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 2)

BlueDev

on Feb 22, 2005

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

I don't remember the exact number but it is about 24th in the world.

But I can see where it gets tough. I mean, what do you want insurance companies to pay for? Should they buy every policy holder a gym membership? Or just home fitness equipment? Or does it only pay for those who get a "prescription" for it?

It becomes a difficult thing to pin down. Whereas with medical procedures that insurance pays for there is a quantifiable, documentable result, that isn't necessarily true for obesity prevention. Blue Cross and Blue Shield of NC knows that they are paying my wife's doctors to provide quantifiable prenatal care with the end result of delivering a baby. When they get the bill for the appointment they pay it because they know what happened.

But what about diet and exercise? Do we send the insurance company a claim after we have lost #X pounds? Do they reimburse us at the end of the month for our gym fee? How do they know we actually used it? Do they pay part of my grocery bill if I can demonstrate increased purchases of fresh fruits/vegetables and whole grains?

When talking about obesity prevention it becomes really difficult to measure and ask an insurance company to pay for some of it. Trust me, I hate insurance just as much as the next person (and more than most probably), but I can see how paying for obesity prevention becomes a very risky proposition.

But some companies do offer some help for it. BCBS has little prizes you can earn (and they actually get decent the more you exercise). IHC would refund you up to $500 or so at the end of the year if you exercised regularly and participated in health activities. I don't know how we can expect them to really do more than that.

lostintexas

on Feb 22, 2005

Blue Dev
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.

Being doctor you can understand the hardship of dieting. I have tried many different kinds of diets. I know all the right things to do but it is also a mind set that is hard to change. There is many large people in my family not just close family but family that I have never been around. So yes genetics play a very big part. I never really understood how easy it was to get really large when I was growing up. So here I am 5'6" and 369.9 pounds later. I try to do something about it everyday. Two step forward one step back, three steps forward, ... all I really could do is teach my children that they have genes that can make it easy for them to get really heavy fast. Both my children really watch themselves and if they start to get heavier than they want they start dieting. I just wish that I could have know that fact before I got so heavy. I am not saying that it isn't my fault that I am the weight I am. I am just saying that it is not as simple as people who just have a little to loss thank it is. Food becomes a drug just like cigarettes,pot, and any other thing that you depend on to make you feel better. If you have any advice I would gladly take it. Thank you for all your insight.

BlueDev

on Feb 22, 2005

lostintexas: No, it isn't necesarily easy. I know, trust me. And even though I may have sounded harsh in my response, I have nothing but compassion for those who are overweight. Really. I also know how hard dieting is, but if I may, I would like to make one suggestion.

Dieting is important. But never, ever discount the importance of exercise. I think exercise is more important than the dieting. Of course, you can totally ruin any exercise if you eat terrible. But the effects of exercise will be more far reaching than those of dieting. Not only does it increase the amount of calories you are consuming, but it also incerases lean body mass, which increases resting metabolism. Cardio coupled with resistance (strenght/weights) is an amazing combination. Often people stress one over the other, but in terms of general fitness you need both. Cardio increases your heart's strength and the lung's ability to deliver oxygen to the blood, making everything run more efficiently. But resistance builds up that muscle mass that will make your body overall more efficient at burning fat and calories.

Not meaning to preach, I just always hope people will realize that diet and exercise are good. If you are only going to do one, do the exercise first, as it will do more for you.

Kobrano

on Feb 22, 2005

Like it or not, but its only going to get worse for fat people. I recommend you watch the DVD/Movie called "Supersize Me".. It really puts the statistics of our every increasinly fat population in perspective. The most ironic thing about it, is that its all preventable, and the only major contributing factor in all of it is that people just don't know when to stop eating.

Your friends very causes for his problems, are his weight, so he should treat the underlying problem, which is that he is fat. You can lose a large amount of weight quite quickly, and safely, if you follow a few general rules. Instead of surgery, this guy should fix whats probably causing ALL of his problems, his fat. People just don't understand how dibilitating being fat is, it ruins your body.

