Comment by adventured | Hacker News Reader

Comment by adventured | Hacker News Reader

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One of the things the US healthcare system has needed for decades is a rebalancing on the amount of healthcare Americans receive.

Canadians receive a lot less care than Americans do. They wait a lot longer for that care. Given the health problems Americans have derived mostly from obesity / diet, will that cause a lot of trauma to American patients vs what it does to Canadians? Maybe (I would say yes, but it's an extremely difficult data point to calculate)

I do believe that if Americans had a better diet and got more exercise, they'd need a lot less healthcare.

Americans are also the most over-tested, over-diagnosed, over-medicine'd people on earth. It's of course one of the factors for why there is so much cost in the system.

One of the first things that was always obvious that a government take-over of healthcare would focus on, is the amount of healthcare available, especially to older patients. Obama tried to dance around that issue when confronted with it when the ACA was being passed, but it was understood by anyone familiar with European style socialized medicine.

1) lower frequency of use; 2) squeeze pay for healthcare workers; 3) stop the rise of drug prices by refusing to pay the ever increasing rates or refusing to allow patients access 4) use cheaper alternatives when possible

As a counter point to that, my wife and I recently moved from the USA to the UK and we've spent more time at the doctor's in the past month than we had in the previous year in the USA.

Part of the difference is that, in the UK, the doctors have been treating my wife's problems as honest medical problems and not just beating the diet and exercise drumbeat regularly. My wife spent a good part of the last year essentially bed ridden. The US doctor performed test after test to find out what was wrong. She eventually prescribed some medication for my wife which made her violently ill, but the doctor promised her body would acclimate to the medicine and that, in a few months, she's be able to walk again.

Since coming to the UK, we've discovered that the battery of blood tests that were performed back in the USA was actually just the diabetes test being performed over and over again because the test kept coming back negative. The medicine prescribed was actually a drug for the treatment of diabetics, despite the doctor having twelve negative blood tests on my wife for diabetes.

Instead, the UK doctor considered the possibility that there was something wrong with my wife besides just being fat. After a week on her new medicine, she was starting to walk without a cane again. In the past two months, she's lost thirty pounds. It's amazing how much more exercise you can get when you're not bedridden. Next week, we're seeing a GI doctor because the UK doctor realized that A) my wife would lose more weight if she ate more salad, B) my wife would eat more salad if she didn't always violently vomit it back up six hours later, and C) regurgitating food eaten more than fours hours ago isn't normal. The doctors in the USA never could seem to figure out B and C, so they would just double down on A.

By the way, in case you think that it was just that one doctor, that's not even our worst experience with it. About a decade back, my wife went to the emergency room after getting stabbed. The nurse told her the the problem would go away with diet and exercise. A stab wound. Thankfully, she caused enough of a scene to get a second opinion and the STITCHES that normally accompany stab wounds.

You know, I've heard the term fat-shaming, but that is a pretty damn extreme example. A stab wound was blamed on being fat?

These kinds of things are very common for fat people. A lot of sites and forums that are frequented by fat people tell these kinds of stories. This is Thin Privilege[1] is a popular one on tumblr where people mostly submit their stories about being treated negatively for being fat and quite a lot of those stories revolve around medical and mental health care in ways that are quite horrifying.

[1] http://thisisthinprivilege.tumblr.com/

Don't promote this appalling nonsense, please. This is a site which actively promotes the idea that being overweight is healthy – which it is not.

I agree that it can be really easy to blame health problems on weight when there are more complex issues present, and the idea of blaming a stab wound on obesity is obviously ludicrous. That said, being overweight is almost always extremely unhealthy and a major cause of many illnesses. It's absolutely correct that there should be a lot of focus on that.

> being overweight is almost always extremely unhealthy and a major cause of many illnesses

This is not true whatsoever. Weight and health have only limited correlations, to say that being overweight means you are unhealthy is ludicrous. This is well studied and known.

This is just not true. Being overweight or obese significantly increases all cause mortality. Here's a study where they followed 527,265 people for 10 years:

http://www.nejm.org/doi/full/10.1056/NEJMoa055643#t=articleR...

"During a maximum follow-up of 10 years through 2005, 61,317 participants (42,173 men and 19,144 women) died. Initial analyses showed an increased risk of death for the highest and lowest categories of BMI among both men and women, in all racial or ethnic groups, and at all ages. When the analysis was restricted to healthy people who had never smoked, the risk of death was associated with both overweight and obesity among men and women. In analyses of BMI during midlife (age of 50 years) among those who had never smoked, the associations became stronger, with the risk of death increasing by 20 to 40 percent among overweight persons and by two to at least three times among obese persons; the risk of death among underweight persons was attenuated."

Did you even read the full results of this study? Only extreme BMI categories had strong correlations for increased risk of death and mostly for those who didn't have a chronic health condition at 50 already:

"Among all men and women, including smokers and those with preexisting disease, there was a U-shaped relation between current BMI and the risk of death, with the highest risk in the lowest and the highest categories of BMI. Overweight was not associated with an increased risk of death among men but was weakly associated with an increased risk of death among women."

Note that the highest and lowest categories were extreme values of weight for an individual and there were significantly fewer people in those categories compared to the others.

Moreover, the authors of this study even talk about being overweight vs. obesity in the discussion section:

"However, whether moderate elevations in BMI (i.e., overweight) truly increase the risk of death is controversial.2 Several studies reported no increase in the risk of death among overweight subjects even after those who died during the initial years of follow-up were excluded or subjects were stratified according to smoking status.25-29 Recently, Flegal et al. reported that overweight was not associated with an excess risk of death in the nationally representative samples of U.S. adults drawn from the National Health and Nutrition Examination Survey."

They go on to talk about possibilities regarding smokers with the data from this study.

Finally, it is worth nothing that this study follow those aged 50 and older and did so through the AARP's health survey and is specifically focused on the health of older people and that is only looking at correlations for individuals who are already at a higher risk of dying in the first place.

Yes, I did. I don't think you're interpreting the results correctly. The conclusion of the paper, in summary of all the evidence, is that "Even against the background of advances in the management of obesity-related chronic diseases in the past few decades, our findings suggest that adiposity, including overweight, is associated with an increased risk of death."

Please look at the figures, in particular figures 1 and 2 D/C. Among non-smokers, as the BMI increases from 25 there is an increased risk of death. You can see the trend clear as day.

Roughly speaking, the nurse saw that my wife was fat and therefore inferred that she must be diabetic. She saw the blood and assumed that my wife was suffering skin lesions from said diabetes.

My wife informed said nurse about the stabbing. The nurse, like anyone who has performed tech support, is aware that people lie about what happened. Furthermore, diabetes is fairly common while stab wounds are relatively rare. She decided that the probability of my wife suffering from a stab wound and not being diabetic was less than the probability of my wife being an embarrassed diabetic who made up a story about being stabbed. She therefore stuck with her original hypothesis and worked from there.

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