Tuesday, 11 July 2017

Jumping Through Hoops for Knee Surgery

knee surgeryOne of the most read and shared blog posts I’ve ever written is about fat people and our knees.  Today we’re going to look a a specific situation. An incredibly common question that I get is from someone who needs knee surgery but whose orthopedist has refused to perform the surgery unless and until the person loses weight.  This happens with other surgeries as well, but the one I hear about the most is knee surgery.

Sometimes the doctor suggests 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 knee that required replacement!) the most likely outcome, based on the research, is that they would end up heavier than they started within a few years, which begs the question: If you think that my size is the problem, then why are you are giving me what is  statistically the worst possible advice?

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 their stomach almost entirely amputated.

The first issue here is that the weight loss requirement is generally an arbitrary percentage or number of pounds, creating a situation where even if the patient achieves the prescribed amount of weight loss (short term at least) they are then offered surgery at a size at which the surgeon would have denied them if it was their starting weight. If that’s not completely ridiculous I don’t know what is.

But far worse, suggesting surgery is an extraordinary breach of the idea of “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 the patient can get a simple surgery, and the doctor can perform an easier surgery 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.

But doctors use the realities of surgery on larger bodies as reasons not to give us healthcare, rather than working to solve these issues (for example, if a fat person’s leg is too heavy for one person to hold during the duration of surgery the correct answer is to find another way to hold the leg – an extra person, a device etc. – not for fat people to simply live with chronic knee pain and limited mobility while medical science aggressively shrugs its shoulders.)

Even if you believe that fat people face additional risk from the surgery and/or have 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 absolutely best outcome for any of many reasons (which is why Shaquille O’Neal received knee surgery even though it was his plan to continue the professional athlete lifestyle that trashed his knee in the first place.)

None of this is to suggest that if you are refused knee surgery you are under any obligation, or even recommendation, 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.)  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.

Remember that you get to choose the path you take. While you shouldn’t have to do it, you might decide that it’s worth it to try to crash diet to lose that 20 pounds the doctor asked for so that you can get your surgery – knowing, of course,  that you’ll be gaining the weight back again and probably more. Maybe it’s worth it (and you have the resources) to travel to see a surgeon who doesn’t practice from a base of fatphobia.  Maybe you want to turn this into activism and start insisting that the doctor provide proof that you can lose weight long term (they can’t) or that you won’t die or have horrific longterm side effects from the surgery (they can’t) and then lobby for the procedure since their position is baseless.  Or be super extra nice and try to sweet talk them into it. 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 (If you have a fat friendly doctor, please take a moment to add them to the list!.)

If you want to help make the world – including medical care – less fatphobic, join us (online!) for the Fat Activism Conference:

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