How timely. I wandered into a discussion among a bunch of women pursuing IVF on my conception forum just yesterday. IVF usually comes with BMI cutoffs. All of them griped how they hadn't lost anything with "diet and exercise", and all of them revealed they were taking weight-loss drugs (one of them without her doctor's knowledge) to get under the cut-off. These are all women who are attempting to get pregnant and who have had issues with fertility; somehow I can't imagine that playing with drugs to alter their size is going to help the situation. And yet here we are. They even shared that their nurses have said it "isn't a big deal, you just have to get under the number" for one weigh-in, and then can gain the weight back. It's just ludicrous.
There are a few states that have laws against size discrimination, aren't there? How do they handle medical issues?
I read some fbook posts yesterday and several people in the thread were suggesting this person (she is having difficulty getting a surgeon to do her knee replacement) go to San Francisco instead of San Jose Kaiser. The thinking is that SF has legislation that makes fat people a protected class. The group was saying it will be more difficult for Kaiser to turn her down in SF because of this protected class legislation. Brilliant idea if it actually works.
This piece is so important. I took note of this sentence "The change needed isn’t just in practitioners, but also in the system in which they work. (I’m working on a piece specifically about this.)" I wanted to make you aware of the issue of bony landmarks, in case you were unaware of it, and to counter this argument for denying needed care to fat patients. Many assessments and procedures, probably especially in areas like orthopedics, but also in basic emergency care, are based on the external identification of bony landmarks as a kind of internal "eyes" to the anatomy of a patient. The best example that I have is the placement of an emergency central line during a code, which relies on finding a particular divet in the clavicle (this would be relevant to any procedure requiring anesthesia, in case the worst happens). Without being able to accurately locate bony landmarks, doctors feel like they're operating blind. A tragic outcome in a past patient similar in size to the patient that sits before them may underpin a physician's reluctance to operate (that's not science, but surgeons are really risk averse--they don't like losing patients, plus it taints their surgical record). Weight loss as a solution to bony landmarks is a huge wild card--who's to say that a percentage loss would make any difference in the identification of landmarks needed for any particular procedure. Bony landmarks are fundamental to physician education. Finding efficacious alternatives for fat patients and tackling patient education head on about the risks, as you note, is critical.
Hospital teams are also preoccupied with the staff or equipment needed for patient movement. Patient body manipulation is a much larger share of hospital and surgical care than people might think. As you so accurately note, a lot of the concern is around cost (the cost of two nurses to hold a patient's leg in a particular position for long periods of time, instead of one; there isn't always machinery that exists to work around some positioning requirements). Some of the concern is around staff safety. As you say, these concerns, emphatically, should not prevent fat patients from receiving needed care. My earnest intention in sharing these concerns is to increase awareness for counterarguments/actions, not to add to fat bias. I hope that is not what I am doing, and if it is, please let me know.
I was diagnosed 6 years ago with a terminal lung disease (a series of conditions) and told I needed a double lung transplant. They will not even refer me to speak to the transplant team until my BMI is below 30. I need to lose around 60 lbs. to get there. I'm 60 years, with limiting lung disease and on prednisone. Yeah, good luck with weight loss, which as we know is hard (if not impossible) to keep off on a good day. I do not know if this is true, but they tell me that 50% of people over 50 years old with a BMI over 30 will die within 1 year of a transplant. Okay, I can understand that organs for transplant are hard to come by. But I guarantee that this requirement has more to do with their stats of great outcomes rather than protecting me or the organ supply. So if I don't lose the weight (which I don't expect to as I refuse to take meds or starve myself or do surgery), then I will die and they will look at me and say "well, she brought this upon herself - she could've just lost the weight." I even asked if I had a turn for the worst and ended up in ICU and needed it NOW, would they make an exception, and they said nope. How is this not medical malpractice? Disgusting.
Common surgeries that I have come across requiring BMI restrictions. kidney transplant, knee replacement, breast reduction, hernia and prostate removal. It is tricky navigating the system and patients are put through extra suffering unnecessarily!
