Yep a big mix of misogynistic and ethnic behavior. Which are the two reasons we do not have universal healthcare. There is a ton of blame the victim involved. The pandemic saw it all heightened.
The stats in your first CNN graph are per 100k. In that light it is much higher than the rest of the west but still a tiny fraction. The issues around giving a child a chance in life are even a lot worse because of our societal behaviors.
This time frame essentially covers my medical career and since I worked at a high risk maternity hospital, right in my wheel house. Shocker of shockers, rise in rates coincide with rise in overall obesity rates in America.
At the beginning of my career, seeing a patient that outweighed me was abnormal (I’m 6’2" and 195#). By the end of may career, seeing a patient that I outweighed was abnormal. Would see a 300# plus almost everyday with the heaviest I treated was 600#.
Yep…and with regard to some of those other developed nations that appear on the comparison graphs upstream, I find myself wondering if a representative group of US women who were included in these data…with a longstanding history of serious overweight/obesity prior to pregnancy…found themselves in these countries with the better stats for all their pre/peri/post natal care, would the outcomes be any different if they were still able to continue their American ways?
Had a “Whiskey, Tango…” moment a few weeks ago. I’m currently working through a course on training women with an emphasis on the childbearing through menopause. There’s an online forum where you can swap idea. One trainer from the UK was bemoaning the fact that one of her clients who was overweight was having a difficult time making the upper cutoff for or receiving IVF on the NHS. A lot of back and forth on recommendations for how to conceive when obese and obesity denialism nonsense from the HAES-friendly contingent and how dreadful it was to be denied this treatment just because of being overweight. Not knowing what this upper limit might be, I did a bit of Googling to see if this was hugely restrictive. Parameters were identical within the NHS and private sector…a BMI of 35. Now that was a bit of a stunner so I posted info and asked…in total naivety, honest!..how far above the cut off this client was. A BMI of 48!! No one posted much after that disclosure.
I’ve a half dozen acquaintances who were denied knee or hip replacement based on “too fat”, and perhaps another half dozen who didn’t meet the “smoking” regulations.
This is the first time I’ve heard about denied IVF due to obesity limits.
Are there other reproductive related treatments that are denied due to “obesity”?
Is IVF also limited based on smoking status?
However, there are excellent reasons for not providing certain procedures in the face of obesity and smoking…or many other b ad behaviours. Clinical outcomes are almost invariably worse than leaving well alone.
As i mentioned, I checked to see the cutoff with the NHS and the private sector for IVF…identical. Meaning, it’s not a third party payor or Big Gubmint trying to rob someone of their entitlement…a BMI of 35 means someone is unlikely to have a healthy pregnancy and the foetus even less
As commonly happens, a coincidence crops up IRL on the heels of a comment on TMF…
Came upstairs from my morning training session to hear the tail end of of a BBC Radio 4 programme dh was listening to. “Listen to this”, sez he “…this woman’s talking about you”. Well, the programme was on the stigma and discrimination attached to obesity…in all walks of life but the bit I caught concerned healthcare. Which is I guess what my husband meant.
The interviewee was American and mentioning a few examples of folk whose medical diagnoses were missed because…in their opinion … their physicians couldn’t see past their fatness. I can see that, as someone whose own body condition and lifestyle choices provided a smokescreen that delayed appropriate prevention. The points all sounded very reasonable on first blush but I picked up a few buzz words that made me think I was listening to the reasonable face of the HAES movement…which along with body positivity has morphed into fat activism and obesity denialism.
So, I asked dh what the BMI cutoff for a liver transplant at his gig was…40. Why? Surgical (including anaesthia) risks are high, healing is poor, rejection is greater, etc.etc. I pointed out that this is the sort of discrimination that the woman on the radio was talking about… and that she probably has at her fingertips those random studies that are outliers to the overwhelming evidence. One person’s idea of appropriate clinical decision making is someone else’ grievance.
