Buy Walking VideosSome Doctors Believe Obese Should Be Refused Treatment
Remember when I said that health insurance companies want to use obesity as a reason to deny insurance coverage?
I was blasted for this supposition and people conjectured that it’s not so hard for obese people to get insurance and once they get it they won’t be denied coverage after paying their premiums. It hasn’t happened yet, but an undercurrent of that sentiment is growing in Great Britain.
The health industry is in a crunch in the United Kingdom and the first thing that they look to to cut costs are the obese. Fortunately, government watchdogs have defended their citizens, but for how long?
I’m not paranoid. I can see where this is leading and if you are overweight, start making healthy choices in your life right now before they decide that it’s legal to discriminate against you because they’ve decided that “it’s your own fault.”
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February 8th, 2006 at 7:37 am
On one hand, quality health care should be a universal right, not a privilege afforded to the rich.
On the other hand, I can understand the frustration felt by doctors who tell their patients that their breathing problems/back problems/knee problems could be helped/cured by losing weight, and they don’t do it. I work with someone who is constantly out on sick leave because of his bad back. He told me his doctor said the only thing that would help is losing weight, but has he done anything about it? Nope.
Finally, I would like a little recognition for my efforts to stay healthy. I work hard to maintain a healthy weight, and good blood pressure and cholesterol. For my car insurance, I was judged to be a low risk and therefore I pay a lower rate than most. Why can’t I do the same for my health insurance?
February 8th, 2006 at 8:02 am
I really love your site. I check it out everyday.
As for the insurance issue, it is insane not to treat people on the basis of obesity. Are they going to also stop treating lung cancer patients who smoke, skin cancer pateints who go tanning, and colon cancer patients who eat poorly ?
This is just blatant discrimination.
February 8th, 2006 at 12:37 pm
If we’re going to set up a medical system where any patient who “causes” their disease or injury is excluded from coverage, then the list of categories of patients has to include more than just the obese. And I’m assuming just for the sake of argument that obesity is truly the “cause” of various medical problems– which medical science has not proven– just as an aside.
1) People who ride motorcycles without a helmet, no coverage if you crash and need intensive care and then decades of rehabilitation for your brain-dead body. This is a clear cause-and-effect relationship between the bad behavior (no helmet) and the problem (brain injury).
2) Drug dealers or customers who are shot, stabbed, or otherwise wounded in the course of a drug transaction. Another clear cause-and-effect.
3) Pregnant women. My pregnancy and delivery cost almost $100,000. I caused my own pregnancy by having (even planning) unprotected sex with my husband. It’s certainly my own fault that I got pregnant, why should society have to pay for it?
Karla
February 8th, 2006 at 1:45 pm
When I read a little further, I found that the 40such percentage of doctors who said surgery should be denied to obese people were speaking specifically to the question of operating for joint problems. I’m not saying it is correct to deny anyone coverage, but the doctors have a point when saying that if a healthier weight is not achieved before surgery for a joint problem then the problem will occur or there will be complications during rehabilitation. In Great Britain there is socialized medicine. Doctors and the bureaucrats behind them must pay attention to the cost of business and if repeat problems will occur. It’s not right, but that’s the way it works.
February 8th, 2006 at 3:01 pm
Indeed, socialized medicine is a business, but as the many commenters pointed out, everyone – including the 1/4 of the British population who are obese – pay the taxes that support the system. I guess the bureaucrats’ better-the-bottom-line business plan is to keep the payment and not bother rendering the services?
And denying specifically knee and hip surgery? This assumes that obesity is the cause of the joint problem, and neglects that the joint problem may well be contributing to the obesity. The assertion that the obese cause their own health problems is a broad generalization, unsupported by science, that does a disservice to patients and health care workers alike.
February 8th, 2006 at 3:30 pm
You are exactly right, Merlin. Just read the post below about removing the panniculus from the former half-ton man. The survey in Britain shows that no one should make generalizations. Patients should be treated as inidviduals–not because of the bottom line.
February 8th, 2006 at 8:14 pm
My sister has psoriasis and her doctor tells her that if she lost weight she would be “cured” but what about the thousands of thin people with psoriasis? How can they be cured? I had very bad acne related to a birth control product and my doctor told me….you guessed it–my acne would clear up if I lost weight. Well, imagine my surprise whenever I run into a thin person with acne! Same thing with carpal tunnel syndrome and diabetes. I don’t have diabetes but I know lots of people who believe that diabetes is self-caused by being overweight and yet I know many people who have adult onset diabetes who are not overweight and weren’t overweight when they got the diabetes–simply had a family history of the disease. I have also met many folks over 300 pounds and in fact once had a patient who weighed 760 pounds who did NOT have diabetes (or psoriasis or carpal tunnel syndrome or acne) Be careful how you judge!
February 9th, 2006 at 12:35 pm
Also, Laura, I’m not sure that everyone can be cured of their obesity by making healthy choices. As someone who had surgery to lose weight (and there are many people out there with an opinion that I took the easy way out) I spent 20 years struggling to lose weight with healthy choices. One problem that kept occurring is that healthy choices is a moving target. I was informed by one physician back in the late 80’s that as long as I kept my fat grams below a certain number, I would lose weight. Can you imagine getting that advice and being among MANY who gained weight on that theory of weight loss? I gained 35 pounds with that theory and yet I lost weight when I abused laxatives. Hmmmm–which is healthier? Neither?
