
Why Do Obese Patients Get Worse Care? Many Doctors Don't See Past the Fat - hvo
http://www.nytimes.com/2016/09/26/health/obese-patients-health-care.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=second-column-region&region=top-news&WT.nav=top-news&_r=0
======
sctb
> _Be civil. Don 't say things you wouldn't say in a face-to-face
> conversation. Avoid gratuitous negativity._

Much of the discussion in this thread does not meet this standard of discourse
that we ask for on Hacker News. It'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't here.

------
ivraatiems
I'm disappointed by the lack of empathy in these comments.

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 "why
don't you just cheer up?" It's totally unuseful advice that incorporate all
sorts of gross value judgments about the person. It doesn't solve problems.

I've been overweight - not obese, but close at times - all my life. I'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's hard work. That's why people are proud of losing weight: it's an
achievement. It represents a permanent change to lifestyle and behavior that
takes weeks, months, even years to effect.

Please don't discount people's experiences by saying things like "oh, just
lose weight." Consider the human being in there, and how to reach them. Don't
assume that because it's easy for you to be fit and skinny, it's easy for
everyone.

~~~
jakebasile
It's infuriating. HN commenters will fall over themselves to rail against
discrimination, real or imagined, against women and minorities, but it's
perfectly OK to insult, demean, and minimize the problems of big people.

They know nothing about their lives, why they are big, what their health
problems come from, what they've tried to lose weight. It's easy to dismiss
them as weak willed disgusting blobs of fat, ignoring the human being
underneath that is trying to live their life as best they can.

~~~
whamlastxmas
The whole point of the majority of the conversation here is that there _isn
't_ systemic discrimination happening. People like to feel victimized and are
claiming discrimination when it's overwhelmingly not the case, and dishonest
articles like this do a huge disservice to the real, legitimate discrimination
that _does_ happen.

~~~
jakebasile
Yes, the majority has investigated the majority and found the majority not
guilty of discrimination. Please tell me more about how you know that big
people aren't discriminated against.

~~~
whamlastxmas
I would if it wasn't the equivalent of talking to a child with hands over
their ears yelling "LALALALALLALA"

~~~
ivraatiems
Insulting parent commenter for asking you to support your arguments makes me
feel that the child here is you.

------
whamlastxmas
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.

~~~
lsy
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.

~~~
imagist
> 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.

~~~
scarface74
When I was in the best shape of my adult life, I weighed 175, with 10% body
fat (measured with calipers) and a size 30 waist. I wasn't overly into lifting
weights but did a lot of cardio. My BMI was 30 - obese.

5 years later. I do about 3 hours of cardio a week, I weigh 185 and my waist
is about 32. My BMI is 31.8. No doctor has ever looked at me and said I need
to lose weight.

BMI is completely bunk in my case.

~~~
botfly
You're 5'3" and weighed 175? You must be built like a tank

~~~
scarface74
5"4\. But like I said. I don't lift weights anymore at all. But most people
assume I do.

As far as the caliper body fat test. It was done using 6 parts of the body.

------
diyseguy
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's an underlying message of "might as well die".
Their chosen method of suicide is death by uninhibited indulgence in food.

~~~
jakebasile
How is it acceptable to call big people revolting and wave off their condition
as "suicidal"? You know nothing of these people, or why they are big. They
aren't here to look pleasing to you, they just want to live their lives.
People are not always big by choice. Do you blame all alcoholics for their
condition?

~~~
hasenj
> They aren't here to look pleasing to you

So?

GP is not here to indulge them either. To each his own. They can choose to
indulge on food, it's their freedom, and he can choose to ignore them, it's
his freedom.

~~~
AstralStorm
Another person who thinks obesity is caused by solely overindulgence.

Maybe next you would claim that people with movement disorders (e.g. in
wheelchairs) are overweight because of overindulgence. Or maybe you will shift
the blame to lack of exercise, not considering they would need multiple times
more. Our maybe you will start designing diets for everyone that are trivial
to adhere to and make millions as a life coach.

GP is there to treat, not indulge. If they are unable to treat obesity, they
are to blame, not the patient. Obesity is extremely hard to treat even when
there is will to change. Heck, the causes of it are not yet well understood.
Something goes wrong with the feedback system of satiety and energy
expenditure, which is evolutionarily stacked to accumulate calories.

~~~
hasenj
I used to be obese.

I know what causes obesity.

It basically does boil down to over indulgence.

If you're in denial about that, I can see why you would be. It's no different
than religious people denying science to protect their egos.

