Too FAT for Surgery?!?

Published on February 21, 2005 By Gideon MacLeish In Health & Medicine

Now, don't get me wrong. I struggle with my weight, so this is kinda personal, but something has really been irking me lately.

I have a friend who has had recurrent problems with his gallbladder. Put simply, it needs to be removed. The problem? The doctors won't perform the surgery because he is too large.

This man has always been a large man, even in his youth. While his eating habits are less than optimal, if you know anything about health, you would understand why diabetes and Congestive Heart Failure happen to be limiting factors in his quest to lose weight. But the larger issue here is the blatant misunderstanding of the Hippocratic Oath.

Until some 20-30 years ago, many doctors refused to perform surgeries or tests on the older population, reasoning that their health problems were simply "old age". When that mindset changed, guess what? So did the average life expectancy. Now we reach a point where I'm inclined to ask if SOME of the shortened life expectancy among the obese isn't because of doctors who refuse to work on patients, reasoning that all their health problems are due to them being "too fat".

I'm hoping this mindset changes as well.

Comments (Page 1)

Zoomba

on Feb 21, 2005

I had a friend who recently had his appendix removed. He's a *very* large guy and due to his weight they were unable to close the incision all the way. The internal lining was stitched up but there had to be a gaping hole through his layers of fat. It never healed up fully and due in part to his own stupiditiy he ruptured the inner stitch. There is nothing they can do for him due to his size.

Sometimes they have to weigh the benefit of the surgery against the possible complications arising from the weight issue. If it had been anything other than the appendix, the cost would have outweighed the benefit in this case.

BlueDev

on Feb 21, 2005

Actually, Gideon, as someone who has operated on very obese people I can tell you that yes, you can simply be too fat for a non-emergent surgery like gall-bladder (assuming he isn't in acute cholangitis).

The surgical and post surgical complications associated with morbid obesity are real and they are very severe. Zoomba already mentioned the difficulty with closure of the wound. Increased abdominal girth also leads to increased wound infections as there is just so much tissue exposed and open when trying to do the surgery. Too fat and you cannot do it laparoscopically as the scopes simply are not long enough to get in and get what they need to. So it must be an open surgery. Because of increased size the operation is going to take longer (again increasing wound infection rate). Longer on the table and increased weight means an increased likelihood of ulcers formed during surgery, no matter how well you pad them. This also leads to increased incidence of nerve injury. I have had my arms up to my elbows in a body because of their weight and it isn't a pretty or good situation. The surgery becomes more complicated because you have so much mass to move out of the way. This decreases visualization of the target organs, increasing surgical error.

I haven't even begun to talk about the complications of anesthesia. Fact: The fatter you are the more difficult you are to intubate, and once intubated the more difficult the maintaining the airway. IV access can be next to impossible without putting in a central line, so you now have to stick the tubing into major vessels simply to be able to have IV access. Throw CHF into the picture and you have a patient who will not have good blood oxygenation if they are flat or head down (and you MUST be head down to get to the gallbladder in a larger patient especially). This leads to increased ventilation pressures to maintain oxygenation, which can lead to lung problems down the road (in lungs that are already overloaded due to a failing heart). And, to be honest, I am just skimming the top of the issue here.

So I am going to have to pretty vehemently disagree. Too fat for surgery isn't an excuse, it is a very legitimate reason to not operate.

lostintexas

on Feb 21, 2005

Being an obese person myself I fully understand what you are saying. I have kidney stones which the doctors will do nothing to until they try to pass and get stuck. With America becoming larger I don't understand why there is not more medical advancements in treating the obese. And if doctors will not treat the obese then why will not the insurance co. pay for weight loss. If you are obese you are just out there all alone.

dharmagrl

on Feb 21, 2005

Too fat for surgery isn't an excuse, it is a very legitimate reason

I'm going to agree with Dr Dev. it's not a case of being 'fat-ist', it's that it's simply dangerous for the patient.

BlueDev

on Feb 21, 2005

With America becoming larger I don't understand why there is not more medical advancements in treating the obese. And if doctors will not treat the obese then why will not the insurance co. pay for weight loss. If you are obese you are just out there all alone.

I really hate to say this (and I say this as a person who could stand to lose a few pounds myself), but there just aren't that many more medical advancements to be made. Think about this, with our country's problem with obesity, coupled with our obsession with being thin, obesity is where the money is. People so want to find the magic bullet, they know that the second they do that is it: millionaires, billionaires even. Folks are trying to find it more frantically than you can imagine.

It all boils down to more out than in. Every trick, every treatment, every diet book, every exercise fad will all fail unless we burn more calories than we eat. Yes, genetics play a role, as do other physical conditions. But there simply won't be a solution that is more effective than more out than in.

Angloesque

on Feb 21, 2005

BlueDev, I have a confession:

I gave you an insightful for what you said above, as I was going to post something like it but knew you'd be more informed than I.

Anyway, so I decided that if I were to give you an insightful, at least I could understand what it does to a person's score. So I opened up the ratings page and it said you had 19039. So I clicked "insightful," waited a minute, and then refreshed the scores. Your score went DOWN two points after I rated you.

Er, should I troll you to get it back up? Anyway, a good deed gone bad, eh? I don't know what to do and I feel really bad.

-A.

