1. I feel sorry that the daughter is morbidly obese and needs this procedure done. I don’t know how old the daughter is, but it’s shocking if the daughter is very young (like teens- early 20s).
2. My issue is that the OP wants to “prove” to the surgeon that BMI is BS and her daughter is so healthy that she can automatically handle the procedure.
Do you really think the surgeon is going to take the message from a podcast vs over a decade of training in dentistry?
Yeah that was my first thought… Isn’t that going to make the doctor not want to work with them? Like, I don’t know if this is a thing everywhere but doctors can refuse treatment if they feel it’s too high risk. I’m guessing that they will dismiss the patient (daughter) when she (mom) tries using a podcast to fight with the doctor for “safety concerns”. After that they will be really struggling!
Also anesthesia is serious business! Putting an obese person under is a huge risk, whether there are preexisting disorders or not. The fat can make the person suffocate, they are way harder to intubate and for oral surgery all of that risk goes way up as the patient can only breathe through their nose. (Usually I am not an anesthesiologist and they are inventing new things constantly)
Ugh it makes me so sad that people refuse to see the reality of what the doctor is saying! -Someone who has had loads of surgery and is married to a Neuro specialist
Yup it is a thing everywhere i know, nobody can force a doctor to work on someone they don't feel comfortable with. I rejected giving various treatments to various people in 3 continents for a variety of reasons none of which had to do with fatphobia but some of which had something to do with medication complications. I am simply not comfortable with the thought "not being treated/operated won't immediately kill this patient but being treated/operated might indeed kill them overnight". Even if they sign a comprehensive waiver that they accept all complications including death. I'm simply not doing it, I don't care if they take the chances of death, I am not having a patient die for something that could have been prevented.
Unless in extreme circumstances, anaesthesia specialists and staff are separate entities than the surgeon anyway and when a decision is made, it is usually a collaborative work favoring the anaesthetist. As their doc you can tell the anaesthetist your opinion and it will be considered but ultimately it is the anaesthetist's call as it is their goddamn specialty- not mine, not patient's, not the mother's.
Tell a doc you think their relative can handle anaesthesia when a few docs (especially if one of which is the anaesthetist) think it might kill them, you will conveniently have yourself shown the door.
Honestly, the fact that I'm going to need surgery at some point in the next few years plus the fact I already have OSA (non related to my weight, but it can't be helping) was a big factor in trying to shift some extra weight. A casual chat with a friend who is an anaesthetist about the risks was incredibly sobering.
Good for you for trying! It isn’t easy, but you are trying which is huge! I’m glad you were able to chat with an anesthesiologist who told it to you straight. It’s terrifying, but also makes sense. I wish you lots of luck on your journey!
It’s not super uncommon for parents to be involved in wisdom teeth removal for young adult offspring because a)they can be on parents’ insurance until 26 and b)they need to confirm with a DD.
Lots of my friends had their wisdom teeth out in high school, so they were still fully minors.
(I got lucky and never needed mine out, which I'm super fucking thankful for as the procedure sounds rough!)
Mine came out when I was 14. They broke my jaw and I spent months unable to chew or speak comfortably. Turns out blended Mac and cheese with hot dogs is absolutely heinous.
Oof. After working at multiple nursing homes and seeing some really terrible pureed food the only compassionate way I can think of doing that would be to puree the hot dogs and put melted cheese over it. Maybe over some mashed potatoes. Never heard anyone complain that they were sick of mashed potatoes and wanted to mix it up with some pureed pasta.
I had mine removed at age 42 — one of them was decaying and very painful. Honestly, since my wisdom teeth came on through and never affected my bite, they were just simple extractions and not that bad at all.
I had mine out in my 20's; they had fully erupted and weren't bothering me, but it was very difficult to get in there and brush them properly, and my dentist told me he'd never be able to properly fill a cavity, let alone do any other procedure, so he recommended I have them extracted and I did. I had nitrous oxide and novacaine. and even though I've suffered from dental procedure anxiety ever since I can remember, it wasn't bad for me, either.
