Coming from a family of medical doctors, medicine stands to gain a lot in terms of quality of service by increasingly automating doctors out of the loop. These people (my family members and relatives included) typically go into the profession for money and social status instead of helping patients, to the point where it borders on being exploitative.
Or doctors could learn to be more humane when dealing with patients? Calling for automation in this case seems to be a very software engineering centric solution to the issue.
I don't even work in software, but it just makes sense considering most of what they do is looking up factoids in a textbook. They frequently misdiagnose or let things slip by because there's just no way for humans to memorize that many books.
That's a little like saying software developers spend all day googling for syntax. The "factoids" aren't very useful unless you know how to put them together and what to do with them.
Who knew that medicine and library science were the same thing? Come to think of it, I bet librarians could replace lawyers, too. Just need to teach them to shout "objection" and be jerks in the coffee room, right?
Comments like this are incredibly uninformed and in my experience not really true. If you can get into medical school, you could do another job that is a lot less of a slog and make more money. There are slides going around somewhere where if you account for hours worked, doctors make about the same as UPS drives on average.
The reality about breakeven with loans doesn't change their expectation of money and social status. Also the current generation of doctors received their education when costs were much lower and becoming doctor had better financial incentives.
There's a saying that we can't block the sun with the palm of our hands. What gp says is definitely a fact. A lot of people just want a decent life for themselves. I would like to deny this because I know when I throw a brick in the mud, it can come back to my shirt as well. However, we shouldn't run away from the truth because it is unpleasant. A lot of people go to school to become doctors, lawyers, (and lately software programming) because they think this is a good way to make a good salary. If it is not about absolute value of salary, it is about opportunity cost. "What would I do if I don't go to medical school?" Military recruiters know that there is something similar going on in potential enlistees as well.
Lets not pretend that it is not going on. Lets face the facts. Many people (if not most) are not motivated primarily by their need to make the world a better place for everyone else. We are too primitive for that. I'd argue we aren't even programmed for that yet. In a world where people think it is acceptable for people to starve if they can't or won't work, it is too much to think that our doctors, lawyers, and corporate executives are a different breed or species.
Sorry I have tremendous respect for our doctors as I have for our soldiers but that doesn't mean everyone who goes in to medical school or military training went in with perfectly altruistic purposes.
I also have health care professionals in my family, and I've heard the phrase "shit through a pipe" used to refer to patients on multiple occasions. Doctors want to help, but primarily because helping is part of their job. If some aspect of a patient's situation makes the job harder, doctors respond just like anyone else does. They don't inherently care more about their customers than e.g. the wait staff at a restaurant.
ISTM that many of the complaints of fat people echo those of elderly people. The medical community has somewhat responded to those by creating the specialization of geriatric medicine. End-of-life care, especially for elderly patients in pain, still sucks, but they're trying to do better. When fat people have better politics, perhaps they'll be able to pressure the doctors into providing less egregiously poor care for them as well.
>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 in doing that in a safe, controlled and sustainable fashion because he doesn't have the equipment, he's actually not very useful. My grandmother could tell a 500lb woman to lose weight, but I wouldn't pay her $200,000 a year to do so.
However, the key allegation of this article isn't just that doctors don't have the equipment to give first-world-quality health care to overweight people, it's that they have biases that cause them to not want to rectify that problem, even though that's as simple as buying a sturdier scale.
That's a much more serious issue. It's one of the key reasons AIDS was such a problem 30 years ago. No one wanted to treat ~~the gays~~ in the 70's, and so HIV was allowed to run rampant rather than be treated. Within a handful of years of our society realizing it didn't actually give a shit about whether people like butt stuff or not, HIV went from a terminal diagnosis to a manageable condition, because /doctors actually started taking the people it affected seriously/.
There was about a 11 year period (first US cases in 1981, "Gay-Related Immune Deficiency" in 1982, Magic Johnson got HIV in 1992) where an HIV/AIDS diagnosis was a certain death sentence. I think there was more of a stigma against gays from politicians and their constituents than doctors, which contributed to it's spread too. It was recognised as early as 1983 that GRID wasn't a gay disease, hence AIDS.
If you would like to read more I believe the definitive history of the early days of the AIDS epidemic is "And the band played on" by Randy Shilts.
I honestly think that if the governments of the world stopped allowing corporations to put sugar in everything then the problem of obesity will fix itself. I'm not going to promote a low-carb diet or whatever, but it is not a disputed fact that sugar makes anything taste better and is addictive, which is why companies add it to everything. People will complain, but it's not really "personal choice" when you are literally choosing food spiked with a drug to make it more addictive.
A lot of people who overeat do it for a number of reasons. I know I like eating a lot now because I was poor once and had to eat as much as possible of whatever was available. I lift 3-4 times a week and bike daily, but am still obese according to my BMI and was recommended against having surgery for appendicitis last year (it fixed itself with a hospital stay and IV antibiotics which was lucky).
I think that for a lot of people counselling would be a good start instead of "eat less". If it were that simple then there wouldn't be fat people, would there? One problem is that some people are just bullies and like to put down others to make themselves feel superior. Then there are things like the "fat acceptance movement". I will never understand that either.
AZT was approved by the FDA in 1987, with some federal funding to pay for it. Which is the real story of why people survive it today, drugs were developed to treat it. But the attitudes of front line doctors in 1990 wouldn't have much to do with the development of those drugs.
One strategy I've used against my poor eating habits is to eat something like broccoli when I want a large serving. A huge serving with a modest amount of butter is ~200 calories.
> One strategy I've used against my poor eating habits is to eat something like broccoli when I want a large serving. A huge serving with a modest amount of butter is ~200 calories.
My wife had a good idea and she has got me eating a big bowl of high-fiber vegetable (cabbage etc) soup before whatever silly main I want to eat. It's very filling and I believe the same strategy as yours.
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.
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?
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.
>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.
Let me save you the time: it's an article pandering to fat people without any substance and really dishonest arguments.
The complaint is that doctors tell fat people to lose weight when they come in with symptoms that match the symptoms of being very overweight. If you go to the doctor with knee pain and you are drastically overweight, the most likely answer is that the knee pain is from being overweight. The doctor is going to tell you to lose weight. This doesn't mean they're dismissing that it might be something else, which is evident by the example in the article where the root cause was also found.
I had to stop reading at the point where the quoted a doctor as saying
>doctors and hospitals have become risk-averse because they fear their ratings will fall if too many patients have complications
followed by
>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.
This survey doesn't confirm that surgeries are refused for the fear of lower ratings. It confirms that doctors have a BMI cuttoff for surgery. Saying that there shouldn't be a limit somewhere is beyond stupid, meaning this survey is pointless. And it's frankly tremendously disrespectful towards doctors - they have BMI cutoffs for the sake of the patient's life. The risk of complications is extremely real and doctors don't want a high risk of literally killing someone to resolve a knee pain that, while crappy, is better than dying. And they're not even asking patients to live the rest of their life with that knee pain - only long enough they can lose weight and not have such drastically dangerous odds from the surgery.
This seems like an unfair characterization of the article. Denial of care, or dangerously mismeasured care, is not acceptable simply based on BMI (a non-scientific measure invented in the early 1800s). 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. If doctors, after examining the patient, have reasons for postponing surgery that can be explained medically, fine. But just saying "we have a BMI cutoff" is pretty much discrimination masquerading as medicine.
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.
As reported in the article, a patient who over the course of a week became unable to walk at all without shortness of breath. Her doctor told her to lose weight. The cause of the shortness of breath was blood clots on the lungs.
And in my personal experience, my mother experienced precisely what you don't think ever happens. A sinus infection went untreated for weeks after repeated doctor visits.
It is not that the doctor won't treat a sinus infection, it's that he won't _diagnose_ a sinus infection because the level of care drops when a patient is obviously overweight.
What her doctor actually probably said was "the limits of what I can diagnose show that you would most likely see a great improvement with weight loss. I can refer you to a specialist who can conduct more tests (MRI etc) but those tend to be very expensive. I wouldn't recommend it without trying weight loss first, which is very important beyond the symptoms you came in for today".
> As reported in the article, a patient who over the course of a week became unable to walk at all without shortness of breath. Her doctor told her to lose weight. The cause of the shortness of breath was blood clots on the lungs.
What some docs seem not to have learned is to ask the first question you learn to consider in tech support (and medicine is, in a sense, tech support for the human body) -- "what's changed?".
Unless the patient had a sudden and rapid change of weight that corresponds to the symptoms occurring, even if it is something whose onset was brought on by weight over time (or just made more likely by weight), its probably not the weight itself directly causing the symptoms, and if you don't properly diagnose the cause, you have no idea if losing weight is an appropriate remedy, irrelevant to the symptoms at hand, or something likely to cause changes in the body which exacerbate those symptoms.
> But therein lies the problem: being overweight is so _unbelievably_ unhealthy that most problems would be resolved simply by losing the weight.
Failure to properly diagnose the actual problems makes it harder for the doctor to assist the patient in actually losing weight. "Lose weight" is an outcome, not a course of action, and choosing the most medically appropriate course of action to achieve that outcome is down to coincidence if you decide to skimp on proper diagnosis just because you think that the patient needs to lose weight.
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 maintain a healthy weight. It will prevent many ailments later in life.
BMI works just fine for someone weighing so much that they need to go and find a special scale to measure them.
Already before you're obese it'll be difficult to give someone CPR. If someone is obese that's dangerous already. It's completely normal and logical response to tell them to lose weight.
> 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't bodybuilders whose muscle mass drives up their BMI--people with high lean body mass are less likely to need hip and knee surgery. Sure, BMI is an approximation with some well-known cases where it's inaccurate, but doctors are well aware of this fact.
