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From the article: "The group concluded that heavy patients should first be counseled to lose weight because a lower weight reduces stress on the joints and can

by imagist 10y ago

From the article: "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." (emphasis mine) I don't have any reason to disbelieve you about your friends, but your friends do not represent all obese people, and in losing weight does fix joints some percentage of the time. Given the alternative is surgery, which kills the patient some percentage of the time, I don't think there's a lot of debate to be had here.

AstralStorm 10y ago
It is true. Counselling is not good enough though. Given how ineffective it is, it is essentially permanent denial. Moreover, there are other issues to verify, say, a person born with hip dysplasia should be treated regardless of weight as weight loss will never fix the underlying problem. Also aching hip joints quite effectively prevent many kinds of exercise, which does not help with weight loss at all. Without an effective alternative course of action, the surgery may be the one remaining effective measure.
- imagist 10y ago
  > It is true. Counselling is not good enough though. Given how ineffective it is, it is essentially permanent denial. I disagree--in fact, I think a large part of the problem here might be this very conversation. It's unclear how much of the reason that counseling is ineffective is because obesity has become an identity politics issue. If you tell someone that it's okay to be fat, and go so far as to say that obesity isn't the cause of their problems, it's a lot easier for them to just cry "denial of care!" than to actually lose weight. The first step to solving the problem is admitting it is a problem, and fat acceptance is actively impeding that part of the recovery process. I don't have personal knowledge to say which way the direction of causality goes: whether identity politics causes counseling to be ineffective, or whether counseling is inherently ineffective and therefore identity politics are right. But I think that doctors are the ones with the most information to decide that, not identity politics activists. What I do know is that even if counseling is only 10% effective, it's far less dangerous than surgery, so it should always be the first choice. If someone tries weight loss programs for a few years and fails to lose weight, then maybe it makes less sense to deny surgery (this would be a situation I'd be interested in hearing medical opinions about). But I see no evidence that this is actually happening. What I'm seeing is people saying that demanding people try weight loss first is equivalent to denial of care, and that people should be allowed to get surgery without even trying to lose weight. And while this firmly steps outside science, I think obesity makes sense to treat as an addiction problem. I've been treated successfully for alcoholism via a program which equally has very low success rates to weight loss programs. My personal experience with this is that, as identity politics say, it makes little sense to shame people for their addiction or to discriminate against people because of their addiction in cases where it doesn't affect their ability to perform. Blaming me for my addiction or punishing me for my addiction didn't work. However, what also didn't work was living in denial that I was an addict and that my addiction was a problem. I don't blame myself for my addiction, but I did need to take action and participate in my treatment. You wouldn't give someone with alcoholic hepatitis a liver transplant unless they stopped drinking, and you shouldn't give an obese person a hip replacement unless they lose weight.

by imagist 10y ago

AstralStorm 10y ago

It is true. Counselling is not good enough though. Given how ineffective it is, it is essentially permanent denial. Moreover, there are other issues to verify, say, a person born with hip dysplasia should be treated regardless of weight as weight loss will never fix the underlying problem. Also aching hip joints quite effectively prevent many kinds of exercise, which does not help with weight loss at all. Without an effective alternative course of action, the surgery may be the one remaining effective measure.

imagist 10y ago
> It is true. Counselling is not good enough though. Given how ineffective it is, it is essentially permanent denial. I disagree--in fact, I think a large part of the problem here might be this very conversation. It's unclear how much of the reason that counseling is ineffective is because obesity has become an identity politics issue. If you tell someone that it's okay to be fat, and go so far as to say that obesity isn't the cause of their problems, it's a lot easier for them to just cry "denial of care!" than to actually lose weight. The first step to solving the problem is admitting it is a problem, and fat acceptance is actively impeding that part of the recovery process. I don't have personal knowledge to say which way the direction of causality goes: whether identity politics causes counseling to be ineffective, or whether counseling is inherently ineffective and therefore identity politics are right. But I think that doctors are the ones with the most information to decide that, not identity politics activists. What I do know is that even if counseling is only 10% effective, it's far less dangerous than surgery, so it should always be the first choice. If someone tries weight loss programs for a few years and fails to lose weight, then maybe it makes less sense to deny surgery (this would be a situation I'd be interested in hearing medical opinions about). But I see no evidence that this is actually happening. What I'm seeing is people saying that demanding people try weight loss first is equivalent to denial of care, and that people should be allowed to get surgery without even trying to lose weight. And while this firmly steps outside science, I think obesity makes sense to treat as an addiction problem. I've been treated successfully for alcoholism via a program which equally has very low success rates to weight loss programs. My personal experience with this is that, as identity politics say, it makes little sense to shame people for their addiction or to discriminate against people because of their addiction in cases where it doesn't affect their ability to perform. Blaming me for my addiction or punishing me for my addiction didn't work. However, what also didn't work was living in denial that I was an addict and that my addiction was a problem. I don't blame myself for my addiction, but I did need to take action and participate in my treatment. You wouldn't give someone with alcoholic hepatitis a liver transplant unless they stopped drinking, and you shouldn't give an obese person a hip replacement unless they lose weight.