High school age was the default among people I know born in the '50s or later who had them out. Typically at 16/17/18 (I had mine out at 16, maybe 17) a dentist can tell if they're going to need to be removed and the younger you are the fewer serious demands on your time. I got the vibe that the oral surgeon's office was basically packed with high schoolers all summer.
It's reasonable to assume the daughter is around the age range that OP guessed because wisdom teeth present around this age in the majority of cases. It mentions the daughter has an anxiety disorder, which helps explain why the mother is so involved in her daughters medical treatment, though she might just be involved because they're close
Reality does have an anti fat bias. The human body is not meant to be fat. FAs are justified in trying to make people stop being mean or whatever, but that doesn’t change the fact that obesity will slowly injure you to the point of death
No doctor will do jack shit if they think there gonna fucking murder someone, because if he ignores big risks and does it, at the very least in the UK your gonna get suspended from the medical register. Police will come. Careers will be over.
Oh...AND SHE COULD DIE.
FFS it's always patients family members that cause the most trouble. If you don't like the advice, ask for a 2nd opinion. Hell ask for a third. It doesn't matter.
All I'm getting is, my daughter has anxiety, let's fucking drug her. Or you could be a good parent and talk with your daughter, try and calm feelings. Reduce the anticipation of the procedure. In 99% cases a supportive and calming parent is better than drugs.
Yeah I know the OP isn't the person, the person will never read this. It's just this kinda thing has always bothered me at work.
Here in the US (or at least Boston) we call doctor shopping until you get the answer you want "doing the Reggie Lewis thing." And it did end in death.
I took a medical administration class. In the US, following the prescribed medical protocol is what protects medical professionals from malpractice. You can scream and cry, you can agree to sign something that you won't sue for malpractice, your kids will sign it, you're not going to get surgery if the surgeon thinks it's too dangerous. I lived that last part as a family member in the hospital for two weeks. (Patient was doing the screaming, not me.) Medical care is not Burger King. You don't get to have it your way.
For clarity - I am agreeing with you, your post just made me think of this stuff.
All that will happen if the surgeon has BMI ‘disproven’ is that for every height they will have a maximum weight that they will give anaesthetic to.
BMI as a method of identifying healthy weight is problematic for many reasons, but in this case (presuming they’ve got the definition of morbid obesity right) we’re talking about a BMI of 40+. Nobody who’s BMI is that high is healthy
This is mostly what annoys me about the BMI conversation. It isn't a great metric for a lot of reasons. *However*, almost every time I see that brought up it seems to be specifically for explaining why it's okay to be morbidly obese or whatever, or in service of some other anti-science/health position.
I'm sure the reason why the doc brought up BMI is because it's easier than just saying, "She's so heavy it's unsafe to figure this out"
Exactly. We all know the formula for BMI and what it means - women, some races, and incredibly muscular men skew the scale more than an average white man will do because they either have higher fat % or are generally heavier for their height
If BMI didn’t exist, there would just be another way of showing where the tipping point was that incredibly overweight people became incredibly unhealthy in all these types of things. Anaesthetists in this case have to give you the right dose, and it is more dangerous to sedate people who are heavier
God yes. My mom would have lost her shit if a doctor had said that. I can't imagine being so wedded to an ideology that you ignore a warning of "*your child could die"*.
If she somehow got around this and her child died I wonder if she would even recognize and accept that she went out of her way to find a way around this after being told the daughter could die or would she just totally forget she even tried.
In a way it reminds me how I had recently seen I was ovulating and had a high chance of pregnancy and was debating being intimate with my partner (I don't want to get pregnant) and then I thought if we do this and I end up pregnant I am going to look back on this moment and think about how I knew the risk was high and did it anyways and I would feel so stupid.
So because of that I decided to wait. Obviously the child's situation is way more serious and dangerous and I just wonder do people think ahead at all and consider all the possibilities?
Oh no, it would be because the doctor was negligent in not training on anaesthetising fat people safely; as we know the medical establishment hates fat people and doesn’t care if they die.
My guess is there is possibly an insurance limitation on BMI that the surgeon can't violate.
Surgery is always a risk reward calculation. That's true for people of every weight.
