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

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.)

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.

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.

> 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.

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 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".

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:

    Component loosening and failure
    Dislocation of the replacement joint, especially in the hip

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.

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.

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.

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.

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.

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.

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

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.

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.

> 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.

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.

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.

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.