7 ms·

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-scienti

by 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.
- dragonwriter 10y ago
  > But therein lies the problem: being overweight is so _unbelievably_ unhealthy that most problems would be resolved simply by losing the weight. Failure to properly diagnose the actual problems makes it harder for the doctor to assist the patient in actually losing weight. "Lose weight" is an outcome, not a course of action, and choosing the most medically appropriate course of action to achieve that outcome is down to coincidence if you decide to skimp on proper diagnosis just because you think that the patient needs to lose weight.
- hourislate 10y ago
  My neighbor is Head of Emergency for one of the largest hospitals in my city. He has said that a large part of Emergency Room cases are due to lifestyle choices whether it is Drugs, Alcohol or being Over Weight. Problems related to being over weight from Heart conditions, Diabetes, High Blood Pressure account for the largest portion of visits. He said the single most important thing you can do for your health is to maintain a healthy weight. It will prevent many ailments later in life.
  - AstralStorm 10y ago
    He's right, but those are not "choices". Few people I know choose to be fat consciously. As opposed to drug users and smokers. This kind of language is part of the problem, shifting blame onto actual patients.
bkor 10y ago
BMI works just fine for someone weighing so much that they need to go and find a special scale to measure them. Already before you're obese it'll be difficult to give someone CPR. If someone is obese that's dangerous already. It's completely normal and logical response to tell them to lose weight.
imagist 10y ago
> Denial of care, or dangerously mismeasured care, is not acceptable simply based on BMI (a non-scientific measure invented in the early 1800s). How did you conclude that BMI is non-scientific? Did you know that Centigrade was invented in the early 1800s, and the first realization of the metric system was in 1799? BMI definitely isn't accurate for people with high lean body mass, but the patients in this article aren't bodybuilders whose muscle mass drives up their BMI--people with high lean body mass are less likely to need hip and knee surgery. Sure, BMI is an approximation with some well-known cases where it's inaccurate, but doctors are well aware of this fact. > 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. I'd like to see those statistics.
- lsy 10y ago
  Do you have resources on the scientific basis for BMI's efficacy as a health indicator? Comparing to linear measurements like temperature and distance seems a little apples-and-oranges when BMI is attempting to do something different, which is to reduce a fairly complex system to a single number. > I'd like to see those statistics. https://www.ncbi.nlm.nih.gov/pubmed/10449014 https://www.ncbi.nlm.nih.gov/pubmed/10449014 "Data from the scientific community indicate that a 15-wk diet or diet plus exercise program produces a weight loss of about 11 kg with a 60-80% maintenance after 1 yr. Although long-term follow-up data are meager, the data that do exist suggest almost complete relapse after 3-5 yr." And that's 11kg… the situation described above is 90kg. You're essentially telling someone to go away and come back after 2+years of dieting to get medical care. Don't you think that seems unrealistic?
  - imagist 10y ago
    > Do you have resources on the scientific basis for BMI's efficacy as a health indicator? http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html#Reliable http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/ind... http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html#Consequences http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/ind... > > > 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. > > I'd like to see those statistics. > "Data from the scientific community indicate that a 15-wk diet or diet plus exercise program produces a weight loss of about 11 kg with a 60-80% maintenance after 1 yr. Although long-term follow-up data are meager, the data that do exist suggest almost complete relapse after 3-5 yr." This in no way indicates how many patients with knee and hip issues are able to solve those knee and hip issues simply by losing weight. > And that's 11kg… the situation described above is 90kg. You're essentially telling someone to go away and come back after 2+years of dieting to get medical care. Don't you think that seems unrealistic? No, I'm not telling someone to go away and come back after 2+ years to get medical care, I'm prescribing medical care that will take 2+ years. Weight loss isn't denial of care; weight loss is the care. There are plenty of forms of treatment that take a long time. If a doctor prescribes a course of medication that takes 2 years before trying surgery because it will solve the problem for most people and is lower-risk, you wouldn't complain about that, or call it denial of care. But in fact, weight loss is safer than most medicines--weight loss for an obese person has almost no negatives. I posit that the only reason you're objecting to weight loss as treatment is that you've formed your opinion based on identity politics rather than medical efficacy.