How timely. I wandered into a discussion among a bunch of women pursuing IVF on my conception forum just yesterday. IVF usually comes with BMI cutoffs. All of them griped how they hadn't lost anything with "diet and exercise", and all of them revealed they were taking weight-loss drugs (one of them without her doctor's knowledge) to get under the cut-off. These are all women who are attempting to get pregnant and who have had issues with fertility; somehow I can't imagine that playing with drugs to alter their size is going to help the situation. And yet here we are. They even shared that their nurses have said it "isn't a big deal, you just have to get under the number" for one weigh-in, and then can gain the weight back. It's just ludicrous.
There are a few states that have laws against size discrimination, aren't there? How do they handle medical issues?
would appreciate info on transplant (kidney etc) BMI barriers, if not already planned in part 2
I read some fbook posts yesterday and several people in the thread were suggesting this person (she is having difficulty getting a surgeon to do her knee replacement) go to San Francisco instead of San Jose Kaiser. The thinking is that SF has legislation that makes fat people a protected class. The group was saying it will be more difficult for Kaiser to turn her down in SF because of this protected class legislation. Brilliant idea if it actually works.
This piece is so important. I took note of this sentence "The change needed isn’t just in practitioners, but also in the system in which they work. (I’m working on a piece specifically about this.)" I wanted to make you aware of the issue of bony landmarks, in case you were unaware of it, and to counter this argument for denying needed care to fat patients. Many assessments and procedures, probably especially in areas like orthopedics, but also in basic emergency care, are based on the external identification of bony landmarks as a kind of internal "eyes" to the anatomy of a patient. The best example that I have is the placement of an emergency central line during a code, which relies on finding a particular divet in the clavicle (this would be relevant to any procedure requiring anesthesia, in case the worst happens). Without being able to accurately locate bony landmarks, doctors feel like they're operating blind. A tragic outcome in a past patient similar in size to the patient that sits before them may underpin a physician's reluctance to operate (that's not science, but surgeons are really risk averse--they don't like losing patients, plus it taints their surgical record). Weight loss as a solution to bony landmarks is a huge wild card--who's to say that a percentage loss would make any difference in the identification of landmarks needed for any particular procedure. Bony landmarks are fundamental to physician education. Finding efficacious alternatives for fat patients and tackling patient education head on about the risks, as you note, is critical.
Hospital teams are also preoccupied with the staff or equipment needed for patient movement. Patient body manipulation is a much larger share of hospital and surgical care than people might think. As you so accurately note, a lot of the concern is around cost (the cost of two nurses to hold a patient's leg in a particular position for long periods of time, instead of one; there isn't always machinery that exists to work around some positioning requirements). Some of the concern is around staff safety. As you say, these concerns, emphatically, should not prevent fat patients from receiving needed care. My earnest intention in sharing these concerns is to increase awareness for counterarguments/actions, not to add to fat bias. I hope that is not what I am doing, and if it is, please let me know.
I was diagnosed 6 years ago with a terminal lung disease (a series of conditions) and told I needed a double lung transplant. They will not even refer me to speak to the transplant team until my BMI is below 30. I need to lose around 60 lbs. to get there. I'm 60 years, with limiting lung disease and on prednisone. Yeah, good luck with weight loss, which as we know is hard (if not impossible) to keep off on a good day. I do not know if this is true, but they tell me that 50% of people over 50 years old with a BMI over 30 will die within 1 year of a transplant. Okay, I can understand that organs for transplant are hard to come by. But I guarantee that this requirement has more to do with their stats of great outcomes rather than protecting me or the organ supply. So if I don't lose the weight (which I don't expect to as I refuse to take meds or starve myself or do surgery), then I will die and they will look at me and say "well, she brought this upon herself - she could've just lost the weight." I even asked if I had a turn for the worst and ended up in ICU and needed it NOW, would they make an exception, and they said nope. How is this not medical malpractice? Disgusting.
Common surgeries that I have come across requiring BMI restrictions. kidney transplant, knee replacement, breast reduction, hernia and prostate removal. It is tricky navigating the system and patients are put through extra suffering unnecessarily!