Are Fat People at Higher Risk?

Ask QuestionsI received an e-mail from reader Emma today who said that she had seen sources that said that obese people were at a higher risk for a number of health conditions and asked  “are you and I at increased risk of that scary list of diseases and health conditions simply because we are overweight/obese?”

In order to understand the context of the research around fat and disease risk, it’s important to look at it from the lens of the current social climate and the confirmation bias that comes with it.  Fear mongering around being fat is a national past time and  researchers design studies from a bias about fat and fat people, and with the goal of proving things about fat and fat people, often funded by companies that profit from their findings. When we examine research around population groups and health we can’t do so without taking into account the stereotypes and prejudices of the culture in which they live.  There’s also the issue that people are much less likely to read a piece like this than a statement like “the disease risks of obesity are well known.”

Let’s begin at the beginning. The statement that fat people are at a higher risk for some health conditions means that these conditions occur more often in fat people based on the current counts, it does not say that fat has been shown to cause these conditions.  There are a number of things that can influence this.

The current counts can be biased.  Imagine that I test brunettes for ingrown toenails early and often, and I never test those with other hair colors. Then I publish a report that just states that brunettes are at a higher risk for ingrown toenails.  If you knew what my research methods were, you would scoff at my findings.  But if you didn’t know, you might accept my conclusion that brunettes are at a higher risk for ingrown toenails, especially if the media picked up my report with headlines such as “Brunettes Ingrown Toenail Costs are Bankrupting the Nation.”

It sounds ridiculous but research about disease prevalence in fat populations that relies on reports of doctor’s diagnoses falls prey to exactly this issue.  We don’t know anything about research until we know everything about their methods.  Without a representative sample that controls for variables that could otherwise be confounding the research can’t even begin to claim to be conclusive. Doctors often test fat patients early and often for these diseases, even in the absence of any symptoms, testing thin people much less often. Some thin people have been misdiagnosed by doctors who believe that that diseases correlated with being fat  aren’t possible for thin people, which leads to incorrect diagnoses for thin people as well.

But let’s say that these diseases do happen more often in fat people.  There are still a number of issues with concluding that all fat people are at a higher risk, or that being fat causes the risk, or what can be done to mitigate it.

First of all, many conditions that cause the health problems have also been shown to cause weight gain – PCOS for example leads to weight gain and insulin resistance.   There is a chicken and egg question that is very often ignored in the rush for headlines.

There is also the issue of access to medical care. In a study by Maroney and Golub called “Nurses’ attitudes toward obese persons and certain ethnic groups found that 31% of nurses said that would rather not treat obese patients, 24% said that obese patients “repulsed them” and 12% said that they prefer not to touch obese patients.  Considering the fact that nurses are responsible for almost all day to day care in hospitalized patients and primary care in many clinics, their personal bigotry can interfere with fat people getting appropriate care (imagine how different your medical care might be if your nurse was actively trying to avoid touching you).  In another study more than half of the 620 primary care doctors questioned described obese patients as “as awkward, unattractive, ugly, and non-compliant”. One-third of the sample further characterized obese patients as “weak-willed, sloppy, and lazy.”

Not only does this bigotry call the standard of care into question, but there are the many many reports from fat people (me included) having their actual health concerns ignored in favor of a diagnosis of fat and a prescription of weight loss.  (My personal experience includes being prescribed weight loss for strep throat, a dislocated shoulder, and a broken toe.)  Which means that fat people don’t get early interventions that may prevent the development of health issues later. Also,  instead of being given interventions specific to health issues as thin people are, fat people are often given a generalized recommendation to change their body size.  In some cases this may actually put them at higher risk for disease.

For example, if a thin person shows elevated blood glucose and a risk for diabetes they will be given lifestyle interventions to affect glucose levels and that risk.  A fat person is much more likely to be told to attempt to become thin.  If they attempt to do so by eating a low calorie, high carbohydrate diet and/or by waiting a long time between meals  it can make their blood glucose numbers worse even if it results in short term weight loss.  In this way the number of health incidences for fat people could actually be increased by following the advice of health care practitioners.