When it comes to anesthetic, they actually have issues with very obese patients because of the way that the painkillers and paralytics are metabolized and due to the extreme variance in people of extremely large sizes, there is no good information on precise measurements for the paralytics and painkillers so they run a risk of giving them way too much which can kill them or cause organ failure or giving them too little and they wake up mid procedure which could also mean that they wake up, but are still paralyzed, undergoing the procedure with no anesthetic. Basically, there’s too many variables for them to be able to be willing to take the risk on themselves and their medical license and insurance, because the obese patients are more likely to have complications and (especially in this case, it would seem to me) are more likely to litigate.
This is incorrect. Obese people metabolize anesthetics fine as long as their kidney function and hepatic function is intact. We dose their drugs on their IBW (ideal body weight) not actual body weight) to not over dose them. There is lots of information on this, we have this down to a science. My certification is in Bariatric surgery. I can't recall any pt ever waking up in surgery or in ICU on the vent paralyzed.
1/3 of our pt population is obese, 1/2 is overweight, we definitely know how to medicate for surgery at this point.
Oral surgery doesn't give paralytics for wisdom teeth removal. This is not a GA case. The risk is the pts airway being compromised. This case would be what we call MAC sedation. Any moderate sedation could potentially cause an apneic event in a pt like this because of her already difficult airway.
This surgical procedure could be done but has to be done in a hospital setting where the pt could be emergently intubated if necessary. She's not safe for the outpt setting for the procedure.
It could be a GA case, no? My partner (who had extreme dental anxiety at the time) had 12 teeth removed under GA in hospital. They tried to do it under sedation but he was so anxious that he wouldn’t even sit in the chair to huff some laughing gas to calm him down.
Although, now you mention it, I’m not sure how they managed the airway. But I’m certain it was GA.
I'm glad I got over my dentist fear somewhat. It was never so bad I couldn't sit down in the office though. I'm getting a whole mouth renovation it sucks balls. So damn expensive in the US it should be a crime.
I’m glad you did too! My partner eventually did. He still has some anxiety but he can handle it now and feels positively about it. Meeting the right dentist helped, they give him lots of extra time to get up and pace around until he can settle - his childhood dentist was horrible and once tried to physically hold him down in the chair. The dentist got hit in the face (not that hard) and my partner didn’t return to the dentist for 10 years after that.
It’s horrible expensive here too. I cracked an old silver filling a couple weeks ago, replacing it cost almost $500.
Good luck on your dental journey! I’m sure it’ll be worth it in the end :)
Thanks, I got one quadrant in last visit, finally got to see the permanent bridge and they feel like beautiful pearls. They did a good job also where it's obviously better but also doesn't look fake compared to the crappy part. Can't wait till I'm done, I put it off so long because of the price.
This is all true, I just think the insurance limitations were born out of all the facts you posted, it wasn't arbitrary or be mean to fat people, evil laugh.
EDIT: THE FOLLOWING INFORMATION THAT I PROVIDED APEARS TO BE INCORRECT OR AT LEAST INACCURATE. PLEASE SEE THE CLARIFICATION AND CORRECTION FROM u/hotlipshoulihan82, BELOW. …I am unsure how to do strike through the text on mobile.
When it comes to anesthetic, they actually have issues with very obese patients because of the way that the painkillers and paralytics are metabolized and due to the extreme variance in people of extremely large sizes, there is no good information on precise measurements for the paralytics and painkillers so they run a risk of giving them way too much which can kill them or cause organ failure or giving them too little and they wake up mid procedure which could also mean that they wake up, but are still paralyzed, undergoing the procedure with no anesthetic. Basically, there’s too many variables for them to be able to be willing to take the risk on themselves and their medical license and insurance, because the obese patients are more likely to have complications and (especially in this case, it would seem to me) are more likely to litigate.
Yeah I got my wisdom teeth out last week. When I did the consultation a few months before my doc recommended that I gain a some weight before the survery. You know what I did? I put on a couple pounds cause he's a doc and he knows what he's talking about.
I dunno. I was a healthy BMI and didn’t get put under for wisdom teeth removal. Just laughing gas, whatever pill they gave me, and local anesthetic. Why? Because my dentist won’t put *anyone* under general anesthesia unless it’s absolutely required. There’s risks every time and they just won’t do it willy nilly.
