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Note: The audio is up for part 2, I apologize for the delay.
In part 1 we discussed the basics of substituting weight loss for healthcare and accommodation. In part 2 we discussed issues with the likelihood of achieving weight loss, even if it was appropriate to insist that higher-weight patients become thinner before accessing care.
Today we’re going to discuss the issues with delaying care for weight loss. Even if the patient is able to lose the required weight (and that is far from a given, as we discussed in part 2, being able to lose the required amount of weight is far from guarnateed. But even if someone is able to manage to lose enough weight, that still takes time, a year to about 1.4 years to get to average weight loss depending on the method.
So we have to start asking questions. How much more advanced is their condition in that time? How will that impact their surgical outcomes? How much more difficult will recovery be if their mobility has been compromised by a year of waiting for a surgery t(hat their condition warranted and that a thin person would have been offered a year ago)? What happens if they start regaining weight while waiting for their procedure to be scheduled? What happens if they try for a year (or more), try extreme methods and still don’t lose enough weight? Then what?
Consider this scenario. A patient has a hip issue that has progressed to the point that they need surgery. They are issued a BMI-based denial of care and a prescription for weight loss drugs. Even if we assume that they can tolerate the drug’s side effects and don’t have any serious adverse events requiring discontinuation, and that they lose the average amount of weight over 72 weeks, and even if that’s considered enough by their provider/facility/insurance to be deemed worthy to receive healthcare, they are spending 72 weeks in pain, their injury gets worse, they lose their mobility which could leads to losing their job, which leads to losing their access to health insurance which prevents them from getting the surgery even if they lose “enough” weight.” Even if they can still get the procedure, in addition to the extended suffering, the increased injury and loss of mobility compromise their ability to recover from the surgery, creating higher complication rates, worse outcomes, and a lowered health-related quality of life (all of which will likely subsequently be blamed on their size.) And this despite evidence that suggests that they could have been helped at their original size and avoided all of that. This example is a composite of a situation that is very real for far too many people.
We also have to ask if the side effects of these weight loss drugs and surgeries (especially combined with the delay in surgical care) are worse than the claimed increased risk of surgery on higher-weight patients (and I say claimed because the claims often ignore evidence that suggests otherwise.)
If it was just medical procedures that were being delayed for weight loss, that would certainly be bad enough, but it’s not. As I mentioned previously, it’s also about substituting weight loss for accommodation in healthcare.
Just to reiterate, healthcare should fit the people who exist, people should not have to change themselves to fit into healthcare. But here again, even if someone believes that sufficient weight loss is likely to occur, that doesn’t help a patient who needs an MRI, surgical procedure, hospital bed, in-patient mental healthcare , skilled nursing, elder care or memory care right now. These are not things that can be put off for a year or more while the patent tries to manipulate their body size.
Make no mistake, higher-weight patients absolutely suffer and die, simply for the lack of accommodation. This is a crisis of ethics and care and it is a solvable problem. In part 4, we’ll look at a case study around accommodation and in part 5 we’ll talk about what can be done.
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More research
The Research Post
More resources
The Resource Post
*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
What a timely post! I just had a major and very complicated surgery. Because of the complexity I needed to surgeons working as a team. One of the team at pre-op asked mentioned my weight and asked me “what are you doing about it?” He told me the surgery would be more difficult and the outcome had a greater risk of complications due to my weight. Okay, so that was bad enough! Then in his post-op report, this surgeon made a point of focusing on my extremely higher BMI and that it significantly increased (3x longer) surgical time. The other surgeon on the team has never mentioned my weight, especially the surgery has nothing to do with my weight, and highlighted specifically that the length of the surgery was due to the significant complexity of the surgery. I am concerned that my insurance will deny adequate reimbursement for the surgery based on my weight!
In the spring of 2024, I consulted an orthopedic surgeon who was highly recommended by my (thin/white/male) neighbor. I bypassed our local docs, including at the state medical school, and went to the doctor, who was at a much-lauded private university-affiliated hospital in Atlanta. I’d had a partial knee replacement 10 years prior; now I needed a total in that knee. Dr. Charming said I needed to lose 25-30 lbs before he would do the surgery because of “increased rate of infection.” Turns out he was in charge of infection control at the hospital. He also said that “you gals never have trouble losing the weight, and it should take only 2-3 months). I’m 66, btw, and typically quite active, though I’d had to curtail those activities because of…you guessed it…knee pain. I went back home, called a local ortho with no such qualms, and had a wonderful experience. I was done with PT before I’d have EVER been able to lose that weight, if I could at all. In retrospect, I should have asked him for studies backing up his claim of increased infection rate, but I just wanted to get the hell out of there.