There’s also the issue of not being able to get adequate treatment because of inappropriately sized equipment.  My partner had a knee injury and at a number of different appointment (including for x-rays and MRIs) the office didn’t have any armless chairs and she was told that she would just have to lean against the wall (in one case for almost an hour.)  Everything from too-small blood pressure cuffs to too-small MRIs and CT scans cause us to get inaccurate test result, or preclude our being tested to begin with which can cause issues with early disease prevention and diagnosis, and could raise disease incidence rates.

There is also the fact that fat people live with a tremendous amount of shame, stigma and oppression in our society which have been shown in studies to be correlated with many of the same diseases as being fat.  Further, campaigns that make fat people feel shame and hatred toward our bodies have been phenomenally successful, and in convincing us to hate and be ashamed of our bodies, they have also convinced many fat people that our bodies are unworthy of care.

Add to that the social stigma that comes with being fat and being diagnosed with one of these diseases, and the fat shaming and poor treatment that we can experience from healthcare professionals, and fat people can be much less likely to engage in our own healthcare.  This spills over to many areas of health.  Movement has been shown to have health benefits for many people of all sizes (though there are no guarantees and, of course, there is no obligation to engage in movement.)  Yet stigma can also affect fat people’s ability to engage in movement – everything from the absence of appropriate workout clothing in our sizes, to people who moo at us and even throw eggs at us for simply being fat in public can create barriers to movement for fat people.

Finally, I think it’s important to remember that society in general, and some researchers and doctors and the media in specific, are content to state assumptions about fat people as if they are fact, which means that the research in the field is highly questionable for a number of reasons.

In short, there are no easy answers where this is concerned, and from my perspective there are way more questions than answers.  But even if being fat puts us at greater risk for disease that doesn’t mean that if we could become thin we would reduce our risk (bald men are at a higher risk for heart disease but giving them hair plugs won’t prevent a heart attack.) We still wouldn’t know if the fat causes the disease risk or if the disease risk and the fat are caused by something else or are unrelated.To me the research is clear that, though there are no guarantees or obligations, healthy behaviors are our best chance for a health body regardless of our disease risk.

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Published in: on December 17, 2013 at 8:16 am  Comments (50)  

50 CommentsLeave a comment

  1. I love your posts about studies and research. You clearly know a lot about it and I thank you for pointing out flaws in research methods, because I wouldn’t have a clue where to start.

    Now, I am completely convinced that a lot of the weight studies are just ‘bad science’. But I do actually have a question about the other ones: have you ever come across a fat-positive research where the methods were not completely accurate?

    I mean, if you can deliberately end up with results that imply that fat is bad, I imagine you can also do the opposite. Though I think that if you were trying to prove that fat is not bad, you would get criticised a lot and for that alone you would make sure your methods were flawless. But I just wonder if there are ‘bad apples’ on both sides …

    Again, every study I read (not just weight-related) I take with a grain of salt and it’s definitely not a question against fat-positive research. I’m just really interested in all of this …

  2. At 1:45 yesterday afternoon I had a complete left knee replacement. Following surgery and at the point in which I was admitted to my room I had my husband bring up my walker. My walker is rated for my weight. The first time I needed to get out of bed to use the restroom, I told the nurses aide that the potty chair that was in here would not work for me I needed a larger one. She searched around and brought back a proper sized potty chair. She also brought a walker that was not properly sized. At this point the nurse had arrived and I indicated to her that I needed to use my own walker. She said that it would not be safe for her or for the nurses aide or for me to use my own walker. I explained to her that I needed to use my own walker. She indicated that I needed to use their walker. She placed it in front of me and I looked at the aluminum walker. She then realized that “yes” it was not going to work for me. I indicated again that I needed to use my own walker. She placed it in front of me and I proceeded to stand up very well with my own walker. At that point I believe she realized that I knew what I was talking about and ever since she has listened to me. She has been amazed at my strength and my progress overnight. Thank you Ragen for this particular blog this morning it really hits home.

