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Gideon MacLeish

Join Date 06/2004

Too FAT for Surgery?!?

Now, don't get me wrong. I struggle with my weight, so this is kinda personal, but something has really been irking me lately.

I have a friend who has had recurrent problems with his gallbladder. Put simply, it needs to be removed. The problem? The doctors won't perform the surgery because he is too large.

This man has always been a large man, even in his youth. While his eating habits are less than optimal, if you know anything about health, you would understand why diabetes and Congestive Heart Failure happen to be limiting factors in his quest to lose weight. But the larger issue here is the blatant misunderstanding of the Hippocratic Oath.

Until some 20-30 years ago, many doctors refused to perform surgeries or tests on the older population, reasoning that their health problems were simply "old age". When that mindset changed, guess what? So did the average life expectancy. Now we reach a point where I'm inclined to ask if SOME of the shortened life expectancy among the obese isn't because of doctors who refuse to work on patients, reasoning that all their health problems are due to them being "too fat".

I'm hoping this mindset changes as well.

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Zoomba

Join Date 11/2002

+114

I had a friend who recently had his appendix removed. He's a *very* large guy and due to his weight they were unable to close the incision all the way. The internal lining was stitched up but there had to be a gaping hole through his layers of fat. It never healed up fully and due in part to his own stupiditiy he ruptured the inner stitch. There is nothing they can do for him due to his size.

Sometimes they have to weigh the benefit of the surgery against the possible complications arising from the weight issue. If it had been anything other than the appendix, the cost would have outweighed the benefit in this case.

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Actually, Gideon, as someone who has operated on very obese people I can tell you that yes, you can simply be too fat for a non-emergent surgery like gall-bladder (assuming he isn't in acute cholangitis).

The surgical and post surgical complications associated with morbid obesity are real and they are very severe. Zoomba already mentioned the difficulty with closure of the wound. Increased abdominal girth also leads to increased wound infections as there is just so much tissue exposed and open when trying to do the surgery. Too fat and you cannot do it laparoscopically as the scopes simply are not long enough to get in and get what they need to. So it must be an open surgery. Because of increased size the operation is going to take longer (again increasing wound infection rate). Longer on the table and increased weight means an increased likelihood of ulcers formed during surgery, no matter how well you pad them. This also leads to increased incidence of nerve injury. I have had my arms up to my elbows in a body because of their weight and it isn't a pretty or good situation. The surgery becomes more complicated because you have so much mass to move out of the way. This decreases visualization of the target organs, increasing surgical error.

I haven't even begun to talk about the complications of anesthesia. Fact: The fatter you are the more difficult you are to intubate, and once intubated the more difficult the maintaining the airway. IV access can be next to impossible without putting in a central line, so you now have to stick the tubing into major vessels simply to be able to have IV access. Throw CHF into the picture and you have a patient who will not have good blood oxygenation if they are flat or head down (and you MUST be head down to get to the gallbladder in a larger patient especially). This leads to increased ventilation pressures to maintain oxygenation, which can lead to lung problems down the road (in lungs that are already overloaded due to a failing heart). And, to be honest, I am just skimming the top of the issue here.

So I am going to have to pretty vehemently disagree. Too fat for surgery isn't an excuse, it is a very legitimate reason to not operate.

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Being an obese person myself I fully understand what you are saying. I have kidney stones which the doctors will do nothing to until they try to pass and get stuck. With America becoming larger I don't understand why there is not more medical advancements in treating the obese. And if doctors will not treat the obese then why will not the insurance co. pay for weight loss. If you are obese you are just out there all alone.

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Too fat for surgery isn't an excuse, it is a very legitimate reason

I'm going to agree with Dr Dev. it's not a case of being 'fat-ist', it's that it's simply dangerous for the patient.

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With America becoming larger I don't understand why there is not more medical advancements in treating the obese. And if doctors will not treat the obese then why will not the insurance co. pay for weight loss. If you are obese you are just out there all alone.

I really hate to say this (and I say this as a person who could stand to lose a few pounds myself), but there just aren't that many more medical advancements to be made. Think about this, with our country's problem with obesity, coupled with our obsession with being thin, obesity is where the money is. People so want to find the magic bullet, they know that the second they do that is it: millionaires, billionaires even. Folks are trying to find it more frantically than you can imagine.

