BMI is trash for many populations; it’s also decent enough for most populations as a staring point. Perhaps a “simple” approach to this would be to develop more robust models with regressions for race and sex factors. Regardless, that would still just be a rough measure and more information is needed.
Another point, people experiencing obesity probably do experience worse health outcomes in general due to bias, which is compounded by the negative outcomes from their extra weight. It is probably tough to calculate how much bias comes from various external sources (school, social media, etc) vs. doctors’ own lived experience with patients.
A point the article doesn’t mention is that most doctors are completely unequipped to seriously help someone lose weight which contributes significantly to the communication and bias issues. So in many ways, the doctors are probably experiencing some shame or inadequacy from their lack of training which makes the topic tough to tackle. But also, many people experiencing obesity are extremely sensitive about their weight and it is very difficult to have a productive conversation on the topic, regardless of the communication style and empathy shown by the health practitioner.
Yeah, my thought exactly. The article talks about how doctors take worse care of overweight folks and they open with an example of a doc trying to be more careful and that’s not good either.
I’m not sure it’s “trash” for any population (maybe some pro-athletes). But I guess that depends on how you define trash. But even with a liberal definition of “many populations” and “trash”, I can’t think of many populations for which it is trash. Imperfect, sure. Trash, idk.
Definitely agree with this, which is why the preceding part is hard to reconcile. They’re not mutually exclusive statements, but they’re in the neighborhood.
I dunno feels like you’re attaching too much weight to some random podcaster’s quotes. That isn’t the important part. It’s stuff like this:
Another study, published in 2003 in the journal Obesity Research , found that even doctors who specialize in clinical management of obesity showed very strong weight bias and used words like “lazy, stupid, and worthless” to describe fat patients.
I’m not a doctor but calling patients with obesity “lazy, stupid, and worthless” seems real fuckin’ bad, as does this
Other studies have shown that higher-weight individuals often experience shorter appointment times, less comprehensive exams, fewer referrals for specialists and imaging, and longer wait times for surgeries and other procedures.
and this
A 2019 research review in Primary Health Care Research & Development about weight bias and utilization found evidence of patronizing and disrespectful treatment, poor communication, and assumptions about weight gain.
and also this:
When patients anticipate judgment, bias, and stigmatizing language from doctors, they tend to avoid seeking health care—not just in terms of checkups, but also for potentially significant concerns that are already causing symptoms.
Here’s the money quote that articulates the point much better:
“We’re seeing that patients aren’t seeking medical care or are delaying care when they’re ill because of anti-fat bias in health care,” says Dr. Rekha Kumar, an endocrinologist who’s the former medical director of the American Board of Obesity Medicine.
“Another negative outcome is the lack of continuity of care, because patients may not return to the same physician if they feel judged based on their weight.” When that happens, strong patient-doctor relationships aren’t formed, “and there’s a lack of trust and of routine screenings.”
Yeah I agree the lead-in is awful and it’s poorly written. She’s a patient with an axe to grind, and justified or not, those quotes typically don’t work well in a piece like this. It reminds me of posts I see on patient support groups where these people come in and give you a full medical history (they think) with a ton of mundane details and perceived aggressions / micro-aggressions included, typically in one giant paragraph. It’s partial venting and I understand it, but one thing we try to help with is explaining that’s not an effective way to communicate as a patient.
I mean there’s no doubt that social attitudes toward overweight people are packed full of biases that the “fat people” are moral failures. I wouldn’t expect doctors to be immune from that bias.
We could spend some time trying to attack the root causes of obesity with good policy, but I think it will be more productive to have a screaming match amongst factions of the left because some people aren’t using the approved language “people experiencing fatness”. Meanwhile billionaires get richer and every else’s life gets worse and the planet dies. I love 2023.
Obesity is also one of the purest examples of the conservative/liberal ideological split over “personal responsibility” vs. sociological influence over circumstances. If one believes fat people are fat because they’re lazy and eat too much, then, definitionally, they fall on the far right side of the spectrum and will likely consider any alternative explanation as “making excuses”.
I think that the moralizing of weight gain is even stronger than that, plenty of people that objectively believe in the social determinants of health and support corresponding government policy will still moralize health/exercise/wealth loss stuff in their daily lives. The right doesn’t have a monopoly on moralizing “bad” choices.
The journey a guy with an expensive medical condition went though with his insurance provider. It has all the hits you imagine insurance companies do. Automatic denials? Check. Company bureaucrats being callous? Check. Corporation doctors who are supposed to review cases rubber stamping denials? Check.
Some things that make sense but surprised me, the relationship between these severe cases and insurance companies is like a inverse whale and casino relationship where these individuals are tracked personally through out the company and are talked about in individual terms up the corporate chain, but instead of catering to their needs like a whale theyre cost centers to be minimized.
The aggravating part is they “accidently” sent his case for review to a doctor who actually did his homework and he basically agreed with the guy’s doctor and then the insurance company buried the doctor’s review and rerouted it to a rubber stamp doctor. The guy’s lawyer only found it because someone off handedly mentioned it in a meeting call he was listening to in discovery.
McNaughton said he contemplated suicide on several occasions, dreading a return to a life where he was housebound or hospitalized.
McNaughton and his parents talked about him possibly moving to Canada where his grandmother lived and seeking treatment there under the nation’s government health plan.
Loftus connected McNaughton with a psychologist who specializes in helping patients with chronic digestive diseases.
The psychologist, Tiffany Taft, said McNaughton was not an unusual case. About 1 in 3 patients with diseases like colitis suffer from medical trauma or PTSD related to it, she said, often the result of issues related to getting appropriate treatment approved by insurers.
“You get into hopelessness,” she said of the depression that accompanies fighting with insurance companies over care. “They feel like ‘I can’t fix that. I am screwed.’ When you can’t control things with what an insurance company is doing, anxiety, PTSD and depression get mixed together.”
I knew this would put me in a blind rage. Delivered.
When the McNaughtons first reached out to the university for help, they were referred to the school’s student health insurance coordinator. The official, Heather Klinger, wrote in an email to the family in February 2021 that “I appreciate your trusting me to resolve this for you.”
In April 2022, United began paying Klinger’s salary, an arrangement which is not noted on the university website. Klinger appears in the online staff directory on the Penn State University Health Services webpage, and has a university phone number, a university address and a Penn State email listed as her contact. The school said she has maintained a part-time status with the university to allow her to access relevant data systems at both the university and United.
The university said students “benefit” from having a United employee to handle questions about insurance coverage and that the arrangement is “not uncommon” for student health plans.
The family was dismayed to learn that Klinger was now a full-time employee of United.
This has been my lived experience for 22 years as an American with a chronic autoimmune disease. Every single thing is denied, deemed not medically necessary, or guarded behind step therapy that resulted in years of added misery and physical decline all in the name of saving the insurance company some money. It’s depressing as fuck. It’s engaging. And it’s the norm for people who are sick in this shit hole country.
Yea insurance companies haaaaate infusions. My biologic infusion costs about $15k/month, so obviously they’ve tried every trick in the book to not cover it or to get me to change my care plan. And I have a lot of friend on the same or similar drugs that have had worse battles than I have. One even has a pending law to address the issue that they are fighting for in their states senate. Being sick is a full time job in America, and the stories of ptsd are 100% believable. Hope your sister is doing well and winning her fights.
Her’s was $80k/infusion, one of the 5 most expensive drugs there is. I think they found a drug for half that. But the battle with the insurance company is never ending.