However, your sensitivity does not warrant that others should indulge your
delusions and fantasies.

~~~
CalRobert
In light of your past experience overcoming your indulgence, you may wish to
take some time to recognize that a community of informed, helpful people
(basically HN) is pointing out that you're indulging in arrogance and self
righteousness, and you might consider applying the same self control that you
used to overcome obesity to your other character flaws.

~~~
hasenj
HN is not pointing out anything to me. There's a couple of members here who
seem to be involved in the "fat acceptance movement" who are defending the
article.

~~~
CalRobert
Hi! I'm a fellow hn user.

You're being a jerk.

That work?

------
jakebasile
Irrespective of the article, the comments in here are appalling. Ask yourself
if it'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?

I'm a big guy. I've been big for 2/3 of my life. It fluctuates up and down as
I'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's not fun
carrying the extra weight around with you, or trying to fit in airline seats
(I'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'd
willingly stay this way?

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't know what they've tried or why they stay
this way. You don't know their struggles and what they've gone through. Please
stop making value judgements on other human beings based on their physical
dimensions.

~~~
CalRobert
The Venn diagram of HN and liberal overlaps a lot, but more than that it also
tends to skew towards the "young, hyper-confident (perhaps arrogant) male who
thinks they can fix every problem and basically knows better than everyone
else" set. I've known plenty of liberals who are aware that being an asshole
isn't magically OK because you're being an asshole to fat people. I am one.

~~~
jakebasile
Me too. I realize that I also painted with a broad brush there. I was
admittedly getting pissed off.

------
JoeAltmaier
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't spend a moment more figuring out probable cause than is necessary.

~~~
AstralStorm
Except medicine works on different principles than Ockham razor. Such as the
Hippocrates oath some doctors selectively forget. (2nd and 4th verse of modern
version)

A doctor is not supposed to stop or not attempt treatment because a person is
fat... which is a kind of sickness, not really a choice. Not should they stop
at the most obvious issue, especially when it takes years to fix.

~~~
JoeAltmaier
Diagnosis works on Occam's razor most of the time. Yes it could be a tumor or
degenerative bone disease, but its probably just a sprain (because you twisted
it hard while playing basketball). In fact Occam's razor describes medicine
perfectly.

As for the 2nd part - my back hurts and I'm fat - weight-related for 99% of
the patients. Fixing weight fixes the back (and the feet and the knees and on
and on). Any other treatment is palliative but doesn't address the fundamental
cause. It would be irresponsible to keep giving obese patients 'crutches'
(treating the complaint) when the cure is weight control.

~~~
AstralStorm
This applies only for movement disorders (e.g. joint damage) directly caused
by obesity, maybe. Which the doctor gets to prove by excluding other
reasonable causes existing in non-obese people. No shortcuts.

~~~
JoeAltmaier
And blood pressure? Circulation issues? Cholesterol? Diabetes? Arthritis?
Sleep apnea? Depression?

All of those cluster around obesity. The simplest, most direct and most
effective cure is controlling weight.

------
CalRobert
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_.

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).

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.

~~~
jessaustin
_riding a recumbent helps a lot_

Don't tell anyone _that_ , or they'll be just as dismissive as before! b^)

------
jimmywanger
It reminds me of the Anna Karenia (sp?) principle.

Happy families are all alike, every unhappy family is unhappy in its own way.

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.

If you're obese, you accumulate fat in different ways, you respond differently
to medication and anesthesia, because you just accumulate in different
patterns.

Doctors don't train on obese patients because they're all different, so it's
hard to get a standard operating procedure. They also don't train on obese
patients because until now, they've been a vanishingly small proportional of
the population.

Take a look at vintage photographs of "fat men" 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.

~~~
AstralStorm
The real question then is why. It is certainly not just access to abundant
cheap food - otherwise you would see more rich fat people in the past. There
is probably more than factor and actual epidemiologists should be able to
disentangle and find most of them, especially as records are available.

It is either something tied to methods of agriculture and farming or
appearance of some sort of endocrine disruptor that is nowadays abundant.

~~~
jimmywanger
I'm pretty sure it's access to abundant cheap food. With a few exceptions
(ahem, Mexico) most obesity crises are in well developed countries.

Even so, cheap abundant food is definitely much more of a thing in
Central/Latin/South America than it used to be.

Also, a lot of corporation have spent a lot of time and energy dressing up
cheap ingredients to directly stimulate our pleasure sensors.

In the past sweet, salt, and fatty food were hard to come by and rather
expensive, so you'd gorge when you could. These days, the cheapest procesed
foods are saltier, sweeter, and fattier than anything in the 1800s.

