[caeril]

> 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.

[nradov]

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]

Thank you for your sane reply.

[mzgaljic]

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.

[buffington]

I used to work with a brilliant software engineer who weighed at least 400lbs when we worked together. Incredibly smart, kind, and thoughtful, and funny. But there was this one puzzling thing about her.

She was vocally critical of the mere concept of "fat" and would find any excuse to pick fights about it. During a company-wide meeting of about 1200 people it was announced that we'd be inviting employees and their families to a theme park for the day, all to ourselves. She stood up during the Q&A portion and asked if the company would be, in her words "giving people who didn't fit on the rides a sum of money equal to the cost of admission, travel expenses, and meals." The HR rep asked for clarification, to which she said "those of us who were born too big to go on rides shouldn't be denied benefits other people get because they fit. That's discriminatory."

She would also frequently and passionately argue about how the idea of "overweight" or "underweight" is an invention of capitalism - a tool to get people to spend money on books, gyms, diet programs. No amount of rational debate would alter her stance. She'd cite supposed medical journals from memory disputing the concept of obesity if anyone asked "aren't there health risks?"

Denial is a crazy, sometimes heart breaking, thing. There are people who don't believe that being fat is unhealthy.

She was one of them. I say "was" because she died of cardiac arrest at the age of 27 while at work, 20 feet away from where I was sitting. Even now, I still have a hard to reconciling who she was (smart, rational, kind) with what she believed and how she died. Utterly tragic.

[caeril]

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]

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.

[jeanlucneptune]

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]

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.