graeme 10y ago
Surgery isn't riskless. This source shows knee surgery has serious complications in 2% of cases. That's for all patients. But it states the risk of knee fracture is higher for overweight patients. http://www.zimmer.com/patients-caregivers/article/knee/knee-surgery-risks.html http://www.zimmer.com/patients-caregivers/article/knee/knee-... Here's a source specific to overweight patients. Obesity is often comorbid with conditions that make it harder to heal and increase the risk of infection, such as diabetes. http://orthoinfo.org/topic.cfm?topic=A00745 http://orthoinfo.org/topic.cfm?topic=A00745 Here's a crucial section: "However, if you have obesity, you may never achieve the increased mobility and range of motion experienced by a patient of normal weight. You may also experience more implant and prosthesis complications after surgery, including: Component loosening and failure Dislocation of the replacement joint, especially in the hip In some cases, a second "revision" surgery may be necessary to remove failed implants and replace them with new ones. " That section would be based almost purely on weight. Certainly, BMI is a crude measure, and it doesn't work well for weight lifters and athletes. But that's mostly an issue an issue for people near the "overweight" cutoff at 25. The more obese someone gets, the less false positives BMI has. There's clearly an issue where past a certain level of adiposity, knee surgery is not sensible: the risks become high, and the outcomes become poor. What would you do instead? To operate with the expectation of poor outcomes is not good medicine.
- lsy 10y ago
  From the article: "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." It's really simple. You can inform people of the increased risks and possible outcomes and let them make their own decisions about their bodies. The article here is not saying that doctors should ignore weight as a factor, but that they shouldn't make decisions to deny or provide care based solely on BMI.
  - asynchronous13 10y ago
    "But there should not be blanket refusals to operate on fat people" I don't know anyone who would disagree with this sentiment. And the article doesn't present any evidence that there are blanket refusals. Sure, the article presents a few anecdotes, but that's not enough to show that blanket refusals are happening on a larger scale. > You can inform people of the increased risks and possible outcomes and let them make their own decisions about their bodies. It's really not that simple. A medical doctor's mission is to help people and very specifically to "do no harm". When the data suggests that they are more likely to do harm by operating, then the doctor is following their oath by not performing a surgery.
whamlastxmas 10y ago
>not acceptable simply based on BMI It's not simply based on BMI. It's based a lot of things, but at some point the BMI will be bad enough that the other things become irrelevant. >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. It would be if that actually happened in any systemic manner. And even in the cases where it does happen, it has less to do with whether the doctor is willing and more to do with whether the doctor is able to diagnose. > But just saying "we have a BMI cutoff" is pretty much discrimination masquerading as medicine. It's discrimination in the same way that saying people under a certain height can't ride rollercoasters. There isn't some conspiracy amongst theme parks to alienate short people. It's dangerous, and it's nothing to do with prejudice against short people. And in reality, it's not "we have a BMI cutoff" as the only criteria. It's "we have an extensive and exhaustive list of things we look for before we recommend surgery to patients, since surgery is a dangerous and often life threatening procedure. One of those criteria is a BMI that doesn't cause undue risk to the life of the patient".
- lsy 10y ago
  BMI can definitely be a starting point for a discussion with the patient about elevated risks, etc. But there's never a point where "other things become irrelevant", which is exactly the point of this article—doctors regularly refuse to provide basic medical treatment beyond a certain BMI point. If someone is experiencing e.g. chest pain, it's deeply unethical and unprofessional to refuse consideration of any other cause than obesity, and to limit treatment to a scolding about dieting—no matter how high a person's BMI is.
  - whamlastxmas 10y ago
    > it's deeply unethical and unprofessional to refuse consideration of any other cause than obesity, and to limit treatment to a scolding about dieting—no matter how high a person's BMI is It would be if this was actually happening, which is never. Maybe there's like a handful of shitheads out there doing it, but this isn't a wide-spread problem.