> 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.
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.
"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."
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?
> > > 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.
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.
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.
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.
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.
> 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, thenmaybe 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.
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.
1. It's true that BMI doesn't provide a complete picture of a healthy fat percentage, but weight and waist measurements provide even less information, so I'm not sure why you would present that information as if it contributed to your point.
2. Caliper fat measurement is pretty accurate if done correctly, but it's also hard to do correctly.
3. In your own words, no doctor has ever looked at you and said you need to lose weight. This seems to indicate that while BMI isn't always an indicator of health, doctors are capable of identifying the exceptions.
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 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.
> 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?
Here's a source specific to overweight patients. Obesity is often comorbid with conditions that make it harder to heal and increase the risk of infection, such as diabetes.
"However, if you have obesity, you may never achieve the increased mobility and range of motion experienced by a patient of normal weight.
You may also experience more implant and prosthesis complications after surgery, including:
Component loosening and failure
Dislocation of the replacement joint, especially in the hip
In some cases, a second "revision" surgery may be necessary to remove failed implants and replace them with new ones. "
That section would be based almost purely on weight. Certainly, BMI is a crude measure, and it doesn't work well for weight lifters and athletes. But that's mostly an issue an issue for people near the "overweight" cutoff at 25. The more obese someone gets, the less false positives BMI has.
There's clearly an issue where past a certain level of adiposity, knee surgery is not sensible: the risks become high, and the outcomes become poor.
What would you do instead? To operate with the expectation of poor outcomes is not good medicine.
"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 increased risks and possible outcomes and let them make their own decisions about their bodies. The article here is not saying that doctors should ignore weight as a factor, but that they shouldn't make decisions to deny or provide care based solely on BMI.
"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 make their own decisions about their bodies.
It's really not that simple. A medical doctor's mission is to help people and very specifically to "do no harm". When the data suggests that they are more likely to do harm by operating, then the doctor is following their oath by not performing a surgery.
"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 also increase risks of complications, and patients are routinely given opportunities to weigh those risks before deciding on surgeries. My suggestion isn't that the doctor throw his duties out the window, but that with high-BMI patients, those duties should not suddenly become more dictatorial than with other patients.
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.
Doctors have to use their best judgment in providing care to patients. An ethical doctor will not provide care to a patient that he or she believes is more likely to cause harm than good. Letting patients "make their own decisions" to this extent doesn't happen in any part of medicine. If you go to the doctor and say "Hey I have really bad anxiety and I've had success with Xanax in the past to manage it" you'll get denied 95% of the time. Are doctors discriminating against people with anxiety because they don't allow them carte-blanche over the medical care provided? The answer is no - doctors know that drug dependency is a huge issue, and in most cases of anxiety, the risk of that dependency doesn't outweigh the quality of life reduction from anxiety. They will have a lot of alternative options to someone with anxiety, just like they have a lot of alternative options to someone severely overweight: lose the weight (in itself it will relief symptoms), mild exercise, steroid shots, physical rehab, anti-inflammatories, the list goes on.
Why would a doctor let his patient take on a risk that he isn't willing to perform? Patients should not get 100% say in their treatments. If there's a high mortality rate for something as trivial as knee pain, then the compassionate thing would be to refuse that operation and look at alternatives like pills or physical therapy. Having that person's family deal with 'suicide by doctor' is a non-starter here. This is like saying mechanics should respect the wishes of people who want to output their exhaust into the cabin. Afterall, the customer is always right!
Also, people in pain aren't terribly rational and don't make good decisions. Doctors should be the gatekeepers here on a certain level. I shouldn't be able to demand surgery willy-nilly and expect doctors and surgeons to act like a concierge service. Surgery is a serious risk and no one is going to casually perform malpractice here. Worse, knee repair is a tricky thing. If your knee can't support 300+lbs then a repair is only going to be a temporary solution until you damage it again, which will probably be soon after. We're not engineered to handle these kinds of loads, thus the weight loss recommendation.
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.)
It's not simply based on BMI. It's based a lot of things, but at some point the BMI will be bad enough that the other things become irrelevant.
>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.
It would be if that actually happened in any systemic manner. And even in the cases where it does happen, it has less to do with whether the doctor is willing and more to do with whether the doctor is able to diagnose.
> But just saying "we have a BMI cutoff" is pretty much discrimination masquerading as medicine.
It's discrimination in the same way that saying people under a certain height can't ride rollercoasters. There isn't some conspiracy amongst theme parks to alienate short people. It's dangerous, and it's nothing to do with prejudice against short people.
And in reality, it's not "we have a BMI cutoff" as the only criteria. It's "we have an extensive and exhaustive list of things we look for before we recommend surgery to patients, since surgery is a dangerous and often life threatening procedure. One of those criteria is a BMI that doesn't cause undue risk to the life of the patient".
BMI can definitely be a starting point for a discussion with the patient about elevated risks, etc. But there's never a point where "other things become irrelevant", which is exactly the point of this article—doctors regularly refuse to provide basic medical treatment beyond a certain BMI point. If someone is experiencing e.g. chest pain, it's deeply unethical and unprofessional to refuse consideration of any other cause than obesity, and to limit treatment to a scolding about dieting—no matter how high a person's BMI is.
> it's deeply unethical and unprofessional to refuse consideration of any other cause than obesity, and to limit treatment to a scolding about dieting—no matter how high a person's BMI is
It would be if this was actually happening, which is never. Maybe there's like a handful of shitheads out there doing it, but this isn't a wide-spread problem.
> It would be if this was actually happening, which is never. Maybe there's like a handful of shitheads out there doing it, but this isn't a wide-spread problem.
The article links to research showing that it is a wide-spread problem. There may be valid criticism of that research, but your flat unsupported denial is not that criticism.
Aside from the actual example cited in the article which would appear to contravene "never", as well as plenty of reports from actual obese people, there's a linked study with research on the various ways obesity can cause lower quality of care:
"Finally, physicians may over-attribute symptoms and problems to obesity, and fail to refer the patient for diagnostic testing or to consider treatment options beyond advising the patient to lose weight. In one study involving medical students, virtual patients with shortness of breath were more likely to receive lifestyle change recommendations if they were obese (54% vs. 13%), and more likely to receive medication to manage symptoms if they were normal weight (23% vs. 5%)."
The study you cite does not seem to support your contention in so doing:
> Comparisons of recommendation categories for shortness of breath by condition revealed that students were more likely to recommend lifestyle changes when the patient was obese than when she was not obese, χ2 (1, N =76) =14.6, p<.0001. They were less likely to recommend symptom management (i.e., bronchodilator prescription) for shortness of breath when the patient was obese, χ2 (1, N =76) =4.8, p<.05. There was, however, no significant difference in recommendation rates for diagnostic tests.
I am exceedingly unlucky then, the tens of doctors I visited so far since I was 13 years old looking for help with my symptoms (that now I know is hashimoto disease) all refused to do any tests and just told me I was fat. Seemly all few shitheads were met by me.
One interesting point they touch upon is medicare's move to bundled payments creating an incentive for physicians (and hospitals) not to operate on anyone they believe more likely to suffer complications, including the obese. Fair or not, people respond to incentives, especially financial incentives. We will start to hear a lot more about this in the future.
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 hospital.
The problem with this story isn't that it's facts are wrong or misrepresented, it's that they're only reporting one side of the debate in a situation which is very much not one-sided.
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 success rate of surgeries for myself or my employer" which is totally founded and reasonable and could have nothing to do with having some egotistical or financial stake in ratings.
> 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.
I agree. The example in the start where the patient asks how will they know if theyre losing weight as theyre off the scale does not make any convincing point. If they actually ate 1200 kcals a day they would definitely be losing weight. It wouldnt be necessary to confirm via weighing.
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].
> 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.
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.
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 < CO.
"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 slowing down "to a crawl" if a person is hungry isn't helpful in the slightest; comments like this demoralise people. They work out, eat kale, make sure to never feel hungry lest they "slow down their metabolism to a crawl" and still aren't losing weight. "why bother?"
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.
I've noticed the liberal media is pretty big on the 'fat rights' bandwagon right now. I imagine its profitable considering the number of fat people in the US and fits in with the largely SJW editorial narrative bias the press is fond of.
As a chronically 25-50lbs overweight person with knee problems, just dropping 10lbs was like night and day for me. Suddenly my feet and knees didn't hurt as much and I felt and slept so much better. There's an ugly narrative here that few press outlets want to sell because I imagine fat rights groups will be offended, but there's a real personal responsibility argument with weight that too often gets brushed under the carpet. Victimization naratives are popular now and get significant ad impressions. Consider the two headlines, which one will get you more clicks? "Doctors biased against the fat patients; thin patients treated better" or "Losing weight is your responsibility when it comes to your health." Obviously, the former will get all the clicks.
I really hope fat rights groups and the liberal media stop with these narratives. Losing weight isn't terribly difficult if you actually care about your health. Its a small investment that significantly pays off. Yes, I get a little offended when my doctor brings it up, but he's right every time. When my weight hits a certain number, my body just falls apart. Suddenly sleep apnea kicks in, I'm sore all the time, I get winded easily, and my back and knees hurt. We shouldn't be fighting against this kind of advice. Its still good and often life-changing advice.
Sadly, this forum being mostly millennials means the comment section is leftist victimization responses straight out of /r/fatlogic. I pity the generation growing up with a 'no one is ever at fault' and 'personal responsibility doesn't exist' philosophy. Its a disservice to them and ruins lives.
