8 ms·

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

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
[deleted]
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.
- dclowd9901 10y ago
  But therein lies the problem: being overweight is so _unbelievably_ unhealthy that most problems would be resolved simply by losing the weight. And conversely, I don't think any doctor out there is refusing to treat a sinus infection because a patient is overweight.
  - JackFr 10y ago
    As reported in the article, a patient who over the course of a week became unable to walk at all without shortness of breath. Her doctor told her to lose weight. The cause of the shortness of breath was blood clots on the lungs. And in my personal experience, my mother experienced precisely what you don't think ever happens. A sinus infection went untreated for weeks after repeated doctor visits. It is not that the doctor won't treat a sinus infection, it's that he won't _diagnose_ a sinus infection because the level of care drops when a patient is obviously overweight.
    - whamlastxmas 10y ago
      What her doctor actually probably said was "the limits of what I can diagnose show that you would most likely see a great improvement with weight loss. I can refer you to a specialist who can conduct more tests (MRI etc) but those tend to be very expensive. I wouldn't recommend it without trying weight loss first, which is very important beyond the symptoms you came in for today".
    - dragonwriter 10y ago
      > As reported in the article, a patient who over the course of a week became unable to walk at all without shortness of breath. Her doctor told her to lose weight. The cause of the shortness of breath was blood clots on the lungs. What some docs seem not to have learned is to ask the first question you learn to consider in tech support (and medicine is, in a sense, tech support for the human body) -- "what's changed?". Unless the patient had a sudden and rapid change of weight that corresponds to the symptoms occurring, even if it is something whose onset was brought on by weight over time (or just made more likely by weight), its probably not the weight itself directly causing the symptoms, and if you don't properly diagnose the cause, you have no idea if losing weight is an appropriate remedy, irrelevant to the symptoms at hand, or something likely to cause changes in the body which exacerbate those symptoms.
nugget 10y ago
One interesting point they touch upon is medicare's move to bundled payments creating an incentive for physicians (and hospitals) not to operate on anyone they believe more likely to suffer complications, including the obese. Fair or not, people respond to incentives, especially financial incentives. We will start to hear a lot more about this in the future.
imagist 10y ago
So, I'm in strong agreement that it's reasonable to have weight cutoffs as requirements for surgery, but let's make that argument based on facts, please. You said: > This survey doesn't confirm that surgeries are refused for the fear of lower ratings. The articles says: > And 42 percent who picked a body mass index cutoff said they had done so because they were worried about their performance score or that of their hospital. The problem with this story isn't that it's facts are wrong or misrepresented, it's that they're only reporting one side of the debate in a situation which is very much not one-sided.
- whamlastxmas 10y ago
  How convenient they don't mention the name of that survey, who conducted it, how it was formed, or link to the actual survey itself. The idea that nearly half of doctors would outright say "we do this to cover our ass" is laughable. That sentence from the article would also be "technically true" is they gave a checkbox of options for factors in that BMI cutoff, one of of which could be "concerns over the overall success rate of surgeries for myself or my employer" which is totally founded and reasonable and could have nothing to do with having some egotistical or financial stake in ratings.
  - imagist 10y ago
    > How convenient they don't mention the name of that survey, who conducted it, how it was formed, or link to the actual survey itself. Ugh, you're just wrong, and I can only conclude you didn't read the article. They mentioned who conducted it and linked the actual survey, which has all the information you mention. From the article: > "There is a perception among some surgeons that it is more difficult, and certainly some felt it was an added risk,” to operate on very obese people, Dr. Yates said. He was a member of a committee that reviewed[1] the risks and benefits of joint replacement in obese patients for the American Association of Hip and Knee Surgeons. 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." > But there should not be blanket refusals to operate on fat people, the committee wrote. Those with a body mass index over 40 — like a 5-foot-5-inch woman weighing 250 pounds or a 6-foot man weighing 300 — and who cannot lose weight should be informed that their risks are greater, but they should not be categorically dismissed, the group concluded. Again, I think that it's reasonable to have BMI cutoffs as a requirement for surgery, but let's make that argument based on facts, please. [1] https://www.researchgate.net/publication/278060582_Obesity_and_Total_Joint_Arthroplasty_A_Literature_Based_Review https://www.researchgate.net/publication/278060582_Obesity_a...