February 9th, 2006 at 8:58 pm
You know what, Laura? You have completely convinced me. There has to be fat acceptance. We should be inclusive. Obesity is a problem, but if it keeps getting villified then help won’t come from the health professionals as it should. The more I read, the more I am convinced.
February 9th, 2006 at 10:08 pm
Hi Laura, what a great site! Nine years ago I was denied work insurance because I was obese. Now I am not working and I am morbidly obese. I still want to try to change. As I get older I want to live longer and that means do or die. After so many years of neglect and bad eating habits I feel overwhelmed and do the yo-yo thing. I joined a support group a couple of months ago, every little pound or there of still counts as a loss and it will all add up. I don’t expect people to accept my fat, just look the other way if I am repulsive to you. I don’t like it either. Thank for the sounding board.
February 10th, 2006 at 9:11 am
I agree that some doctors may be biased against their obese patients, and that they would need to be more rational — maybe more fat acceptant.
I think we have to be careful to understand what is meant by “denying people treatment because they are obese”. The articles Laura linked to lumped together different ideas, without explaining them clearly.
In the “Daily Mail” article, the last paragraph states “It is believed that the risks of operating on obese patients are higher and the treatment may be less effective” * If it is true that the risks of operating on obese patients are higher and/or * If it is true that the treatment may be less effective then these facts should be considered in the risk-benefit analysis the patient and doctors do to decide on the surgery, in the same way that all risk factors are considered for all patients with any conditions that might have an effect on the expected risks and benefits of the surgery.
The danger signal here is “It is believed”. The Daily Mail interviewees are not quoting numbers from actual studies that would support this belief (i.e. the risk of complications is X% higher / the joint replacement fails Y% sooner for obese patients, as reported in , which SOMEONE could evaluate for validity/relevance)
There ARE studies that link obesity to increased risk of certain medical outcomes. If the insurance use these studies without assuring themselves they are properly done, they will likely do a poor job of predicting which procedures on which patient groups are going to give the most benefit for the least risk (and cost). A decision to make obesity a scape goat would be financially irresponsible, among other things. If they deny payment for certain medical procedures to a lower-risk group and allow payment for the same procedures to a higher-risk group, they are not running their business well. And if they lead their customers to believe that they will pay for certain procedures, but then do not, they are likely to lose customers. It is bad for the company if they lose customers who pay in more than the company pays out.
Are the insurance companies doing a lousy job of evaluating risk and benefit? In order to answer that question, we would need enough data, knowledge, and experience to beat them at their own game. I don’t have it. Do we know anyone who CAN DO or HAS DONE this analysis, and make it public?
“Everyone” seems to refer to Medical hazards of obesity. Ann Intern Med 1993;119:655-60 http://www.annals.org/cgi/content/full/119/7Part2/655 . There are also many more recent studies of obesity and specific health outcomes (http://www.jco.org/cgi/content/full/22/3/439, http://www.epi.bris.ac.uk/staff/gdaveysmith/pdf/P538%20Obesity%20and%20overweight%20in%20relation%20to%20disease%20specific.pdf, http://www.findarticles.com/p/articles/mim0CYD/is440/ain12416128, and others)
Then, there is the “moral hazard” argument (http://www.plexusinstitute.org/NewsEvents/showThursdayComplexity_Posts.cfm?id=142) as it relates to the effect of various insurance models on obesity(but not expected health outcomes) (The Economics of Obesity / E-FAN-04-004 Economic Research Service/USDA http://www.ers.usda.gov/publications/efan04004/efan04004g.pdf)
And this article (http://www.managedcaremag.com/archives/0207/0207.obesity.html) states that weight-loss is important for obese patients, but requires (among other things) “the kind of hand-holding that most primary care physicians are not in a position to provide.” Which is a sad state of affairs on its own, but a wholly other topic.
Of course, there are a bunch of popular-press articles pointing to the problems in using BMI to measure overweight and obesity (muscular people also have a hight BMI — do they increase or decrease the “health profile” of the high-BMI population), as well as the problem of lumping people who have lost weight due to advanced disease in with those who have lost weight in a healthy way or maintained their weight over time (the cachexic make it look less healthy to be skinny). I did not immediately find the primary sources for these online.
I think this is one route you could go down to see if you can poke holes in the studies correlating obesity with disease. It is not an easy problem. It could be expensive to run the studies required to figure it all out.
March 4th, 2006 at 4:37 pm
I am in the catergory being discussed and I find the whole thing distasteful and ludicrous. I do not smoke or drink and have tried to get help to sort my weight out from my doctors. One told me to ” peel an orange” when I feel hungry, another basically ignored me. We see so much on the tv for free clinics to help quit smoking but the medical profession do not offer any help at all to help you change your lifestyle – in my case find an exercise that will help. I also have a medical condition that has a by product of causing weight gain but I cannot have the operation to help this until I loose weight. I totally agree with magmen about people’s attitude to the overweight. I would probably feel more at ease in a gym if it wasn’t for the looks. I want to see our health care offer services to us as they do for other so called self inflicted ailments like smoking, drinking and drug abuse.
June 18th, 2007 at 2:17 am
Doctors (and all others) who believe this? I can only hope they will one day know what it’s like to be obese. Their ‘thinking’ is ridiculous. I’m glad there are still REAL doctors out there with compassion. That’s where my money will go.