I struggled with my weight once, weighing nearly 300lbs (i'm 6'4" though and have a good muscle build and large bones). I got sick of it, saw the health problems, and solved the problem.. Since then, i've kept "Most" of it off. But it usually starts to creep up when I eat fast food and get careless about my lifestyle. For example, the last job I had, I gained 15lbs during the course of 3 months on the job. Primarily due to the horrible lunches everyone eats at that workplace, and the lack of any movement other than your mouse hand during the course of the workday. Its my fault really, I got careless, I let the environment effect my habits, health and eating patterns. My fault.

Since leaving, i've lost about 50% of the weight I gained, and i'm on my own personal modified Atkins diet (which helped me lose 300lbs before), which basically sheds 20lbs per month off my frame. It takes work, it takes devotion, and it takes constant reinforcement and willpower.. Unfortuntely, its become obvious that most Americans are either too lazy to do something about it, or just don't give a damn.

But anyone thats fat, should be ready for a general public malice like your friend is recieving. People are just tired of fat lazy people that eat too much and don't exercise. Can you blame them?

lostintexas

on Feb 22, 2005

Kobrano
But anyone that’s fat, should be ready for a general public malice like your friend is receiving. People are just tired of fat lazy people that eat too much and don't exercise. Can you blame them?

I am sorry but not everyone acts like a jerk. I am a large person and find that most everyone I meet is kind. It is not fun or easy to be large. But just because someone is large doesn't mean that they are lazy or even that they eat to much. There is allot of reason to be over weight.

Blue Dev

Thank you for your advice! I didn't feel that you was being to harsh. You was just telling the truth. Thank you again. With my husbands help I am going to try again really hard. There is very little exercise I am phys. able to do right know. I will try moving more and walking some everyday. Again I can't thank you enough!

BlueDev

on Feb 22, 2005

There is very little exercise I am phys. able to do right know. I will try moving more and walking some everyday

My recommendation is to start with a little, just walking some. Don't push it too hard, but also don't be afraid to make it hurt a bit. The more often and regular you do it, the better it gets, quickly. Just don't let being sore stop you from giving it a go again. And try some resistance training, even with household items like cans of soup/fruit/vegetables or water bottles. Best of luck!

Furry Canary

on Feb 23, 2005

'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.)'

Before people begin to suffer the ill-effects of obesity via the onset of a variety of other medical conditions, obesity itself is a medical condition. Even weight loss programs are therefore not truly preventive medicine, but reactive approaches.

I can't speak for the USA, but Australia spends a substantial amount of money educating people on the benefits of adopting a healthy diet and exercise regime. If health insurance costs rocket because some people stubbornly elect to ignore such advice and subsequently require bailing out via expensive medical procedures / ongoing healthcare, don't those who follow such advice have a right to feel hard done by? Given this level of education, surely there comes a point - exactly as with such 'ills' as drinking alcohol and smoking cigarettes - beyond which, if - through ignoring common guidelines in respect of diet and exercise - individuals becomes obese, this might be viewed as ... (gulp) ... their OWN responsibility?

Gideon MacLeish

on Feb 23, 2005

But what about diet and exercise? Do we send the insurance company a claim after we have lost #X pounds? Do they reimburse us at the end of the month for our gym fee? How do they know we actually used it? Do they pay part of my grocery bill if I can demonstrate increased purchases of fresh fruits/vegetables and whole grains?

Actually, I once had an insurance company that was on the right track, at least. They would reimburse $50 per year of a gym membership (not a large percentage, but large enough to make it an incentive) to policyholders. I don't know what the answer is, but surely we could at least try to figure one out.

