Thursday, 5 March 2020

Resources to Fight Joint Replacement Denials for Fat Patients

ITISAN~1I get a lot of e-mails from people who need joint replacements,  but whose doctors have refused to perform the surgery unless and until the person loses weight.

Sometimes the doctor suggests that the patient attempt weight loss through diet and exercise.  I would point out that even if diet and exercise might lead to short term weight loss (and even if they could manage exercise on a joint that requires replacement!) the most likely outcome, based on the research, is that they would gain the weight back, with many ending up heavier than they started, which begs the question: If you think that our size is the problem, then why are you are prescribing an intervention whose most common outcome is a larger body?

Now I’m hearing more and more from people whose doctor has claimed that knee surgery is “too dangerous” at their weight and has recommended … wait for it … weight loss surgery.  You aren’t reading that wrong – doctors are refusing to fix someone’s knee until they are willing to have a surgery in which their perfect healthy digestive system will be mutilated to create a disease state, forcing them to starve – though most people who have the surgery still end up in the so-called  “ob*se” category.

Suggesting these dangerous surgeries is an extraordinary breach of the promise to do no harm, since they are asking fat patients to risk their lives and quality of life by having a surgery that is a complete crapshoot in terms of outcome (some people are happy, some people die, some people have horrific lifelong side effects and people don’t know which group they’ll be in until they are in it) so that in theory, the doctor can perform an easier surgery and despite the fact that two surgeries are riskier than one. Jumping through hoops to receive knee surgery is bad enough, risking your life to receive it should be out of the question.

Even if you believe that fat people face additional risk from the surgery and/or receive less benefit, that doesn’t mean that the procedure should be denied. Less pain and more mobility is a reasonable motivation for seeking healthcare even for patients who are unlikely to have the absolute best outcome for any of many reasons (which is why so many other professional athletes have received these surgeries, even though it was their plan to continue the professional athlete lifestyle that trashed their joints in the first place.)

RESOURCE LIST 

Happily, the absolutely brilliant Deb Burgard, PhD, FAED has created a list of research to help fat people and our advocates who want to fight joint replacement denials. She has graciously agreed to let me share them here.

Before I do, I want to be clear that none of this is to suggest that if you are refused joint replacement surgery you are under any obligation to try to change your doctor’s mind. That’s certainly an option (and for those who live in areas with limited practitioners and the inability to travel to see another doctor it may be the only option that works for them.)  Many people have found that their best option was simply to find a more compassionate and talented surgeon who isn’t interested in simply cherry-picking only the easiest surgeries. It’s important to remember that, while this becomes our problem, it’s not our fault and we should never have had to deal with this in the first place.

Trigger Warning: These studies used are not written from a Health at Every Size paradigm, and use terms like “ob*sity” and “overweight” that stigmatize fat bodies and may contain other triggering wording and weight stigma.  The material in quotations under each study link was written by Deb.

Resources for joint replacement surgery denial

https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.96B5.33136

This is actually a study OF KAISER MEMBERS that shows worse outcomes with intentional weight loss before surgery

https://ueaeprints.uea.ac.uk/58880/1/Bariatric_surgery_paper_ACCEPTED_10.05.2016.pdf

This review shows weight loss surgery does not improve surgical complication rates:

https://www.sciencedaily.com/releases/2017/07/170719084707.htm?fbclid=IwAR3b9XS0fzqrY4GYXw8wbW3fYHsTlnIDby0h_9ftiZlgSg7KtOpziiPY8aU

This review shows longer term outcomes are just as good for higher weight people

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

This doctor talks about weight stigma and withholding care

 https://www.ncbi.nlm.nih.gov/m/pubmed/30778723/?fbclid=IwAR3wbfLKvaJxl4CrxYqAio97jxRM5SumLoVVyoRLgwB25-T0VzcgniFK-xE

This review says the benefits are still there even with some complications

https://wellroundedmama.blogspot.com and search for “joint”

Well Rounded Mama has Part 1 and Part 2 blog posts on total joint replacement

https://journals.lww.com/jbjsjournal/Abstract/2018/04040/Risk_Reduction_Compared_with_Access_to_Care_.1.aspx

Notes: Difference between flip of coin and screening for BMI>+40 was 6.74-5.05  =  1.69% = less than 2 percentage points.  Positive predictive value is the number out of 100 who actually have the problem of the people who are identified by the screening – ie, there are 5 people identified by flipping a coin and 2 more identified by using BMI of 40 or more.

Remember that you get to choose the path you take and that sometimes trying to access medical care in a deeply fatphobic society means doing whatever it takes to get the care we deserve.

If you’re looking for a fat friendly doctor you can check out the international fat friendly doctor list at http://fatfriendlydocs.com (If you have a fat friendly doctor, please take a moment to add them to the list!.)

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