> It’s also the typical shitty response overweight people tend to often get
That does not stop it being true!
When a doctor tells someone to lose weight to help some health problem s/he's not dismissing the health problem. S/he's giving very good, useful, achievable, advice. In England the doctor may also give a prescription to 12 weeks free on a weight loss course, such as "Slimming World".
You seem to think this is some kind of /r/fatpeoplehate or /r/fatlogic thing, but it isn't. Your dismissal of this calmly presented, good faith, evidence based bit of advice is odd.
If a person is unable to lose weight on their own, even after a doctor advises them that it could literally cure a life-threatening disease, what does that tell you?
This is the typical exchange in the US:
MD: Losing 20kg of body fat would reduce your other symptoms tremendously.
Pt: Great. Can you help me do that?
MD: No.
Pt: But I just gave you a $30 co-pay on a $300 office visit.
MD: I can prescribe pills to treat your symptoms for as long as you continue to take
them, and order additional tests. You won't know how much the tests will cost until
after you take them, and your insurance denies the claim to stick you with the entire
bill.
Pt: Could you prescribe exercise? Would that let me use my insurance to get a bench and
barbell or exercise bike or elliptical machine or something?
MD: No. Your insurance won't cover a preventative treatment that would very
inexpensively reduce your risk for literally dozens of horribly expensive diseases.
The assumption is that you won't exercise, even if you own all the necessary
equipment in your home.
Pt: What about a prescription diet? Could I go on Atkins or some other ketogenic diet?
MD: I can't recommend any diet in particular, because I don't want to get sued, or
censured and persecuted by the AMA. But yes, changes to your diet may or may not
help you achieve a goal of fat loss, depending on what the available research may
indicate.
Pt: What research? Can I read it?
MD: Are you a student or professor?
Pt: No.
MD: Then you probably don't want to pay Elsevier $100 a pop just to read articles with
ambiguous results.
Pt: What about liposuction?
MD: That's a cosmetic procedure. You can't afford it, and your insurance won't pay a
dime.
Pt: Fat loss drugs?
MD: None approved by the FDA that won't make your heart explode.
Pt: Why am I here?
MD: Because you want to help pay for my daughter's orthodontic treatment?
The dialogue was intended to be illustrative rather than informative. Health insurance companies, in general, absolutely will not reimburse for preventative measures, even if they are known to be effective. Every check has to have a diagnosis code attached to it.
They will, however, give you some cash or premium discounts if you enroll in their health nagging/spying program. You self-report a sackfull of valuable risk factor information, and they, in turn, frequently call you and read from a script at you. There is no material support or genuine incentive for positive lifestyle change.
As regular walking has such great, demonstrable health benefits, you would think that a health insurance company might do something like send you a free new pair of walking shoes if you send them your old pair, with the soles worn out from walking.
I can't exactly agree with the part about being enjoyable, relaxing, and mentally stimulating, though. That's largely dependent on your route and companions. Someone walking through a sprawl of suburban McMansions with an unrelenting babbler is not going to keep at it as easily as someone who can enjoy a hiking trail at a scenic park with someone who knows how to just shut up and enjoy nature in companionable silence. (~Any resemblance to actual walking experiences is purely coincidental.~)
The number one reason I have for keeping exercise equipment in my home is because I think you shouldn't have to get in a car and drive somewhere in order to have a positive exercising experience, and walking around my neighborhood is not one.
> Health insurance companies, in general, absolutely will not reimburse for preventative measures
Well, except for the long list of preventive measures they must pay for, as a result of state and federal regulations [1].
And, except for the fact that some insurers paid for non-mandated preventive services previously (and cover non-mandated preventive measures now), but only to the extent that their experience bore out that those services reduced their downstream expected costs.
"Health insurance companies, in general, absolutely will not reimburse for preventative measures"
Of course they don't. It's tautological. Insurance companies by definition do not insure against regular, predictable expenses.
A car insurance company will never insure you for new tires and a health insurance company will never insure you for regular, recurring wellness checkups. Because math.
Yes, sometimes they say they will, and sometimes such a reimbursement actually occurs, but make no mistake - that is never a claim payment and basically amounts to fee for service. You will not receive claim payment for items like this - they are not underwriteable.
These things can be interpreted as interventions by the insurers to lower the insured parties' risks that could result in claims later, akin to a fire insurance carrier's possible willingness to buy you a fire extinguisher if it calculates that that its resulting expected liability will go down by more than the cost of the extinguisher.
Alternatively, you could view the physical exam as a genuine insurance claim because not all insured parties actually take advantage of all the preventative services that they're theoretically entitled to under their policies. I've had years where I didn't get a physical exam or dental exam that my policies would have allowed me to, and so have many other people (but the carriers still got paid the premiums for those years!). If the carrier makes actuarial estimates of the likelihood of people not using those services, it's pretty solidly back in insurance territory!
