Care is getting the obese person to lose weight. Which is hard, harder than dealing with hard drugs. Dieteticians, who are supposed to be specialists, fail hard at care. GP doesn't even know where to start.
So let's fix what is broken. If a person cannot eat, they are fed, right? That is a task for a properly trained nurse.
But I don't know of a doctor who wants to provide essentially more than daily care and effective one to begin with.
And doctors do not like to feel like failures.
However, that's not what most people here are arguing for. The specific case here is a complaint that people are denied surgery, and people feel that this is denial of care; that is, people are arguing that we should perform knee and hip surgeries on obese people, even though weight loss would be a much safer treatment.
The joints can and do regenerate except from chronic problems. Unfortunately, obesity is one, just losing weight does not fix joints as quite a few long time former weight lifters can attest.
I don't have any reason to disbelieve you about your friends, but your friends do not represent all obese people, and in losing weight does fix joints some percentage of the time. Given the alternative is surgery, which kills the patient some percentage of the time, I don't think there's a lot of debate to be had here.
Moreover, there are other issues to verify, say, a person born with hip dysplasia should be treated regardless of weight as weight loss will never fix the underlying problem.
Also aching hip joints quite effectively prevent many kinds of exercise, which does not help with weight loss at all.
Without an effective alternative course of action, the surgery may be the one remaining effective measure.
I disagree--in fact, I think a large part of the problem here might be this very conversation. It's unclear how much of the reason that counseling is ineffective is because obesity has become an identity politics issue. If you tell someone that it's okay to be fat, and go so far as to say that obesity isn't the cause of their problems, it's a lot easier for them to just cry "denial of care!" than to actually lose weight. The first step to solving the problem is admitting it is a problem, and fat acceptance is actively impeding that part of the recovery process.
I don't have personal knowledge to say which way the direction of causality goes: whether identity politics causes counseling to be ineffective, or whether counseling is inherently ineffective and therefore identity politics are right. But I think that doctors are the ones with the most information to decide that, not identity politics activists.
What I do know is that even if counseling is only 10% effective, it's far less dangerous than surgery, so it should always be the first choice. If someone tries weight loss programs for a few years and fails to lose weight, then maybe it makes less sense to deny surgery (this would be a situation I'd be interested in hearing medical opinions about). But I see no evidence that this is actually happening. What I'm seeing is people saying that demanding people try weight loss first is equivalent to denial of care, and that people should be allowed to get surgery without even trying to lose weight.
And while this firmly steps outside science, I think obesity makes sense to treat as an addiction problem. I've been treated successfully for alcoholism via a program which equally has very low success rates to weight loss programs. My personal experience with this is that, as identity politics say, it makes little sense to shame people for their addiction or to discriminate against people because of their addiction in cases where it doesn't affect their ability to perform. Blaming me for my addiction or punishing me for my addiction didn't work. However, what also didn't work was living in denial that I was an addict and that my addiction was a problem. I don't blame myself for my addiction, but I did need to take action and participate in my treatment.
You wouldn't give someone with alcoholic hepatitis a liver transplant unless they stopped drinking, and you shouldn't give an obese person a hip replacement unless they lose weight.
http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/ind...
http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/ind...
> > > 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.
> "Data from the scientific community indicate that a 15-wk diet or diet plus exercise program produces a weight loss of about 11 kg with a 60-80% maintenance after 1 yr. Although long-term follow-up data are meager, the data that do exist suggest almost complete relapse after 3-5 yr."
This in no way indicates how many patients with knee and hip issues are able to solve those knee and hip issues simply by losing weight.
> And that's 11kg… the situation described above is 90kg. You're essentially telling someone to go away and come back after 2+years of dieting to get medical care. Don't you think that seems unrealistic?
No, I'm not telling someone to go away and come back after 2+ years to get medical care, I'm prescribing medical care that will take 2+ years.
Weight loss isn't denial of care; weight loss is the care.
There are plenty of forms of treatment that take a long time. If a doctor prescribes a course of medication that takes 2 years before trying surgery because it will solve the problem for most people and is lower-risk, you wouldn't complain about that, or call it denial of care. But in fact, weight loss is safer than most medicines--weight loss for an obese person has almost no negatives.
I posit that the only reason you're objecting to weight loss as treatment is that you've formed your opinion based on identity politics rather than medical efficacy.