It's doubtful that it's tied to methods of farming or an endocrine disruptor.
Unless you're talking about food subsidies for cheap grains. We just like
salty, greasy, sweet food cause it used to be rare, and now it's not.

~~~
AstralStorm
I am pretty sure access to food is a prerequisite, but not a direct causative
agent. Otherwise everyone in the West would be obese today, not 1 in 5.

And yes, manufacturing practices may be truly causing this, coupled with more
hectic but sedentary lifestyle preventing people from cooking properly (it
takes time and care), compounded by lower quality of basic ingredients and
higher levels of stress.

It is highly unfair and unjust to throw it also onto a single person to
invert, especially a sufferer.

~~~
jimmywanger
> And yes, manufacturing practices may be truly causing this

How? Are you talking about pharmaceuticals used in factory farming, trans
fats, what?

> coupled with more hectic but sedentary lifestyle preventing people from
> cooking properly (it takes time and care)

It does not take that much time or care. The choice is yours. You can either
watch an episode of Seinfeld on the couch, or spend time on your feet and cook
dinner and lose weight and feel healthier.

> It is highly unfair and unjust to throw it also onto a single person to
> invert, especially a sufferer.

Fairness and justice are two concepts the universe does not care about.

And how is it unfair and unjust? Once you accept that your suffering, in this
case, is based on decisions you've made (remember 4/5 people are not obese in
the west, placing you in the lowest 20 percentile.) you can start changing
that.

Also, these things don't just happen to you. You still have a choice in the
great majority of situations.

------
csours
There is something similar in IT operations/support. Many companies refuse to
investigate an issue until you are on the latest versions of software and
firmware.

There are good reasons for each of these checkpoints: there may be a real
issue not caused by obesity/old firmware, but it is really hard to tell until
you get past that.

~~~
hart_russell
Great analogy

~~~
AstralStorm
If an upgrade took years to apply, this wouldn't be a standard operating
practice.

Such as in high risk environments with certification requirements. You
wouldn't tell a bank or military "upgrade it".

------
et2o
The problem is that obesity is truly the primary cause of many medical
problems. You can treat other symptoms but sometimes things won't get better.
This article is garbage.

~~~
0xcde4c3db
> The problem is that obesity is truly the primary cause of many medical
> problems.

Obesity makes lots of medical conditions worse (or more likely), but it's the
primary cause of almost none of them. It's rare that it's even the biggest
risk factor.

------
fjjrxcbdhx
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.

~~~
et2o
Comments like this are incredibly uninformed and in my experience not really
true. If you can get into medical school, you could do another job that is a
lot less of a slog and make more money. There are slides going around
somewhere where if you account for hours worked, doctors make about the same
as UPS drives on average.

~~~
thanksgiving
There's a saying that we can't block the sun with the palm of our hands. What
gp says is definitely a fact. A lot of people just want a decent life for
themselves. I would like to deny this because I know when I throw a brick in
the mud, it can come back to my shirt as well. However, we shouldn't run away
from the truth because it is unpleasant. A lot of people go to school to
become doctors, lawyers, (and lately software programming) because they think
this is a good way to make a good salary. If it is not about absolute value of
salary, it is about opportunity cost. "What would I do if I don't go to
medical school?" Military recruiters know that there is something similar
going on in potential enlistees as well.

Lets not pretend that it is not going on. Lets face the facts. Many people (if
not most) are not motivated primarily by their need to make the world a better
place for everyone else. We are too primitive for that. I'd argue we aren't
even programmed for that yet. In a world where people think it is acceptable
for people to starve if they can't or won't work, it is too much to think that
our doctors, lawyers, and corporate executives are a different breed or
species.

Sorry I have tremendous respect for our doctors as I have for our soldiers but
that doesn't mean everyone who goes in to medical school or military training
went in with perfectly altruistic purposes.

------
RyanOD
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, "You're working/training too hard. Just take a
break."

No real diagnosis, just a quick assumption that, "Hey, this person looks like
they're in great shape. They'll get better one way of the other. I have bigger
fish to fry."

Just curious.

~~~
ivraatiems
Oh, yeah, that definitely happens. It happens to young people, too. They come
in with X symptom and doctors are like "nah, you're so young, you're just
fine." Then it turns out you are not fine. This also negatively effects people
who have unusual or hard-to-diagnose conditions that exhibit symptoms similar
to those of other conditions.

Doctors apply 90%-suitable heuristics to 100% of candidates too often, in my
opinion.

~~~
AstralStorm
If it were 90% applicable if would be good. These are not validated and are
likely much less accurate.

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

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.

------
gjolund
Most doctors will also tell an alchoholic to stop drinking.