Why isn't media big on the controversy on a the pro-personal responsibility side of things? As far as I can tell it panders to fat rights groups uncritically. I think pretending this bias doesn't exist is being generous towards the real media bias that surrounds us. There's no debate here. Its clear obesity and surgical outcomes are linked. Doctors aren't "discriminating" here. Lets stop the leftist nonsense as it contradicts the science.
It's also worth noting the risks to staff in doing surgeries, procedures, and scans on extremely obese patients. Someone has to move them on and off tables and platforms. My brother in law (xray tech) wrecked his back getting an obese patient up for an xray. You'd need to staff a couple extra aides just to lift patients of that size, but hospitals don't do it.
This is the sentiment that I hear from my friends who are doctors.
And it's not that they're trying to be disparaging or mean. It's very frustrating for doctors who have to explain to patients repeatedly the root cause of their issues, and that there is no "fast fix" or medicine that will fix their problems until they lose weight.
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.
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.
To be a bit blunt, the doctors are probably thinking "if you won't take care of your body, why should I?"
If someone is so massively overweight that they need to use equipment intended for large animals or industrial scrap, they are putting themselves in an extremely precarious health situation.
And when those people go to the doctor with complaints related to not taking care of themselves, the doctors tell them they need to stop drinking, smoking, or whatever. Why would obesity be any different?
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.
So they don't prescribe statins, and just tell people to change their diets, yes? Hold back on insulin until those nasty diabetics stop gulping soda, even the thin ones? They tell people who do physical work to suck up the back pain, because they should have taken care of their body?
Your needlessly weird comments about equipment betray your bias, as does your implicit belief that everyone who has a weight issue can do something about it. But even if you can't get past your personal feelings, I'd hope you can see that the rather nasty condemnation and moral judgement implicit in how this line of thinking runs looks pretty awful when applied to other medical conditions.
On the less straw-man extreme, we also make alcoholics stop drinking before giving them organ transplants, and smokers have to quit before receiving a lung transplant. Medical care is a finite resource, especially in countries where it's publicly funded. We prioritize people who don't destroy their bodies because it's more likely that we'll diagnose them correctly and that a treatment will be successful. The article talks about people who have e.g. joint pain, which is almost certainly caused by their continuous obesity, rather than something like diabetes, which won't go away if they lose weight.
> Your needlessly weird comments about equipment betray your bias
What are you talking about? Did you even read the article? That's where I got those examples from.
> your implicit belief that everyone who has a weight issue can do something about it
You caught me; I believe in conservation of energy.
> this line of thinking runs looks pretty awful when applied to other medical conditions.
You clearly aren't familiar with how medicine actually works. Prioritization and triage are unfortunate facts of life.
Bluntly, this discussion makes it pretty clear that asking skinny technical people about medical obesity is pretty close to asking Donald Trump about how to solve crime: get more violent. If it doesn't work, you weren't violent enough. If it does, get more violent, because it is clearly working.
Change a few words and you're there. The ignorant certainty the arrogant dismissiveness that comes with it are breathtaking. It is genuinely sad.
> You clearly aren't familiar with how medicine actually works.
Nice response. Instead of addressing anything I said, just make tenuous political metaphors and baseless claims of ignorance.
> It is genuinely sad.
It's ironic that you're using Trump as an example of bad argumentation, given that your styles are quite similar. "You're so sad. You're a slob. You're a mess." Etc. etc.
The problem is that obesity is truly the primary cause of many medical problems. You can treat other symptoms but sometimes things won't get better. This article is garbage.
> The problem is that obesity is truly the primary cause of many medical problems.
Obesity makes lots of medical conditions worse (or more likely), but it's the primary cause of almost none of them. It's rare that it's even the biggest risk factor.
Obesity is deeply repulsive on two levels. People who get to these extreme levels of obesity are basically suicidal. Aside from the obvious revolting physical appearance, there's an underlying message of "might as well die". Their chosen method of suicide is death by uninhibited indulgence in food.
How is it acceptable to call big people revolting and wave off their condition as "suicidal"? You know nothing of these people, or why they are big. They aren't here to look pleasing to you, they just want to live their lives. People are not always big by choice. Do you blame all alcoholics for their condition?
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 coach.
GP is there to treat, not indulge. If they are unable to treat obesity, they are to blame, not the patient. Obesity is extremely hard to treat even when there is will to change. Heck, the causes of it are not yet well understood. Something goes wrong with the feedback system of satiety and energy expenditure, which is evolutionarily stacked to accumulate calories.
"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?
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.
In light of your past experience overcoming your indulgence, you may wish to take some time to recognize that a community of informed, helpful people (basically HN) is pointing out that you're indulging in arrogance and self righteousness, and you might consider applying the same self control that you used to overcome obesity to your other character flaws.
HN is not pointing out anything to me. There's a couple of members here who seem to be involved in the "fat acceptance movement" who are defending the article.
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 - all my life. I'm now on a weight loss program and seeing significant success. It took years of mental and physical issues to get me to that point and it is a struggle every day. It's hard work. That's why people are proud of losing weight: it's an achievement. It represents a permanent change to lifestyle and behavior that takes weeks, months, even years to effect.
Please don't discount people's experiences by saying things like "oh, just lose weight." Consider the human being in there, and how to reach them. Don't assume that because it's easy for you to be fit and skinny, it's easy for everyone.
I would say that your depression comparison isn't totally accurate.
There are safe, reliable, and well-understood ways to lose weight. They're not easy, enjoyable, or fast, but they're almost certain to work, excluding other medical conditions.
Depression on the other hand, is far less well understood. It's also far more more difficult to treat and fight, and while weight loss has an effective general solution of eating less and exercising more, no such general solution exists for depression. Plenty of people spend their lives chronically depressed with little to no improvement, despite trying countless medications, forms of therapy, and lifestyle adjustments. The same can't really be said for weight loss.
That's not quite the point I am making. The point is that taking either condition at its most surface level and just saying "why don't you just fix it?" is unhelpful.
The fact that there are known ways to help solve weight loss isn't the problem. Obese people know there are ways to lose weight. The issue is psychological - not believing one can achieve the goal, not being ready/willing to fully commit to the goal, feeling too ashamed of oneself to believe one can improve one's situation, and on and on.
Plus, you suggest that because the way to lose weight is clear (it is), that makes it easy. That's a false equivocation. I'm speaking from experience when I say it's simple, but quite challenging. That's like saying "winning the Olympic 100m sprint is easy, just be faster than everyone else." (No, I don't think my weight loss is an Olympian effort, but I am exaggerating for effect.)
Yes, but then he goes on to suggest that it IS easier than dealing with depression. I think that while that is probably true, it is not true by much, and not true enough to make a distinction here.
As someone who has dealt with both, I personally think weight is far easier to deal with than depression, specifically because I know what to do about weight. Neither is "easy" in the absolute sense, though.
"The issue is psychological - not believing one can achieve the goal, not being ready/willing to fully commit to the goal, feeling too ashamed of oneself to believe one can improve one's situation, and on and on."
And here I was, thinking it was just that you love constantly stuffing large amounts of high-calorie foods down your throats.
> There are safe, reliable, and well-understood ways to lose weight.
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.
> They're not easy, enjoyable, or fast
They are often at least one of those (most often the last) if the appropriate method is chosen for the person, though its true that this is not always the case.
> but they're almost certain to work, excluding other medical conditions.
"Excluding other medical conditions" is exactly the problem, since comorbidities with obesity are not at all rare, and many of them are directly relevant to weight-loss strategies.
> 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 categorically denying diagnostic tests, only surgeries.
> "Excluding other medical conditions" is exactly the problem, since comorbidities with obesity are not at all rare, and many of them are directly relevant to weight-loss strategies.
I have yet to encounter a doctor whose response to my weight is just, "Hi! Lose weight! TTFN!" It's hard to tell with the kind of surveys presented in this article if people are really being brushed off or if they are just being told things they don't want to hear.
[1] Relevant because urgent care centers tend towards shitty experiences regardless of your weight or medical problems. Especially the ones not affiliated with a hospital system.
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.
Disagreeing with the article and agreeing with that they lose weight does NOT imply lacking empathy. Then entire article states some ridiculous claims. If you're obese, it is a danger to your health. If go then go to a doctor what do you expect the doctor to do? Ignore this because the person might not want to hear it?
You're rephrasing things with "just lose weight": nobody said it is easy to lose weight. But if you're obese, you're in the danger zone.
This isn't about what I'd expect a doctor to do. Of course I'd expect a doctor to say "lose weight." What I am taking issue with is the way commenters here are treating that imperative, "lose weight," as though it is some very simple thing for severely obese people. It isn't.
> Disagreeing with the article and agreeing with that they lose weight does NOT imply lacking empathy.
That's true. Dismissing the studies cited in the article clearly showing that doctors do give inferior care (particularly, in being less willing to refer for medically-appropriate diagnostic tests) to obese people (which, incidentally, inhibits their ability to give useful direction to those people on how to safely and effectively lose weight) goes beyond mere lack of empathy the whole way to willful ignorance and active hostility.
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, ignoring the human being underneath that is trying to live their life as best they can.
> 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.
I don't think that's true at all. The people that are most described by the latter are also, often, the HN posters most opposed to the former. THere's, obviously, some differences here, but not to the extent of your description.
My issue is that if comments like this happened on an article about another class of people, it simply wouldn't be acceptable here.
Imagine an article about African American men getting poorer care for heart disease because they are more susceptible to it, and the comments claiming that it's perfectly reasonable and they should just exercise more to compensate for it.
> My issue is that if comments like this happened on an article about another class of people, it simply wouldn't be acceptable here.