Kobrano

on Feb 23, 2005

'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.)'Before people begin to suffer the ill-effects of obesity via the onset of a variety of other medical conditions, obesity itself is a medical condition. Even weight loss programs are therefore not truly preventive medicine, but reactive approaches.I can't speak for the USA, but Australia spends a substantial amount of money educating people on the benefits of adopting a healthy diet and exercise regime. If health insurance costs rocket because some people stubbornly elect to ignore such advice and subsequently require bailing out via expensive medical procedures / ongoing healthcare, don't those who follow such advice have a right to feel hard done by? Given this level of education, surely there comes a point - exactly as with such 'ills' as drinking alcohol and smoking cigarettes - beyond which, if - through ignoring common guidelines in respect of diet and exercise - individuals becomes obese, this might be viewed as ... (gulp) ... their OWN responsibility?

Well said! That about sums it all up. American people have a general inability to accept responsibility for their own actions. This entire Obesity issue is a prime example of it.. MY medical insurance shouldn't go up because people decide to ignore all common sense and get fat. We have a serious problem in this country, where 60% of all people are obese by definition of obese. Its not fair that everyone that has common sense, and elects to live healthy lifestyles, has to suffer because the masses are ignorant, is it?

Sorry, I have no sympathy for obese people. My best friend is obese, and he comes to my lan parties, and sucks down 3 2Liters of Soda and pushes endless candy bars into his fat face, and frankly, its disgusting. I tell him that right to his face, and he doesn't seem to care.. Hes only 28, and has the health problems of a 60 year old. He doesn't seem to care. Thats been my take on the majority of obese people, they just don't care. These "Movements" they try to start that attempt to prove to the world they are "happy" being obese are pathetic. (you know like those Happy2BeFat organizations and crap) Grrr..

Zoomba

on Feb 23, 2005

My issue with the health insurance company bit is why do they have to provide us monetary incentives to do what we should be doing on our own anyway? Why should they pick up the tab to try and offset our bad McDonalds habits? I'm about 20lbs overweight (I'm a 5' 9" male, I should be around 150, I'm about 170-175) and it's entirely my fault. But the thing is I'm the only one who can fix it... and I can do it for free. Actually I can save some money in the process on my own. I get a $3 veggie sub from Subway instead of a $5 Value Meal at McDs or Burger King. I can get a great amount of exercise in for the cost of a pair of running shoes instead of getting a gym membership. Yes, the gym will give me a more complete workout and probably speed up the process, but if money is an issue, this is the way to go.

Everyone with able legs can walk a bit more every day, everyone can cut down on calories, or make sure you're consuming better calories and less fat etc. It's a choice (and a sacrifice) one must make. The idea that weight loss is expensive or impossible to attain doesn't want to try.

Just through better eating and a little bit more movement, I've dropped about 5lbs since Christmas. Friends and family have commented that I've lost some weight. Didn't cost me anything but a little bit of energy and time.

Gideon MacLeish

on Feb 23, 2005

My issue with the health insurance company bit is why do they have to provide us monetary incentives to do what we should be doing on our own anyway?

So, what you're saying is, why should we look at other countries who have a proven track record of better health care provision than ours and learn what they're doing right? Sorry, zoomba; if our results were anywhere NEAR the best considering our expenses, you MIGHT have a point. But they're not; something's gotta give.

But anyone thats fat, should be ready for a general public malice like your friend is recieving. People are just tired of fat lazy people that eat too much and don't exercise. Can you blame them?

Kobrano,

This is probably among the most idiotic things I have read in my time on JU. Have you never heard of hypothyroidism? Prader Willy Syndrome? Pica? overeating due to depression? There are many limiting factors that cause individuals to gain weight that have NOTHING to do with being "fat" or "lazy". I'm not saying everyone has a legitimate excuse; most DON'T (in fact, in the case of depression, one of the best cures is to get out and exercise, in my experience). But I AM saying you can't put everyone in a box.

By the way, if you notice, I have expressly kept my terminology to the words "limiting factors" because they shouldn't be used as excuses, but should be CONSIDERED in evaluating treatment options.