~~~
pixl97
Actually they won't.

You can very quickly kill a dependent alcoholic without special treatments.
Going cold turkey has a risk of sudden death.

Quickly losing a massive amount of weight has risks too. That said, if a
doctor says you have a condition that is being exacerbated by obesity, the
patient should be sent to a weight specialist.

~~~
tcj_phx
> You can very quickly kill a dependent alcoholic without special treatments.
> Going cold turkey has a risk of sudden death.

My girlfriend became profoundly psychotic when she ran out of alcohol. She was
taken to the hospital, who didn't care that she had been drinking, and didn't
include on their 'petition for court-ordered evaluation' that their initial
blood work found cocaine metabolites. The psychiatrists at the county's
behavioral health center also didn't care that their patient told them she'd
been drinking heavily.

Modern Medicine does some things quite well. Weight loss and addiction are two
areas where conventional medicine is inadequate.

------
wyager
To be a bit blunt, the doctors are probably thinking "if you won't take care
of your body, why should I?"

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.

~~~
et2o
Doctors take care of people who don't take care of themselves all the time,
everyday. It's part of being a doctor.

~~~
jlarocco
And when those people go to the doctor with complaints related to not taking
care of themselves, the doctors tell them they need to stop drinking, smoking,
or whatever. Why would obesity be any different?

~~~
jakebasile
Telling them to correct the initial cause is wholly different than not
treating the symptoms or not mitigating damage because "they don't deserve it"
or "they can't even take care of themselves".

~~~
jlarocco
I'm not sure it has anything to do with the patient "deserving it" or not.
Nobody wants to put effort into something when somebody else is actively
working against it.

~~~
jakebasile
Big people do not want to be obese, and doctors are paid for their efforts.
Nobody sets out with the life goal of being fat.

------
speeder
I didn't read the article yet, since I opened the comments first... and was
shocked by them.

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.

I didn't knew, it was a thyroid problem, my mom, for some reason (that back
then offended me, I told her I didn't wanted to go to a "fat people doctor")
took me to a endocrinologist, suspecting something was wrong.

The endocrinologist made no tests, only said I was fat, and dismissed me.

The thing is: according to BMI, I was only slightly overweight, not even
really "fat" yet.

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).

A random friend of my mother then commented I had obvious thyroid problems
symptons, including a obviously enlarged neck.

My mother started to take me to endrocrinologists again... and again, they
just kept telling me I was fat, and refusing to help.

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.

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't believe me, and don'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).

I am currently trying to drop my weight until I get obviously "not fat" 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.

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 "persuasive" 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).

~~~
hasenj
Whatever condition you had didn't cause you to gain weight. You can't defy
physics. If you control your caloric intake, your body /will/ lose fat. Your
story is anecdotal so I'll response with an anecdote as well: I've seen more
than one person with a "thyroid condition" who were in good shape.

~~~
speeder
You just forget the body is made of more than fat.

Yes, eating less calories than I use will make me lose weight, but where that
weight will come from? Nothing guarantees it will be from fat.

For example right now my hair, nails and skin is breaking, and I am losing
muscle. But when I raise my food intake, I get an increase in fat, and my
nails, hair, muscle and so on continue fucked up. But when I cut calories,
they get worse faster, but the fat remains.

~~~
hasenj
There's hardly any calories in your nails.

You can supplement with specific vitamins and minerals for your nails and
skin. You can supplement with protein and perform basic exercises to protect
muscles (pushups, beginner level).

Protecting hair is not a good excuse to not lose weight.

~~~
speeder
Are proteins calorieless?

Right now my diet is already protein heavy.

There is a way to force all my protein eaten to do protein job without a
single bit of it being turned into calories for other purposes?

EDIT: my questions were rethorical. I know proteins have calories, that is my
whole point. even with a diet where I get only the macronutrients I need, my
calorie intake is too high. Right now my lifestyle consists of switching
periods of losing weight woth periods of fixing the damage. so far lost 30kg
from my peak weight, still need to lose more 30kg to doctors stop telling me I
am fat and start helping me.

~~~
hasenj
Combine it with healthy fats and healthy carbs.

Muscle loss is unavoidable. But you can't use it as an excuse to not lose
weight. You just try to minimize it by having a balanced diet and performing
some basic exercises.

~~~
AstralStorm
Another platitude of a "balanced" diet. Not even dieteticians know what that
means for purposes of weight loss. Muscle loss is a major problem for people
who fail diets and bounce back. Muscle once lost is very hard to regain. Lack
thereof will also reduce energy output making further attempts harder.