Comments like this happen on articles about the poor, blacks, and women, among others, here, with pretty much similar debate on both sides. So, I think that you're just, factually, wrong.
The whole point of the majority of the conversation here is that there isn't systemic discrimination happening. People like to feel victimized and are claiming discrimination when it's overwhelmingly not the case, and dishonest articles like this do a huge disservice to the real, legitimate discrimination that does happen.
Yes, the majority has investigated the majority and found the majority not guilty of discrimination. Please tell me more about how you know that big people aren't discriminated against.
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 weight loss is a low-risk, effective way to treat the patient's condition isn't discrimination, it's just proper medical practice.
The actual study cited in the article which is being cited as showing systemic discrimination: "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." There were, of course, exceptions to the rule mentioned.
So yes, I do think that fat people are discriminated against, but I do not think that recommending weight loss as treatment to obese patients is an example of discrimination.
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.
> The whole point of the majority of the conversation here is that there isn't systemic discrimination happening.
Yes, the article links to research showing systematic discrimination here, and many people here are dismissing the possibility without addressing the research, acknowledging it is even referenced, or doing anything more than stating their firm belief that discrimination is not occurring.
> People like to feel victimized and are claiming discrimination
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 to believe that recommending weight loss is discriminatory, you would have to show that weight loss isn't an effective treatment for obese patients presenting with hip and knee problems.
I don't think the message is "just lose weight". It's "before we can treat this knee problem, we need to deal with your weight problem".
Being obese is a critical health problem. It's not wrong for doctors to prioritize it, and I don't think it belies a lack of empathy to agree with them.
I say this as a person with a weight control problem.
This is pretty much how I felt when I read these comments. The argument being made by the piece is that weight is treated as a binary issue, without nuance. Yes, the problem is there—it's apparent, they see it right in front of them, thanks for noticing—but that doesn't mean that other issues should be looked over in diagnosis.
Some doctor choosing not to even consider a patient's medical problem without looking past a single issue—especially when that patient is actually seeing some success in dealing with that issue on their own, as seen in the Patty Nece example highlighted by the Times—is a waste of everyone's time.
From a purely economic perspective, a patient who is paying thousands of dollars for insurance and not-insignificant copays is not getting what they paid for if the doctor treats their patients in this way.
Yes, weight loss solves a lot of problems, but the complication of losing weight for the myriad metabolism types out there makes the solution a challenging one for many types of people. For all the doctors know, their patients could be walking five miles a day and eating a 1,500-calorie vegan diet, but finding their success rate doesn't match the amount of work they're putting in. Their weight may yo-yo in a dramatic way that can make sustaining a healthy weight very challenging.
Weight loss is not like aspirin. It doesn't work exactly the same for everyone. (And there are bad ways of losing weight, of course.)
Don't assume that because it's easy for you to be fit and skinny, it's easy for everyone.
I'm neither fit nor skinny.
I am empathetic, what I am NOT is sympathetic. I have a problem, and I need to fix it.
I'm working on it. But even when I'm not, I understand that my health problems are and will be primarily weight related.
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 know what the resources a person might need to overcome depression are or how much more complicated it can be. Sure, they both have an initial inertia that needs to be overcome to get started on fixing it, but I'm much more sympathetic to the depressed.
> 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 have a problem, and I need to fix it.
That's a healthy outlook for you to have. It's the one I have, too. The people we need to have sympathy/empathy for, though, are the people who haven't gotten there yet. I imagine there was a time for you where you hadn't reached the point of understanding your problem, for any of the various reasons of shame, denial, anger, blaming others, etc.
There are a lot of people in that boat. What I think commenters here don't understand isn't that weight loss is relatively straightforward, it's that straightforward things aren't always easy, and that preparing oneself to do something difficult is hard, even if that difficult thing has clear steps to take.
Given that other people have pointed out the same vagueness in my comparison to depression, maybe it wasn't the best one to make. I will think on a different one for next time. I do think that, given the above, it makes my point though.
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 imagine there was a time for you where you hadn't reached the point of understanding your problem, for any of the various reasons of shame, denial, anger, blaming others, etc.
They're adults. I'll treat them with the civility I treat everyone. Beyond that? Fuck 'em.
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.
That means you haven't put in the time to develop a sense of empathy for them.
How can you claim to treat all people with basic civility, while at the same time admitting to disrespecting (and thus judging) something about a specific group of people on a mass level without trying to understand it?
I think you need to reevaluate how you treat this issue and the people who are affected by it.
>Empathy is not a "fad," empathy is a basic human societal construct and a fundamental psychological building block.
I agree. But would you not also agree that "empathy" has become quite the buzzword recently? I have a hard time separating "empathy" from "Empathy."
And the people peddling "Empathy" seem to think if everyone was empathetic, we'd all come to the same set of conclusions. A very narrow set. I want off this train because I haven't found the right way to retool my lack of respect into the "Empathtic" vocabulary for strong disagreement. I think it involves uses the words "problematic" and "pernicious" quite a lot, but I don't care to find out.
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.
Well, working support for software company where we often do just that sometimes, the reasoning is different. Often times update to latest version is simply the fastest and safest solution to many problems, since why bother with fixes and workarounds when the underlying bug has been properly resolved elsewhere? We still are required first to identify that upgrade is the right path
Software support isn't exactly analogous to healthcare since the upgrade requirement often is trivial and troubleshooting past that checkpoint is instantaneous. It's also generally not potentially life threatening, despite what angry DBAs might threaten
I would say that weight as a checkpoint for some things is mildly arbitrary and not nearly as useful as most recent patch. With most recent patch, you at least can see what fixes have been incorporated. Losing weight doesn't have the capacity to immediately resolve the underlying issue like a patch does.
I do agree that obesity is a personal thing, but a patient being obese is just part of the considerations as they troubleshoot. It's a major problem but it's also integrated into the patient, and it's the unfortunate reality of what doctors need to deal with.
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.
My experience, having been both a very obese person (100 lbs overweight) an an almost normal-weight person (10ish pounds overweight) is that obese people get worse _everything_.
I expected to have an easier time talking to the opposite sex when I lost weight, and this ended up being true. I had no idea how much better talking to everyone else would be. In customer-business interactions, job interviews, and really every interaction you have with other people it made a remarkable difference. I was an avid cyclist before I lost weight, and I still am now, but people are nowhere near as dismissive when I tell them I rode a half-century the previous weekend, even though I did so before as well (riding a recumbent helps a lot).
This is anecdotal inasmuch as it was just me, but over the course of my life thousands and thousands of data points suggested the idea that people are just extremely prejudiced against fat people.
Having been obese in the past as well, I can confirm some of your experience.
However, to be honest, I don't see it as a form of negative prejudice. It's a completely reasonable prejudice.
You can only become obese due to some very critical character flaw.
For example: inability to delay gratification, lusting over immediate pleasures, inability to make plans and stick to them, inability to read social cues telling you to stop gaining weight, perhaps indifference to society all together, general apathy (nothing matters anyway so might as well enjoy this cookie, for the 20th time today), etc.
No one wants to be around people who don't take care of themselves and ooze of negativity and desperation.
I have autoimmune hypothyroidism and didn't found yet a good treatment.
Tell me, how I fix it with self-discipline? currently I am using discipline to lose weight, but my hair is falling, my feet skin is splitting open, my nails are breaking, and I am losing muscle faster than I lose fat.
Any suggestions on what I should disciplined about?
> I have autoimmune hypothyroidism and didn't found yet a good treatment.
The treatment is taking the appropriate dose of levothyroxine. It's very unfortunate that you have had a string of shitty GPs and endos, but to treat it you need someone to measure your T3 and TSH levels while gradually ratcheting up the synthetic hormone dose until your numbers are in the acceptable range.
Good luck handling first three with discipline. Make sure to run a placebo controlled trial of "discipline" and compare to results of insulin and thyroid hormones. You won't be able to, because it is considered unethical for a good reason.
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.
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.
> - untreated hypothyroidism (even low grade)
>
> - certain autoimmune diseases including type 1 diabetes
>
> - inborn errors of metabolism
None of those conditions is sufficient to push you above borderline obesity (~30 BMI). To get beyond that requires something else. I will not subscribe to the GP's notion that "something else" is necessarily a "very critical character flaw", but I also will not accept that it is out of the control of the person in question.
You wave away so many reasons a person could be big and put them all into the "they are asking for it" box with a nice big bow. From your comments elsewhere you claim to have been big and since lost the weight. That's great for you. I wish you'd stop making yourself feel better by being vile towards others who haven't been able to make that change.
> No one wants to be around people who don't take care of themselves and ooze of negativity and desperation.
No one wants to be around hateful people like you.
"No one wants to be around people who don't take care of themselves and ooze of negativity and desperation. "
To be fair, nobody wants to be around people who reek of judgment and pass off simple answers to complex problems like they're brilliant insights.
Anyway, you kind of proved my point, so thanks. Regardless, I should mention that I am the same person, with (I imagine) largely the same character, as I was before. I think my own issues had a lot to do with 1) the diet which Americans are encouraged to have, and 2) our built environment.
For the first, US culture has so drastically lost sight of what a proper portion is that many people genuinely don't know what a healthy portion is. When I was in my early 20's I had always been fed way too much, and my college meal plan was all you can eat and based on number of meals per week (encouraging someone to think they should take as much as possible). Coupled with that, the exercise people recommended was EXACTLY the wrong exercise for a heavy, self-loathing person. Running is AWFUL. Getting acquainted with the elliptical does help a lot (though exercise, while wonderful for general health, is of limited benefit for weight loss).