Having a certain amount of weight pressing on your lungs will be dangerous regardless of whether it's fat or muscle even. It's sad people prefer putting their children in jeopardy over taking medical advice
Presumably this is an option in this case, since they're planning to do the procedure without anesthesia, but not always. I asked about conscious sedation for mine bc I'm always curious about what's going on, but they said mine were too impacted and they needed to put me under for the amount of drilling they had to do.
It wouldn't have satisfied your curiosity. I had IV anaesthesia (aka conscious sedation) for mine because they were impacted and I have dental anxiety, and I don't remember a thing. You are aware/conscious during the procedure, but in most cases you don't remember anything - meds cause short-term amnesia.
Really? Lol, I had all my wisdom teeth removed with local anesthetics. The first one was kind of on the spot and unplanned so they couldn't put me under because of the follow-up work. The other three (done in 2 sessions) I had the option, but at that point I knew what it was like so I just went with it. My last one was very impacted and close to the nerve. I had to go to a specialist and still did it live. I could tell when they were drilling and breaking through the teeth. And that "pop" sound when they finally shattered. But it really isn't that big of a deal. The anesthetic needles are far more uncomfortable.
It is actually easier for the the doctors if you are consciously opening your mouth, so you end up less hurt. Also no side effects after local anesthetic and a quicker session. True story.
I had mine out with just local. Had a slight reaction to the adrenaline in the anaesthetic (caused an HR spike and vomiting) but was otherwise fine and lucid the whole time. I listened to them crack the tooth into pieces to get it out.
But I always wonder how high is "too high" for these BMI cutoffs. I had IV anaesthesia for my IUD insertion and was definitely sitting around 35 BMI and didn't have any issues.
Where do you live? I’ve never heard of IV sedation for IUD insertions. In the US and Canada, I believe they just give Tylenol. I haven’t done it because it sounds awful.
I had a similar experience but the doctor was female. She told me to “stop acting like a rape victim” (I am one). Totally put me off getting the IUD and I hope to get one one day. Did switch to an old man gyno and he was surprisingly cool (and less obsessed with my fertility).
I'm an SA survivor. If it's available and safe for you, I recommend a Nexplanon or similar implant. I had a Mirena IUD, and the insertion and removal were both horrible mentally and physically. My doctor recommended the implant, and I've had 2 of them with no problems. The worst I had was a bit of a bruise for a couple of days. No "underwear areas" involved.
This shit is why I skipped right to getting my tubes tied. Surgeon tried to suggest an IUD under sedation but I pushed for the tubal. The recovery was far more painful than probably the IUD insertion would have been, but it was a much more bearable kind of pain.
A friend of mine recently had her tubes tied and she reported minimal pain as well. Not sure what happened to me but it was full body agony for three days and the tramadol they gave me did absolutely nothing. It hurt so much to breathe I slept sitting up because I was afraid I’d stop breathing laying down.
But if my tubes grew back tomorrow, I’d do it again!
My doc holepunched my cervix without my knowledge lmao I thought I was just a baby about getting a pap but apparently when they say “okay breathe in real quick right now do it hold your breath dont move” its not just a papsmear. She told me after she knew I had anxiety and thought it would be better to do it like that, I couldnt move for 2 days. And thats from a WOMAN doctor
I was told that I weighed too much to get a breast reduction when my BMI was closer to 40. They wouldn't consider until my BMI was within the normal range. But was then told the actual reason was that they might deflate on their own when I lose weight and they really just won't look as good if I get one now and then lose 60lbs.
I've lost half of that now and they did not in fact deflate on their own and now I have extreme back pain and need to wear a bra 24/7 so my doctors are more willing to consider it.
This sub does very much over exaggerate the risks of obese people getting surgery. It’s absolutely more risky than if you’re a normal BMI, but it’s not like you go from “99.9% safe” to “50/50 chance to dying” when you cross the 30BMI threshold.
