THIS FAT OLD LADY’S FAT FRIDAY – NO, I WON’T GET DOWN ON MY KNEES AND BEG – I CAN’T, MY KNEES HURT TOO MUCH

Fat people often have a rough time getting appropriate medical care. 

Even when not appropriate, the only advice they sometimes get is “lose weight.”

This advice is ridiculous on its face because (as any physician OUGHT to know) there is no known way to achieve long term substantial weight loss. 

This problem is exacerbated when it comes to joint replacement surgery. 

Despite more and more science to the contrary, most physicians believe it is pointless to do joint replacement surgery on a fat person. 

And yet, fat people can benefit so much from this surgery. 

The science is in on the fact that keeping active is important to health; but fat people are denied a surgery that will allow them to be active without excrutiating pain. 

I know several fat people who were fortunate enough to find surgeons who were willing to do knee replacement surgery on a fat person and their lives were vastly improved by having the surgery.  My own sister has had both knees replaced, and a shoulder replaced and she is not a thin person.  She was required to lose weight first, and (predictably) the weight came back on, but she had already had the surgery and continues to benefit from the surgery as a fat person.  She didn’t regain the weight and suddenly the new knees stopped working. 

The wonderful Deb Burgard has given me permission to share with you a list of questions to ask a physician who is refusing to give a fat person joint replacement surgery solely based on weight; as well as links to the science that refutes the myth that weight is a reason to deny this type of surgery.  My many thanks to Deb.

And please note, there are surgeons out there who will do this surgery on fat people, but, sadly, you have to search for them and they may not be in your insurance network.

Resources for joint replacement surgery denial

General strategies

1.      Ask for the research that supports denial of surgery. Make the surgeon do their homework and justify holding medical care hostage to a demand for weight loss.

2.      Have a conversation that notes the correct scientific question and see if it is actually what the research addresses:

a.       Note that comparisons of fat people to thin people are irrelevant, since a fat person is not going to ever be an always-been-thin person

b.      Note that the possibility that thinner (and more privileged) people have better outcomes from a surgery is irrelevant to the question of whether to provide medical care to less privileged people

c.       Note that the impact on the performance metrics of surgeons from providing medical care to less privileged people are not a reason to withhold that care

d.      Note that in order to justify prescribing intentional weight loss (suppression) that will almost always result in weight cycling, there should be evidence comparing the surgical outcomes of fat people who try to lose weight and fat people who do not, including the consequences of weight cycling

e.      Note that literally no one who prescribes intentional weight loss provides informed consent that walks a person through the overwhelming likelihood of weight cycling, increased risk of internalized weight stigma, increased risk of  provider weight stigma from “failure” to lose weight, harm to the therapeutic alliance, the possibility of triggering disordered eating and eating disorders, etc.

f.        Note that the actual evidence for or against a surgery for fat people is the (short- and long-term) outcomes for fat people who get the surgery vs fat people who do not.

Helpful links:

Risk Reduction Compared with Access to Care:  Quantifying the Trade-Off of Enforcing a Body Mass Index Eligibility Criterion for Joint Replacement

https://doi.org/10.2106/JBJS.17.00120

The risk of surgical site infection and re-admission in obese patients undergoing total joint replacement who lose weight before surgery and keep it off post-operatively

https://doi.org/10.1302/0201-620X.96B5.33136

Functional Gain and Pain Relief After Total Joint Replacement According to Obesity Status

https://doi.org/10.2106/JBJS.16.00960

The #1 Medical Complication of Bing Eating Disorder: Poor General Medical and Surgical Care Arising from Weight Stigma

http://www.gaudianiclinic.com/gaudiani-clinic-blog/2017/7/27/the-1-medical-complication-of-binge-eating-disorder-poor-general-medical-and-surgical-care-arising-from-weight-stigma

The outcomes of total knee arthroplasty in morbidly obese patients: a systematic review of the literature

https://doi.org/10.1007/s00402-019-03127-5

Obesity and Joint Replacement, Part 1: Are BMI Restrictions Ethical?

Obesity and Joint Replacement, Part 2: Does Losing Weight First Improve Outcomes?

(including links to studies, etc.) https://wellroundedmama.blogspot.com/search?q=joint

One thought on “THIS FAT OLD LADY’S FAT FRIDAY – NO, I WON’T GET DOWN ON MY KNEES AND BEG – I CAN’T, MY KNEES HURT TOO MUCH

  1. Pingback: THIS FAT OLD LADY’S FAT FRIDAY – NO, I WON’T GET DOWN ON MY KNEES AND BEG – I CAN’T, MY KNEES HURT TOO MUCH | Fatties United!

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