by lsy 10y ago

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.
dragonwriter 10y ago
> But therein lies the problem: being overweight is so _unbelievably_ unhealthy that most problems would be resolved simply by losing the weight. Failure to properly diagnose the actual problems makes it harder for the doctor to assist the patient in actually losing weight. "Lose weight" is an outcome, not a course of action, and choosing the most medically appropriate course of action to achieve that outcome is down to coincidence if you decide to skimp on proper diagnosis just because you think that the patient needs to lose weight.
hourislate 10y ago
My neighbor is Head of Emergency for one of the largest hospitals in my city. He has said that a large part of Emergency Room cases are due to lifestyle choices whether it is Drugs, Alcohol or being Over Weight. Problems related to being over weight from Heart conditions, Diabetes, High Blood Pressure account for the largest portion of visits. He said the single most important thing you can do for your health is to maintain a healthy weight. It will prevent many ailments later in life.
- AstralStorm 10y ago
  He's right, but those are not "choices". Few people I know choose to be fat consciously. As opposed to drug users and smokers. This kind of language is part of the problem, shifting blame onto actual patients.

bkor 10y ago

BMI works just fine for someone weighing so much that they need to go and find a special scale to measure them. Already before you're obese it'll be difficult to give someone CPR. If someone is obese that's dangerous already. It's completely normal and logical response to tell them to lose weight.

imagist 10y ago

> Denial of care, or dangerously mismeasured care, is not acceptable simply based on BMI (a non-scientific measure invented in the early 1800s). How did you conclude that BMI is non-scientific? Did you know that Centigrade was invented in the early 1800s, and the first realization of the metric system was in 1799? BMI definitely isn't accurate for people with high lean body mass, but the patients in this article aren't bodybuilders whose muscle mass drives up their BMI--people with high lean body mass are less likely to need hip and knee surgery. Sure, BMI is an approximation with some well-known cases where it's inaccurate, but doctors are well aware of this fact. > 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. I'd like to see those statistics.

lsy 10y ago
Do you have resources on the scientific basis for BMI's efficacy as a health indicator? Comparing to linear measurements like temperature and distance seems a little apples-and-oranges when BMI is attempting to do something different, which is to reduce a fairly complex system to a single number. > I'd like to see those statistics. https://www.ncbi.nlm.nih.gov/pubmed/10449014 https://www.ncbi.nlm.nih.gov/pubmed/10449014 "Data from the scientific community indicate that a 15-wk diet or diet plus exercise program produces a weight loss of about 11 kg with a 60-80% maintenance after 1 yr. Although long-term follow-up data are meager, the data that do exist suggest almost complete relapse after 3-5 yr." And that's 11kg… the situation described above is 90kg. You're essentially telling someone to go away and come back after 2+years of dieting to get medical care. Don't you think that seems unrealistic?
- imagist 10y ago
  > Do you have resources on the scientific basis for BMI's efficacy as a health indicator? http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html#Reliable http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/ind... http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html#Consequences http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/ind... > > > 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. > > I'd like to see those statistics. > "Data from the scientific community indicate that a 15-wk diet or diet plus exercise program produces a weight loss of about 11 kg with a 60-80% maintenance after 1 yr. Although long-term follow-up data are meager, the data that do exist suggest almost complete relapse after 3-5 yr." This in no way indicates how many patients with knee and hip issues are able to solve those knee and hip issues simply by losing weight. > And that's 11kg… the situation described above is 90kg. You're essentially telling someone to go away and come back after 2+years of dieting to get medical care. Don't you think that seems unrealistic? No, I'm not telling someone to go away and come back after 2+ years to get medical care, I'm prescribing medical care that will take 2+ years. Weight loss isn't denial of care; weight loss is the care. There are plenty of forms of treatment that take a long time. If a doctor prescribes a course of medication that takes 2 years before trying surgery because it will solve the problem for most people and is lower-risk, you wouldn't complain about that, or call it denial of care. But in fact, weight loss is safer than most medicines--weight loss for an obese person has almost no negatives. I posit that the only reason you're objecting to weight loss as treatment is that you've formed your opinion based on identity politics rather than medical efficacy.