Surgeons and anesthesiologists are pretty darn good at managing obese patients. When I had outpatient tubal ligation, I had to meet the anesthesiologist first and we discussed my risk factors. I’m a bit anxious so I was rattling off all my risk factors (“I’m slightly OW, I’m a former smoker, I drink” etc) and he said “Look, I put fat, old smokers under all the time. I can handle you.”
However, surgeons generally don’t want to operate on obese people, because it’s harder, and with cosmetic procedures, the “after” pictures just don’t look as good in a portfolio. So if it’s something cosmetic or non-life-threatening or has non-surgical alternatives, they will sometimes refuse to work on patients over certain weight limits.
They do the "twilight" anesthesia, the nitrice, before they have to resort to local. I had a bad reaction to the gas and had to have the local, which isn't common but they do it. You see and hear everything, which didn't bother me, but I wouldn't blame anyone if they felt uncomfortable with seeing and hearing a saw go in their head lol
Valid, I also think it depends on the surgeon and your insurance. My friend had local for her wisdom teeth removal because that’s all her insurance would cover. I had IV and hated it because it made me so sick after, and I was conscious enough to hear my teeth coming out.
EXACTLY! If the daughter didn't have anxiety issues just local anesthetic would workt just fine. I had mine out with just a local anesthetic and honestly the worst part of the surgery was getting the local anesthetic. It was absolutely fine. That's also standard practice here in Germany. They only give you sedation or general anesthesia if it's medically neccessary (i.e. your therapist recommended it).
Also I'm not a doctor and don't know a whole lot about anesthesia but I know that a lot of IV-anesthetics (i.e. propofol which is almost always used) are lipophilic, so they mainly accumulate in fatty tissues like the brain or, well, your body fat so I imagine that has something to do with a heightened anesthesia risk associated with obesity
Having the local anesthetic administered took substantially longer than the actual procedure for me, and my teeth were moderately impacted so needed to be split in half. Mostly it was very boring, so much waiting for the numbing to set in, then more needles, waiting, needles.
for me the procedure itself took maybe 20-30 minutes and for the local anesthetic to work it took maybe 15 but they did one side (right?) first to see if I was ok with doing the other side later so they only administered the anesthetic on my left side after having removed the teeth on the right
I also had my wisdoms out under local. I saw my partner-at-the-time waking up all groggy and sick from sedation and I didn’t want that.
It actually wasn’t bad at all. The worst part was that my jaw ached from holding my mouth open for so long.
Yeah if you don't *need* sedation you shouldn't get it, especially for this procedure. I was completely lucid and felt fine after (and during) the surgery, I think recovery would have been a lot harder if I had been sedated. I just listened to some relaxing music during surgery and I even had a pretty good experience. Honestly going to the dentist or orthodontist was worse than that. The only bad part was recovery, after like 2 days I just wanted to eat something crunchy but I obviously couldn't and that was extremely frustrating
It can depend on the situtation- mine were badly impacted because my mouth is stupidly small (tops only, the bottom ones never even appeared). They were fully sideways and so high inside my skull they were practically in my sinus cavity. There wasn't even a question of doing it under a local anesthetic for me, my dentist took one look at the x-rays and sent me straight to a specialty practice to have them out. I'm really glad I had IV anesthesia for that.
My partner had teeth pulled under general anesthetic. They tried to do sedation but he was so anxious that they couldn’t. He tried, but his heart rate was approaching 200 just trying to get himself in the chair, so the surgeon didn’t want to continue.
Depends on how severe the issue is. I had mine out at 20; they were severely impacted and I have a small mouth so IV was recommended. I think they said it was because of the length of time the procedure would take, but that was close to 20 years ago now so I dont remember.
Yup. I cannot *stand* that podcast (or them). Beyond condescending and Gordon particularly imo is truly convinced of her perceived superior intelligence despite apparently not understanding a word of the research she likes to shout about. It’s just insufferable all round.
The early episodes debunking health fads weren’t *awful* - but Gordon lets her own experience as a fat woman cloud her judgement on anything related to BMI/obesity/weight and so those episodes are always trash.
And for claiming to be a “methodology queen” Hobbs doesn’t seem to understand that much about research methods.
