Where are you getting this from? I didn't see anything like it in the study you linked, it doesn't match the general impression I've gotten reading other OSA studies, and it's unusual for lifestyle intervention studies to have a large number of people lose enough weight to go from obese to non-obese. Are you sure that you're not neglecting some other qualification of the population (e.g. mild sleep apnea, bariatric surgery)?
> For this subset of people, shouldn't insurers (and often the Public) encourage the patient to use the free, safe, and natural solution (eating less) before being dependent on an expensive machine?
No, because weight loss takes time, and there's nothing particularly safe about leaving OSA untreated in the interim. Weight loss is a fine thing to pursue for overweight and obese OSA patients, but deciding up-front to do that instead of CPAP is reckless. I agree with the authors of the study you linked when they conclude that "it is clear that treatment of OSA cannot be limited to any single strategy, but rather requires a multidisciplinary approach". Not every patient will respond to or tolerate every treatment approach, and the possibility of synergistic effects should not be ignored.
Therefore, I believe that everybody agrees discrimination against known risks must be limited by regulation or other means to make insurance viable; we're just arguing about where to set the boundary. It is generally accepted that race, religion, and so on are prohibited forms of discrimination, but that doesn't mean there is some principle that says all other forms of discrimination are ok. Furthermore, the arguments for discriminating against the obese logically apply to protected categories, so how do you reconcile that?
Apart from logic, I don't understand why anyone would want to argue in favor of discrimination against people who have a tendency to be obese, even if you don't have that particular issue. There are an unlimited number of conditions a person could have that could be similarly discriminated against.
Insurance as a product is a way to manage that risk, but it doesnt eliminate it, and as a product it makes the total cost higher, as you need to pay to manage the risk. Insurance itself always bears the risk of adverse selections: it attracts those that will have higher tendencies to abuse the insurance.
That is the nature of insurance, what it solves and why it requires human effort to manage, it can't be automated away: it is an economic solution.
Another problem would be: some people have very expensive medical treatment and we should not as a society let them die or suffer death from it. But that problem is not soluble through insurance, that is soluble through charity and charity alone. Using insurance as a mechanism of charity is using a hammer on a screw.
Insurance cannot exist and solve any problem if insurers are able to discriminate perfectly, so it cannot be a matter of principle that they should be able to discriminate to any arbitrary degree.
The idea that insurers are inherently justified in discriminating against poor risks is a nihilistic attack on the idea of insurance.
Total information awareness would lead to perfect discrimination and the annihilation of insurance, so you cannot justify by a principled argument discrimination against those you don't like purely on the basis that insuring them is charity.
Truly don't get this. Insurance discriminates before the fact: it's a framework to gauge risk, and collect a premium for managing it. There is no charity involved in that process.
It so happens that antidepressants cause people to gain weight frequently.
Ever tried debugging a program on a machine with bad RAM? It’s kinda like that.
People have an inbuilt homeostatic feedback system which can be naturally out of whack or it can be modified by drugs, and blaming them for not being able to compensate is senseless.
Also, the fact that it can be modified by drugs proves to me that weight gain should not be presumed to be a personal failing. The person who has weight gain didn't become a different person because they took pills.
It's analogous to having a religious experience through electrical brain stimulation - it should make you realize that having such experience is not to your personal credit or detriment.
Everybody who is naturally not overweight knows that they don't have to rigorously monitor their food intake, because they have an internal thermostat that does it for them. They just eat when they are hungry and stop when they are full.
Some drugs affect that thermostat, and some people have a naturally defective thermostat. It is very very difficult to fight it because the imbalance is very small and the intensity of the output is very high.
The thing that annoys me is, given that I have never been obese, and I assume you have never been obese, we both know from personal experience that people without weight problems do not exert effort to control it. So how can you blame those who need to for being unable? We both know better without needing the least empathy or experience of being obese.
Please don't create HN accounts to abuse the site with.
A school-friend of mine, who had been an elite athlete during high school and was as healthy and fit as anybody you'd find, developed schizophrenia during his twenties and needed to be put on strong anti-psychotic medication, which caused dramatic weight gain.
He's continued to need various medications for schizophrenia and anxiety ever since, and despite relentless efforts to keep his weight down with the same kind of exercise and diet that kept him in good shape when he was younger, cannot return to an ideal weight.
The reason for this is to do with the way neurotransmitters and hormones alter metabolism, and it's straightforward to understand with a little research.
The question "How do antidepressants create matter from thin air?" amounts to trolling and doesn't belong on HN in my opinion.
I would however, further suggest that not only should we have sympathy for people who have obesity from medication, but those who have obesity without it.
If you take a drug and you perceive God as a result, it is logical to infer that people who perceive God without drugs may be also experiencing something that results from similar brain chemistry.
Sometimes it's a side-effect of a drug. Sometimes it's a symptom of other issues in the body/mind.
My point is that people who are obese (to an extent that causes issues like sleep apnoea or other complications) are not that way because they simply choose to be that way, or because they "just eat too much".
People who can easily lose the weight have already done so. Everyone else is stuck with it, for one or more of any number of complex reasons, and outside observers are in no position to pass judgment.
I personally haven't been seriously obese - moderately overweight at worst - but even then I've experienced how difficult/impossible it is to get down to an ideal weight when also dealing with health complications like auto-immunity, stress/trauma/anxiety/depression, or hormonal issues.
I do know others who struggle with more serious obesity, along with some combination of the aforementioned issues, which when you pay attention turns out to being almost always the case with obesity.
"Just lose weight" is simply not possible.
"Just overcome all your auto-immune, hormonal and emotional issues" is really what you're saying, in which case the response must be "OK, give me about 15 years and a ton of support and patience along the way".
“... use the free, safe, and natural solution (eating less)”
Your comment said:
“you should be incentivized to lose weight and do so”
I’m not sure where the nuance is that my paraphrasing failed to capture.
It’s not as if people don’t already have huge incentives to lose weight. Those that have not lost weight are likely unable to for complex physiological or psychological reasons. Telling people to “eat less” amounts to trolling.
If you or the parent commenter have insights on what methods of weight loss could work for people who have yet to find an effective solution, then there might be an interesting discussion. I do have some insights on this, for what it’s worth.
The parent commenter signaled that they have no such interest, hence the downvoting and the ban after their blatant troll comment downthread.