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Archive for Wednesday, October 28, 2009

Ambulances start charging extra for obese patients

October 28, 2009

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American Medical Response operations manager Ken Keller talks about the specially equipped ambulance used for obese patients at the company’s Topeka facility in this August 2009 file photo. The company charges more to transport obese patients.

American Medical Response operations manager Ken Keller talks about the specially equipped ambulance used for obese patients at the company’s Topeka facility in this August 2009 file photo. The company charges more to transport obese patients.

— The memory still bothers Ken Keller: A panicked ambulance crew had a critically ill patient, but the man weighed more than 1,000 pounds and could not fit inside the vehicle. And the stretcher wasn’t sturdy enough to hold him.

The crew offered an idea to Keller, who was then an investigator with the Kansas Board of Emergency Medical Services. Could they use a forklift to load the man — bed and all — onto a flatbed truck? Keller agreed: There was no other choice.

“I’m sure it was terribly embarrassing to be in his own bed, riding on the back of a flatbed with straps tying him down, going to the hospital, and then have a forklift at the hospital unload him,” Keller said.

As the nation battles the obesity crisis, ambulance crews are trying to improve how they transport extremely heavy patients, who become significantly more difficult to move as they surpass 350 pounds. And caring for such patients is expensive, requiring costly equipment and extra workers, so some ambulance companies have started charging higher fees for especially overweight people.

The move to modify ambulances is just the latest effort to accommodate plus-sized patients. Some hospitals already offer specially designed beds, wheelchairs, walkers and even commodes.

Ambulance companies say it’s time for insurance providers, Medicaid and Medicare, or patients themselves to begin paying the added costs, which are cutting into their razor-thin profit margins.

In the past, ambulance companies often absorbed the extra expense of serving the obese. Now they are adding charges similar to those already imposed on intensive-care patients, people requiring multiple medications and patients on ventilators.

“In order for these systems to survive and continue to provide their service, there has to be some way to recover those costs,” said Jim Buell, a director at the American Ambulance Association.

Added costs

Transporting extremely heavy people costs about 2 1/2 times as much as normal-weight patients. It takes more time to move them and requires three to four times more crew members, who often must use expensive specialty equipment, Buell said.

Keller, now an operations manager for the American Medical Response unit in Topeka, successfully petitioned the Shawnee County Commission last summer to raise ambulance fees from $629 to $1,172 for critical-care patients and people who are 500 pounds or heavier.

In Colorado Springs, Colo., and the Nebraska cities of Omaha and Lincoln, the fees are $1,421 for an extremely obese patient, compared with $758 for a typical patient.

Before those ambulances had heavy-duty equipment, crews just had to make do, often calling in burly firefighters to help lift patients.

“I’ve heard stories of people moved by U-Haul trucks and sides of mobile homes having to be removed to move patients out, things of that nature,” said Ted Sayer, a general manager for the American Medical Response unit.

The Centers for Disease Control and Prevention has long said that nearly a third of Americans are obese. About 5 percent of the population is morbidly obese, meaning they are more than 100 pounds heavier than their ideal weight.

Discrimination charged

Some critics say the higher fees are a form of discrimination.

“Ambulance services are a critical public service and should accommodate the needs of all of those who require them at a fair cost,” said Joseph Nadglowski, president of the Obesity Action Coalition, a group that advocates for the obese.

Ambulance companies say the insurance industry is their best hope for closing the financial gap.

As with any medical service, ambulance companies bill private insurers or government health care programs. Medicare and Medicaid do not pay extra for transporting the extremely obese, although that’s something the ambulance industry wants to change. The uninsured are charged directly, but many of them cannot pay.

“It’s really an emerging area,” said Susan Pisano, a spokeswoman for the America’s Health Insurance Plans, an insurance industry trade group. “It is one more way that obesity is contributing to health costs.”

Comments

imastinker 4 years, 10 months ago

This is discrimination. It's also discrimination that my house isn't as big as someone elses and that other people have nicer cars. All cars should be exactly the same and cost the same amount of money.