BlueDev

on Feb 21, 2005

Er, should I troll you to get it back up? Anyway, a good deed gone bad, eh? I don't know what to do and I feel really bad.

Sure, troll me and see what happens. I appreciate the insightful, and that means a lot more than the points, so think nothing of it.

Angloesque

on Feb 21, 2005

troll me and see what happens.

Yeah, your score went up three points, from 19042 to 19045 when I trolled you. In the end, a net gain of one measly little point.

Er, so, should we, like, tell someone? Or maybe the admins think I give bad ratings, so they're playing a cruel yet also very cool trick on me? (Come to think of it, I know a lot of people I'd love to give "insightfuls" to right now, heh heh.)

-A.

Ziggystyles

on Feb 22, 2005

When I went in for surgery to get my wisdom teeth taken out...I first went in for a...whatever its called....not observation...but more of a consulatation...all the fine print and stuff. I was told at the time that they couldnt put me completly under because of my weight.

This was because since im a big dude (330)...with the drugs in me and all....I might not be able to expand and contract my lungs under the anestheeethesrerasrhoihwwxisia. Then on the day of the surgery...the doc told me he was putting me under and said that it was no problem...imagine the panic as I didnt know who to believe. Anywho...I was out in 45 minutes and dont remember a thing...so whatever they did...it worked.

Nobody wants to be fat...its just a result of not what we eat...but how much. I mean...if we could be full...quickly after eating and stay full...we wouldnt be as big as we are. But since it takes so long to feel full...adn with the constant munchies we get...thats what is killing us....litteraly.

Furry Canary

on Feb 22, 2005

'I don't understand why there is not more medical advancements in treating the obese.'
Just as, for example, a weak or damaged heart may well affect the risk of conducting an operation, so too may obesity in the patient. Obesity - like kidney stones or appendicitis - is a medical condition, and needs to be taken into account. However, it can be conquered in a variety of ways. There are plenty of non-medical procedures; eg. one can improve one's diet, reduce one's food intake, get more exercise. There are medical techniques too; eg. drugs to suppress one's appetite. And if all else fails, there are surgical techniques, such as liposuction and stomach stapling. So where exactly is the shortfall?

'And if doctors will not treat the obese then why will not the insurance co. pay for weight loss.'
As a number of respondents have indicated above, it's not so much 'won't' as 'can't' or 'shouldn't'. Given the degree of coverage in the media that this subject commands, it is extremely hard to imagine that the vast majority of obese people were not fully aware of the expected outcomes of the very behaviours that led them to become obese in the first place. Similarly, this same majority must surely know what it is they need to do in order to address the condition. Consequently, while I really don't mean to sound unsympathetic here, why should the insurance companies carry the can?

Surely the saddest irony in all this is that a significant number of the conditions requiring surgery that arise in chronically obese people are at least partially due to them being obese in the first place. Still, the positive spin on this is that by addressing one's obesity, there is a good chance that one will go some way towards alleviating one's other ailments too!

Ivon Fergus

on Feb 22, 2005

Age you can't change; weight you can. For example, as I type, I'm slowly eating sunflower seeds - in the shell - shell and all. This is a lot fewer calories than chocolate, etc. When I get really desperate to lose weight, I crack open the shells, throw away the sunflower kernels and chew the shells. The act of chewing is satisfying.

Draginol

on Feb 22, 2005

Perhaps if people stopped filing so many lawsuits you would have doctors willing to take more risks.

Gideon MacLeish

on Feb 22, 2005

Age you can't change; weight you can.

Assuming you are a normal, healthy individual, yes. There are, however, occasions when limiting factors arise. While this doesn't necessarily mean the person CAN'T lose weight, it can make it greatly unlikely. I can tell you from personal experience that not every man can aspire to putting back on a pair of size 32 jeans.

Perhaps if people stopped filing so many lawsuits you would have doctors willing to take more risks.

I'd be an idiot to disagree with you there, Drag.

Blue and Zoomba: thanks for weighing in. It does shed an interesting perspective on the matter. I do find it interesting, however, as lostintexas points out, that the insurance companies won't pay for weight loss programs. It is, I believe, one of the reasons our medical costs are skyrocketing; we don't want to invest enough in PREVENTION, rather than treatment (although I'd be surprised to find a doctor that disagreed.)

BlueDev

on Feb 22, 2005

It is, I believe, one of the reasons our medical costs are skyrocketing; we don't want to invest enough in PREVENTION, rather than treatment (although I'd be surprised to find a doctor that disagreed.)

Sadly that is a universal problem. There are very few truly preventive measures that insurance companies go for. You really have to be able to show something beyond solid. You have to hit them over the head with the notion that preventive costs will be lower in the long run (like they were able to do with Pap smears). Too often, money talks.

Gideon MacLeish

on Feb 22, 2005

You have to hit them over the head with the notion that preventive costs will be lower in the long run (like they were able to do with Pap smears). Too often, money talks.

And, from the consumer perspective, so do results:

1st in per capita health care spending

17th in life expectancy

(I can't remember where we fall on infant mortality, but it isn't pretty!)

Welcome Guest! Please take the time to register with us.
There are many great features available to you once you register, including:

Richer content, access to many features that are disabled for guests like commenting on the forums.
Access to a great community, with a massive database of many, many areas of interest.
Access to contests & subscription offers like exclusive emails.
It's simple, and FREE!