This problems the dialogue hi lights affect almost every part of the health care system, unfortunately. You have to educate yourself because otherwise you surrender yourself to only the information which is in the best interests of the current system to provide you.
However, in this case, it's hugely beneficial that common sense wins the day, most of the time. Most obese people can lose a huge chunk of their fat by cutting out sugar, replacing it with fibre and healthy fats. Throw in a few walks a week and that's the first 100 pounds.
> 1.1 Continuous positive airway pressure (CPAP) is recommended as a treatment option for adults with moderate or severe symptomatic obstructive sleep apnoea/hypopnoea syndrome (OSAHS).
> 1.2 CPAP is only recommended as a treatment option for adults with mild OSAHS if:
> they have symptoms that affect their quality of life and ability to go about their daily activities, and
> lifestyle advice and any other relevant treatment options have been unsuccessful or are considered inappropriate.
> 2.4 Major risk factors for developing OSAHS are increasing age, obesity and being male. OSAHS is also associated with certain specific craniofacial characteristics (such as retrognathia), enlarged tonsils and enlarged tongue. Use of alcohol or sedatives can also increase the risk or severity of the condition. OSAHS has been reported to affect up to 4% of middle-aged men and 2% of middle-aged women in the UK. It is estimated that 1% of men in the UK may have severe OSAHS.
> 2.5 Treatments aim to reduce daytime sleepiness by reducing the number of episodes of apnoea/hypopnoea experienced during sleep. The alternatives to CPAP are lifestyle management, dental devices and surgery. Lifestyle management involves helping people to lose weight, stop smoking and/or decrease alcohol consumption. Dental devices are designed to keep the upper airway open during sleep. The efficacy of dental devices has been established in clinical trials, but these devices are traditionally viewed as a treatment option only for mild and moderate OSAHS. Surgery involves resection of the uvula and redundant retrolingual soft tissue. However, there is a lack of evidence of clinical effectiveness, and surgery is not routinely used in clinical practice.
Talking about weight loss in a thread about lack of sleep is not a derailment; it is not condescending. Lack of sleep is one cause of obesity. Obesity plays a major role in lack of sleep.
The point you are making is correct and well argued for. I also think I sucked at expressing myself and haven’t been very polite at all.
I also think that this is a much better comment than your first one. I really think one should be very careful when dragging victim terminology into this discussion or, in fact, any discussion about weight. I have been unable to lose weight for years (all the time being extremely aware of how shitty I felt all the time and the negative impact on my health) and now after I did I’m still not sure how I actually did it.
Point is, it’s not as simple as telling people to just lose weight. Because just losing weight is extremely hard and it’s time we acknowledge that. And I’m not talking about the raw mechanics of losing weight here – those are easy and work with mathematical precision (well, ok, I myself may be generalizing too much here, but for me they did: if calories out minus calories in are equal to roughly 7000 I had lost 1kg, maybe ±.3kg, though that’s probably mostly due to the inherent uncertainties of estimating calories).
It’s about psychology and accusing people of playing the victim or trying to insult them to lose weight is just not a workable strategy. It just doesn’t work. Or it may even work for some people, but I don’t think it’s in general a wise strategy because it’s plain dehumanizing.
> In the UK positive pressure machines are only recommended after lifestyle interventions have been tried.
The medical opinion in the US is that CPAP is the first-line treatment to be done in parallel with any necessary lifestyle adjustments in all cases of OSA.
> Recommendation 1: ACP recommends that all overweight and obese patients diagnosed with OSA should be encouraged to lose weight. (Grade: strong recommendation; low-quality evidence)
> Recommendation 2: ACP recommends continuous positive airway pressure treatment as initial therapy for patients diagnosed with OSA. (Grade: strong recommendation; moderate-quality evidence)
Though not explicitly stated in the paper, the general consensus I have heard from physicians here (and others in this sub-thread have stated) is that lifestyle intervention is much more likely to fail if CPAP is not initiated in parallel.
> 1.2 CPAP is only recommended as a treatment option for adults with mild OSAHS if:
I can't see the definitions of mild and severe, but clearly this is not recommending CPAP only "after lifestyle interventions have been tried" for the entire population.
That does not stop it being true!
When a doctor tells someone to lose weight to help some health problem s/he's not dismissing the health problem. S/he's giving very good, useful, achievable, advice. In England the doctor may also give a prescription to 12 weeks free on a weight loss course, such as "Slimming World".
You seem to think this is some kind of /r/fatpeoplehate or /r/fatlogic thing, but it isn't. Your dismissal of this calmly presented, good faith, evidence based bit of advice is odd.