For the second, we have built our cities so that you get pretty much no exercise whatsoever in the course of a normal day. The walk from the parking lot to the store, the office, and home is what most people get.
Anyway, what worked for me was aggressively counting every single calorie I ate, living in a place where I could have a 7 mile round trip bike commute (with a brutal climb on the way home), and making meals that could still be big and filling but low calorie - mostly gigantic mountains of vegetables prepared without oil.
I didn't read the article yet, since I opened the comments first... and was shocked by them.
I have a thyroid problem, the first symptons started to show up when I was 13 or 14, including my hair starting to get white.
I didn't knew, it was a thyroid problem, my mom, for some reason (that back then offended me, I told her I didn't wanted to go to a "fat people doctor") took me to a endocrinologist, suspecting something was wrong.
The endocrinologist made no tests, only said I was fat, and dismissed me.
The thing is: according to BMI, I was only slightly overweight, not even really "fat" yet.
But I worsened over the years, and became obese, no matter how hard I tried to not to (including having strict diet and going to the gym, and having medical help from cardiologist, physiotherapist and nutrition).
A random friend of my mother then commented I had obvious thyroid problems symptons, including a obviously enlarged neck.
My mother started to take me to endrocrinologists again... and again, they just kept telling me I was fat, and refusing to help.
I ended researching my own problem, figuring on my own what I needed to have tested, and spending lots of money and time looking for a decent endocrionologist.
I found one that is half-decent, and started at 25 years old my treatment finally... and only then, the treatment is kinda half-assed, my current endocrinologist mostly don't believe me, and don't really want to help, in fact I ended mostly treating myself by myself, buying whatever medicine I wanted, and informing the medic after the fact (where if I made the right choice, the medic would inform me that I made the right choice, so far I always made the right choice, according to improvement in symptons and blood tests results).
I am currently trying to drop my weight until I get obviously "not fat" so I can then save some money, and go to a expensive endocrionologist and hope he will treat me correctly, instead of telling me I am fat.
I even tried to go to the most famous endocrinologist in my country, I spent a entire month salary in one single visit, and the guy just told me I was fat and refused to ask for any tests, despite tests being kinda straightforward (I have a autoimmune disease, a test to see if I have anti-thyroid antibodies would already be enough to diagnose me, yet not a single doctor ever wanted to test that, the single one that did, was a doctor that was going to retire, and that I was very "persuasive" in convincing her to ask for the test, that indeed proved I was correct, and indeed I had a huge amount of anti-thyroid antibodies destroying my thyroid).
Whatever condition you had didn't cause you to gain weight. You can't defy physics. If you control your caloric intake, your body /will/ lose fat. Your story is anecdotal so I'll response with an anecdote as well: I've seen more than one person with a "thyroid condition" who were in good shape.
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 get worse faster, but the fat remains.
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.
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.
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.
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.
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 obese person absolutely will cause your body to burn fat.
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.
That's really interesting. How was your body able to continue to acquire the calories to gain more fat and eventually become obese with such strict controls on diet. Does the body a mechanism for drawing calories from the atmosphere?
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."
Obesity is a descriptor of somebody's physical state. It's not technically a disease. Your physical state is your medical condition. So, being athletic is an important piece of medical information. Athletes are at risk for some things that non-athletic people are not.
A descriptor of physical state is not mutually exclusive with condition. In fact a condition is almost always a description of a body's physical state.
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 opinion.
Irrespective of the article, the comments in here are appalling. Ask yourself if it's truly acceptable to paint big people with such a broad brush. HN commenters are generally liberal, and liberals (I am one as well, this is not an insult) will fall over themselves to decry real or perceived discrimination against women, minorities, or disabled people - unless that disability happens to be obesity. Would these comments be acceptable if the subject was some other class of people receiving inadequate care?
I'm a big guy. I've been big for 2/3 of my life. It fluctuates up and down as I've tried everything in the book to lose weight. I would _love_ to lose weight. I hate being fat. It causes numerous physical problems and complicates everything I do. Most big people I know are in the same boat. It's not fun carrying the extra weight around with you, or trying to fit in airline seats (I've given up), or being uncomfortable in your own skin, or looking in the mirror every day and hating what you see. I know my weight is unhealthy. I promise you the vast, vast majority of big people are similarly aware. Do you think if we could lose the weight as you say that we would not? That we'd willingly stay this way?
Calling big people weak willed, revolting, or undeserving of medical care is unacceptable. I am not a Healthy At Every Size activist. You know nothing of why these people are big. You don't know what they've tried or why they stay this way. You don't know their struggles and what they've gone through. Please stop making value judgements on other human beings based on their physical dimensions.
The Venn diagram of HN and liberal overlaps a lot, but more than that it also tends to skew towards the "young, hyper-confident (perhaps arrogant) male who thinks they can fix every problem and basically knows better than everyone else" set. I've known plenty of liberals who are aware that being an asshole isn't magically OK because you're being an asshole to fat people. I am one.
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 anesthesia, because you just accumulate in different patterns.
Doctors don't train on obese patients because they're all different, so it's hard to get a standard operating procedure. They also don't train on obese patients because until now, they've been a vanishingly small proportional of the population.
Take a look at vintage photographs of "fat men" in carnivals in the beginning of the 1900s. You see people like that all over the place these days. Cheap abundant food and obesity has only recently been a problem.
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.
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.
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.
> 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.
Constantly ignored is that medical problems are a huge source of weight gain. The arrow of causality is frequently diabetes-> weight or sleep apnea-> weight or sciatica-> weight or asthma -> weight or joint problems -> weight
Not the other way around. A constant thread in the dismissal here and across culture is that the only way you could possibly weigh more that 200lbs is pure weakness of character.
> Be civil. Don't say things you wouldn't say in a face-to-face conversation. Avoid gratuitous negativity.
Much of the discussion in this thread does not meet this standard of discourse that we ask for on Hacker News. It's all too easy to respond reflexively (and thus with less likelihood of reaching this bar) when commenting on controversial issues, and while that might be OK elsewhere, it isn't here.
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[ 2.9 ms ] story [ 236 ms ] threadWho knew that medicine and library science were the same thing? Come to think of it, I bet librarians could replace lawyers, too. Just need to teach them to shout "objection" and be jerks in the coffee room, right?
Lets not pretend that it is not going on. Lets face the facts. Many people (if not most) are not motivated primarily by their need to make the world a better place for everyone else. We are too primitive for that. I'd argue we aren't even programmed for that yet. In a world where people think it is acceptable for people to starve if they can't or won't work, it is too much to think that our doctors, lawyers, and corporate executives are a different breed or species.
Sorry I have tremendous respect for our doctors as I have for our soldiers but that doesn't mean everyone who goes in to medical school or military training went in with perfectly altruistic purposes.
ISTM that many of the complaints of fat people echo those of elderly people. The medical community has somewhat responded to those by creating the specialization of geriatric medicine. End-of-life care, especially for elderly patients in pain, still sucks, but they're trying to do better. When fat people have better politics, perhaps they'll be able to pressure the doctors into providing less egregiously poor care for them as well.
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 in doing that in a safe, controlled and sustainable fashion because he doesn't have the equipment, he's actually not very useful. My grandmother could tell a 500lb woman to lose weight, but I wouldn't pay her $200,000 a year to do so.
However, the key allegation of this article isn't just that doctors don't have the equipment to give first-world-quality health care to overweight people, it's that they have biases that cause them to not want to rectify that problem, even though that's as simple as buying a sturdier scale.
That's a much more serious issue. It's one of the key reasons AIDS was such a problem 30 years ago. No one wanted to treat ~~the gays~~ in the 70's, and so HIV was allowed to run rampant rather than be treated. Within a handful of years of our society realizing it didn't actually give a shit about whether people like butt stuff or not, HIV went from a terminal diagnosis to a manageable condition, because /doctors actually started taking the people it affected seriously/.
If you would like to read more I believe the definitive history of the early days of the AIDS epidemic is "And the band played on" by Randy Shilts.
I honestly think that if the governments of the world stopped allowing corporations to put sugar in everything then the problem of obesity will fix itself. I'm not going to promote a low-carb diet or whatever, but it is not a disputed fact that sugar makes anything taste better and is addictive, which is why companies add it to everything. People will complain, but it's not really "personal choice" when you are literally choosing food spiked with a drug to make it more addictive.
A lot of people who overeat do it for a number of reasons. I know I like eating a lot now because I was poor once and had to eat as much as possible of whatever was available. I lift 3-4 times a week and bike daily, but am still obese according to my BMI and was recommended against having surgery for appendicitis last year (it fixed itself with a hospital stay and IV antibiotics which was lucky).
I think that for a lot of people counselling would be a good start instead of "eat less". If it were that simple then there wouldn't be fat people, would there? One problem is that some people are just bullies and like to put down others to make themselves feel superior. Then there are things like the "fat acceptance movement". I will never understand that either.
https://www.aids.gov/hiv-aids-basics/hiv-aids-101/aids-timel...
AZT was approved by the FDA in 1987, with some federal funding to pay for it. Which is the real story of why people survive it today, drugs were developed to treat it. But the attitudes of front line doctors in 1990 wouldn't have much to do with the development of those drugs.
One strategy I've used against my poor eating habits is to eat something like broccoli when I want a large serving. A huge serving with a modest amount of butter is ~200 calories.
My wife had a good idea and she has got me eating a big bowl of high-fiber vegetable (cabbage etc) soup before whatever silly main I want to eat. It's very filling and I believe the same strategy as yours.
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 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.
I do not blame doctors for my weight. I do blame doctors that do not give adequate medical care to people because of weight.