It all boils down to more out than in. Every trick, every treatment, every diet book, every exercise fad will all fail unless we burn more calories than we eat. Yes, genetics play a role, as do other physical conditions. But there simply won't be a solution that is more effective than more out than in.

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BlueDev, I have a confession:

I gave you an insightful for what you said above, as I was going to post something like it but knew you'd be more informed than I.

Anyway, so I decided that if I were to give you an insightful, at least I could understand what it does to a person's score. So I opened up the ratings page and it said you had 19039. So I clicked "insightful," waited a minute, and then refreshed the scores. Your score went DOWN two points after I rated you.

Er, should I troll you to get it back up? Anyway, a good deed gone bad, eh? I don't know what to do and I feel really bad.

-A.

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Er, should I troll you to get it back up? Anyway, a good deed gone bad, eh? I don't know what to do and I feel really bad.

Sure, troll me and see what happens. I appreciate the insightful, and that means a lot more than the points, so think nothing of it.

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troll me and see what happens.

Yeah, your score went up three points, from 19042 to 19045 when I trolled you. In the end, a net gain of one measly little point.

Er, so, should we, like, tell someone? Or maybe the admins think I give bad ratings, so they're playing a cruel yet also very cool trick on me? (Come to think of it, I know a lot of people I'd love to give "insightfuls" to right now, heh heh.)

-A.

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When I went in for surgery to get my wisdom teeth taken out...I first went in for a...whatever its called....not observation...but more of a consulatation...all the fine print and stuff. I was told at the time that they couldnt put me completly under because of my weight.

This was because since im a big dude (330)...with the drugs in me and all....I might not be able to expand and contract my lungs under the anestheeethesrerasrhoihwwxisia. Then on the day of the surgery...the doc told me he was putting me under and said that it was no problem...imagine the panic as I didnt know who to believe. Anywho...I was out in 45 minutes and dont remember a thing...so whatever they did...it worked.

Nobody wants to be fat...its just a result of not what we eat...but how much. I mean...if we could be full...quickly after eating and stay full...we wouldnt be as big as we are. But since it takes so long to feel full...adn with the constant munchies we get...thats what is killing us....litteraly.

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'I don't understand why there is not more medical advancements in treating the obese.'
Just as, for example, a weak or damaged heart may well affect the risk of conducting an operation, so too may obesity in the patient. Obesity - like kidney stones or appendicitis - is a medical condition, and needs to be taken into account. However, it can be conquered in a variety of ways. There are plenty of non-medical procedures; eg. one can improve one's diet, reduce one's food intake, get more exercise. There are medical techniques too; eg. drugs to suppress one's appetite. And if all else fails, there are surgical techniques, such as liposuction and stomach stapling. So where exactly is the shortfall?

'And if doctors will not treat the obese then why will not the insurance co. pay for weight loss.'
As a number of respondents have indicated above, it's not so much 'won't' as 'can't' or 'shouldn't'. Given the degree of coverage in the media that this subject commands, it is extremely hard to imagine that the vast majority of obese people were not fully aware of the expected outcomes of the very behaviours that led them to become obese in the first place. Similarly, this same majority must surely know what it is they need to do in order to address the condition. Consequently, while I really don't mean to sound unsympathetic here, why should the insurance companies carry the can?

Surely the saddest irony in all this is that a significant number of the conditions requiring surgery that arise in chronically obese people are at least partially due to them being obese in the first place. Still, the positive spin on this is that by addressing one's obesity, there is a good chance that one will go some way towards alleviating one's other ailments too!

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Age you can't change; weight you can. For example, as I type, I'm slowly eating sunflower seeds - in the shell - shell and all. This is a lot fewer calories than chocolate, etc. When I get really desperate to lose weight, I crack open the shells, throw away the sunflower kernels and chew the shells. The act of chewing is satisfying.

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Draginol

Join Date 03/2001

+137

Perhaps if people stopped filing so many lawsuits you would have doctors willing to take more risks.

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Age you can't change; weight you can.

