this, coupled with more hectic but sedentary lifestyle preventing people from cooking properly (it takes time and care), compounded by lower quality of basic ingredients and higher levels of stress. It is highly unfa…

> And yes, manufacturing practices may be truly causing this

How? Are you talking about pharmaceuticals used in factory farming, trans fats, what?

> coupled with more hectic but sedentary lifestyle preventing people from cooking properly (it takes time and care)

It does not take that much time or care. The choice is yours. You can either watch an episode of Seinfeld on the couch, or spend time on your feet and cook dinner and lose weight and feel healthier.

> It is highly unfair and unjust to throw it also onto a single person to invert, especially a sufferer.

Fairness and justice are two concepts the universe does not care about.

And how is it unfair and unjust? Once you accept that your suffering, in this case, is based on decisions you've made (remember 4/5 people are not obese in the west, placing you in the lowest 20 percentile.) you can start changing that.

Also, these things don't just happen to you. You still have a choice in the great majority of situations.

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

#238

Post by JoeAltmaier » Wed, Sep 28, 2016, 9:25 PM UTC

AstralStorm wrote: post #213

JoeAltmaier wrote: post #150

Earlier quoted context omitted.

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.

And blood pressure? Circulation issues? Cholesterol? Diabetes? Arthritis? Sleep apnea? Depression?

All of those cluster around obesity. The simplest, most direct and most effective cure is controlling weight.

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

#239

Post by imagist » Thu, Sep 29, 2016, 3:09 PM UTC

AstralStorm wrote: post #230

imagist wrote: post #227

Earlier quoted context omitted.

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…

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

I disagree--in fact, I think a large part of the problem here might be this very conversation. It's unclear how much of the reason that counseling is ineffective is because obesity has become an identity politics issue. If you tell someone that it's okay to be fat, and go so far as to say that obesity isn't the cause of their problems, it's a lot easier for them to just cry "denial of care!" than to actually lose weight. The first step to solving the problem is admitting it is a problem, and fat acceptance is actively impeding that part of the recovery process.

I don't have personal knowledge to say which way the direction of causality goes: whether identity politics causes counseling to be ineffective, or whether counseling is inherently ineffective and therefore identity politics are right. But I think that doctors are the ones with the most information to decide that, not identity politics activists.

What I do know is that even if counseling is only 10% effective, it's far less dangerous than surgery, so it should always be the first choice. If someone tries weight loss programs for a few years and fails to lose weight, then maybe it makes less sense to deny surgery (this would be a situation I'd be interested in hearing medical opinions about). But I see no evidence that this is actually happening. What I'm seeing is people saying that demanding people try weight loss first is equivalent to denial of care, and that people should be allowed to get surgery without even trying to lose weight.

And while this firmly steps outside science, I think obesity makes sense to treat as an addiction problem. I've been treated successfully for alcoholism via a program which equally has very low success rates to weight loss programs. My personal experience with this is that, as identity politics say, it makes little sense to shame people for their addiction or to discriminate against people because of their addiction in cases where it doesn't affect their ability to perform. Blaming me for my addiction or punishing me for my addiction didn't work. However, what also didn't work was living in denial that I was an addict and that my addiction was a problem. I don't blame myself for my addiction, but I did need to take action and participate in my treatment.

You wouldn't give someone with alcoholic hepatitis a liver transplant unless they stopped drinking, and you shouldn't give an obese person a hip replacement unless they lose weight.