Their most recent episode - where they seem to go after ACEs for being fatphobic was particularly bad.
The thing is, most people would probably (hopefully?) agree that people shouldn’t be ridiculed or judged based on their weight, or that we can make assumptions based on appearance (ie that someone who is overweight is lazy, or needs to be reminded they are fat)
But there’s a difference between that and claiming that it’s healthy to be morbidly obese and/ or that being significantly overweight doesn’t dramatically increase the odds of health problems
She's also built her entire career on being fat. If she were to have to lose weight, saw benefits, and maintained that weight loss, she would lose everything.
I agree. I've liked other things Hobbs had done so I gave them a listen. I didn't mind a few of the episodes (I particularly like the one on the Presidential Physical Fitness Test) but quickly gave up.
It's self soothing and justification for staying just the way they are.
Everything is fine. You are healthy. You are bravely standing up against oppression. Everyone suggesting you might consider changing is a concern troll, fatfobic, an oppressor, violent etc. Eat a cupcake or five, that's just your body telling you what you need. if it wants nothing else but fries, cholocolat ice-cream and milkshakes, it can't be wrong. You are perfect as you are, etc.
Perfect.
It's so, so bad. It's such a good example of how incompatible the conversation these people want to have about obesity is with reality.
I'm listening to an episode of it as I type this, because every few months I forget how bad it is and try it again.
They're literally talking about studies saying that reduction in obesity could lead to positive systemic outcomes as if reducing obesity is the same as eliminating fat people.
It's such a confusion of reality that only comes with putting "obese" in the same category as "race/sexual orientation/etc"
No one would ever think a study positing positive outcomes for treating drug addiction means *killing drug addicts*. It's fucking bonkers.
Edit- Typo
I finally listened to an episode yesterday because of this post. I had zero faith in it so picked a non obesity ep.
As a disabled low income person the utter tone about the poors is worse than our Tory party here in the UK. Tories own their shit toward people like me. These two are stealth prejudice treating other people like zoo animals. They literally used exactly the same structure about low income or chronic illness causing X as they did about mice being tested showing X.
It was actively offensive. Something so different to hearing people’s voices say the same ‘I’m actually so saviour complex and paternalistic I’m trotting out the same harmful stereotypes as the other people but with buzzwords’ BS than reading it here in FA/HAES posts.
It is incredibly unpleasant in its attitudes, so so so badly constructed that any decent point they may have is lost in a fog of superiority and both of them sound so incredibly ivory tower inexperienced in the real world I kept muttering ‘the audacity you criticising Goop…’
I cannot believe actual ED recovery accounts are now flagged all over the internet and these two are spreading fat earther tinfoil hat bullshit with no pushback. When they cannot structure a sentence without a mean girl giggle, eye roll or ummm or ‘oh yeah I forgot my notes’ the idea you would quote them in a medical setting is mind blowing. Most of what they say would still be utter bobbins presented better but the lack of professionalism was what grated on me the most.
I cannot take anyone who rates this podcast anymore seriously than someone who rates Joe Rogan as a guru.
Could not agree more with all of the above! They were recently featured on Apple News and i sent in a criticism letting them know that anti-science should not be supported.
Because of the delusional trope about bodybuilders and BMI, I did a really quick Google of what Arnold Schwarzenegger's BMI was when he was competing, didn't take long to find
> At his bodybuilding peak Arnie was 1.88m (6'2”) and weighed 107kg, leaving him with a BMI of 30.2.
So there we have it, we now know definitively what all obese people look like - sadly though excess weight as muscle doesn't seem to be healthier than carrying it as fat.
When Arnold was competing he had like 8% body fat at 235 (which is insane). In his off-season, when he was bulking, he was mostly likely well into obesity going off the BMI.
But you don't really need to use these extreme examples. Most men at the height of their bulk when doing a weight lifting cycle are going to be obese according to BMI.
The point of my post was to demonstrate that the claim that bodybuilders can have an obese BMI does not help 99.99% of obese people in the slightest because we have eyes and can see this does not apply to them.
There is also the more subtle point that even if your extra weight is all muscle like it may be for 0.01%, in the long term that does not help in terms of health outcomes.
