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Comment by ivraatiems | Hacker News Reader

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.

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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.)

"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.

Imagine how pleased I am to see you've changed that perception.

> Plus, you suggest that because the way to lose weight is clear (it is), that makes it easy.

> > 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.

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.

That's fair. I don't mean to judge your specific experience.

> 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.

> Other than a few anecdotes [...] the article provides no evidence of categorically denying diagnostic tests, only surgeries.

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

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.

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.

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.

I would if it wasn't the equivalent of talking to a child with hands over their ears yelling "LALALALALLALA"

Insulting parent commenter for asking you to support your arguments makes me feel that the child here is you.

You got me, I'm just ignoring your mountains of evidence.

> 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

With, you know, actual research backing them up.

> when it's overwhelmingly not the case

[citation needed]

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.

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

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

Quite true

> 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.

In fairness to HN, this is a societal problem, not an HN problem. It's a viewpoint issue that affects lots of people.

That's true. I think I'm just especially aghast at the comments here because I generally enjoy this community and figured there would be more empathy.

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.

>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.

treating someone with sympathy but not also with respect is a bad thing.

OK, I think we're on the same page. I have no reason to respect that about them and don't.

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.

How can you claim to treat all people with basic civility

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.

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.)

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.

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.

> 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.

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.

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.

"Before we fix your knee we're gonna need you to start running more"

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