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.
The complaint is that doctors tell fat people to lose weight when they come in with symptoms that match the symptoms of being very overweight. If you go to the doctor with knee pain and you are drastically overweight, the most likely answer is that the knee pain is from being overweight. The doctor is going to tell you to lose weight. This doesn't mean they're dismissing that it might be something else, which is evident by the example in the article where the root cause was also found.
I had to stop reading at the point where the quoted a doctor as saying
>doctors and hospitals have become risk-averse because they fear their ratings will fall if too many patients have complications
followed by
>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.
This survey doesn't confirm that surgeries are refused for the fear of lower ratings. It confirms that doctors have a BMI cuttoff for surgery. Saying that there shouldn't be a limit somewhere is beyond stupid, meaning this survey is pointless. And it's frankly tremendously disrespectful towards doctors - they have BMI cutoffs for the sake of the patient's life. The risk of complications is extremely real and doctors don't want a high risk of literally killing someone to resolve a knee pain that, while crappy, is better than dying. And they're not even asking patients to live the rest of their life with that knee pain - only long enough they can lose weight and not have such drastically dangerous odds from the surgery.
This article is garbage.
And in my personal experience, my mother experienced precisely what you don't think ever happens. A sinus infection went untreated for weeks after repeated doctor visits.
It is not that the doctor won't treat a sinus infection, it's that he won't _diagnose_ a sinus infection because the level of care drops when a patient is obviously overweight.
What some docs seem not to have learned is to ask the first question you learn to consider in tech support (and medicine is, in a sense, tech support for the human body) -- "what's changed?".
Unless the patient had a sudden and rapid change of weight that corresponds to the symptoms occurring, even if it is something whose onset was brought on by weight over time (or just made more likely by weight), its probably not the weight itself directly causing the symptoms, and if you don't properly diagnose the cause, you have no idea if losing weight is an appropriate remedy, irrelevant to the symptoms at hand, or something likely to cause changes in the body which exacerbate those symptoms.
Failure to properly diagnose the actual problems makes it harder for the doctor to assist the patient in actually losing weight. "Lose weight" is an outcome, not a course of action, and choosing the most medically appropriate course of action to achieve that outcome is down to coincidence if you decide to skimp on proper diagnosis just because you think that the patient needs to lose weight.
This kind of language is part of the problem, shifting blame onto actual patients.
Already before you're obese it'll be difficult to give someone CPR. If someone is obese that's dangerous already. It's completely normal and logical response to tell them to lose weight.
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't bodybuilders whose muscle mass drives up their BMI--people with high lean body mass are less likely to need hip and knee surgery. Sure, BMI is an approximation with some well-known cases where it's inaccurate, but doctors are well aware of this fact.
> 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.
> I'd like to see those statistics.
https://www.ncbi.nlm.nih.gov/pubmed/10449014
"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."
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?
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 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.
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.
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.
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.
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.
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.
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.
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.
2. Caliper fat measurement is pretty accurate if done correctly, but it's also hard to do correctly.
3. In your own words, no doctor has ever looked at you and said you need to lose weight. This seems to indicate that while BMI isn't always an indicator of health, doctors are capable of identifying the exceptions.
As far as the caliper body fat test. It was done using 6 parts of the body.
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.
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?
That's for all patients. But it states the risk of knee fracture is higher for overweight patients.
http://www.zimmer.com/patients-caregivers/article/knee/knee-...
Here's a source specific to overweight patients. Obesity is often comorbid with conditions that make it harder to heal and increase the risk of infection, such as diabetes.
http://orthoinfo.org/topic.cfm?topic=A00745
Here's a crucial section:
"However, if you have obesity, you may never achieve the increased mobility and range of motion experienced by a patient of normal weight.
You may also experience more implant and prosthesis complications after surgery, including:
In some cases, a second "revision" surgery may be necessary to remove failed implants and replace them with new ones. "That section would be based almost purely on weight. Certainly, BMI is a crude measure, and it doesn't work well for weight lifters and athletes. But that's mostly an issue an issue for people near the "overweight" cutoff at 25. The more obese someone gets, the less false positives BMI has.
There's clearly an issue where past a certain level of adiposity, knee surgery is not sensible: the risks become high, and the outcomes become poor.
What would you do instead? To operate with the expectation of poor outcomes is not good medicine.
"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 increased risks and possible outcomes and let them make their own decisions about their bodies. The article here is not saying that doctors should ignore weight as a factor, but that they shouldn't make decisions to deny or provide care based solely on BMI.
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 make their own decisions about their bodies.
It's really not that simple. A medical doctor's mission is to help people and very specifically to "do no harm". When the data suggests that they are more likely to do harm by operating, then the doctor is following their oath by not performing a surgery.
"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 also increase risks of complications, and patients are routinely given opportunities to weigh those risks before deciding on surgeries. My suggestion isn't that the doctor throw his duties out the window, but that with high-BMI patients, those duties should not suddenly become more dictatorial than with other patients.
Why would a doctor let his patient take on a risk that he isn't willing to perform? Patients should not get 100% say in their treatments. If there's a high mortality rate for something as trivial as knee pain, then the compassionate thing would be to refuse that operation and look at alternatives like pills or physical therapy. Having that person's family deal with 'suicide by doctor' is a non-starter here. This is like saying mechanics should respect the wishes of people who want to output their exhaust into the cabin. Afterall, the customer is always right!
Also, people in pain aren't terribly rational and don't make good decisions. Doctors should be the gatekeepers here on a certain level. I shouldn't be able to demand surgery willy-nilly and expect doctors and surgeons to act like a concierge service. Surgery is a serious risk and no one is going to casually perform malpractice here. Worse, knee repair is a tricky thing. If your knee can't support 300+lbs then a repair is only going to be a temporary solution until you damage it again, which will probably be soon after. We're not engineered to handle these kinds of loads, thus the weight loss recommendation.
It's not simply based on BMI. It's based a lot of things, but at some point the BMI will be bad enough that the other things become irrelevant.
>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.
It would be if that actually happened in any systemic manner. And even in the cases where it does happen, it has less to do with whether the doctor is willing and more to do with whether the doctor is able to diagnose.
> But just saying "we have a BMI cutoff" is pretty much discrimination masquerading as medicine.
It's discrimination in the same way that saying people under a certain height can't ride rollercoasters. There isn't some conspiracy amongst theme parks to alienate short people. It's dangerous, and it's nothing to do with prejudice against short people.
And in reality, it's not "we have a BMI cutoff" as the only criteria. It's "we have an extensive and exhaustive list of things we look for before we recommend surgery to patients, since surgery is a dangerous and often life threatening procedure. One of those criteria is a BMI that doesn't cause undue risk to the life of the patient".
It would be if this was actually happening, which is never. Maybe there's like a handful of shitheads out there doing it, but this isn't a wide-spread problem.
The article links to research showing that it is a wide-spread problem. There may be valid criticism of that research, but your flat unsupported denial is not that criticism.
http://onlinelibrary.wiley.com/doi/10.1111/obr.12266/full
"Finally, physicians may over-attribute symptoms and problems to obesity, and fail to refer the patient for diagnostic testing or to consider treatment options beyond advising the patient to lose weight. In one study involving medical students, virtual patients with shortness of breath were more likely to receive lifestyle change recommendations if they were obese (54% vs. 13%), and more likely to receive medication to manage symptoms if they were normal weight (23% vs. 5%)."
> Comparisons of recommendation categories for shortness of breath by condition revealed that students were more likely to recommend lifestyle changes when the patient was obese than when she was not obese, χ2 (1, N =76) =14.6, p<.0001. They were less likely to recommend symptom management (i.e., bronchodilator prescription) for shortness of breath when the patient was obese, χ2 (1, N =76) =4.8, p<.05. There was, however, no significant difference in recommendation rates for diagnostic tests.
> 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 hospital.
The problem with this story isn't that it's facts are wrong or misrepresented, it's that they're only reporting one side of the debate in a situation which is very much not one-sided.
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...
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_foods
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.
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.
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.
https://www.ncbi.nlm.nih.gov/pubmed/8772559
https://www.ncbi.nlm.nih.gov/pubmed/2185664
"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 slowing down "to a crawl" if a person is hungry isn't helpful in the slightest; comments like this demoralise people. They work out, eat kale, make sure to never feel hungry lest they "slow down their metabolism to a crawl" and still aren't losing weight. "why bother?"
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.
As a chronically 25-50lbs overweight person with knee problems, just dropping 10lbs was like night and day for me. Suddenly my feet and knees didn't hurt as much and I felt and slept so much better. There's an ugly narrative here that few press outlets want to sell because I imagine fat rights groups will be offended, but there's a real personal responsibility argument with weight that too often gets brushed under the carpet. Victimization naratives are popular now and get significant ad impressions. Consider the two headlines, which one will get you more clicks? "Doctors biased against the fat patients; thin patients treated better" or "Losing weight is your responsibility when it comes to your health." Obviously, the former will get all the clicks.
I really hope fat rights groups and the liberal media stop with these narratives. Losing weight isn't terribly difficult if you actually care about your health. Its a small investment that significantly pays off. Yes, I get a little offended when my doctor brings it up, but he's right every time. When my weight hits a certain number, my body just falls apart. Suddenly sleep apnea kicks in, I'm sore all the time, I get winded easily, and my back and knees hurt. We shouldn't be fighting against this kind of advice. Its still good and often life-changing advice.
Sadly, this forum being mostly millennials means the comment section is leftist victimization responses straight out of /r/fatlogic. I pity the generation growing up with a 'no one is ever at fault' and 'personal responsibility doesn't exist' philosophy. Its a disservice to them and ruins lives.