This article was about treatment being denied because the patient was too large. If you want to rant your opinion about "fat, lazy slobs", I suggest your own blog as a better place for it.

Reiki-House

on Feb 23, 2005

In today's environment doctors are more wary to do surgeries that may cause them to be sued. I think it's more dangerous and more risk involved if the patient is obese.

Furry Canary

on Feb 25, 2005

'This is probably among the most idiotic things I have read in my time on JU. Have you never heard of hypothyroidism? Prader Willy Syndrome? Pica? overeating due to depression? There are many limiting factors that cause individuals to gain weight that have NOTHING to do with being "fat" or "lazy". I'm not saying everyone has a legitimate excuse; most DON'T (in fact, in the case of depression, one of the best cures is to get out and exercise, in my experience). But I AM saying you can't put everyone in a box.'

Gideon, you should read more JU posts before you make outrageous claims such as this. What percentage of obese people actually suffer from these conditions? And for this, you (most surprisingly, in my experience) bad-mouth Kobrano. Isn't this just reverting - in the name of some misguided notion of political correctness - to previously employed lamer-than-lame excuses such as 'gland trouble'? The truth is that the vast majority of the Western world's obese people are obese simply because they eat too much of the wrong stuff and don't exercise enough.

I ask you simply this: In those parts of the world where food is not so plentiful as in the West, what percentage of the population actually suffer from conditions such as those you mention?

'I don't want to be held responsible for skinny people (Kobrano) who seem pissed at fat people who are enjoying their food and not torturing themselves with three bran muffins a day, a bottle of water, and a lifetime of denial in the savory foods department.

Also attempts by the skinny society to humiliate and castigate the other (majority/over weight) half of the population can be considered pathetic.'

Helix the II, a number of questions:
1) How do you know Kobrano is 'skinny'?
2) Who says you are 'responsible'?
3) Whence the evidence that 'skinny' people are 'pissed at fat people', don't enjoy their food, and torture themselves?
4) Who says this is what 'skinny' people eat?
This all sounds suspiciously like 'It's not MY fault!' to me.

lostintexas

on Feb 25, 2005

Furry Canary
What is your excuse for being rude to other people just because of the way the look?
I will gladly take the limitation of obesity any day over the malice that you and Kobrano seem to have towards a group of people. It is really sad that somewhere in you guys life someone has made you so unhappy that you have to lash out at people that you do not know. I am fully aware that most skinny people don't torture themselves over food. Obese people watch what skinny people eat. The only problem with that is most skinny people don't eat the right foods of amounts either. The just have good genes. That is not an excuse that is just a fact. Know if I had realized that fact before I became obese then I would have done something about it. The fact is that time has passed so ... know to change that fact is very hard. And people like you that have no compassion makes it hard to do something about it. I live in a very large city and can honestly say that I have never meet someone as rude and cold hearted as you and Kobrano are towards me because of my size. I hope that what ever makes you guys different from someone that they do not treat you in the way that you have treated obese people in this. May God Bless you and always let you be like everyone else.

Furry Canary

on Feb 25, 2005

'What is your excuse for being rude to other people just because of the way the look?'

Lostintexas, I apologise if I have inadvertently caused any offence, but I really don't see how my comments can be construed as being rude.

All I said was (and I am repeating myself here, I know) that the vast majority of the Western world's obese people are obese simply because they eat too much of the wrong stuff and don't exercise enough. Yes, genetics plays a part, but I think you attribute to it far too much importance. The fact remains that - with very few exceptions - people who take exercise, eat healthy food and don't overeat don't get fat.

That doesn't mean that I think any less of fat people than I do of everybody else. Nor does it mean that I feel 'malice' towards fat people, have 'no compassion', am 'cold hearted' or any of your other frankly rather silly claims.

'I have never meet someone as rude and cold hearted as you and Kobrano are towards me because of my size.'
And this is just ludicrous. I never directed a single comment at you. Get a grip.

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