NYT article on obesity

[Colba55o]

http://nyti.ms/2cOqrE8

The doctor bashing continues...

The last third of the article deals with anesthesia and an "expert" Stanford doc adds that:

"20 to 30 percent of all obese patients in intensive care after surgery were there because of anesthetic complications. Given the uncertainties about anesthetic doses for the obese, Dr. Lemmens said, he suspects that a significant number of them had inappropriate dosing."

The only medication class I can think of that would contribute to such high post op ICU admission rates in the obese is neuromusc blockers...but if we are underdosing in obese patients I'm not sure why this would lead to complications.

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[sigrhoillusion]

http://nyti.ms/2cOqrE8

The doctor bashing continues...

The last third of the article deals with anesthesia and an "expert" Stanford doc adds that:

"20 to 30 percent of all obese patients in intensive care after surgery were there because of anesthetic complications. Given the uncertainties about anesthetic doses for the obese, Dr. Lemmens said, he suspects that a significant number of them had inappropriate dosing."

The only medication class I can think of that would contribute to such high post op ICU admission rates in the obese is neuromusc blockers...but if we are underdosing in obese patients I'm not sure why this would lead to complications.

Maybe the thought is that we are overdosing these patients, giving them too much roc because of their larger frames rather than dosing on IBW. To be fair, I never give more than 10mg of rocuronium at a time and later in the case I never give more than 5mg. And I also adjust my dosing and timing on how the patient is doing... go figure! I also find that roc is very variable between patients. Some people recover after like 20 minutes and some it takes over an hour. I tend to push the limits on limiting my muscle relaxation and always reverse.

That being said... F this expert. Obese people are a pain in the @$$ and it's not surprising that more of them end up in the ICU. To blame anesthesia is pathetic. Might as well blame the PCPs for not fixing them in the first place and then the surgeons for having them do these "miracle" surgeries that will supposedly fix them, so they can continue to gorge themselves and smoke until their kidneys, hearts, livers and lungs completely fail them...

 

[urge]

http://nyti.ms/2cOqrE8

The doctor bashing continues...

The last third of the article deals with anesthesia and an "expert" Stanford doc adds that:

"20 to 30 percent of all obese patients in intensive care after surgery were there because of anesthetic complications. Given the uncertainties about anesthetic doses for the obese, Dr. Lemmens said, he suspects that a significant number of them had inappropriate dosing."

The only medication class I can think of that would contribute to such high post op ICU admission rates in the obese is neuromusc blockers...but if we are underdosing in obese patients I'm not sure why this would lead to complications.

So this guy is saying 100mg to 200mg extra propofol put these people in the icu?

I hope the ABA is regretting letting this guy certify.

 

[WholeLottaGame7]

http://nyti.ms/2cOqrE8

The doctor bashing continues...

The last third of the article deals with anesthesia and an "expert" Stanford doc adds that:

"20 to 30 percent of all obese patients in intensive care after surgery were there because of anesthetic complications. Given the uncertainties about anesthetic doses for the obese, Dr. Lemmens said, he suspects that a significant number of them had inappropriate dosing."

The only medication class I can think of that would contribute to such high post op ICU admission rates in the obese is neuromusc blockers...but if we are underdosing in obese patients I'm not sure why this would lead to complications.

Oh yeah, definitely the intubating doses of prop and sux that bought them an ICU admission... Not the atelectasis, or decrease in FRC, or sleep apnea, or pulmonary hypertension, or diabetes, or HTN.

 

[sigrhoillusion]

So this guy is saying 100mg to 200mg extra propofol put these people in the icu?

I hope the ABA is regretting letting this guy certify.

Dr. Lemmens concluded that Propofol should be based on lean body weight and succinylcholine should be based on TBW?! This guy must be some sort of genius!!! Hope he wins the Nobel prize for that discovery...

 

[sigrhoillusion]

Oh yeah, definitely the intubating doses of prop and sux that bought them an ICU admission... Not the atelectasis, or decrease in FRC, or sleep apnea, or pulmonary hypertension, or diabetes, or HTN.