And it's not that they're trying to be disparaging or mean. It's very frustrating for doctors who have to explain to patients repeatedly the root cause of their issues, and that there is no "fast fix" or medicine that will fix their problems until they lose weight.
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.
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.
All of those cluster around obesity. The simplest, most direct and most effective cure is controlling weight.
If someone is so massively overweight that they need to use equipment intended for large animals or industrial scrap, they are putting themselves in an extremely precarious health situation.
Your needlessly weird comments about equipment betray your bias, as does your implicit belief that everyone who has a weight issue can do something about it. But even if you can't get past your personal feelings, I'd hope you can see that the rather nasty condemnation and moral judgement implicit in how this line of thinking runs looks pretty awful when applied to other medical conditions.
> Your needlessly weird comments about equipment betray your bias
What are you talking about? Did you even read the article? That's where I got those examples from.
> your implicit belief that everyone who has a weight issue can do something about it
You caught me; I believe in conservation of energy.
> this line of thinking runs looks pretty awful when applied to other medical conditions.
You clearly aren't familiar with how medicine actually works. Prioritization and triage are unfortunate facts of life.
Change a few words and you're there. The ignorant certainty the arrogant dismissiveness that comes with it are breathtaking. It is genuinely sad.
> You clearly aren't familiar with how medicine actually works.
Physician, heal thyself.
> It is genuinely sad.
It's ironic that you're using Trump as an example of bad argumentation, given that your styles are quite similar. "You're so sad. You're a slob. You're a mess." Etc. etc.
Thanks. I realized that discussing this with you was a waste of time.
That's done by providing alcohol treatment and smoking cessation, not telling them to just stop.
Obesity makes lots of medical conditions worse (or more likely), but it's the primary cause of almost none of them. It's rare that it's even the biggest risk factor.
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.
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 coach.
GP is there to treat, not indulge. If they are unable to treat obesity, they are to blame, not the patient. Obesity is extremely hard to treat even when there is will to change. Heck, the causes of it are not yet well understood. Something goes wrong with the feedback system of satiety and energy expenditure, which is evolutionarily stacked to accumulate calories.
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.
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.
I'm not asking for special treatment, I'm asking to be treated like a human being who deserves dignity and life.
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?
You're being a jerk.
That work?
Sometimes they might be, but this is far from universally true.
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 - all my life. I'm now on a weight loss program and seeing significant success. It took years of mental and physical issues to get me to that point and it is a struggle every day. It's hard work. That's why people are proud of losing weight: it's an achievement. It represents a permanent change to lifestyle and behavior that takes weeks, months, even years to effect.
Please don't discount people's experiences by saying things like "oh, just lose weight." Consider the human being in there, and how to reach them. Don't assume that because it's easy for you to be fit and skinny, it's easy for everyone.
There are safe, reliable, and well-understood ways to lose weight. They're not easy, enjoyable, or fast, but they're almost certain to work, excluding other medical conditions.
Depression on the other hand, is far less well understood. It's also far more more difficult to treat and fight, and while weight loss has an effective general solution of eating less and exercising more, no such general solution exists for depression. Plenty of people spend their lives chronically depressed with little to no improvement, despite trying countless medications, forms of therapy, and lifestyle adjustments. The same can't really be said for weight loss.
The fact that there are known ways to help solve weight loss isn't the problem. Obese people know there are ways to lose weight. The issue is psychological - not believing one can achieve the goal, not being ready/willing to fully commit to the goal, feeling too ashamed of oneself to believe one can improve one's situation, and on and on.
Plus, you suggest that because the way to lose weight is clear (it is), that makes it easy. That's a false equivocation. I'm speaking from experience when I say it's simple, but quite challenging. That's like saying "winning the Olympic 100m sprint is easy, just be faster than everyone else." (No, I don't think my weight loss is an Olympian effort, but I am exaggerating for effect.)
> > There are safe, reliable, and well-understood ways to lose weight. They're not easy
The poster you are replying to specifically said it wasn't easy.
And here I was, thinking it was just that you love constantly stuffing large amounts of high-calorie foods down your throats.
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.
> They're not easy, enjoyable, or fast
They are often at least one of those (most often the last) if the appropriate method is chosen for the person, though its true that this is not always the case.
> but they're almost certain to work, excluding other medical conditions.
"Excluding other medical conditions" is exactly the problem, since comorbidities with obesity are not at all rare, and many of them are directly relevant to weight-loss strategies.
Other than a few anecdotes, one of which comes from an urgent care center[1], the article provides no evidence of categorically denying diagnostic tests, only surgeries.
> "Excluding other medical conditions" is exactly the problem, since comorbidities with obesity are not at all rare, and many of them are directly relevant to weight-loss strategies.
I have yet to encounter a doctor whose response to my weight is just, "Hi! Lose weight! TTFN!" It's hard to tell with the kind of surveys presented in this article if people are really being brushed off or if they are just being told things they don't want to hear.
[1] Relevant because urgent care centers tend towards shitty experiences regardless of your weight or medical problems. Especially the ones not affiliated with a hospital system.
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
You're rephrasing things with "just lose weight": nobody said it is easy to lose weight. But if you're obese, you're in the danger zone.
That's true. Dismissing the studies cited in the article clearly showing that doctors do give inferior care (particularly, in being less willing to refer for medically-appropriate diagnostic tests) to obese people (which, incidentally, inhibits their ability to give useful direction to those people on how to safely and effectively lose weight) goes beyond mere lack of empathy the whole way to willful ignorance and active hostility.
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, ignoring the human being underneath that is trying to live their life as best they can.
I don't think that's true at all. The people that are most described by the latter are also, often, the HN posters most opposed to the former. THere's, obviously, some differences here, but not to the extent of your description.
Imagine an article about African American men getting poorer care for heart disease because they are more susceptible to it, and the comments claiming that it's perfectly reasonable and they should just exercise more to compensate for it.
Comments like this happen on articles about the poor, blacks, and women, among others, here, with pretty much similar debate on both sides. So, I think that you're just, factually, wrong.
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 weight loss is a low-risk, effective way to treat the patient's condition isn't discrimination, it's just proper medical practice.
The actual study cited in the article which is being cited as showing systemic discrimination: "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." There were, of course, exceptions to the rule mentioned.
So yes, I do think that fat people are discriminated against, but I do not think that recommending weight loss as treatment to obese patients is an example of discrimination.
"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.
Yes, the article links to research showing systematic discrimination here, and many people here are dismissing the possibility without addressing the research, acknowledging it is even referenced, or doing anything more than stating their firm belief that discrimination is not occurring.
> People like to feel victimized and are claiming discrimination
With, you know, actual research backing them up.
> when it's overwhelmingly not the case
[citation needed]
For me to believe that recommending weight loss is discriminatory, you would have to show that weight loss isn't an effective treatment for obese patients presenting with hip and knee problems.
Being obese is a critical health problem. It's not wrong for doctors to prioritize it, and I don't think it belies a lack of empathy to agree with them.
I say this as a person with a weight control problem.
Some doctor choosing not to even consider a patient's medical problem without looking past a single issue—especially when that patient is actually seeing some success in dealing with that issue on their own, as seen in the Patty Nece example highlighted by the Times—is a waste of everyone's time.
From a purely economic perspective, a patient who is paying thousands of dollars for insurance and not-insignificant copays is not getting what they paid for if the doctor treats their patients in this way.
Yes, weight loss solves a lot of problems, but the complication of losing weight for the myriad metabolism types out there makes the solution a challenging one for many types of people. For all the doctors know, their patients could be walking five miles a day and eating a 1,500-calorie vegan diet, but finding their success rate doesn't match the amount of work they're putting in. Their weight may yo-yo in a dramatic way that can make sustaining a healthy weight very challenging.
Weight loss is not like aspirin. It doesn't work exactly the same for everyone. (And there are bad ways of losing weight, of course.)
This Times article from May, while it obviously highlights extreme cases (Biggest Loser contestants), is worth bringing up in the context of this conversation: http://www.nytimes.com/2016/05/02/health/biggest-loser-weigh...
Obesity is a hard problem to solve as a society. To solve that problem, we have to consider the issue thoughtfully, from all sides.
I'm neither fit nor skinny.
I am empathetic, what I am NOT is sympathetic. I have a problem, and I need to fix it.
I'm working on it. But even when I'm not, I understand that my health problems are and will be primarily weight related.
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 know what the resources a person might need to overcome depression are or how much more complicated it can be. Sure, they both have an initial inertia that needs to be overcome to get started on fixing it, but I'm much more sympathetic to the depressed.
> I am empathetic, what I am NOT is sympathetic. I have a problem, and I need to fix it.
That's a healthy outlook for you to have. It's the one I have, too. The people we need to have sympathy/empathy for, though, are the people who haven't gotten there yet. I imagine there was a time for you where you hadn't reached the point of understanding your problem, for any of the various reasons of shame, denial, anger, blaming others, etc.
There are a lot of people in that boat. What I think commenters here don't understand isn't that weight loss is relatively straightforward, it's that straightforward things aren't always easy, and that preparing oneself to do something difficult is hard, even if that difficult thing has clear steps to take.
Given that other people have pointed out the same vagueness in my comparison to depression, maybe it wasn't the best one to make. I will think on a different one for next time. I do think that, given the above, it makes my point though.
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 imagine there was a time for you where you hadn't reached the point of understanding your problem, for any of the various reasons of shame, denial, anger, blaming others, etc.
They're adults. I'll treat them with the civility I treat everyone. Beyond that? Fuck 'em.