everyone 10y ago
I agree. The example in the start where the patient asks how will they know if theyre losing weight as theyre off the scale does not make any convincing point. If they actually ate 1200 kcals a day they would definitely be losing weight. It wouldnt be necessary to confirm via weighing.
- roflchoppa 10y ago
  Idk why this is being downvoted, its Cal-in,Cal-out... this should have been taught in that health class we took in highschool. I'd argue it should be taught in elementary.
  - tcj_phx 10y ago
    > Idk why this is being downvoted, its Cal-in,Cal-out... Calories-in vs. Calories-out is not helpful advice. A person's metabolism can slow to a crawl if the person is starving. It's much better to fix the metabolism, and remove metabolism-destroying foods from the diet. Many common foods should not be eaten (tofu), or only eaten when well-cooked (kale) [1]. [1] https://en.wikipedia.org/wiki/Goitrogen#Goitrogenic_foods https://en.wikipedia.org/wiki/Goitrogen#Goitrogenic_foods
    - vonmoltke 10y ago
      > Calories-in vs. Calories-out is not helpful advice. A person's metabolism can slow to a crawl if the person is starving. To be at that level of starvation would require the person's body fat percentage to drop to essential levels. "Starvation mode" in normal weight and overweight people is a pernicious myth.
      - AstralStorm 10y ago
        Not true about body fat levels. Metabolism is not quite regulated in this way. Otherwise those people would get hot before they get fat, as their metabolism would speed up. Metabolism control seems to be based of medium term intake rather than fat stores. Either that or there is a set point which is quite hard to move. Or both. Handling the fat does increase basal metabolic rate to an extent. But only so far. The abovementioned slowdown starts with mild thyroid suppression and shows up in bloodwork. This can cut BMR by up to half without starvation. (25% calorie cut from high levels is nowhere near enough) The problem is, this reduces will to both diet and exercise and induces a low grade depression.
drzaiusapelord 10y ago
I've noticed the liberal media is pretty big on the 'fat rights' bandwagon right now. I imagine its profitable considering the number of fat people in the US and fits in with the largely SJW editorial narrative bias the press is fond of. As a chronically 25-50lbs overweight person with knee problems, just dropping 10lbs was like night and day for me. Suddenly my feet and knees didn't hurt as much and I felt and slept so much better. There's an ugly narrative here that few press outlets want to sell because I imagine fat rights groups will be offended, but there's a real personal responsibility argument with weight that too often gets brushed under the carpet. Victimization naratives are popular now and get significant ad impressions. Consider the two headlines, which one will get you more clicks? "Doctors biased against the fat patients; thin patients treated better" or "Losing weight is your responsibility when it comes to your health." Obviously, the former will get all the clicks. I really hope fat rights groups and the liberal media stop with these narratives. Losing weight isn't terribly difficult if you actually care about your health. Its a small investment that significantly pays off. Yes, I get a little offended when my doctor brings it up, but he's right every time. When my weight hits a certain number, my body just falls apart. Suddenly sleep apnea kicks in, I'm sore all the time, I get winded easily, and my back and knees hurt. We shouldn't be fighting against this kind of advice. Its still good and often life-changing advice. Sadly, this forum being mostly millennials means the comment section is leftist victimization responses straight out of /r/fatlogic. I pity the generation growing up with a 'no one is ever at fault' and 'personal responsibility doesn't exist' philosophy. Its a disservice to them and ruins lives.
- whamlastxmas 10y ago
  Media is big on controversy and always has been. The controversy doesn't matter.
  - drzaiusapelord 10y ago
    Why isn't media big on the controversy on a the pro-personal responsibility side of things? As far as I can tell it panders to fat rights groups uncritically. I think pretending this bias doesn't exist is being generous towards the real media bias that surrounds us. There's no debate here. Its clear obesity and surgical outcomes are linked. Doctors aren't "discriminating" here. Lets stop the leftist nonsense as it contradicts the science.
JohnTHaller 10y ago
It's also worth noting the risks to staff in doing surgeries, procedures, and scans on extremely obese patients. Someone has to move them on and off tables and platforms. My brother in law (xray tech) wrecked his back getting an obese patient up for an xray. You'd need to staff a couple extra aides just to lift patients of that size, but hospitals don't do it.
BlackjackCF 10y ago
This is the sentiment that I hear from my friends who are doctors. And it's not that they're trying to be disparaging or mean. It's very frustrating for doctors who have to explain to patients repeatedly the root cause of their issues, and that there is no "fast fix" or medicine that will fix their problems until they lose weight.