I was joking about the article before I even read it... but now after reading it, it makes me more disgusted.
Those damn hospitals not ensuring they have MRI machines that can accomodate 500+ pound patients. They do realize how costly a basic MRI is? Or that these MRIs that they use in the zoo don't even offer as good imaging? I mean I feel bad for many of these patients but why does the entire medical field have to stand on it's head for them? And then you realize that healthcare costs are already ridiculous in part because of the chronic diseases due to obesity.

Then at one point in the article they talk about how they wouldn't be obese if they could JUST get that knee replacement to solve their arthritis (caused by obesity...) but didn't someone recently post a study how patients on average GAIN weight after these joint replacements, and low-impact exercising and dieting would probably be more effective, safer and cheaper than undergoing a surgery?

 

[PainDrain]

I was joking about the article before I even read it... but now after reading it, it makes me more disgusted.
Those damn hospitals not ensuring they have MRI machines that can accomodate 500+ pound patients. They do realize how costly a basic MRI is? Or that these MRIs that they use in the zoo don't even offer as good imaging? I mean I feel bad for many of these patients but why does the entire medical field have to stand on it's head for them? And then you realize that healthcare costs are already ridiculous in part because of the chronic diseases due to obesity.

Then at one point in the article they talk about how they wouldn't be obese if they could JUST get that knee replacement to solve their arthritis (caused by obesity...) but didn't someone recently post a study how patients on average GAIN weight after these joint replacements, and low-impact exercising and dieting would probably be more effective, safer and cheaper than undergoing a surgery?

You also forgot how total joint replacements in the obese have increased rates of hardware failure and post-op complications like wound infection.

 

[Psai]

I am very offended by the amount of fat shaming in this thread. It's not as though people have control over their actions or that they can change how much they weigh simply by decreasing po intake and increasing energy expenditure.

It's the doctors being mean to the obese that is the issue, not the diabetes from being too fat causing immunosuppression leading to increased infection rates or the fact that being fat as hell causes a lot of stress on joints or that a huge chest sitting on the lungs causes atelectasis.

 

[lane]

So this guy is saying 100mg to 200mg extra propofol put these people in the icu?

I hope the ABA is regretting letting this guy certify.

I would hope the error lies in the author not fully grasping what Dr Lemmens was trying to convey and they cherry picked some misleading quotes (or conveniently left out the anesthetic complications that would lead to ICU admission).

It is the NY Slimes after all

 

[PainDrain]

So I looked up Dr. Lemmens and I am somewhat confused by his bio online. It says he a professor at Stanford. It says he was boarded in 2013. How does one advance from being boarded in 2013 to full prof in three years? I am a little confused by his bio on the Stanford website. And where does he get this figure? Did he pull it out of his @ss?

 

[urge]

So I looked up Dr. Lemmens and I am somewhat confused by his bio online. It says he a professor at Stanford. It says he was boarded in 2013. How does one advance from being boarded in 2013 to full prof in three years? I am a little confused by his bio on the Stanford website. And where does he get this figure? Did he pull it out of his @ss?

My guess is he did residency out of the US long ago but the ABA let him sit for the test recently. They have special windows for "research" people.

 

[fakin' the funk]

It's the doctors being mean to the obese that is the issue, not the diabetes from being too fat causing immunosuppression leading to increased infection rates or the fact that being fat as hell causes a lot of stress on joints or that a huge chest sitting on the lungs causes atelectasis.

Youve got it all wrong! Its the fat shaming in society that causes anxiety and depression in the obese and leads to unhealthy lifestyles! If you would stop insisting that there is a "normal" BMI the obese would become healthy immediately!!!

 

[fakin' the funk]

http://nyti.ms/2cOqrE8

This article is a total disaster. The confrontational tone, the implied assumption that obesity is unavoidable, the unmentioned NUMEROUS complications of obesity, the unmentioned technical challenges in caring for and making diagnoses in obese patients....

To put it another way: how can you expect the highest level of medical excellence in a population so diseased that (e.g.) they don't fit in standard diagnostic equipment?

 

[Temeraire]

On a related note, it's amazing how desensitized we are to the obese habitus. BMI of 31? Most docs don't even blink an eye nowadays. The new normal seems like BMI 25-40, especially if you're down south.