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.
OK, I think we're on the same page. I have no reason to respect that about them and don't.
How can you claim to treat all people with basic civility, while at the same time admitting to disrespecting (and thus judging) something about a specific group of people on a mass level without trying to understand it?
I think you need to reevaluate how you treat this issue and the people who are affected by it.
Civility, manners and etiquette are to show people you respect them when it isn’t obvious that you respect them – like when you don’t respect them.
And just because I don't respect them w/r/t their weight, doesn't mean I can't respect them at all.
without trying to understand it?
You assume that understanding would imply respect.
I agree. But would you not also agree that "empathy" has become quite the buzzword recently? I have a hard time separating "empathy" from "Empathy."
And the people peddling "Empathy" seem to think if everyone was empathetic, we'd all come to the same set of conclusions. A very narrow set. I want off this train because I haven't found the right way to retool my lack of respect into the "Empathtic" vocabulary for strong disagreement. I think it involves uses the words "problematic" and "pernicious" quite a lot, but I don't care to find out.
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.
Such as in high risk environments with certification requirements. You wouldn't tell a bank or military "upgrade it".
Software support isn't exactly analogous to healthcare since the upgrade requirement often is trivial and troubleshooting past that checkpoint is instantaneous. It's also generally not potentially life threatening, despite what angry DBAs might threaten
I would say that weight as a checkpoint for some things is mildly arbitrary and not nearly as useful as most recent patch. With most recent patch, you at least can see what fixes have been incorporated. Losing weight doesn't have the capacity to immediately resolve the underlying issue like a patch does.
I do agree that obesity is a personal thing, but a patient being obese is just part of the considerations as they troubleshoot. It's a major problem but it's also integrated into the patient, and it's the unfortunate reality of what doctors need to deal with.
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.
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.
I expected to have an easier time talking to the opposite sex when I lost weight, and this ended up being true. I had no idea how much better talking to everyone else would be. In customer-business interactions, job interviews, and really every interaction you have with other people it made a remarkable difference. I was an avid cyclist before I lost weight, and I still am now, but people are nowhere near as dismissive when I tell them I rode a half-century the previous weekend, even though I did so before as well (riding a recumbent helps a lot).
This is anecdotal inasmuch as it was just me, but over the course of my life thousands and thousands of data points suggested the idea that people are just extremely prejudiced against fat people.
However, to be honest, I don't see it as a form of negative prejudice. It's a completely reasonable prejudice.
You can only become obese due to some very critical character flaw.
For example: inability to delay gratification, lusting over immediate pleasures, inability to make plans and stick to them, inability to read social cues telling you to stop gaining weight, perhaps indifference to society all together, general apathy (nothing matters anyway so might as well enjoy this cookie, for the 20th time today), etc.
No one wants to be around people who don't take care of themselves and ooze of negativity and desperation.
Maybe in some alternate universe. In this universe, you can get obese by, among other things:
- untreated hypothyroidism (even low grade)
- certain autoimmune diseases including type 1 diabetes
- inborn errors of metabolism
- having parents consistently overfeed you at youth
None of the above is a character flaw.
Tell me, how I fix it with self-discipline? currently I am using discipline to lose weight, but my hair is falling, my feet skin is splitting open, my nails are breaking, and I am losing muscle faster than I lose fat.
Any suggestions on what I should disciplined about?
The treatment is taking the appropriate dose of levothyroxine. It's very unfortunate that you have had a string of shitty GPs and endos, but to treat it you need someone to measure your T3 and TSH levels while gradually ratcheting up the synthetic hormone dose until your numbers are in the acceptable range.
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.
The body sadly seems to sense lack of input/output balance, not current energy state.
None of those conditions is sufficient to push you above borderline obesity (~30 BMI). To get beyond that requires something else. I will not subscribe to the GP's notion that "something else" is necessarily a "very critical character flaw", but I also will not accept that it is out of the control of the person in question.
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.
> No one wants to be around people who don't take care of themselves and ooze of negativity and desperation.
No one wants to be around hateful people like you.
To be fair, nobody wants to be around people who reek of judgment and pass off simple answers to complex problems like they're brilliant insights.
Anyway, you kind of proved my point, so thanks. Regardless, I should mention that I am the same person, with (I imagine) largely the same character, as I was before. I think my own issues had a lot to do with 1) the diet which Americans are encouraged to have, and 2) our built environment.
For the first, US culture has so drastically lost sight of what a proper portion is that many people genuinely don't know what a healthy portion is. When I was in my early 20's I had always been fed way too much, and my college meal plan was all you can eat and based on number of meals per week (encouraging someone to think they should take as much as possible). Coupled with that, the exercise people recommended was EXACTLY the wrong exercise for a heavy, self-loathing person. Running is AWFUL. Getting acquainted with the elliptical does help a lot (though exercise, while wonderful for general health, is of limited benefit for weight loss).
For the second, we have built our cities so that you get pretty much no exercise whatsoever in the course of a normal day. The walk from the parking lot to the store, the office, and home is what most people get.
Anyway, what worked for me was aggressively counting every single calorie I ate, living in a place where I could have a 7 mile round trip bike commute (with a brutal climb on the way home), and making meals that could still be big and filling but low calorie - mostly gigantic mountains of vegetables prepared without oil.
Don't tell anyone that, or they'll be just as dismissive as before! b^)
I have a thyroid problem, the first symptons started to show up when I was 13 or 14, including my hair starting to get white.
I didn't knew, it was a thyroid problem, my mom, for some reason (that back then offended me, I told her I didn't wanted to go to a "fat people doctor") took me to a endocrinologist, suspecting something was wrong.
The endocrinologist made no tests, only said I was fat, and dismissed me.
The thing is: according to BMI, I was only slightly overweight, not even really "fat" yet.
But I worsened over the years, and became obese, no matter how hard I tried to not to (including having strict diet and going to the gym, and having medical help from cardiologist, physiotherapist and nutrition).
A random friend of my mother then commented I had obvious thyroid problems symptons, including a obviously enlarged neck.
My mother started to take me to endrocrinologists again... and again, they just kept telling me I was fat, and refusing to help.
I ended researching my own problem, figuring on my own what I needed to have tested, and spending lots of money and time looking for a decent endocrionologist.
I found one that is half-decent, and started at 25 years old my treatment finally... and only then, the treatment is kinda half-assed, my current endocrinologist mostly don't believe me, and don't really want to help, in fact I ended mostly treating myself by myself, buying whatever medicine I wanted, and informing the medic after the fact (where if I made the right choice, the medic would inform me that I made the right choice, so far I always made the right choice, according to improvement in symptons and blood tests results).
I am currently trying to drop my weight until I get obviously "not fat" so I can then save some money, and go to a expensive endocrionologist and hope he will treat me correctly, instead of telling me I am fat.
I even tried to go to the most famous endocrinologist in my country, I spent a entire month salary in one single visit, and the guy just told me I was fat and refused to ask for any tests, despite tests being kinda straightforward (I have a autoimmune disease, a test to see if I have anti-thyroid antibodies would already be enough to diagnose me, yet not a single doctor ever wanted to test that, the single one that did, was a doctor that was going to retire, and that I was very "persuasive" in convincing her to ask for the test, that indeed proved I was correct, and indeed I had a huge amount of anti-thyroid antibodies destroying my thyroid).
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 get worse faster, but the fat remains.
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.
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.
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.
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.
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.
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 more than excess weight. I've started to fix my metabolism, and I'm not so anorexic-looking anymore.
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 obese person absolutely will cause your body to burn fat.
Consistently so.
All you have to do is endure the hunger.
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.
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.
Being athletic is not a medical condition.
Doctors apply 90%-suitable heuristics to 100% of candidates too often, in my opinion.
I'm a big guy. I've been big for 2/3 of my life. It fluctuates up and down as I've tried everything in the book to lose weight. I would _love_ to lose weight. I hate being fat. It causes numerous physical problems and complicates everything I do. Most big people I know are in the same boat. It's not fun carrying the extra weight around with you, or trying to fit in airline seats (I've given up), or being uncomfortable in your own skin, or looking in the mirror every day and hating what you see. I know my weight is unhealthy. I promise you the vast, vast majority of big people are similarly aware. Do you think if we could lose the weight as you say that we would not? That we'd willingly stay this way?
Calling big people weak willed, revolting, or undeserving of medical care is unacceptable. I am not a Healthy At Every Size activist. You know nothing of why these people are big. You don't know what they've tried or why they stay this way. You don't know their struggles and what they've gone through. Please stop making value judgements on other human beings based on their physical dimensions.
What is your daily caloric intake? What about height / weight? What is your estimated TDEE?
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 anesthesia, because you just accumulate in different patterns.
Doctors don't train on obese patients because they're all different, so it's hard to get a standard operating procedure. They also don't train on obese patients because until now, they've been a vanishingly small proportional of the population.
Take a look at vintage photographs of "fat men" in carnivals in the beginning of the 1900s. You see people like that all over the place these days. Cheap abundant food and obesity has only recently been a problem.
It is either something tied to methods of agriculture and farming or appearance of some sort of endocrine disruptor that is nowadays abundant.
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.
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.
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.
Not the other way around. A constant thread in the dismissal here and across culture is that the only way you could possibly weigh more that 200lbs is pure weakness of character.
Even worst, majority of doctors fixate on reducing weight (as if that would solve everything else)
Much of the discussion in this thread does not meet this standard of discourse that we ask for on Hacker News. It's all too easy to respond reflexively (and thus with less likelihood of reaching this bar) when commenting on controversial issues, and while that might be OK elsewhere, it isn't here.