Posts Tagged obesity
In a nation with 93 million obese people, a few ob-gyn doctors in South Florida now refuse to see otherwise healthy women solely because they are overweight. Fifteen obstetrics-gynecology practices out of 105 polled by the Sun Sentinel said they have set weight cut-offs for new patients starting at 200 pounds or based on measures of obesity — and turn down women who are heavier. Some of the doctors said the main reason was their exam tables or other equipment can’t handle people over a certain weight. But at least six said they were trying to avoid obese patients because they have a higher risk of complications.
While I have not specifically “refused to treat” obese patients, I have in a few cases recommended against surgery or recommended weight loss and re-evaluation later. Than again I am not in primary care and do understand what these OB/GYNs are saying. Obese patients do represent more risk when it comes to surgery and that would of course cover pregnancy and child bearing.
Take into account that insurance-based medicine does not pay anything additional for the risk certain populations pose to the medical community. This is truly uncompensated liability. It is really not surprising that some medical groups have figured it might be smart to cut that risk.
This practice has already been perceived in a discriminatory light by this story’s slant. I’d wager someone has statistically reduced management of the obese to increased risk of complications and litigation and decided to “pull the plug.” It is not discrimination. It is liability containment here.
John Di Saia MD
Originally posted 2011-05-17 09:00:14.
Ultimately, our study shows that obesity significantly increases the odds of experiencing a postoperative complication after undergoing medically indicated, elective breast surgery. Our findings have important implications for plastic surgeons in terms of appropriate patient selection and counseling. These results also may be applicable to surgeons who perform other elective procedures in the obese population.
Earlier this year, I opined on a story involving OB/GYNS in the State of Florida. Specifically these OB/GYNS were refusing as a group to see obese patients claiming they were an increased risk to the practice. I defended the doctors arguing that obese patients constituted an increased liability and limiting liability was basic to business. I repeated this viewpoint on Fox and Friends a few days later (as they were kind of enough to invite me on.) My closing comment was that this was a liability issue and doctors should be allowed to shield themselves as if they were in any other business from uncompensated liability.
Interesting enough is this article in Plastic and Reconstructive Surgery that supports my position quite a bit. It finds that obese patients are a higher risk population to the tune of 11.8 times more risky.
The study article goes on:
Our study demonstrates the need for quality and payment decisions to account for obesity given the increased rate of complications in this select population. Failure to do so can result in discrimination against obese patients when evaluating surgical candidates who may lower quality scores and reimbursements, or inappropriately penalizing physicians who continue to provide care to this population. Instead, surgeons who operate on obese patients should have an adjusted payment for the increased likelihood of complications in this population.
So the author suggests considering obese patients as higher risk and compensating the surgeons for that risk. Well I wonder who suggested that?
John Di Saia MD
The leader of the anti-obesity lawsuit movement is threatening physicians-in-training with lawsuits if they don’t warn obese patients about their excessive weight. George Washington University law professor John Banzhaf III, who has led efforts to sue fast-food chains for contributing to America’s extra weight, is scheduled to speak tomorrow morning at the annual convention for the American Medical Student Association.
A lawyer warns of obesity suits. He is telling medical students that they need to warn their patients of the risks of their obesity. Not long ago we spoke of a doctor being sued for the way he told a patient she was obese.
Is the bottom line no matter what you do, as a doctor you will be sued?
Maybe as a public service we need to write a legal disclaimer for doctor:
Dear potential patient,
At the advice of counsel, we have been urged to let you know that you are fat. Being fat can make you prematurely die. Please do not be offended in any way. This is a public service message.
I am glad that I am not an internist.
John Di Saia MD
Originally posted 2005-10-09 20:10:00.
Reader Laura Comment:
I have to admit that I was surprised to see how much sugar was in this “health” drink. It seems that Vitamin Water actually has 5 teaspoons of sugar per bottle. I have had this water after a workout thinking it was better for me than other drinks. With obesity becoming an epidemic it’s sad to see the hidden sugar in items being pushed as healthy.
It is the second time in little over a year that the firm has been censured for claims about health-giving properties of the drink, which contains 23g of sugar per half-litre bottle. It comes in eight ‘give-health-a-big-kiss’ varieties with names like Spark, Defense and Power-C, in flavours such as ‘apple-kiwi’ and ‘tropical citrus’, even though they do not contain any fruit. The Advertising Standards Authority yesterday ruled that consumers ‘would not expect a “nutritious” drink to have the equivalent of four or five teaspoons of added sugar’. Coca-Cola had argued the sugar level was within the range of a low-calorie drink, while vitamin content, such as a daily dose of vitamin C, meant it could be considered healthy. But the ASA banned it from using the word ‘nutritious’ in future ad campaigns.
Everything is relative. While I wouldn’t call Vitamin Water “healthy, it is less unhealthy than Coca-Cola. On the sugar content, look at these comparables:
7Up = 39 grams
Coca-Cola Classic = 39 grams
Dr Pepper = 40 grams
Minute Maid Orange Soda = 48 grams
Mountain Dew = 46 grams
Pepsi = 41 grams
Sprite = 38 grams
This is compared to a bottle of Vitamin Water at 23 grams. On the subject of obesity, drinks with sugar don’t make us obese unless we drink a ton of them. Quantity management and lack of exercise are the main culprits in the epidemic of obesity.
If you want a “healthy” drink after you work out, I would suggest water or an electrolyte / protein supplement.
John Di Saia MD
Marco Wanderwitz, a conservative member of parliament for the German state of Saxony, said it is unfair and unsustainable for the taxpayer to carry the entire cost of treating obesity-related illnesses in the public health system.
“I think that it would be sensible if those who deliberately lead unhealthy lives would be held financially accountable for that,” Wanderwitz said, according to Reuters.
There is actually an argument here. In a society in which there is socialized medicine, should the taxpayer carry the increased costs of caring for the ills of obesity…high blood pressure, heart attacks, strokes, and the like? These costs can be very high.
There are ways to do this short of straight taxation though…..like limiting the benefits from the socialized health care system on diseases related to obesity and making the obese carry additional insurance at their own expense. Socialized medicine doesn’t mean it is all free folks. Someone has to pay the bill. If ObamaCare stands, we will all see that soon enough.
John Di Saia MD
New York Governor David Paterson has proposed to levy an 18 percent tax on non-diet soft drinks under the guise of combating obesity. Government doesn’t get much more cynical than this.
The Governor of New York may not be just physically handicapped. Drinks are rarely a source of enough calories to cause weight problems…except maybe alcoholic drinks.
Furthermore, the concept of new taxes is based on the primary premise that we currently pay too little. We don’t. And although politicians tend to tie the taxation to some “common good,” collected taxes are almost never ultimately spent on that. In criminal terms this is called a “bait and switch scam.”
Tell your representatives to cut spending or hand them a pink slip. We don’t do this enough.
John Di Saia MD