Assuming you are a normal, healthy individual, yes. There are, however, occasions when limiting factors arise. While this doesn't necessarily mean the person CAN'T lose weight, it can make it greatly unlikely. I can tell you from personal experience that not every man can aspire to putting back on a pair of size 32 jeans.

Perhaps if people stopped filing so many lawsuits you would have doctors willing to take more risks.

I'd be an idiot to disagree with you there, Drag.

Blue and Zoomba: thanks for weighing in. It does shed an interesting perspective on the matter. I do find it interesting, however, as lostintexas points out, that the insurance companies won't pay for weight loss programs. It is, I believe, one of the reasons our medical costs are skyrocketing; we don't want to invest enough in PREVENTION, rather than treatment (although I'd be surprised to find a doctor that disagreed.)

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It is, I believe, one of the reasons our medical costs are skyrocketing; we don't want to invest enough in PREVENTION, rather than treatment (although I'd be surprised to find a doctor that disagreed.)

Sadly that is a universal problem. There are very few truly preventive measures that insurance companies go for. You really have to be able to show something beyond solid. You have to hit them over the head with the notion that preventive costs will be lower in the long run (like they were able to do with Pap smears). Too often, money talks.

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You have to hit them over the head with the notion that preventive costs will be lower in the long run (like they were able to do with Pap smears). Too often, money talks.

And, from the consumer perspective, so do results:

1st in per capita health care spending

17th in life expectancy

(I can't remember where we fall on infant mortality, but it isn't pretty!)

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(I can't remember where we fall on infant mortality, but it isn't pretty!)

I don't remember the exact number but it is about 24th in the world.

But I can see where it gets tough. I mean, what do you want insurance companies to pay for? Should they buy every policy holder a gym membership? Or just home fitness equipment? Or does it only pay for those who get a "prescription" for it?

It becomes a difficult thing to pin down. Whereas with medical procedures that insurance pays for there is a quantifiable, documentable result, that isn't necessarily true for obesity prevention. Blue Cross and Blue Shield of NC knows that they are paying my wife's doctors to provide quantifiable prenatal care with the end result of delivering a baby. When they get the bill for the appointment they pay it because they know what happened.

But what about diet and exercise? Do we send the insurance company a claim after we have lost #X pounds? Do they reimburse us at the end of the month for our gym fee? How do they know we actually used it? Do they pay part of my grocery bill if I can demonstrate increased purchases of fresh fruits/vegetables and whole grains?

When talking about obesity prevention it becomes really difficult to measure and ask an insurance company to pay for some of it. Trust me, I hate insurance just as much as the next person (and more than most probably), but I can see how paying for obesity prevention becomes a very risky proposition.

But some companies do offer some help for it. BCBS has little prizes you can earn (and they actually get decent the more you exercise). IHC would refund you up to $500 or so at the end of the year if you exercised regularly and participated in health activities. I don't know how we can expect them to really do more than that.

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Blue Dev
It all boils down to more out than in. Every trick, every treatment, every diet book, every exercise fad will all fail unless we burn more calories than we eat. Yes, genetics play a role, as do other physical conditions. But there simply won't be a solution that is more effective than more out than in.

Being doctor you can understand the hardship of dieting. I have tried many different kinds of diets. I know all the right things to do but it is also a mind set that is hard to change. There is many large people in my family not just close family but family that I have never been around. So yes genetics play a very big part. I never really understood how easy it was to get really large when I was growing up. So here I am 5'6" and 369.9 pounds later. I try to do something about it everyday. Two step forward one step back, three steps forward, ... all I really could do is teach my children that they have genes that can make it easy for them to get really heavy fast. Both my children really watch themselves and if they start to get heavier than they want they start dieting. I just wish that I could have know that fact before I got so heavy. I am not saying that it isn't my fault that I am the weight I am. I am just saying that it is not as simple as people who just have a little to loss thank it is. Food becomes a drug just like cigarettes,pot, and any other thing that you depend on to make you feel better. If you have any advice I would gladly take it. Thank you for all your insight.

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lostintexas: No, it isn't necesarily easy. I know, trust me. And even though I may have sounded harsh in my response, I have nothing but compassion for those who are overweight. Really. I also know how hard dieting is, but if I may, I would like to make one suggestion.

