3 ms·

> keep you out of the hospital/ER You're a veteran doctor. You are presumably fully aware of the health statistics in this country. And yet, you did not list t

by caeril 4y ago

> keep you out of the hospital/ER You're a veteran doctor. You are presumably fully aware of the health statistics in this country. And yet, you did not list the number one correct recommendation: If you are overweight, lose the weight. ~80% of healthcare costs in this country are attributable to chronic conditions, and ~80% of chronic conditions are caused by obesity or lifestyle directly connected to obesity. You improve your own health outcomes, and reduce the burden on the healthcare system as a whole, by ~64% if you're not fat. And your response, as a doctor, mirrors the most infuriating thing about your profession: Hi, you're 260lbs and pre-diabetic. I'm going to put you on Metformin. Hi, you're 280lbs and your LDL/HDL is WAY too high. Here's a prescription for statins. Hi, you're 190lbs at 5'1 and your infertility is caused by LH/FSH imbalances. Take this Clomid. When the hell are the "professionals" in your line of work going to stop medicating away the consequences of this absolutely absurd epidemic and actually address it? The only time I've ever heard of a physician actually advising an obese person to lose weight is for conditions where pharmaceutical interventions don't exist, such as non-alcoholic fatty liver disease. The rest of the time? Take these drugs so you have a couple more years to enjoy your triple bacon cheeseburgers and large fries. It's absolutely maddening.

jeanlucneptune 4y ago
Your solution to the healthcare crisis is just make everybody lose weight and all the problems of our system go away. You ever try to lose 10 pounds? 100? Spend some time in a general medicine clinic and come back to me.
- caeril 4y ago
  No, all the problems wouldn't go away. But a healthy-weight population would cost roughly 64% less to treat, which implies a 64% reduced hospital congestion and workload. This could get offset somewhat as people die later in life of "old age" rather than chronic conditions or CVD events, but those costs would be much lower. So let's say a 50% reduction over the long run. Yes, I am a former fatty who has kept it off for well over a decade now. It's really quite trivial to do.
nradov 4y ago
You're not wrong about the root cause of chronic medical conditions. Depending on how you count, something like 1/7 of all healthcare spending now goes to type-2 diabetes and related conditions, and nearly 100% of those cases are caused by lifestyle issues. But it's unfair to blame doctors. In a typical office visit they only have a few minutes with the patient which isn't enough time for useful lifestyle counseling. And it isn't even really their job anyway; diet counseling should be provided by Registered Dieticians who are specifically trained in that field. Any real improvements will require major national political policy changes to better align incentives and shift resources away from treatment and towards prevention.
- jeanlucneptune 4y ago
  Thank you for your sane reply.
mzgaljic 4y ago
serious question - you think overweight people do not know they are overweight? And they don’t know it’s bad for them? They are probably overweight because they physically have trouble losing the weight (disability, hormonal issues, etc), or they have no self-control, or they are poor and don’t have the means or time to focus on their health. if you are already fat and prediabetic, you have a lifestyle problem, not a medical problem a doctor can fix.
- caeril 4y ago
  My point is that the medical industry prioritizes treatment of expedient consequences over treatment of root causes, and then they bitch that they're so overworked and overwhelmed. If they were truly interested in un-clogging their hospitals and clearing their dockets, they'd be actively engaged in treating root causes. Sure, maybe alongside the pharmaceutical interventions, but the focus ought to be on the cause. To your points: - Most moderately overweight people do not, in fact, know they are. Humans operate on the basis of visual comparison, not medically significant measurements like BMI or visceral fat measurements. If you look approximately like your other overweight coworkers, friends, etc, then you'll assume you're fine (in the genpop case, HN denizens and other data-driven folks likely excluded). - Many of those who are morbidly obese to the point it's obvious they're much larger than their peers, are likely blind to the actual health consequences of their behavior. The general population is vaguely aware that being fat is not super healthy, but they have no idea of HOW devastatingly unhealthy the actual medical literature indicates. On top of this, you have HAES/fat-acceptance nutcases convincing huge swathes of the obese population that they are perfectly healthy.
  - nradov 4y ago
    The medical industry prioritizes treatment of current problems instead of prevention because that's how incentives are set up in the system. Most treatments are delivered under under a fee-for-service model. Insurers and government generally won't pay to prevent a patient who isn't obese yet from becoming obese. Any major changes will have to come at the state and federal government level. The medical industry can't do much to change that on it's own.
- 4y ago

by caeril 4y ago

jeanlucneptune 4y ago

Your solution to the healthcare crisis is just make everybody lose weight and all the problems of our system go away. You ever try to lose 10 pounds? 100? Spend some time in a general medicine clinic and come back to me.

caeril 4y ago
No, all the problems wouldn't go away. But a healthy-weight population would cost roughly 64% less to treat, which implies a 64% reduced hospital congestion and workload. This could get offset somewhat as people die later in life of "old age" rather than chronic conditions or CVD events, but those costs would be much lower. So let's say a 50% reduction over the long run. Yes, I am a former fatty who has kept it off for well over a decade now. It's really quite trivial to do.

nradov 4y ago

You're not wrong about the root cause of chronic medical conditions. Depending on how you count, something like 1/7 of all healthcare spending now goes to type-2 diabetes and related conditions, and nearly 100% of those cases are caused by lifestyle issues. But it's unfair to blame doctors. In a typical office visit they only have a few minutes with the patient which isn't enough time for useful lifestyle counseling. And it isn't even really their job anyway; diet counseling should be provided by Registered Dieticians who are specifically trained in that field. Any real improvements will require major national political policy changes to better align incentives and shift resources away from treatment and towards prevention.

jeanlucneptune 4y ago
Thank you for your sane reply.

mzgaljic 4y ago

serious question - you think overweight people do not know they are overweight? And they don’t know it’s bad for them? They are probably overweight because they physically have trouble losing the weight (disability, hormonal issues, etc), or they have no self-control, or they are poor and don’t have the means or time to focus on their health. if you are already fat and prediabetic, you have a lifestyle problem, not a medical problem a doctor can fix.

caeril 4y ago
My point is that the medical industry prioritizes treatment of expedient consequences over treatment of root causes, and then they bitch that they're so overworked and overwhelmed. If they were truly interested in un-clogging their hospitals and clearing their dockets, they'd be actively engaged in treating root causes. Sure, maybe alongside the pharmaceutical interventions, but the focus ought to be on the cause. To your points: - Most moderately overweight people do not, in fact, know they are. Humans operate on the basis of visual comparison, not medically significant measurements like BMI or visceral fat measurements. If you look approximately like your other overweight coworkers, friends, etc, then you'll assume you're fine (in the genpop case, HN denizens and other data-driven folks likely excluded). - Many of those who are morbidly obese to the point it's obvious they're much larger than their peers, are likely blind to the actual health consequences of their behavior. The general population is vaguely aware that being fat is not super healthy, but they have no idea of HOW devastatingly unhealthy the actual medical literature indicates. On top of this, you have HAES/fat-acceptance nutcases convincing huge swathes of the obese population that they are perfectly healthy.
- nradov 4y ago
  The medical industry prioritizes treatment of current problems instead of prevention because that's how incentives are set up in the system. Most treatments are delivered under under a fee-for-service model. Insurers and government generally won't pay to prevent a patient who isn't obese yet from becoming obese. Any major changes will have to come at the state and federal government level. The medical industry can't do much to change that on it's own.
4y ago