    • Good for you for standing up for yourself!!!! My experience last summer after my foot surgery was so frustrating. I’d already been figuring out how to get from the bed to the chair and the chair to the toilet. The PT came in and was adamant that I get up again and ‘prove’ I could get from bed to toilet, but wanted me to use crutches. The crutches were not gauged for my weight or height.. totally unsafe.. plus I was completely worn out from just going to the bathroom and having had my bed changed prior to that (making me get into the wheelchair). I was in tears… I finally said for her to leave me alone and come back the next day… We brought my crutches from home and I did fine…. The PT was a tiny thing…. maybe 5 foot tall and easily a third my weight. I was NOT going to be confident with her help, even if I did have the right equipment.

    • Good for you! I love that they did finally listen to you.

    • Awesome job standing up for yourself – literally! That is hard to do even when we are feeling great and on top of our game, nevermind following surgery, wearing a johnny and trying to get to the bathroom. Thank you so much for sharing this!

  3. I was just told that I would have to live with the pain in my knee and it locking up on me and making me fall until I either stop being fat essentially or get old enough for a knee replacement. Good threat that one. Stop being a fatty or live with 30 years of pain and random falling.

    I think that orthopedic surgeons cause high blood pressure. They can add that to the study and choke on it.

    • I’m 33 and was diagnosed with osteoarthritis in both knees this week. I stumbled across info tonight that suggested that taking turmeric would alleviate the pain as well or better than NSAIDs and with fewer side effects. Have you heard of that or tried it? I’m wondering if it’s worth a try.

      • Turmeric (one of the spices in curry powder) is a powerful anti-inflammatory, so it might be worth a try.

        I have osteoarthritis in my knees after a bad car accident a few years ago. I take turmeric and have not noticed a decrease in pain with it, but I do think it’s helpful to my health in general. I don’t take it in large doses, though, and of course, if you are on other medications, you need to check for any interactions.

        I wouldn’t count on it to be a miracle pain-reliever, but it might help. You can try it and see. In reasonable amounts (like what you would get in food), it’s not likely to be harmful.

  4. I had a health scare in the last year during which my primary doctor sent me to a slew of specialists… I found that other than having B12 and D deficiencies, migraines and a “sliding” hiaital hernia, I’m quite healthy (yea!).
    Oral medications are helping with some of the symptoms of the hiaital hernia, but not all. Pressure in my chest and shortness of breath after eating is more than just “discomfort.” On the list of risk factors for hiaital hernias they list obesity. Oh, goody. My health care is currently free (military spouse) but only for the next year (health care is not free for military retirees). I want to have an informed discussion with my primary care giver with regard to surgery. I have not yet found anything that says hiaital hernia’s “heal” themselves, and I would prefer to have the surgery while it’s free if, indeed, surgery is the only way to permanently fix the issue.
    Can you or your lovely readers point me to some studies/research on the topic?
    Love you!

    • I can’t give you specific advice, but I would like to point you in the direction of this procedure for your own research. This is a fairly common surgical procedure for hiatal hernias/GERD – http://en.wikipedia.org/wiki/Nissen_fundoplication

      • Thanks!
        That’s the surgery I have been researching. A friend had it done. It’s not exactly pleasant (liquid diet for a month) but if it fixes things? I’m all for it!
        I tend to be a “surgery last” type of gal, but if hiaital hernias do not readily “heal” themselves, surgery is high on my list.

    • I can only tell you of a good friend who unknowingly had one and ignored the pain. She is at this moment recovering from a very serious surgery. Neither her hiatal hernia nor her surgery were typical. In fact, her hiatal hernia was so bad that it wrapped around her intestines and was pressing on her heart. The doctors said it could have permanently damaged both. It was very serious. She is quite thin, so obesity was not the cause in her case. She can’t eat solid food for three months. If you’re having trouble breathing after eating and feeling pressure in your chest, I would definitely get them to do proper diagnostic tests to see exactly where it is located and what it’s doing. If it’s anything like my friend’s, it could be dangerous. Better safe than sorry.

      • Thank you! I am concerned precisely because there is discomfort and shortness of breath. It’s not horrible right now, but I do not wish it to become horrible and do not plan on ignoring it.

