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

• fjjrxcbdhx 10y ago
  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.
  • ZanyProgrammer 10y ago
    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.
    • fjjrxcbdhx 10y ago
      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.
      • et2o 10y ago
        You have no idea what you are talking about.
        • fjjrxcbdhx 10y ago
          Well that sure is substantive.
      • nugget 10y ago
        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.
        • fjjrxcbdhx 10y ago
          It's a very different kind of knowledge retrieval, i.e. knowledge about something as opposed how to do something. Your example doesn't really fit.
      • __jal 10y ago
        Wow. 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?
        • fjjrxcbdhx 10y ago
          You be smug as much as you like, but there's a reason why they say medical school is mostly memorization.
  • et2o 10y ago
    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.
    • fjjrxcbdhx 10y ago
      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.
    • thanksgiving 10y ago
      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.
  • jessaustin 10y ago
    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.
• NDizzle 10y ago
  The article starts out talking about a woman who is 502 lbs. Why wouldn't "lose weight" be the best suggestion? You're 500 lbs!
  • Sir_Substance 10y ago
    >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/.
    • rangibaby 10y ago
      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.
• whamlastxmas 10y ago
  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 article is garbage.
  • deleted 10y ago
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  • lsy 10y ago
    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.
• JoeAltmaier 10y ago
  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.
  • deleted 10y ago
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  • AstralStorm 10y ago
    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.
    • JoeAltmaier 10y ago
      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.
      • AstralStorm 10y ago
        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.
        • 10y ago
• wyager 10y ago
  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.
  • et2o 10y ago
    Doctors take care of people who don't take care of themselves all the time, everyday. It's part of being a doctor.
    • jlarocco 10y ago
      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?
      • jakebasile 10y ago
        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".
        • jlarocco 10y ago
          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.
          • jakebasile 10y ago
            Big people do not want to be obese, and doctors are paid for their efforts. Nobody sets out with the life goal of being fat.
  • 10y ago
• et2o 10y ago
  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.
  • 0xcde4c3db 10y ago
    > 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.
• diyseguy 10y ago
  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.
  • jakebasile 10y ago
    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?
    • deleted 10y ago
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    • hasenj 10y ago
      > They aren't here to look pleasing to you 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.
      • AstralStorm 10y ago
        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.
• ivraatiems 10y ago
  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.
  • joenot443 10y ago
    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.
    • ivraatiems 10y ago
      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.)
• csours 10y ago
  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.
  • hart_russell 10y ago
    Great analogy
    • AstralStorm 10y ago
      If an upgrade took years to apply, this wouldn't be a standard operating practice. Such as in high risk environments with certification requirements. You wouldn't tell a bank or military "upgrade it".
  • csydas 10y ago
    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.
• gjolund 10y ago
  Most doctors will also tell an alchoholic to stop drinking.
  • LeifCarrotson 10y ago
    And smokers to stop smoking! Discrimination!
  • pixl97 10y ago
    Actually they won't. 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.
    • tcj_phx 10y ago
      > 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.
• CalRobert 10y ago
  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.
  • hasenj 10y ago
    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.
    • AstralStorm 10y ago
      > You can only become obese due to some very critical character flaw. 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.
      • jtuente 10y ago
• speeder 10y ago
  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).
  • hasenj 10y ago
    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.
• tgb 10y ago
  Veterinary medicine always does dosing by weight. Why doesn't human medicine?
  • sbierwagen 10y ago
    They do. Weight dosing is way more common in pediatric medicine, though, since children cover a pretty wide range of weights.
• RyanOD 10y ago
  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." Just curious.
  • hasenj 10y ago
    Obesity is an actual condition. Being athletic is not a medical condition.
    • ivraatiems 10y ago
      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.
      • hasenj 10y ago
        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.
  • ivraatiems 10y ago
    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.
    • AstralStorm 10y ago
      If it were 90% applicable if would be good. These are not validated and are likely much less accurate.
• jakebasile 10y ago
  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.
  • CalRobert 10y ago
    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.
    • jakebasile 10y ago
      Me too. I realize that I also painted with a broad brush there. I was admittedly getting pissed off.
  • Evgeny 10y ago
• jimmywanger 10y ago
  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.
  • AstralStorm 10y ago
    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.
    • jimmywanger 10y ago
      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.
• Avshalom 10y ago
  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.
• woliveirajr 10y ago
  Yes, I know/experience that since my BMI increased from 23 to >30. Even worst, majority of doctors fixate on reducing weight (as if that would solve everything else)
• sctb 10y ago
  > 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.