graeme 10y ago

Surgery isn't riskless. This source shows knee surgery has serious complications in 2% of cases. That's for all patients. But it states the risk of knee fracture is higher for overweight patients. http://www.zimmer.com/patients-caregivers/article/knee/knee-surgery-risks.html http://www.zimmer.com/patients-caregivers/article/knee/knee-... Here's a source specific to overweight patients. Obesity is often comorbid with conditions that make it harder to heal and increase the risk of infection, such as diabetes. http://orthoinfo.org/topic.cfm?topic=A00745 http://orthoinfo.org/topic.cfm?topic=A00745 Here's a crucial section: "However, if you have obesity, you may never achieve the increased mobility and range of motion experienced by a patient of normal weight. You may also experience more implant and prosthesis complications after surgery, including: Component loosening and failure Dislocation of the replacement joint, especially in the hip In some cases, a second "revision" surgery may be necessary to remove failed implants and replace them with new ones. " That section would be based almost purely on weight. Certainly, BMI is a crude measure, and it doesn't work well for weight lifters and athletes. But that's mostly an issue an issue for people near the "overweight" cutoff at 25. The more obese someone gets, the less false positives BMI has. There's clearly an issue where past a certain level of adiposity, knee surgery is not sensible: the risks become high, and the outcomes become poor. What would you do instead? To operate with the expectation of poor outcomes is not good medicine.

lsy 10y ago
From the article: "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." It's really simple. You can inform people of the increased risks and possible outcomes and let them make their own decisions about their bodies. The article here is not saying that doctors should ignore weight as a factor, but that they shouldn't make decisions to deny or provide care based solely on BMI.
- asynchronous13 10y ago
  "But there should not be blanket refusals to operate on fat people" I don't know anyone who would disagree with this sentiment. And the article doesn't present any evidence that there are blanket refusals. Sure, the article presents a few anecdotes, but that's not enough to show that blanket refusals are happening on a larger scale. > You can inform people of the increased risks and possible outcomes and let them make their own decisions about their bodies. It's really not that simple. A medical doctor's mission is to help people and very specifically to "do no harm". When the data suggests that they are more likely to do harm by operating, then the doctor is following their oath by not performing a surgery.

whamlastxmas 10y ago

>not acceptable simply based on BMI It's not simply based on BMI. It's based a lot of things, but at some point the BMI will be bad enough that the other things become irrelevant. >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. It would be if that actually happened in any systemic manner. And even in the cases where it does happen, it has less to do with whether the doctor is willing and more to do with whether the doctor is able to diagnose. > But just saying "we have a BMI cutoff" is pretty much discrimination masquerading as medicine. It's discrimination in the same way that saying people under a certain height can't ride rollercoasters. There isn't some conspiracy amongst theme parks to alienate short people. It's dangerous, and it's nothing to do with prejudice against short people. And in reality, it's not "we have a BMI cutoff" as the only criteria. It's "we have an extensive and exhaustive list of things we look for before we recommend surgery to patients, since surgery is a dangerous and often life threatening procedure. One of those criteria is a BMI that doesn't cause undue risk to the life of the patient".

lsy 10y ago
BMI can definitely be a starting point for a discussion with the patient about elevated risks, etc. But there's never a point where "other things become irrelevant", which is exactly the point of this article—doctors regularly refuse to provide basic medical treatment beyond a certain BMI point. If someone is experiencing e.g. chest pain, it's deeply unethical and unprofessional to refuse consideration of any other cause than obesity, and to limit treatment to a scolding about dieting—no matter how high a person's BMI is.
- whamlastxmas 10y ago
  > it's deeply unethical and unprofessional to refuse consideration of any other cause than obesity, and to limit treatment to a scolding about dieting—no matter how high a person's BMI is It would be if this was actually happening, which is never. Maybe there's like a handful of shitheads out there doing it, but this isn't a wide-spread problem.