        I am trying to ensure that I am armed with research when I go in. My close friend who had the “typical” surgery had it when she was in her 20’s and in the “normal” BMI category. So I’m well aware that one does not have to be labeled obese to have the issue. What concerns me is that weight is labeled as a risk factor and I want to have an arsenal at hand should “lose weight” talk creep in. If they don’t typically heal themselves, any action other than fixing it shouldn’t even matter.

        I do thank you for giving me your friend’s story. I believe I can use it as an example I to ask for extra diagnostics to figure out the extent of my issue if the test I had done isn’t extensive enough.

      • However, about 1 in 6 people have a hiatus hernia, and mostly they aren’t dangerous, if that’s any reassurance. But there are other conditions with similar symptoms so its important to get checked out by a doctor. In women a very common cause of hiatus hernia (apart from genetics) is pregnancy – in late pregnancy, the pressure can exacerbate a weakness in the diaphragm which causes the hernia. Obesity in women tends to be differently located (lower down on the abdomen) so I’m a little sceptical it has anything to do with it – in men with central obesity, possibly, but hiatus hernia is much more common in women.

  5. Jessica: I am 48 yrs old and currently almost a 35 BMI (not that my BMI is a good indicator of anything–just saying, I am not thin), and I just got my right knee replaced. None of my surgeons or nurses or therapists so much as mentioned my weight, from the diagnosis of advanced osteoarthritis all the way through physical therapy. Maybe they knew that having a working joint would help me maintain the high level of activity I enjoy, maybe the attitude where I live (not the U.S.) is just different. My point is this: the idea that joint replacements are a privilege to be given only to the thin, and that joint problems can be solved ONLY by losing weight, is absolute nonsense. I got my triggering injury on the ski slopes at age 16, and I have been both fat and thin thereafter. Either way, denying a patient an operation that literally restores theability to be active in the first place is not only counterproductive, but cruel. How do we get this common-sense idea across? It’s so frustrating. I wish you the best of luck and don’t believe the haters.

    • Thanks for the comment. I’m going to try a rheumatologist when I get over the “What do you call 200 doctors chained together at the bottom of the Ocean? A Good Start” phase. This is the second orthopedic specialist I have seen and this one was recommended to me by a fat male co-worker, so either this guy is nicer to fat men with “real” problems or my co-worker thinks he deserves this kind of thing.

      I have however decided to mail his office a packet of documentation I know he won’t read. But it will make me feel better. I’m moving from sad to angry.

      My point still stands that I think the torture doctors inflict on the fat to prove we aren’t worth treatment or time is part of the problem for our higher risks. Sobbing in the car before I drive home from the doctor can’t be good for my heart.

      • Yes, yes, and yes. Anti-fat bias is not beneficial to anyone, fat or thin, but boy did that attitude make me dread doctors in the U.S. It HAS to change. I think your idea of sending the documentation is good, even if it seems futile. You never know what will stick. But definitely, boycott any doctor who is biased against you, there’s no care happening there. Again, I hope you get the care you need.

  6. I’m brunette and I have ingrown toenails! *panic*

    • You’re clearly just another statistic. *shakes head sadly*

  7. You make some excellent points, thank you. I’d like to add that while fat is blamed on rising healthcare costs, a more significant cause is the aging population. Since people tend to get heavier as they get older (‘middle aged spread’ or whatever) I wonder if diseases of old age (such as COPD, Type II diabetes, arthritis etc) are being inaccurately blamed purely on weight. For instance, breast cancer, which is predominantly found in the over 60s, is blamed on obesity.

    • Anna – excellent points. It is absolutely true that as we get older as a nation we will *of course* see rising rates of all sorts of age-related diseases/conditions. Important to keep in mind when we are reading the “{insert disease here} is skyrocketing!!1!!” headlines.

  8. Your blogs always make me think, sometimes they make me angry at the way things are, but today this made me cry. Cry in frustration and anger, and sadness.

    I had a bad night last night, throwing up, pain, fever, all the fun of a defective gallbladder. After months of being told eating a low fat diet and losing weight will make me all better I’m done. After having not just my life at risk, but my son’s when I was pregnant with him I’m so angry. If I were thin when all this started I know I would have had my gallbladder removed.