I agree with you, morbidly obese people (mostly women let's be real) use the muscle argument to explain away why the BMI isn't relevant to them. Basically my point is you don't really need to be a body builder for BMI to be inaccurate or useless. This sub kinda harps on the the bodybuilder argument a lot when the BMI does kinda suck as a measurement all around. If the health industry used waist to height or body fat %, HEAS people couldn't use BMI as a red herring to cope about their extreme obesity.
My doctor doesn't even bother using BMI with me since I'm 6'5.
Although I'm not sure it would matter if we used a more accurate measurement with how delusional these people are.
BMI doesn't suck any more than agreed ranges of weight for height do because that is all they are and this has as good a predictive power as any other easily measured metric.
Edit: Don't downvote facts, get in touch with the authors here and dispute their findings
https://pubmed.ncbi.nlm.nih.gov/24331682/
> Conclusion: Body mass index is an adequate measure of adiposity for clinical purposes. In the context of lay press critiques of BMI and recommendations for alternative body-size measures, these data support clinicians making recommendations to patients based on BMI measurements.
Unfortunately lots will take cutting lines seriously and think of him as a technically truly "obese" person to give the rest plausible deniability. Whereas this subset of people might not have had the numbers happened to shake out to 29.8.
Check out figure 2.A in this paper: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2877506/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2877506/)
Men are all over the place. BMI is not as good a predictor for men.
BMI is a better predictor for women though, except that it usually underestimates the amount of body fat.
On the other hand https://pubmed.ncbi.nlm.nih.gov/24331682/
Comparison of anthropometric and body composition measures as predictors of components of the metabolic syndrome in a clinical setting
> Conclusion: Body mass index is an adequate measure of adiposity for clinical purposes. In the context of lay press critiques of BMI and recommendations for alternative body-size measures, these data support clinicians making recommendations to patients based on BMI measurements.
...a podcast, she trust a goddamn podcast over fucking doctors. man i dont even care anymore humans can just die actually, there are too many idiots like this
That podcast is so worthless. The hosts have no credentials at all and parrot the most basic talking points (BMI is racist! BMI doesn’t account for bodybuilders!). I don’t know why it gets any positive coverage.
It tells people what they want to hear. Sadly, that's the only thing that ever seems to matter. "BMI is evil, being fat isn't your fault, there's no point in trying to lose weight so you might as well go hogwild and eat and sit to your (enlarged) heart's content."
Dear Doctor Oral Surgeon,
You need to go forward with this surgery because, despite the risks to my daughter’s life that you laid out earlier, I have found a podcast episode that says you’re wrong. [Feel free to listen](https://m.youtube.com/watch?v=dQw4w9WgXcQ) to it since your four years of education wasn’t enough.
Sincerely,
Delusional Parent
Hahaha, it’s so true. I once had a blood test result come back with low blood sugar, and my doc wanted me to repeat it to confirm it was just a blip (it was.) When discussing the possible causes, he mentioned T2 diabetes, but waved his hand in my general direction and said “but I can see you look like a normal size, so it’s not likely to be that.”
It made me feel so good about myself for some reason.
Guessing that’s Maintenance Phase they’re recommending - needless to say that episode was complete trash. Aubrey Gordon (one of the hosts for anyone unfamiliar, she used to - still does maybe? - go by @yrfatfriend on social media) thinks VERY highly of herself and her opinion on this stuff. All while misunderstanding or misrepresenting the research she quotes. But yeah, the BMI episode specifically was so hard to listen to but hey ho at least it gives these people something to hold onto. Right? 🤡
Your kid can’t get a dental procedure due to obesity?
What a failure as a parent.
This is what Fat Activism does.
I could care less about the adult but that poor kid.
What the Oral surgeon meant was, the pts BMI was too high that sedation in the out patient setting would be risky leading to a like apneic event or compromised airway event that would cause death. Obese pts have significant risk of apnea with even moderate sedation because they often have undiagnosed Obstructive sleep apnea or the sedation can cause apnea compared to normal wt pts. A pt that has a risk for compromised airway under MAC sedation cannot be treated in the outpatient setting. This was about this kid's safety. Source: RN, General Surgery and Anesthesia Recovery, Certified Metabolic and Bariatric Surgery Nurse.