Even a vegan or near vegan diet easily exceeds required caloric intake for
weight loss. Going for healthy foods is no good if caloric input is too high.

Protein has a star quality in that it suppresses hunger directly. The trouble
is finding sources not also laden in fat and also making it palatable.

What you need is a highly unbalanced diet, but one that will not damage your
health. It is very tricky to set up.

------
woliveirajr
Yes, I know/experience that since my BMI increased from 23 to >30.

Even worst, majority of doctors fixate on reducing weight (as if that would
solve everything else)

------
NDizzle
The article starts out talking about a woman who is 502 lbs. Why wouldn't
"lose weight" be the best suggestion? You're 500 lbs!

~~~
Sir_Substance
>The doctor’s scale went up to 350 pounds, and she was heavier than that. If
she did not know the number, how would she know if the diet was working?

The important bit of that anecdote that you skipped over. Every doctor will
tell overweight people to lose weight, but they also tell them not to lose it
too fast, or it can lead to liver and kidney problems.

If a doctor says "lose weight", but can't actually assist you in doing that in
a safe, controlled and sustainable fashion because he doesn't have the
equipment, he's actually not very useful. My grandmother could tell a 500lb
woman to lose weight, but I wouldn't pay her $200,000 a year to do so.

However, the key allegation of this article isn't just that doctors don't have
the equipment to give first-world-quality health care to overweight people,
it's that they have biases that cause them to not want to rectify that
problem, even though that's as simple as buying a sturdier scale.

That's a much more serious issue. It's one of the key reasons AIDS was such a
problem 30 years ago. No one wanted to treat ~~the gays~~ in the 70's, and so
HIV was allowed to run rampant rather than be treated. Within a handful of
years of our society realizing it didn't actually give a shit about whether
people like butt stuff or not, HIV went from a terminal diagnosis to a
manageable condition, because /doctors actually started taking the people it
affected seriously/.

~~~
rangibaby
There was about a 11 year period (first US cases in 1981, "Gay-Related Immune
Deficiency" in 1982, Magic Johnson got HIV in 1992) where an HIV/AIDS
diagnosis was a certain death sentence. I think there was more of a stigma
against gays from politicians and their constituents than doctors, which
contributed to it's spread too. It was recognised as early as 1983 that GRID
wasn't a gay disease, hence AIDS.

If you would like to read more I believe the definitive history of the early
days of the AIDS epidemic is "And the band played on" by Randy Shilts.

I honestly think that if the governments of the world stopped allowing
corporations to put sugar in _everything_ then the problem of obesity will fix
itself. I'm not going to promote a low-carb diet or whatever, but it is not a
disputed fact that sugar makes anything taste better and is addictive, which
is why companies add it to everything. People will complain, but it's not
really "personal choice" when you are literally choosing food spiked with a
drug to make it more addictive.

A lot of people who overeat do it for a number of reasons. I know I like
eating a lot now because I was poor once and had to eat as much as possible of
whatever was available. I lift 3-4 times a week and bike daily, but am still
obese according to my BMI and was recommended against having surgery for
appendicitis last year (it fixed itself with a hospital stay and IV
antibiotics which was lucky).

I think that for a lot of people counselling would be a good start instead of
"eat less". If it were that simple then there wouldn't be fat people, would
there? One problem is that some people are just bullies and like to put down
others to make themselves feel superior. Then there are things like the "fat
acceptance movement". I will never understand that either.

~~~
maxerickson
Yeah, it was for sure recognized as a public health problem in 1981.

[https://www.aids.gov/hiv-aids-basics/hiv-aids-101/aids-
timel...](https://www.aids.gov/hiv-aids-basics/hiv-aids-101/aids-timeline/)

AZT was approved by the FDA in 1987, with some federal funding to pay for it.
Which is the real story of why people survive it today, drugs were developed
to treat it. But the attitudes of front line doctors in 1990 wouldn't have
much to do with the development of those drugs.

One strategy I've used against my poor eating habits is to eat something like
broccoli when I want a large serving. A huge serving with a modest amount of
butter is ~200 calories.

~~~
rangibaby
> One strategy I've used against my poor eating habits is to eat something
> like broccoli when I want a large serving. A huge serving with a modest
> amount of butter is ~200 calories.

My wife had a good idea and she has got me eating a big bowl of high-fiber
vegetable (cabbage etc) soup before whatever silly main I want to eat. It's
very filling and I believe the same strategy as yours.

------
tgb
Veterinary medicine always does dosing by weight. Why doesn't human medicine?

~~~
sbierwagen
They do. Weight dosing is way more common in pediatric medicine, though, since
children cover a pretty wide range of weights.