It's like we are in kindergarten again when we can't have cookies unless we brought enough for everyone. Is it my fault that Jamies mother didn't make cookies?

Is it Jamies fault that I didn't share the cookies and ate them and now need a forklift to be moved around? Let's make Jamie pay for the forklift - that'll make it fair!

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remember_username 4 years, 10 months ago

Multi - The Deaf and Blind are in a "somewhat" different category of handicap status than the morbidly obese. Your example of non-English speaker may be more suitable and in most cases the hospital staff are not paid more for second language skills. (Although having a second language does place one in a better hiring position.)

I don't see how it could be discrimination if more expensive equipment requirements are needed. If you need Oxygen you are charged for what you use. It is not discrimination to charge you more than the fellow that doesn't need Oxygen does it?

If all AMR ambulances were equipped with ramps, special gurneys, additional personnel, and more internal space then everybody could get the same (more expensive) price for transport. Sometimes keeping costs down is discriminatory and there's no way around it.

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Mel Briscoe 4 years, 10 months ago

note to self: don't get hurt bad enough to require an EMT!

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costello 4 years, 10 months ago

"Not the same. Nobody makes themself deaf or blind. Obese people make themselves obese. So they should take some responsibility and pay for the extra cost."

You're making a number of assumptions here. The obese don't necessarily make themselves obese. Certainly it would be difficult to reach 500+ pounds without an underlining metabolic problem. And some people do make themselves blind and deaf - and disabled in numerous other ways - intentionally or not.

Perhaps those who are disabled through no fault of their own (the "deserving" or "worthy" disabled) should carry on their persons at all times a note from their doctor certifying their guilt-free status. That way the ambulance company will know who to charge for any special accommodations their disability may require.

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billbodiggens 4 years, 10 months ago

If you have extra big feet do not your shoes cost extra?

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billbodiggens 4 years, 10 months ago

If you have an extra large waist do not your trousers cost extra?

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somedude20 4 years, 10 months ago

People can afford to make themselves fat, then those same people can afford to pay the extra money. I have a few drinks now and again and some times I like a smoke with my beer. I am taxed out the wazoo for this. I am not (at this time) making an argument for or against "sin taxes" but it is discrimination if the fatties are not taxed in some extra special way like how I am. Fatties, get thin, as you will be the first to be eaten by the zombies when the attack.

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costello 4 years, 10 months ago

"If one hits 500 pounds because of a metabolic problem, then they can pay extra, just like they have to pay for the medical treatment for the metabolic problem."

Yes, and that's covered by insurance.

"But sorry, no sympathy here for someone that eats their way to 350+ pounds."

And I say you can't eat your way to 350+ pounds without a metabolism which allows it. Most people simply cannot reach the weights discussed in this article no matter how much they eat.

Obesity is not caused by gluttony or psychological problems. It's cause by a metabolic problem which is a medical condition which should be treated.

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Stuart Evans 4 years, 10 months ago

look at all the discrimination allowed within these posts. calling overweight people, "fatty", etc. you don't know the situations in peoples lives that caused this. there are an abundance of issues that lead to excessive eating and poor diet. But it seems perfectly fine in this society to discriminate and namecall on the subject of weight. if anyone in here were using negative words for gays, blacks, hispanics, women, asians, etc. the posts would be pulled immediately. and I'm sure that some of you with the quick to point out someones weight problem are the same ones who champion individual rights and probably jumped on the anti-gay hate crime legislation this week.

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costello 4 years, 10 months ago

"People can afford to make themselves fat, then those same people can afford to pay the extra money."

Nonsense. Most obese people get that way eating a diet of cheap, highly-processed carbs - think macaroni and ramen noodles. They eat that way because they don't have much money and the food is cheap.

"Fatties, get thin, as you will be the first to be eaten by the zombies when the attack."

If there were an easy solution to this problem, we'd all be thin.

