[colechristensen]

>I'd go so far to say this is probably the case for most people. Your average person is in really poor fitness-shape but just fine health-shape.

Modern medicine has failed to move into the era of subtlety and small problems and many people suffer as a result. Fitness nerds and general non-scientists fill the gap poorly so we get a ton of guessing and anecdotal evidence and likely a whole lot of bad advice.

Doctors won't say there's a problem until you're SICK and usually pretty late in the process when there's not a lot of room to make improvements.

At the same time, doctors won't do anything if you're 5% off optimal, but they'll happily give you a medicine that improves one symptom that's 50% off optimal that comes along with 10 side effects. Although unless you're dying or have something really straightforward wrong with you, doctors don't do much at all besides giving you a sedative and or a stimulant.

Doctors don't know what to do with small problems because they're barely studied and the people who DO try to do something don't do it scientifically.

[anon7000]

A worthwhile book to read on this topic is Outlive by Peter Attia (MD). The core premise is that American healthcare focuses far too much on treating problems after they’re extremely severe. It is would be cheaper and healthier to invest more into conservative & preventative care, trying to prevent or minimize problems early in life before they become incredibly dangerous and expensive/difficult/impossible to treat.

I have a close friend who works in conservative care, and it’s astonishing what they see. For example, someone went to a number of specialists and doctors about a throat condition where they really struggled swallowing. They even had to swallow a radioactive pill to do some kind of imaging. Unnecessary exposure, and an expensive process to go through, and ultimately went exactly nowhere.

Meanwhile, it was a simple musculoskeletal issue which my friend was able to resolve in a single visit with absolutely no risk to the patient.

Medical schools need to stop producing MDs who reach for pills as the first line of defense without trying to root cause issues. Do you really need addictive pain killers, or maybe some PT, exercise, massage, etc. to help resolve your pain.

[lnsru]

It’s not medicine. It’s healthcare system. Doctor isn’t paid enough to go thoroughly through the complaint and dig deeper. In Germany you get 5 minutes diagnose and that’s all from health insurance. And this from the better doctor. For normal one diagnose comes from 2 minutes interaction. Believing that the diagnose is right is very naive.

[Angostura]

> Doctors won't say there's a problem until you're SICK and usually pretty late in the process when there's not a lot of room to make improvements.

As someone who is fit and active,in their 60s with zero obvious symptoms, but is nonetheless on cholesterol and blood pressure medication, this isn't true (in the UK, at least)

[pjc50]

One of the things the NHS does surprisingly well, and is only really possible because it's a completely vertically integrated system, is population-level preventative medicine. Distributing insulin and salbutamol. Screening for various sorts of cancer. Cholesterol and BP checks. Encouraging people to stop smoking.

[PlatoIsADisease]

I think one of the major problems is that biologists/scientists cannot legally treat people. Physicians take their studies and have monopolistic treatment powers over them.

I think this creates a huge knowledge gap.

[steveBK123]

It’s also cultural. Most American doctors don’t bother to tell people if they are overweight and out of shape. It’s not something their customers reward.

[thewebguyd]

> customers

And there's the problem. That they are "customers" that pay, either direct or via insurance, or via government insurance vs. a nationalized healthcare system, and I mean healthcare not nationalized health insurance

[colechristensen]

I mean... most people already know, it's not like either of those things come as a surprise to anybody.

[machomaster]

Most obese people think "I am a bit on a heavy side, but I am not that fat and definitely not obese".

People are generally in denial about their fat percentage and their muscle mass. Even somewhat healthy people (~20% fat) who are calculating how much they must lose in order to get to a healthy 12-15%, are surprised when the reality shows that they calculations were 5-15kg off.

[steveBK123]

Most people are wrong about their body type, in the wrong direction (overweight think they aren't that overweight, skinny think they need to lose weight).

Having an objective voice from your doctor giving you annual feedback and suggestions is better than ignoring the topic entirely.

[colechristensen]

that's gym bro science, there's no compelling health reason to lower your fat percentage to 12-15% and it carries as much risk as being rather obese when accounting for all causes mortality, particularly for women and people getting older

[Propelloni]

Maybe I'm not getting you right, but IMO it hasn't? I, as a customer/patient, just don't weekly converse with my MD about small issues, and frankly, they have better things to do, for example treating sick people.

Instead I use the health benefits programs of my health care insurer. My insurer has an interest in prevention, so I can get consulting for free (or very low fees), and even kickbacks if I regularly participate in fitness courses and maintain my yearly check-up routine. Now, I live in Germany and it probably is different in other countries, but it just makes economic sense from the insurer's point of view so that I would be surprised if it were very different elsewhere.