    On the diabetes front, my best friend was recently told she’s pre-diabetic. She’s fat, and instead of being treated like a thin person, her doctor has prescribed weight loss. She’s got other medical issues, including a cyst in her brain that causes dizziness, migraines and other symptoms. Her neurologist told her cutting calories could make her neurological symptoms worse, especially the dizziness. It makes me so angry that her primary is completely disregarding her neurological condition and just diagnosing her as fat.

    • I wonder if they would take action if you asked, “Are you sure my gallbladder isn’t going to rupture?” Because it would force them to consider the consequences of not treating your condition properly. You could also explicitly threaten to sue if it bursts, but some doctors might shut down when that happens and want nothing to do with the patient.

      • Thank you for that, I’m going to the ER today because I’ve been in such horrible pain I can barely move. Maybe saying that will get them to do something instead of loading me up with antinausea meds and pain meds an sending me home.

        • Sending good thoughts and hopes for some decent health care your way, Inkspots!

        • I hope you were able to get decent care, and feel better.

          Best wishes!!

          –A. Elizabeth

  9. As I’ve mentioned before, Mr. Twistie recently spent three nights in the hospital after his doctor diagnosed him as fat and therefore in need of antacids… when in reality he had severe edema and pneumonia.

    Oh, and when he was leaving the hospital and was handed his meds for dealing with the remains of the situation, there was ANOTHER damn bottle of Prilosec we had to pay for in the bag. When he said he still hadn’t opened the first bottle his doctor prescribed because he doesn’t get heartburn, they told him they could remove it, but then he would have to spend another night in the hospital while they redid all the paperwork.

    Besides, a fat guy like him clearly needed Prilosec, anyway, no matter what he said.

    And so it is that several months later we have the Two Most Expensive Bottles of Prilosec in the World sitting atop our fridge gathering dust because we seriously don’t get heartburn.

    Oh, and to add insult to injury, we could have bought the same strength over the counter for less than a quarter of the price, had we actually needed it.

    • I have to take prilosec for the rest of my life because it is the only thing that makes my GERD not murder me in my sleep and I am SO not having surgery if I can just take pills.
      If you ever wanted to get rid of it, I would give it a great home. =P

      • I had a moderate degree of GERD. I found that acupuncture made a world of difference to the GERD. I’m rarely bothered by foods now. Might be something you could consider if you are open to that. Not a miracle cure but might help lessen the severity.

  10. Since I have gained weight on my stomach, I recently looked online to see what the causes of that were. The few articles I found indicated too much estrogen (getting older), not enough testosterone (getting older) and maybe too much cortisol (life stress).

    They did encourage trying to lose weight, but it seems to me that those causes are a part of life. Moving and eating a balanced diet will help with the diseases associated with belly fat (which are also associated with growing older) so the losing weight seemed rather moot.

    I think if we could rid our culture of the obsession with youth and thinness and some crazy idea of health, we could all enjoy life with all its inherent ups and downs a heck of a lot more.

  11. One thing that I see no-one touched on is proper medication dosage. Recently had dental work. Got pain medicine. It was an amount the dentist gives everybody, from the 110lb person to 300plus. So, of course THIS one needs a refill! I’m sure I didn’t need that extra stress.

    • Why do they calibrate medicine by weight for animals, but not humans? It doesn’t make any sense.

    • Well, NOW you’re just adding to the statistic stress. Clearly your situation indicates that fat people are undisciplined and will become addicted to pain meds faster because we want the easy way out. //sarcasm.

    • One nurse practitioner told me that medication dose has to do with the activity of the liver and not body weight. I’ve never given it much thought or looked into it to see if that’s true.

      • It depends on the drug. Anaesthetics are very much given according to body weight, for instance, and other drugs have a range of doses – antidepressants, for instance, which are more dependent on the patient’s symptoms than their weight.

        • Yes, it very much depends on the drug and how it works.

          For example, some antibiotics definitely *should* be prescribed in weight-based dosing, while others work differently and don’t need to be prescribed with weight-based dosing (lipophilic vs. lipophobic).