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costello 4 years, 10 months ago

"It did seem though, that 95% of the obese patients suffered from the same thing………A Big Mac Attack"

How do you know that, hillbilly_jim? I thought EMT's spent a very short time with their clients/patients. I also didn't realize EMT's were qualified to diagnosis disease.

Were you an EMT here in Lawrence/Douglas County? Were you this scornful and disrespectful of all your patients - or only the fat ones? Did the other EMT's share your disrespectful attitudes?

I've been fortunate in that I've never needed the services of an EMT or an ambulance. If you're representative of the kind of person I might meet, I hope I never do.

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vinividivici 4 years, 10 months ago

I used to work at a hospital, and 80% of the morbidly obese people that I had to take care of had family members bringing them fast food constantly (and often do EVERYTHING else for them too). A low metabolism or thyroid problem can only account for so much.

Isn't sloth supposed to be one of the unforgivables? "Sin" tax anyone?

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costello 4 years, 10 months ago

How many of your non-obese patients had family members bring them fast food? How many of your non-obese patients did everything for them? (And don't people in hospitals need to have people wait on them hand and foot anyway?) I doubt you'd even notice these things much if the patient weren't obese.

A high carb diet leading to insulin resistance accounts for a huge amount of the current obesity crisis. We can continue to blame fat people for being "sinful" - and keep getting fatter and fatter as a nation. Or we can actually look at the science behind obesity and see if we can fix the problem.

If you have any interest in understanding this subject, read Gary Taubes' Good Calories, Bad Calories. Or watch this video: http://webcast.berkeley.edu/event_details.php?webcastid=21216. (Warning: either the book or the video will involve an investment of time and brain power.)

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Leslie Swearingen 4 years, 10 months ago

One thousand pounds is way beyond plus sized. I mentioned to someone that my ex always told me when I gained five pounds and they said he was mean. Well, no, because it is a lot easier to lose five pounds than fifty. Some fat people have mental problems and eat to soothe themselves and only have the bathroom mirror so they can remain in denial of what is going on. It is a kind of oral fixation like with smoking and drinking as such. I have changed my eating and exercise habits and it was the death of Michael Jackson that was the prompt. It is a struggle for the health community to deal with the really obese. Isn't it cruel to stand by while someone kills themselves or even gives them the means to do so?

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Katara 4 years, 10 months ago

There has been some interesting research involving leptin & obesity. I wonder how much has been researched in relation to the morbidly obese.

"Although leptin is a circulating signal that reduces appetite, in general, obese people have an unusually high circulating concentration of leptin.[23] These people are said to be resistant to the effects of leptin, in much the same way that people with type 2 diabetes are resistant to the effects of insulin. The high sustained concentrations of leptin from the enlarged adipose stores result in leptin desensitization. The pathway of leptin control in obese people might be flawed at some point so the body doesn't adequately receive the satiety feeling subsequent to eating." http://en.wikipedia.org/wiki/Leptin

I am sure there are other metabolic factors involved as well.

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headdoctor 4 years, 10 months ago

I am beginning to wonder if some of you on here are not closet members of the food Nazi's that want to tax the fat content of food.

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Christine Anderson 4 years, 10 months ago

To tell the truth, I don't know if extremely obese persons should be charged more for services or not. Yes, there are definetly metabolic problems which contribute to being that obese. Yes, there is a "science" behind being obese. At the same time, I also relate to the frustration expressed by some on this thread. When I was still a nurse, I saw it all the time. A 300 lb. or more patient coming in with severe breathing problems, pvd, diabetes out of control, and cardiac problems so severe one would marvel that this person were still alive. And guess what? In at least 80% of those cases, family members would bring in fast food. Or Chinese. I've had patients who were self-administering insulin deliberately adjust their sliding scale dose, thinking it made it okay to eat that way. In other words, don't "preach" to me about eating that stuff instead of the diet my dr. ordered; I'll just take a few more units of regular. I believe there are genetic and behavioral causes of obesity. A great many of us (including myself) are fat. Many of us have a genetic predisposition to being fat. But...no one but me is to blame for stuffing my face with bagels with cream cheese, pizza, Mc D's, and so on. That would be my choice. It would be really, really stupid of me to not own the food choices I make, and then say, "Well, I'm fat only because my parents and grandparents are fat."