Dieting is important. But never, ever discount the importance of exercise. I think exercise is more important than the dieting. Of course, you can totally ruin any exercise if you eat terrible. But the effects of exercise will be more far reaching than those of dieting. Not only does it increase the amount of calories you are consuming, but it also incerases lean body mass, which increases resting metabolism. Cardio coupled with resistance (strenght/weights) is an amazing combination. Often people stress one over the other, but in terms of general fitness you need both. Cardio increases your heart's strength and the lung's ability to deliver oxygen to the blood, making everything run more efficiently. But resistance builds up that muscle mass that will make your body overall more efficient at burning fat and calories.

Not meaning to preach, I just always hope people will realize that diet and exercise are good. If you are only going to do one, do the exercise first, as it will do more for you.

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Like it or not, but its only going to get worse for fat people. I recommend you watch the DVD/Movie called "Supersize Me".. It really puts the statistics of our every increasinly fat population in perspective. The most ironic thing about it, is that its all preventable, and the only major contributing factor in all of it is that people just don't know when to stop eating.

Your friends very causes for his problems, are his weight, so he should treat the underlying problem, which is that he is fat. You can lose a large amount of weight quite quickly, and safely, if you follow a few general rules. Instead of surgery, this guy should fix whats probably causing ALL of his problems, his fat. People just don't understand how dibilitating being fat is, it ruins your body.

I struggled with my weight once, weighing nearly 300lbs (i'm 6'4" though and have a good muscle build and large bones). I got sick of it, saw the health problems, and solved the problem.. Since then, i've kept "Most" of it off. But it usually starts to creep up when I eat fast food and get careless about my lifestyle. For example, the last job I had, I gained 15lbs during the course of 3 months on the job. Primarily due to the horrible lunches everyone eats at that workplace, and the lack of any movement other than your mouse hand during the course of the workday. Its my fault really, I got careless, I let the environment effect my habits, health and eating patterns. My fault.

Since leaving, i've lost about 50% of the weight I gained, and i'm on my own personal modified Atkins diet (which helped me lose 300lbs before), which basically sheds 20lbs per month off my frame. It takes work, it takes devotion, and it takes constant reinforcement and willpower.. Unfortuntely, its become obvious that most Americans are either too lazy to do something about it, or just don't give a damn.

But anyone thats fat, should be ready for a general public malice like your friend is recieving. People are just tired of fat lazy people that eat too much and don't exercise. Can you blame them?

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Kobrano
But anyone that’s fat, should be ready for a general public malice like your friend is receiving. People are just tired of fat lazy people that eat too much and don't exercise. Can you blame them?

I am sorry but not everyone acts like a jerk. I am a large person and find that most everyone I meet is kind. It is not fun or easy to be large. But just because someone is large doesn't mean that they are lazy or even that they eat to much. There is allot of reason to be over weight.

Blue Dev

Thank you for your advice! I didn't feel that you was being to harsh. You was just telling the truth. Thank you again. With my husbands help I am going to try again really hard. There is very little exercise I am phys. able to do right know. I will try moving more and walking some everyday. Again I can't thank you enough!

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There is very little exercise I am phys. able to do right know. I will try moving more and walking some everyday

My recommendation is to start with a little, just walking some. Don't push it too hard, but also don't be afraid to make it hurt a bit. The more often and regular you do it, the better it gets, quickly. Just don't let being sore stop you from giving it a go again. And try some resistance training, even with household items like cans of soup/fruit/vegetables or water bottles. Best of luck!

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'I do find it interesting, however, as lostintexas points out, that the insurance companies won't pay for weight loss programs. It is, I believe, one of the reasons our medical costs are skyrocketing; we don't want to invest enough in PREVENTION, rather than treatment (although I'd be surprised to find a doctor that disagreed.)'

Before people begin to suffer the ill-effects of obesity via the onset of a variety of other medical conditions, obesity itself is a medical condition. Even weight loss programs are therefore not truly preventive medicine, but reactive approaches.