Not interested enough to check on “smoking” (is that different from regular smoking?) But I suspect those cutoffs your friends experienced were in some measure related to what dh listed. I guess the fatness makes the usual difference at the surgical site and for the anaesthesiologist, but I suspect that the earth’s gravitational pull on the M in BMI post surgery is what kills the prosthesis prematurely. Do you think those cutoffs were inappropriate?
Their outcomes, at best, would be the same and most likely worse. I’ve seen several studies trying to get direct apples to apples comparisons of USA treatment outcomes vs. other countries and it is very hard to get good data. But generally the USA comes out with same or better outcomes.
Obese people produce abnormal estrogen which further complicates and decreases the chances of IVF working. While I’ve never heard of a cutoff limit, it seems logical that at some point things no longer work.
Well, if by health care bureaucracy you mean the surgeon who has to cut through 3 or more inches of blubber before reaching any recognisable anatomy, the anaesthesiologist who has to find/maintain an airway and generally keep the patient alive and the transplant hepatologist (who I chose to ask this question of) who’s charged with keeping the patient alive for long enough to justify the surgery in the face of all the metabolic problems that are trying to kill the patient, I guess you’d be right. Not much different from requirements for a demonstrated period of sobriety prior to replacing an organ killed by alcohol abuse.
If you recall, I mentioned upstream that examples of the cutoff BMI in the UK was 35 on the examples I read. May well be higher here in the US because…well, we know “because”. Note that I investigated the private sector too which doesn’t have quite the influence of the insurance industry as it does in the US. Doesn’t everyone claim this as a purely USian phenom when discussing health-care spending??
Would you provide any and every service someone requested/demanded in above scenarios just because the paying customer was able to shove a shed load of money your way, assuming you had enough of a knowledge base to be worth paying?? I’m sure people do…which is probably one way we know that making sub optimal clinical decisions (like elsewhere in life, I guess) are, well…“suboptimal”
Well, if you think about it, this is probably the least valid reason to deny IVF treatment. First of all, it frequently fails in the non-obese, metabolically healthy population. The problems would arise if the procedure is successful. Per the links posted upstream, the context is the higher mortality during pregnancy here in the US vs. overseas. Nothing you can do if a patient with a stratospheric BMI does become pregnant…except for initiating all the clinical care that attempts to mitigate the poorer health of the mother and the foetus and, subsequently neonate. Accepting the cost.
Another route to understanding how obesity results in poor clinical outcomes.
The part I don’t understand is that if you go right across the border to Canada, where the diet is basically the same as the US, maternal mortality rates plunge by about half. Lots of other health care outcomes improve as well.
Well, the interesting thing about statistics in the here and now is that they only tell you about the here and now…not about what’s gone before. I’m sure most folk would have a hard time refuting the reality that USians have been big for a long time. Leading other nations, no less.
Now a good many are certainly doing a bang up job of playing catch up, that’s for sure but close as the race appears to be getting there’s a few things to bear in mind. A person isn’t necessarily metabolically healthy just because their BMI (using that as the standard definition) falls below 30. Especially women. Additionally…and I believe this was mentioned in the opening article … the problem is with the numbers of American women becoming pregnant and who’ve had long standing obesity before the event. Adding the top end of “only” overweight to those figures and backtracking what the history of those women must have been, I suspect that far more were overweight/obese in childhood decades earlier than their counterparts north of the border…and the departure from healthy homeostasis began way before they were contemplating pregnancy
One thing you need to control for is ethnicity. Maternal mortality rates for nonHispanic Blacks is roughly 2-3 times that of nonHispanic Whites. I assume Canada has fewer Blacks than the US on a percentage basis.
The argument that systemic racism contributes substantially to the high US maternal death rate is made in this NPR article:
Some folks want to make that argument, and it may be justified. As noted upthread somewhere, while the study broke the data down by race, and age, it did not break down the data by income. I somehow suspect that poor whites are just as likely to get the bum’s rush out of the hospital, as poor blacks.