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notajayhawk 4 years, 10 months ago

"You might not be a great candidate to recover from typical knee injuries you get once you are too heavy. You've have to suffer with being lame until you've dieted it off, then get the surgery. Of course by then, you may need the entire knee replaced instead of a more minor surgery because you've damaged it more trying to walk with it half torn off."

And nobody is going to give you a liver transplant while you're still drinking. There's a reason for that. You're not a good candidate for a new heart if you're a smoker, either.

Have you heard those commercials on the radio for KU med, the ones with Dr. Burton saying smoking can make back pain worse and/or slow recovery from corrective surgery? That same Dr. Burton refused to do my wife's back surgery (most of which was reversing a procedure done in the same clinic) unless/until she stopped smoking.

It's pretty simple:

If someone has a condition that requires more costly treatment, shouldn't they pay more for it? And if someone has a condition which would make performing a procedure meaningless, why go through the expense of performing it?

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Katara 4 years, 10 months ago

notajayhawk (Anonymous) says…

And nobody is going to give you a liver transplant while you're still drinking. There's a reason for that. You're not a good candidate for a new heart if you're a smoker, either.

Have you heard those commercials on the radio for KU med, the ones with Dr. Burton saying smoking can make back pain worse and/or slow recovery from corrective surgery? That same Dr. Burton refused to do my wife's back surgery (most of which was reversing a procedure done in the same clinic) unless/until she stopped smoking.

It's pretty simple:

If someone has a condition that requires more costly treatment, shouldn't they pay more for it? And if someone has a condition which would make performing a procedure meaningless, why go through the expense of performing it? ~~~~~~~~~~~~~~~~~ I understand the reasoning for the smoking and other lifestyle choices however, if the goal is to get the person to lose weight, refusing to repair body parts that will assist them in becoming more active does not help.

If your knees are in bad condition, something as simple as walking can be too painful and if you are overweight and also not in shape due to lack of exercise, you are not going to begin the first step in getting back into shape & losing weight because of the pain.

Additionally the physical therapy that one goes through after a knee surgery would also be helpful in getting that person active again. It does not make sense to wait for the person to lose weight for the surgery when the surgery can assist them in losing the weight by enabling them to have a more active lifestyle.

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Connacht 4 years, 10 months ago

Are people seriously defending someone who weighs more than 1,000 pounds?

Come on people! Think about what that means. I am 5'7". I weigh 172 pounds, and I am overweight. I can run between 2 and 3 miles at a time, but I'm overweight. I'm not obese and try to stay healthy, but I have weight I should and want to lose. This is my responsibility and no one else's, and I would feel personal shame if tax payers had to pay special attention to me as an individual based on my life choices.

No one. And I mean NO ONE, is made 1,000 pounds because of their genetics or some illness that leads to obesity. Stop blaming other people, the media, or your "genetics" for lifestyle choices.

We have become a culture that blames everyone else for our own personal problems. This needs to stop.

And before I get attacked for "fattism", or whatever that crap is about discriminating against fat people, let me just say this:

I suppose universal health care. I support comprehensive support for people in society, particularly for people who have real, pre-existing conditions that nothing will change. I absolutely do NOT support people leeching off a system designed to help people who simply cannot help their position.

No one who weighs 1,000 pounds is a victim of anything but their own bad lifestyle choices.

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notajayhawk 4 years, 10 months ago

Katara (Anonymous) says…

"I understand the reasoning for the smoking and other lifestyle choices however, if the goal is to get the person to lose weight, refusing to repair body parts that will assist them in becoming more active does not help."