          I’ve written about the topic here:

          http://wellroundedmama.blogspot.com/2010/08/antibiotic-underdosing-in-obesity.html

          http://www.wellroundedmama.blogspot.com/2012/08/lowering-risk-for-surgical-site.html

          Some blood thinners should have weight-based dosing, and chemotherapy is another important area where weight-based dosing is important but often ignored, leading to poorer outcomes among people of size.

          OTOH, there are other drugs where weight-based dosing is not needed at all. It all depends on the drug.

          • The reason I’ve ALWAYS been told I need to be weighed at every doc. appt (even for a flu shot) has been just in case an Rx is ordered. I’m wondering if thats just the first thing off the top of their heads……?

  12. You know here’s another angle that I think is important: even if we new for 1000% certain that someone’s actual adiposity (and not one of the confounders that Ragen mentioned) is what is causing their illness, **we don’t know how to make fat people safely and permanently thin, and we don’t know if former-fat-now-thin-people will have the same outcomes as always-thin-people**

    So recommending weight loss would still not be a great idea to help these people recover. But interventions/treatments routinely offered to thinner people just might!

  13. The other thing that we don’t know is how many doctors do genetic testing on their obese patients to determine whether they were born with a gene mutation that predisposes them to getting a specific disease. When thin, non-smokers get cancer, it is assumed that genetics must have been the cause. However, when an obese person gets cancer, it is automatically decided — without doing genetic testing — that their obesity caused the cancer. Why is that? After all, we’re all born human. Obese people are not a separate species. We are humans prone to the same genetic mutations as “thin” humans. Yet genetics is “rarely” considered as a cause for cancer or “many” other diseases in obese people. For example, a survey in Sweden (I think) claimed that fibromyalgia was more prevalent among obese women and therefore obesity must be the cause of fibromyalgia. Did they ever consider that fibromyalgia patients often become obese “after” getting fibromyalgia, because the fibromyalgia causes them to become more sedentary due to the tremendous, widespread pain and chronic, debilitating fatigue they suffer every day as a result of this condition? Having fibromyalgia is a real balancing act. If you do too much physical activity, you are in excruciating, incapacitating pain for days afterward and often miss work because of it. However, if you do too little, then you are in a constant state of pain. I was very active until I got fibromyalgia, but between my physical limitations and my very sedentary job, long work hours and bad eating habits (fast food), I eventually became obese. But the obesity came “after” I developed fibromyalgia, not before. I’m sure the same is true for a number of obese patients and the diseases they have.

    • I have read articles where research seems to indicate that fibromyalgia has to do with nerves firing too much. I really don’t see how that is connected to weight.

      That Swedish study does seem sloppy. It seems like lots of fat research is sloppy and that annoys me.

      Not just because it is negatively affecting fat people, which is very bad, but because I hate sloppy science. Science has enough issues without people doing it badly.

      • Yes. They’ve done MRIs of people with and without fibromyalgia, and they discovered that there’s a problem with cerebral blood flow in the part of the brain that sends signals to the central nervous system. Also, people with fibromyalgia have too much of a certain chemical in the brain and too little of another chemical. The MRIs also revealed that when certain tender points associated with fibromyalgia were pressed on, areas of the brain lit up; whereas when those same points were pressed in the average person, nothing happened on the MRI. For years doctors believed that fibromyalgia was all in the head. Turns out it is, but it’s physical “not” psychological.

        • That’s interesting; I thought it was a peripheral nerve disease. Thanks for the info.

          • My consultant believes that fibromyalgia is actually a group of conditions, not one, and is often secondary to other joint conditions. In my case, I have Ehlers-Danlos Syndrome, but others in my local support group have lupus, rheumatoid arthritis and crohns disease, as well as fibro. Fibro, like IBS, seems to be a condition in which the receptors in the brain are misinterpreting nerve signals from the body, which technically makes them neurological conditions (this is incidentally why lots of fibro patients also have IBS, and conditions like neuropathy and chronic pain syndrome).