I can't speak for the USA, but Australia spends a substantial amount of money educating people on the benefits of adopting a healthy diet and exercise regime. If health insurance costs rocket because some people stubbornly elect to ignore such advice and subsequently require bailing out via expensive medical procedures / ongoing healthcare, don't those who follow such advice have a right to feel hard done by? Given this level of education, surely there comes a point - exactly as with such 'ills' as drinking alcohol and smoking cigarettes - beyond which, if - through ignoring common guidelines in respect of diet and exercise - individuals becomes obese, this might be viewed as ... (gulp) ... their OWN responsibility?

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But what about diet and exercise? Do we send the insurance company a claim after we have lost #X pounds? Do they reimburse us at the end of the month for our gym fee? How do they know we actually used it? Do they pay part of my grocery bill if I can demonstrate increased purchases of fresh fruits/vegetables and whole grains?

Actually, I once had an insurance company that was on the right track, at least. They would reimburse $50 per year of a gym membership (not a large percentage, but large enough to make it an incentive) to policyholders. I don't know what the answer is, but surely we could at least try to figure one out.

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'I do find it interesting, however, as lostintexas points out, that the insurance companies won't pay for weight loss programs. It is, I believe, one of the reasons our medical costs are skyrocketing; we don't want to invest enough in PREVENTION, rather than treatment (although I'd be surprised to find a doctor that disagreed.)'Before people begin to suffer the ill-effects of obesity via the onset of a variety of other medical conditions, obesity itself is a medical condition. Even weight loss programs are therefore not truly preventive medicine, but reactive approaches.I can't speak for the USA, but Australia spends a substantial amount of money educating people on the benefits of adopting a healthy diet and exercise regime. If health insurance costs rocket because some people stubbornly elect to ignore such advice and subsequently require bailing out via expensive medical procedures / ongoing healthcare, don't those who follow such advice have a right to feel hard done by? Given this level of education, surely there comes a point - exactly as with such 'ills' as drinking alcohol and smoking cigarettes - beyond which, if - through ignoring common guidelines in respect of diet and exercise - individuals becomes obese, this might be viewed as ... (gulp) ... their OWN responsibility?

Well said! That about sums it all up. American people have a general inability to accept responsibility for their own actions. This entire Obesity issue is a prime example of it.. MY medical insurance shouldn't go up because people decide to ignore all common sense and get fat. We have a serious problem in this country, where 60% of all people are obese by definition of obese. Its not fair that everyone that has common sense, and elects to live healthy lifestyles, has to suffer because the masses are ignorant, is it?

Sorry, I have no sympathy for obese people. My best friend is obese, and he comes to my lan parties, and sucks down 3 2Liters of Soda and pushes endless candy bars into his fat face, and frankly, its disgusting. I tell him that right to his face, and he doesn't seem to care.. Hes only 28, and has the health problems of a 60 year old. He doesn't seem to care. Thats been my take on the majority of obese people, they just don't care. These "Movements" they try to start that attempt to prove to the world they are "happy" being obese are pathetic. (you know like those Happy2BeFat organizations and crap) Grrr..

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Zoomba

Join Date 11/2002

+114

My issue with the health insurance company bit is why do they have to provide us monetary incentives to do what we should be doing on our own anyway? Why should they pick up the tab to try and offset our bad McDonalds habits? I'm about 20lbs overweight (I'm a 5' 9" male, I should be around 150, I'm about 170-175) and it's entirely my fault. But the thing is I'm the only one who can fix it... and I can do it for free. Actually I can save some money in the process on my own. I get a $3 veggie sub from Subway instead of a $5 Value Meal at McDs or Burger King. I can get a great amount of exercise in for the cost of a pair of running shoes instead of getting a gym membership. Yes, the gym will give me a more complete workout and probably speed up the process, but if money is an issue, this is the way to go.

Everyone with able legs can walk a bit more every day, everyone can cut down on calories, or make sure you're consuming better calories and less fat etc. It's a choice (and a sacrifice) one must make. The idea that weight loss is expensive or impossible to attain doesn't want to try.

Just through better eating and a little bit more movement, I've dropped about 5lbs since Christmas. Friends and family have commented that I've lost some weight. Didn't cost me anything but a little bit of energy and time.

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