The problems being 1) a 1,000 pound person doesn't do a lot of walking around in the first place, and 2) the damage to their knee(s) may very well have been caused (or at least contributed to) by their weight. At the very least, recovery from the surgery is going to be more complicated, if not impossible, with the extra baggage.

Also, following your argument, maybe a person hoping for a new liver transplant would be likely to drink less if they weren't about to die (rather uncomfortably) from hepatitis, cirrhosis, or liver cancer. But it's still a waste of an organ that's in pretty short supply.

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Katara 4 years, 10 months ago

notajayhawk (Anonymous) says…

The problems being 1) a 1,000 pound person doesn't do a lot of walking around in the first place, and 2) the damage to their knee(s) may very well have been caused (or at least contributed to) by their weight. At the very least, recovery from the surgery is going to be more complicated, if not impossible, with the extra baggage.

Also, following your argument, maybe a person hoping for a new liver transplant would be likely to drink less if they weren't about to die (rather uncomfortably) from hepatitis, cirrhosis, or liver cancer. But it's still a waste of an organ that's in pretty short supply. ~~~~~~~~~~~~~~~~~~ But we aren't talking about just 1000 lb people (which are pretty darn rare). If you read multidisciplinary's post, she was referring to people who had been denied surgery for being obese (300 lbs) not morbidly obese.

And yes, the surgery is going to be more complicated but do we deny it just because of that? That's an odd argument for refusing to perform a surgery. There are lots of surgical procedures that are complicated. Why would it be impossible to recover from a knee surgery? Just because they are really fat? Perhaps with underlying conditions (such as diabetes which slows healing) but just being obese by itself does not make recovery impossible.

You also miss the fact that if one has a knee surgery, one goes to physical therapy. Not only do they get the care to help strengthen their repaired joint(s) so they can be mobile again but they also get care to continue that mobility past just the recovery time.

Comparing organ transplant surgery to knee replacement surgery is not that great of a comparison. There is no waiting list for "knees" or knee repair. You don't have to wait for a knee donor to die in order to get the repair or replacement done.

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Katara 4 years, 10 months ago

Multidisciplinary (Anonymous) says…

OK.. I think there is some unnecessary polarization going on here. Many comments seem to say that if someone says something that isn't bashing someone who is overweight, they are on the cheerleading squad for everyone to become 1000 lbs. ~~~~~~~~~~~~~~~~ I think that is because a lot of people see being overweight/obese/fat/whatever you want to call it people as morally weak. The thinking is that there is no self-control, no willpower, etc. They don't want to look at the fact that there are genetic & metabolic reasons for some people getting to the morbidly obese point and they don't like the fact that they may end up one day being there.

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costello 4 years, 10 months ago

"No one. And I mean NO ONE, is made 1,000 pounds because of their genetics or some illness that leads to obesity. Stop blaming other people, the media, or your 'genetics' for lifestyle choices."

You don't know what you're talking about. You're completely uninformed on this topic. You would sound far less foolish if you'd learn something about a subject before posting on it. I'll again recommend the book and video I recommended above.

I would say the exact opposite of the quoted statement above. Anyone who weighs 1000 pounds MUST have some kind of underlying metabolic problem. I'd wager you would not be able to gain that much weight. Eat an extra 1000 calories a day. Supposedly that would cause you to gain 2 pounds a week, 100 pounds a year. Eight years to gain the extra 800 pounds. Trouble is it won't work. Even if you could force yourself to eat an extra 1000 calories a day, day after day, year after year - which would be a feat in itself - you wouldn't put on the 800 pounds. Your metabolism would go into overdrive to burn off excess calories. No doubt you'd quickly lose your appetite. You might even find the thought of more food nauseating. You certainly would not gain 800 pounds! I'm not saying you wouldn't plump up; I'm sure you would - especially if you make that extra 1000 calories carbs. But you would never get anywhere close to turning your 172 pounds into 1000 pounds.)