Yet, when I did an overseas anesthesia rotation in Taiwan (a country full of skinny asians who, admittedly, have an unapologetic fat shaming culture), the whole OR staff would get all worked up about a patient whose BMI was, like, 33. They'd mutter in consternation about positioning the patient and difficult airways. And then when the patient rolled in, I'd chuckle to myself, "This is totally unremarkable."

Also, I have never seen so many clear and beautiful CXRs during my week in a Taiwanese preop clinic.

 

[aneftp]

On a related note, it's amazing how desensitized we are to the obese habitus. BMI of 31? Most docs don't even blink an eye nowadays. The new normal seems like BMI 25-40, especially if you're down south.

Yet, when I did an overseas anesthesia rotation in Taiwan (a country full of skinny asians who, admittedly, have an unapologetic fat shaming culture), the whole OR staff would get all worked up about a patient whose BMI was, like, 33. They'd mutter in consternation about positioning the patient and difficult airways. And then when the patient rolled in, I'd chuckle to myself, "This is totally unremarkable."

Also, I have never seen so many clear and beautiful CXRs during my week in a Taiwanese preop clinic.

Actually my brother at west coast hospital with 60-70% Asians population . 9 9 of 14 MD are Asians. White administration (hopefully they were joking saying they got too many Asians anesthesiologist (Korean, Chinese etc)

Well he can go a week without a 200 pound patient

Of course he got that 4 foot 10 inch 415 pounder somoan patient once time for thoracic procedure.

But I digress. The vast majority of his Asian patients are skinny. It's just the USA culture with obesity outside the ethnic parts of town

 

[PainDrain]

This is a first world problem, why we continue to enable them is beyond me.

 

[Man o War]

This is a first world problem, why we continue to enable them is beyond me.

Yep. This never was more clear to me than when my previous hospital took out half the regular sized seats in each waiting room and replaced 2 seats with one double wide seat.

 

[Psai]

Yep. This never was more clear to me than when my previous hospital took out half the regular sized seats in each waiting room and replaced 2 seats with one double wide seat.

I will never forget when one fat patient got offended that I brought the "big boy" wheelchair for them. Do you really think that you will fit in a normal wheelchair? Jesus Christ.

 

[Ipassgas]

We live in an amazing time. For most of human history, the ability to eat was directly related to life.

Here and now, the ability to eat is actually the leading cause of DISABILITY! It's unprecedented and would be truly remarkable if it weren't so devastating to our society.

 

[Man o War]

I will never forget when one fat patient got offended that I brought the "big boy" wheelchair for them. Do you really think that you will fit in a normal wheelchair? Jesus Christ.

How dare you jeopardize the satisfaction score!!!

 

[GravelRider]

This was easily one of the most absurd anti-doctor articles I have ever read. It is completely one-sided and there is not one mention of the difficulties that we face when caring for obese patients. Instead, it gets framed as discrimination? So I am overdosing the narcotics on purpose so an obese patient gets apneic and has to spend a night in the ICU? This article is complete garbage.

Why not frame it like this:
- The differential diagnoses for a patient who is obese and short of breath are much more extensive than someone who is not obese.
- Delivering an anesthetic to a patient who is obese is difficult because of the differences in how the drugs work in someone with a larger body mass. Anesthesiologists also have to ride a fine line between keeping an obese patient comfortable and keeping them safe. Obese patients are prone to periods of breathing obstruction when they are too sleepy from pain medications. Oftentimes these patients are better off in an ICU where they are monitored more closely after a surgery so we can keep them comfortable while keeping them safe.

Honestly, if our organizations and societies were actually worth the membership fees we pay then there would be a big long article in response to nonsense like this. You might see a letter to the editor, but that is not the kind of response we need. Someone needs to point out the outright nonsense in an inflammatory article like this.

 

[Consigliere]

I will never forget when one fat patient got offended that I brought the "big boy" wheelchair for them. Do you really think that you will fit in a normal wheelchair? Jesus Christ.

I wonder how that behemoth felt when he read the "Passengers of Extreme Size" policy from Southwest Airlines.

