Tag Archives: surgery

New Study Suggests Obesity Doesn’t Make Joint Surgery Less Safe

BadKnees

Another media appearance for the bad knees.

I recently came across a recently published study that was published in The Journal of Arthroplasty regarding overweight and obese patients and joint surgery.  In particular, the study evaluates data from 900 hip surgeries and over 1,500 knee surgeries.  The data was evaluated in terms of weight, BMI, how often blood transfusions were necessary, complications from infections, and time spent under the knife (how long the surgeries took).

The study results were “counterintuitive” to many–meaning it failed to confirm some of their deeply held biases about hip and knee surgery and people who are fat.  The concern was that surgery on fat people would take longer than surgery conducted on thin people, and thus would increase the probability that a blood transfusion would be required.  This is of deep concern to doctors because blood transfusions can cause serious complications–with as many as 1 in 5 causing some sort of negative effect.

However, this assumption was not borne out by the research.  In fact, overweight and obese patients were less likely to require a transfusion than their thinner counterparts.  During hip surgery, on average 35 percent of the “normal weight’ patients required a transfusion compared to 28 percent of the “overweight”  patients and 22 percent of the “obese” patients.  During knee surgery, 17 percent of the “normal weight” patients needed transfusions compared to 11 percent of the “overweight” patients and 8 percent of the “obese” patients.

Furthermore, the study indicates that their research turned up no evidence that overweight or obese patients spend any more time under the knife than their thinner counterparts.  However, a slight uptick in complications from infection was noted for those in the overweight and obese categories.

A recent article in HealthDay turns to a surgeon from Los Angeles for a quote.  Dr. Alex Miric, an orthopaedic surgeon with Kaiser Permanente in Los Angeles stated:

“I agree that the results are counterintuitive,” Miric said. But he also agreed that conclusions “would need to be replicated with more surgeons and a larger and more current patient population before such a finding would gain traction in the orthopaedic community.”

Hmmm.  While surgeries for fat people might not take longer or be more dangerous than those for thin people, it seems pretty clear that surgeon bias against fat people is alive and well.  I have read many anecdotal accounts from people denied surgery–especially hip or knee replacement surgery because they were too fat.  People with diminished mobility and often severe pain are sent home to “lose enough weight” to be a candidate.  Those fat people determined to receive surgical relief often find themselves wandering a desert of medical red tape looking for a surgeon willing to take on their case.  And they suffer needlessly while they do.

The question of whether the mobility and pain outcomes are as successful for fat people as thin people is a topic for another post.  But in the meantime, I wonder how many studies will have to be done and how many cases will need to be reviewed before the “counterinituitive” nature (read physician weight-based bias) will be reversed.  And how many fat people will have to suffer for how long while we wait for that to happen.

Fired up?  Want to fight stigma and bias?  I’d love to recommend that you join Ragen Chastain, a huge group of additional talented speakers and I for the Fat Activism Conference THIS WEEKEND.  We start on Friday night, so if you don’t want to miss it, I suggest you register now!

Love,

Jeanette DePatie

AKA The Fat Chick

Docs Admit Diet and Exercise Don’t Equal Weight Loss, Then Jump to Wrong Conclusion

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An article hit my feed from LA Times today and it seemed to offer some refreshing news.  It seems 4 doctors, weight-loss specialists set out to say what so many of us have been saying for so long now.  They admit that for the vast majority of obese children and adults in this country, telling them to eat less and move more is a prescription for failure.

They acknowledge that once a fat body begins to lose weight, a whole lot of processes, hormonal and otherwise kick in.  Hormones increase hunger signals.  Metabolisms slow down.  The body struggles to maintain the weight.

Furthermore, the 4 weight loss experts admit that a body that has lost weight are biologically quite different from bodies that have never been fat.  One states:

“Few individuals ever truly recover from obesity,” the authors wrote. Those that do, they add, “still have ‘obesity in remission,’ and are biologically very different from individuals of the same age, sex and body weight who never had obesity.” They are constantly at war with their bodies’ efforts to return to their highest sustained weight.

So far, so good.  Many of us have been pointing out the studies that show these results for years.  So after this, those docs recommend a behavior-based approach where we focus on exercising and eating well for their own sakes (as both have been demonstrated to improve health regardless of whether or not they are accompanied by weight loss), right?  Right?

