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

&gt; <i>Be civil. Don&#x27;t say things you wouldn&#x27;t say in a face-to-face conversation. Avoid gratuitous negativity.</i><p>Much of the discussion in this thread does not meet this standard of discourse that we ask for on Hacker News. It&#x27;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&#x27;t here.

I&#x27;m disappointed by the lack of empathy in these comments.<p>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 &quot;why don&#x27;t you just cheer up?&quot; It&#x27;s totally unuseful advice that incorporate all sorts of gross value judgments about the person. It doesn&#x27;t solve problems.<p>I&#x27;ve been overweight - not obese, but close at times - all my life. I&#x27;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&#x27;s hard work. That&#x27;s why people are proud of losing weight: it&#x27;s an achievement. It represents a permanent change to lifestyle and behavior that takes weeks, months, even years to effect.<p>Please don&#x27;t discount people&#x27;s experiences by saying things like &quot;oh, just lose weight.&quot; Consider the human being in there, and how to reach them. Don&#x27;t assume that because it&#x27;s easy for you to be fit and skinny, it&#x27;s easy for everyone.

Let me save you the time: it&#x27;s an article pandering to fat people without any substance and really dishonest arguments.<p>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&#x27;t mean they&#x27;re <i>dismissing</i> that it might be something else, which is evident by the example in the article where the root cause was also found.<p>I had to stop reading at the point where the quoted a doctor as saying<p>&gt;doctors and hospitals have become risk-averse because they fear their ratings will fall if too many patients have complications<p>followed by<p>&gt;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.<p>This survey doesn&#x27;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&#x27;t be a limit <i>somewhere</i> is beyond stupid, meaning this survey is pointless. And it&#x27;s frankly tremendously disrespectful towards doctors - they have BMI cutoffs for the sake of the patient&#x27;s life. The risk of complications is extremely real and doctors don&#x27;t want a high risk of literally killing someone to resolve a knee pain that, while crappy, is better than dying. And they&#x27;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.<p>This article is garbage.

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&#x27;s an underlying message of &quot;might as well die&quot;. Their chosen method of suicide is death by uninhibited indulgence in food.

Irrespective of the article, the comments in here are appalling. Ask yourself if it&#x27;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?<p>I&#x27;m a big guy. I&#x27;ve been big for 2&#x2F;3 of my life. It fluctuates up and down as I&#x27;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&#x27;s not fun carrying the extra weight around with you, or trying to fit in airline seats (I&#x27;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&#x27;d willingly stay this way?<p>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&#x27;t know what they&#x27;ve tried or why they stay this way. You don&#x27;t know their struggles and what they&#x27;ve gone through. Please stop making value judgements on other human beings based on their physical dimensions.

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&#x27;t spend a moment more figuring out probable cause than is necessary.

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_.<p>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).<p>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.

It reminds me of the Anna Karenia (sp?) principle.<p>Happy families are all alike, every unhappy family is unhappy in its own way.<p>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.<p>If you&#x27;re obese, you accumulate fat in different ways, you respond differently to medication and anesthesia, because you just accumulate in different patterns.<p>Doctors don&#x27;t train on obese patients because they&#x27;re all different, so it&#x27;s hard to get a standard operating procedure. They also don&#x27;t train on obese patients because until now, they&#x27;ve been a vanishingly small proportional of the population.<p>Take a look at vintage photographs of &quot;fat men&quot; 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.

There is something similar in IT operations&#x2F;support. Many companies refuse to investigate an issue until you are on the latest versions of software and firmware.<p>There are good reasons for each of these checkpoints: there may be a real issue not caused by obesity&#x2F;old firmware, but it is really hard to tell until you get past that.

The problem is that obesity is truly the primary cause of many medical problems. You can treat other symptoms but sometimes things won&#x27;t get better. This article is garbage.

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.

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, &quot;You&#x27;re working&#x2F;training too hard. Just take a break.&quot;<p>No real diagnosis, just a quick assumption that, &quot;Hey, this person looks like they&#x27;re in great shape. They&#x27;ll get better one way of the other. I have bigger fish to fry.&quot;<p>Just curious.

Constantly ignored is that medical problems are a huge source of weight gain. The arrow of causality is frequently diabetes-&gt; weight or sleep apnea-&gt; weight or sciatica-&gt; weight or asthma -&gt; weight or joint problems -&gt; weight<p>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.

Most doctors will also tell an alchoholic to stop drinking.

To be a bit blunt, the doctors are probably thinking &quot;if you won&#x27;t take care of your body, why should I?&quot;<p>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.

I didn&#x27;t read the article yet, since I opened the comments first... and was shocked by them.<p>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.<p>I didn&#x27;t knew, it was a thyroid problem, my mom, for some reason (that back then offended me, I told her I didn&#x27;t wanted to go to a &quot;fat people doctor&quot;) took me to a endocrinologist, suspecting something was wrong.<p>The endocrinologist made no tests, only said I was fat, and dismissed me.<p>The thing is: according to BMI, I was only slightly overweight, not even really &quot;fat&quot; yet.<p>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).<p>A random friend of my mother then commented I had obvious thyroid problems symptons, including a obviously enlarged neck.<p>My mother started to take me to endrocrinologists again... and again, they just kept telling me I was fat, and refusing to help.<p>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.<p>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&#x27;t believe me, and don&#x27;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).<p>I am currently trying to drop my weight until I get obviously &quot;not fat&quot; 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.<p>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 &quot;persuasive&quot; 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).

Yes, I know&#x2F;experience that since my BMI increased from 23 to &gt;30.<p>Even worst, majority of doctors fixate on reducing weight (as if that would solve everything else)

The article starts out talking about a woman who is 502 lbs. Why wouldn&#x27;t &quot;lose weight&quot; be the best suggestion? You&#x27;re 500 lbs!

Veterinary medicine always does dosing by weight. Why doesn&#x27;t human medicine?