 

[fakin' the funk]

I wonder how that behemoth felt when he read the "Passengers of Extreme Size" policy from Soutwestern Airlines.

I think you mean Southwest...Googled it and found this juicy tidbit in the policy. Incidentally, it's called the "Customer of Size" Policy, not as not to offend the fatties. Emphasis mine:

"Customers of size who prefer not to purchase an additional seat in advance have the option of purchasing just one seat and then discussing their seating needs with the Customer Service Agent at their departure gate. If it is determined that a second (or third) seat is needed, they will be accommodated with a complimentary additional seat(s)."

 

[WholeLottaGame7]

I think you mean Southwest...Googled it and found this juicy tidbit in the policy. Incidentally, it's called the "Customer of Size" Policy, not as not to offend the fatties. Emphasis mine:

"Customers of size who prefer not to purchase an additional seat in advance have the option of purchasing just one seat and then discussing their seating needs with the Customer Service Agent at their departure gate. If it is determined that a second (or third) seat is needed, they will be accommodated with a complimentary additional seat(s)."

Uhh, if they're going to give it to you complimentarily at the gate, why would you ever pay for an extra one ahead of time? I wonder where those additional seats come from if it's a full flight?

 

[GravelRider]

Uhh, if they're going to give it to you complimentarily at the gate, why would you ever pay for an extra one ahead of time? I wonder where those additional seats come from if it's a full flight?

Maybe I should get one of those fat suits from the Nutty Professor movies or the old Weird Al music video and get myself some extra room in a row.

 

[chocomorsel]

Uhh, if they're going to give it to you complimentarily at the gate, why would you ever pay for an extra one ahead of time? I wonder where those additional seats come from if it's a full flight?

They refund you the fee once you get to your destination. If the flight is not full, you get to have extra seats for free. Otherwise, you pay in advance and get a refund at the end. I personally don't think that's fair at all, because if it was an extra person on that seat, they sure would be paying.

 

[Psai]

If they're going to charge for 30 pounds of luggage, why won't they charge for 100 pounds of fat?

 

[deleted162650]

If they're going to charge for 30 pounds of luggage, why won't they charge for 100 pounds of fat?

Next time just wear all your clothes on the plane.

https://goo.gl/images/ToKSnM

 

[bashwell]

On a related note, it's amazing how desensitized we are to the obese habitus. BMI of 31? Most docs don't even blink an eye nowadays. The new normal seems like BMI 25-40, especially if you're down south.

Yet, when I did an overseas anesthesia rotation in Taiwan (a country full of skinny asians who, admittedly, have an unapologetic fat shaming culture), the whole OR staff would get all worked up about a patient whose BMI was, like, 33. They'd mutter in consternation about positioning the patient and difficult airways. And then when the patient rolled in, I'd chuckle to myself, "This is totally unremarkable."

Also, I have never seen so many clear and beautiful CXRs during my week in a Taiwanese preop clinic.

Actually my brother at west coast hospital with 60-70% Asians population . 9 9 of 14 MD are Asians. White administration (hopefully they were joking saying they got too many Asians anesthesiologist (Korean, Chinese etc)

Well he can go a week without a 200 pound patient

Of course he got that 4 foot 10 inch 415 pounder somoan patient once time for thoracic procedure.

But I digress. The vast majority of his Asian patients are skinny. It's just the USA culture with obesity outside the ethnic parts of town

Lots of skinny Asian patients here in Australia too (e.g., Chinese, Vietnamese, Thai, Singaporean, Malaysian, Indonesia). Although bigger Samoans, Fijians, etc.

 

[Iso4ane]

I think you mean Southwest...Googled it and found this juicy tidbit in the policy. Incidentally, it's called the "Customer of Size" Policy, not as not to offend the fatties. Emphasis mine:

"Customers of size who prefer not to purchase an additional seat in advance have the option of purchasing just one seat and then discussing their seating needs with the Customer Service Agent at their departure gate. If it is determined that a second (or third) seat is needed, they will be accommodated with a complimentary additional seat(s)."

You know, if they take you two seats, they probably weigh as much as two people. If we consider that a airline ticket is for cargo (fi.e one person), abnormally large cargo should pay more.
)