Well, as it turns out, no not so much.  The docs are suggesting that we simply increase awareness of other tools for weight loss (pills, potions, surgeries and devices) and turn to them sooner.  They suggest we increase fear mongering in the overweight to help keep them from becoming obese.  They suggest a greater focus on weight maintenance for those who have lost weight in order to help them keep it off.  (They somehow neglect to tell us how this is going to work or how it will help.)

The funny thing is, that the doctors see the stigma.  They see how telling patients to just eat less and move more is cruel, since it for the most part doesn’t work.  They see how stigmatizing fat patients and simply labeling them as non-compliant isn’t the answer.

But they simply substitute in another bad answer.  And this bad answer is likely to drag along much more devastating side effects than the original bad answer.  At least suggesting people move their bodies more and eat more nutrient-dense foods is likely to improve health, regardless of whether or not it leads to the holy grail of weight loss.  While pills and potions and surgeries and devices are slightly less ineffective than diet and exercise alone for weight loss, these methods can also carry significant dangers like increased heart rate, higher blood pressure, heart defects, permanent disfigurement, malnutrition, depression, suicide and death from other causes.  And there is not much evidence that in the long run, the few people who do sustain weight loss from the pills and potions and surgeries and devices end up any healthier than the people who stayed fat.

Meanwhile, there is ample evidence that eating well and exercising have a positive impact on health regardless of whether they are accompanied by weight loss.

So why on earth are we not just focusing on healthy behaviors here?  Why do we insist on focusing on weight loss at all?  Well these docs do label themselves as weight loss specialists and that may have a lot to do with it.  And as a society, we do love to blame fat people for stuff.  So I guess they took a few steps out into the light and then fell into a deep, dark hole.

Oh well.

I for one am going to continue my focus on living the best life I can in the gloriously wondrous body I have now.  So if you’ll excuse me, I’mma gonna get on with it.

Love,

Jeanette DePatie (AKA The Fat Chick)

P.S. Want me to talk about evidence-based medicine and wellness at your school or organization?  Learn more HERE.

ESPN Hits It Outa the Park with New Cover Model

OMG I am so excited that ESPN chose studly baseball man Prince Fielder as the cover model for their 2014 Body Issue.  Far from the typical wasp waisted, v-shaped Adonis types, Fielder’s muscular and substantial physique is a breath of fresh air.  While the Texas Rangers star shares some concern about a need to fuel his work with healthy eating habits in this decidedly NSFW video here, he also shares some candid thoughts about how he loves the skin he’s in.

Fielder: You don’t have to look like an Under Armour mannequin to be an athlete. A lot of people probably think I’m not athletic or don’t even try to work out or whatever, but I do. Just because you’re big doesn’t mean you can’t be an athlete. And just because you work out doesn’t mean you’re going to have a 12-pack. I work out to make sure I can do my job to the best of my ability. Other than that, I’m not going up there trying to be a fitness model.

And it takes even more courage to say these things in light of the fact that he’s recovering from surgery to repair a herniated disc in his neck.  He talks about the path of his physical therapy and says, “I can’t do much of anything right now.  I just have to let the process of healing take place.”

I think I might just be a teensy bit in love with Fielder.  He represents so much of what I think is important about fitness.  He’s way more focused on what his body can do than how it looks.  He understands the need to rest and heal from surgery and injury.  He’s lovingly caring for his body so he can get back to using it to do stuff that he really loves.  And he’s quite okay with the fact that he doesn’t look anything like a male underwear model.  *Swoons.* 

While every magazine can always do more to promote body diversity, I’m pretty impressed with the step ESPN took with this cover model.  And as long as you make a firm commitment with yourself not to read the comments (no feeding the trolls) I think you will derive a fair amount of encouragement from this as well.  Sure they’ve got Michael Phelps.  He’s a beautiful athlete.  But his body is trained to do something very different than Fielder.  So of COURSE Phelps and Fielder are going to look different.  That doesn’t mean that they can’t both be beautiful.  And as the French say, vive la difference!

Love,  Jeanette (AKA The Fat Chick)

P.S.  Learn more about making the world safe for folks of all shapes and sizes at the upcoming Fat Activism Conference here. P.P.S.  And don’t forget to join my mailing list and get free stuff!