deleted 10y ago

[deleted]

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.

dclowd9901 10y ago
But therein lies the problem: being overweight is so _unbelievably_ unhealthy that most problems would be resolved simply by losing the weight. And conversely, I don't think any doctor out there is refusing to treat a sinus infection because a patient is overweight.
- JackFr 10y ago
  As reported in the article, a patient who over the course of a week became unable to walk at all without shortness of breath. Her doctor told her to lose weight. The cause of the shortness of breath was blood clots on the lungs. And in my personal experience, my mother experienced precisely what you don't think ever happens. A sinus infection went untreated for weeks after repeated doctor visits. It is not that the doctor won't treat a sinus infection, it's that he won't _diagnose_ a sinus infection because the level of care drops when a patient is obviously overweight.
  - whamlastxmas 10y ago
    What her doctor actually probably said was "the limits of what I can diagnose show that you would most likely see a great improvement with weight loss. I can refer you to a specialist who can conduct more tests (MRI etc) but those tend to be very expensive. I wouldn't recommend it without trying weight loss first, which is very important beyond the symptoms you came in for today".
  - dragonwriter 10y ago
    > As reported in the article, a patient who over the course of a week became unable to walk at all without shortness of breath. Her doctor told her to lose weight. The cause of the shortness of breath was blood clots on the lungs. What some docs seem not to have learned is to ask the first question you learn to consider in tech support (and medicine is, in a sense, tech support for the human body) -- "what's changed?". Unless the patient had a sudden and rapid change of weight that corresponds to the symptoms occurring, even if it is something whose onset was brought on by weight over time (or just made more likely by weight), its probably not the weight itself directly causing the symptoms, and if you don't properly diagnose the cause, you have no idea if losing weight is an appropriate remedy, irrelevant to the symptoms at hand, or something likely to cause changes in the body which exacerbate those symptoms.

nugget 10y ago

One interesting point they touch upon is medicare's move to bundled payments creating an incentive for physicians (and hospitals) not to operate on anyone they believe more likely to suffer complications, including the obese. Fair or not, people respond to incentives, especially financial incentives. We will start to hear a lot more about this in the future.

imagist 10y ago

So, I'm in strong agreement that it's reasonable to have weight cutoffs as requirements for surgery, but let's make that argument based on facts, please. You said: > This survey doesn't confirm that surgeries are refused for the fear of lower ratings. The articles says: > And 42 percent who picked a body mass index cutoff said they had done so because they were worried about their performance score or that of their hospital. The problem with this story isn't that it's facts are wrong or misrepresented, it's that they're only reporting one side of the debate in a situation which is very much not one-sided.

whamlastxmas 10y ago
How convenient they don't mention the name of that survey, who conducted it, how it was formed, or link to the actual survey itself. The idea that nearly half of doctors would outright say "we do this to cover our ass" is laughable. That sentence from the article would also be "technically true" is they gave a checkbox of options for factors in that BMI cutoff, one of of which could be "concerns over the overall success rate of surgeries for myself or my employer" which is totally founded and reasonable and could have nothing to do with having some egotistical or financial stake in ratings.
- imagist 10y ago
  > How convenient they don't mention the name of that survey, who conducted it, how it was formed, or link to the actual survey itself. Ugh, you're just wrong, and I can only conclude you didn't read the article. They mentioned who conducted it and linked the actual survey, which has all the information you mention. From the article: > "There is a perception among some surgeons that it is more difficult, and certainly some felt it was an added risk,” to operate on very obese people, Dr. Yates said. He was a member of a committee that reviewed[1] the risks and benefits of joint replacement in obese patients for the American Association of Hip and Knee Surgeons. 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." > But there should not be blanket refusals to operate on fat people, the committee wrote. Those with a body mass index over 40 — like a 5-foot-5-inch woman weighing 250 pounds or a 6-foot man weighing 300 — and who cannot lose weight should be informed that their risks are greater, but they should not be categorically dismissed, the group concluded. Again, I think that it's reasonable to have BMI cutoffs as a requirement for surgery, but let's make that argument based on facts, please. [1] https://www.researchgate.net/publication/278060582_Obesity_and_Total_Joint_Arthroplasty_A_Literature_Based_Review https://www.researchgate.net/publication/278060582_Obesity_a...

