[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.