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costello 4 years, 10 months ago

Obesity is caused by a combination of genetics and environment. Our current food environment has created a perfect storm for obesity. We eat a steady diet of highly processed carbohydrates, sugar, and high fructose corn syrup. The average American now eats something like 150 pounds of sugar per year. Compare that with the scant 20 pounds per year we ate in the early 1800's.

Then in the 1970's the idiots in the gubmint decided to tell us how to eat. Basing their recommendations on shaky science and politics, they told us to eat less fat and more carbs. The diet that had sustained human bodies from time immemorial was thrown out as "dangerous" and we were told to eat MARGARINE for God's sake!

http://www.youtube.com/user/FatHeadMovie#p/u

We've been getting fatter and fatter ever since.

Lord save me from the gubmint!

Most obese people would never have become obese on what our grandparents or great-grandparents ate - real food, whole food. The problem is once a person who is genetically susceptible to fatten has lived on the standard American diet for long enough, his or her metabolism is broken. A low-carb diet can reverse some of the negative health effects and bring the weight down some, but the odds of attaining a normal weight just aren't good for most.

If you're not fat or suffering from metabolic problems, I'd recommend Michael Pollan's In Defense of Food. If you're fat and diabetic or prediabetic, I'd recommend a low-carb approach - Atkins, South Beach, Eades, etc.

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Christine Anderson 4 years, 10 months ago

Ah, my cardiologist prefers South Beach over Atkins, etc. Guess I should think about heeding his advice before I hit 50. Grandfather dead at 65 of M.I. Dad dropped dead of sudden cardiac arrest at 74. Mom defying odds at 74, with five stents. She had a triple CABG at 57. Scary.

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natas 4 years, 10 months ago

Ok ... so I have not read the whole thread .. I am a medic in the KC area and I see no reason why there shouldnt be an extra charge for "large" patients. When you consider that the cots that most all of the ambulances use around here are rated for 650lbs and you have a patient that is over that weight .. they can make the cot fail and that would be a lawsuit. Also you have to take into consideration the amount of man power it takes to move these patients (the last one that I moved over that weight took 8 people all together, 2 medics and 6 firefighters) All of us have to get paid (school loans). There is also the risk of a career ending back or shoulder injury. I am never rude to a patient unless they give me reason to (just so you all know that I am not an a$$hole from the get-go). Another thing to think about is that these people do not fit on the cot .. even some of the ones that are well under 500lbs. The back of the ambulance does not have much room to work in and when it is all taken up by the patient .. then they may as well be riding in the back of a pick up! So what I am trying to say is that if you are large enough to require specialized equipment .... then you should have a larger bill!! And no, I do not work for AMR.

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costello 4 years, 10 months ago

Hi misplacedcheesehead: People tend to have a knee jerk negative reaction to Atkins. He was demonized in the press and by public health people and nutritionists. I lost 45 pounds on Atkins, my blood pressure (which was creeping upward) returned to normal and my blood lipids (which were always ok) improved. I'm also no longer prediabetic.

South Beach is fine too. Take your doc's advice and start the diet.

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costello 4 years, 10 months ago

Hi natas: I don't object to charging these super obese patients more for transport (although I think the insurance company should pick up the bill). Clearly the ambulance company can't eat the costs.

I felt compelled to reply to some of the comments in this thread blaming the obese for their problems. It's simply ignorant to discuss a biochemical problem using the language of sin and psychology. The obese are no more sinful or neurotic that the rest of us.

I doubt if it will change the minds of most people - particularly lean people who seem to believe they've done something right when they've just been lucky. But possibly someone is reading this thread who is obese (or headed in that direction) who will decide to stop beating him- or herself up and start working WITH their metabolism instead of against it. (Low carb isn't necessarily best for everyone, but if you're insulin resistant or have metabolic syndrome or prediabetes, it may be a good choice for you.)

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jonas_opines 4 years, 10 months ago

"OK.. I think there is some unnecessary polarization going on here."

How long've you been posting on this site, MultiD?

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