everyone 10y ago

I agree. The example in the start where the patient asks how will they know if theyre losing weight as theyre off the scale does not make any convincing point. If they actually ate 1200 kcals a day they would definitely be losing weight. It wouldnt be necessary to confirm via weighing.

roflchoppa 10y ago
Idk why this is being downvoted, its Cal-in,Cal-out... this should have been taught in that health class we took in highschool. I'd argue it should be taught in elementary.
- tcj_phx 10y ago
  > Idk why this is being downvoted, its Cal-in,Cal-out... Calories-in vs. Calories-out is not helpful advice. A person's metabolism can slow to a crawl if the person is starving. It's much better to fix the metabolism, and remove metabolism-destroying foods from the diet. Many common foods should not be eaten (tofu), or only eaten when well-cooked (kale) [1]. [1] https://en.wikipedia.org/wiki/Goitrogen#Goitrogenic_foods https://en.wikipedia.org/wiki/Goitrogen#Goitrogenic_foods
  - vonmoltke 10y ago
    > Calories-in vs. Calories-out is not helpful advice. A person's metabolism can slow to a crawl if the person is starving. To be at that level of starvation would require the person's body fat percentage to drop to essential levels. "Starvation mode" in normal weight and overweight people is a pernicious myth.
    - AstralStorm 10y ago
      Not true about body fat levels. Metabolism is not quite regulated in this way. Otherwise those people would get hot before they get fat, as their metabolism would speed up. Metabolism control seems to be based of medium term intake rather than fat stores. Either that or there is a set point which is quite hard to move. Or both. Handling the fat does increase basal metabolic rate to an extent. But only so far. The abovementioned slowdown starts with mild thyroid suppression and shows up in bloodwork. This can cut BMR by up to half without starvation. (25% calorie cut from high levels is nowhere near enough) The problem is, this reduces will to both diet and exercise and induces a low grade depression.

drzaiusapelord 10y ago

I've noticed the liberal media is pretty big on the 'fat rights' bandwagon right now. I imagine its profitable considering the number of fat people in the US and fits in with the largely SJW editorial narrative bias the press is fond of. As a chronically 25-50lbs overweight person with knee problems, just dropping 10lbs was like night and day for me. Suddenly my feet and knees didn't hurt as much and I felt and slept so much better. There's an ugly narrative here that few press outlets want to sell because I imagine fat rights groups will be offended, but there's a real personal responsibility argument with weight that too often gets brushed under the carpet. Victimization naratives are popular now and get significant ad impressions. Consider the two headlines, which one will get you more clicks? "Doctors biased against the fat patients; thin patients treated better" or "Losing weight is your responsibility when it comes to your health." Obviously, the former will get all the clicks. I really hope fat rights groups and the liberal media stop with these narratives. Losing weight isn't terribly difficult if you actually care about your health. Its a small investment that significantly pays off. Yes, I get a little offended when my doctor brings it up, but he's right every time. When my weight hits a certain number, my body just falls apart. Suddenly sleep apnea kicks in, I'm sore all the time, I get winded easily, and my back and knees hurt. We shouldn't be fighting against this kind of advice. Its still good and often life-changing advice. Sadly, this forum being mostly millennials means the comment section is leftist victimization responses straight out of /r/fatlogic. I pity the generation growing up with a 'no one is ever at fault' and 'personal responsibility doesn't exist' philosophy. Its a disservice to them and ruins lives.

whamlastxmas 10y ago
Media is big on controversy and always has been. The controversy doesn't matter.
- drzaiusapelord 10y ago
  Why isn't media big on the controversy on a the pro-personal responsibility side of things? As far as I can tell it panders to fat rights groups uncritically. I think pretending this bias doesn't exist is being generous towards the real media bias that surrounds us. There's no debate here. Its clear obesity and surgical outcomes are linked. Doctors aren't "discriminating" here. Lets stop the leftist nonsense as it contradicts the science.

JohnTHaller 10y ago

It's also worth noting the risks to staff in doing surgeries, procedures, and scans on extremely obese patients. Someone has to move them on and off tables and platforms. My brother in law (xray tech) wrecked his back getting an obese patient up for an xray. You'd need to staff a couple extra aides just to lift patients of that size, but hospitals don't do it.

BlackjackCF 10y ago

This is the sentiment that I hear from my friends who are doctors. And it's not that they're trying to be disparaging or mean. It's very frustrating for doctors who have to explain to patients repeatedly the root cause of their issues, and that there is no "fast fix" or medicine that will fix their problems until they lose weight.