            Of course, this has nothing whatsoever to do with how much you weigh, but a survey estimated something like 60% of fibro sufferers also had connective tissue problems like EDS and other forms of hypermobility. In EDS, the tissues are stretchier than they should be, which means your stomach stretches more than it should and doesn’t signal to your brain when its full (whilst other times it signals too early, leading to nausea). So there’s a correlation between fibro, ‘obesity’ and joint problems, and its not because being fat causes fibro!

  14. On a somewhat related matter: It appears that insurance companies are still discriminating against obese people in 2014 — even under the Affordable Care Act. I just applied for insurance for 2014 with one of the major insurers and when reading the Limitations and Exclusions (things not covered) section of the plan, I came across this exclusion — “Any treatment for obesity, regardless of any potential benefits for co-morbid conditions, including but not limited to: … (b.) Services or procedures for the purpose of treating a sickness or bodily injury caused by, complicated by, or exacerbated by the obesity; …” Basically, the way this is worded, the insurance company could refuse to cover just about any disease, condition or injury that an obese person gets if it is deemed to be caused by, complicated by, or exacerbated by that person’s obesity. For example, heart disease, vascular disease, arthritis, fibromyalgia, cancer, diabetes, sleep apnea, lung disease, gallbladder disease/gallstones, hernias, broken or fractured bones, pulled ligaments, flat feet, and a host of other diseases and conditions. Last year, the American Medical Association (AMA) “officially recognized obesity as a chronic disease,” which means that is also subject to being a pre-existing condition. Under the Affordable Care Act, insurers “must” cover any services or treatments provided to obese people whether obesity has caused, complicated or exacerbated their disease/condition or not, just as they do for people with diseases or conditions such as lupus, juvenile diabetes, rheumatoid arthritis, etc. who are prone to getting other diseases and conditions as a complication of their primary disease.

    • I hadn’t heard of this happening at all. Could you possibly send me a scanned copy of the exclusions (with your personal information redacted of course) and the contact info for the plan administrators? or a link if it’s available online?
      My e-mail is ragen at danceswithfat dot org. Thanks!

      ~Ragen

    • That’s frightening. I saw that my plan does not cover treatment specifically for obesity (like weight loss surgery), but I did not see anything about not treating “co-morbidities.” In fact the only required health/physical descriptor questions on my application were smoker/non-smoker status and age. They also had optional questions about physical disabilities, but I think this is to determine eligibility for Medicaid.

  15. Hi Regan,

    I really love your blog and your posts on medical care and Obesity. I just recently found out I’m pregnant which is happy news for me and my husband. I scheduled my first prenatal visit and unfortunately my Kaiser plan requires me to see a provider I’m not happy about before I can see the doctor of my choice. This provider has ordered a thyroid and diabetes test for me to do before I have even been in her office. I know this is because my most recent weigh in of 200 pounds or so. I also know that it is not routine to order these tests at 6 weeks for most people. I have no risk factors and low blood pressure and think of myself as very healthy. I am torn between just doing these tests or going in and explaining why this is not good care. The doctor has not even seen me yet and is profiling me on my weight already. Sorry for the lengthy/ personal post. I just wanted to vent a bit since I feel like weight bias is twisting such happy news into something shaming and stressful.

    -Jenny

    • Hi Jenny,

      Congratulations!!!! I’m so sorry that you have to deal with this. It’s completely your choice whether to take the tests or refuse them and of course either choice is valid. You can also take the tests and use that as a platform to have a discussion about your expectations for care. If you haven’t found it already, I would suggest checking out http://wellroundedmama.blogspot.com/

      If there is anything that I can do to support you just let me know, my e-mail is ragen at danceswithfat dot org!

      Congratulations!!!!

      ~Ragen

      ________________________________

  16. I’ve recently been declared cancer-free (spent a year fighting breast cancer — surgeries, chemo rad, blah, blah, blah), but instead of congratulating me, I’ve had a number of people say things such as, “Now you can start over and take better care of yourself.” Or, “Now, you’ve got a second chance.”

    I’m so glad I found your blog. I’ll be reading you regularly from now on.

    • Wow. Some people are beyond clueless.

      I’m glad you are cancer-free and I hope the next year is much better.


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