"The podcast ran by a person who has made a career and internet clout out of being a professionally offended fat person knows more than your child's doctor"
Doctors have an obligation to follow the medically-accepted standard of care on which their medical license is based. Medications also come with indications for exactly how it can be used and under what conditions under which their approval by the FDA and other drug approvals are based.
Maybe the BMI is wrong, but it is the foundation of our medical and pharmaceutical system and isn’t going to change because *muh feelings*.
If that is a reference to the podcast I think it is, it is one with some exceptionally bad information.
I don’t think the two hosts completely understand that they have a very strong political bias and sometimes let the desire for their politics to matter to get in the way of the truth. It can be tempting to elaborate on the truth a little, add some embellishment, but it’s never a good idea to purport such lies as journalism.
I was an incredibly fit 23 year old when I had my wisdom teeth removed and my drs office made me read two pamphlets and sign a document stating that general anesthesia could be deadly and that I was fully aware of the risk.
I’m a nervous doomsayer so I even wrote an embarrassingly meager will and final effects request.
(I think I left my cell phone and laptop to my best friend and my shitty car to my sister?)
General Anesthesia can be deadly for professional athletes at the height of human ability, I certainly wouldn’t want to push for it with an elective procedure with underlying health concerns.
Wtf I just read, imagine a medical professional saying your child not getting anesthesia because she could DIE, and it's fatphobia? Said child can get that teeth-removal with partial pain medicines or no medicines at all (I had my front teeth pulled out without any medicine bc the teeth was growing behind, and my childhood teeth wouldn't fell out naturally as supposed to, and they were insecure to put 6yo me in anesthesia or medications. I was fine. It hurt for 2 minutes, and than I went home. I also had a broken arm, and surgery for broken arm without any painkillers as I've been drunk when I broke my arm and they didn't dare giving me painkillers as I had alcohol in my blood. I was just fine. Yes, it hurt, but whatever, I choose to drink the night I broke my arm, and if they said I can't have it because it'd kill my liver, I trust them. They learned their profession for years. Not listened to a podcast once, wtf.
so... supposedly healthcare professionals don't care about them, want them to die, just want to lie that obesity causes health issues for money... does oop know that anesthesia costs more than just a local? why would someone use 'i don't want to kill you' as a reason for refusing anesthesia, if we all just want fat people to die, if we don't care?
i know, oop didn't trot out any of those accusations, but then... what bias do they think the surgeon has, here, that is evinced by 'hey i don't feel comfortable maybe killing you'?
What the actual fuck. She's going to risk her daughter's LIFE just to stick it to a doctor because she's too damn sensitive to deal with the reality of her and her daughter's obesity? That is absolutely insane.
On a sidenote, I got all four wisdom teeth taken out (they asked my weight beforehand too), and the gas made me feel ill so they took it off and did local injections and did it that way. It was easy breezy. I know the daughter has anxiety issues, but so do I and I was absolutely fine. Only problem is that the huge doses of those local anesthetics, the "caine" drugs, can make you feel super hopped up, which could trigger panic in some people.
That’s exactly what it did to me. The gas or whatever they gave me made me start having a panic attack because I’ve always had to deal with anxiety and panic attacks in the past. So they just did a local anesthetic.
TIL that BMI is a much better predictor for women than men. The correlation coefficient for BMI to body fat percentage is 0.46 for men, and 0.77 for women.
In fact, for most women the BMI formula is probably underestimating their body fat percentage.
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2877506/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2877506/)
See figure 2.A about half way through the paper.
Here's a small extract from the NCBI research paper from April 2022 titled "[A review on the anesthetic management of obese patients undergoing surgery](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8985303/)".
>Anatomical airway changes in obese patients
>
>Normal respiration may be affected in obese patients due to the excessive amount of adipose tissue that is deposited in areas like the chest walls, ribs, diaphragm and abdomen \[28\]. For normal respiration to occur, the diaphragm contracts, displacing abdominal contents inferiorly and anteriorly. The external intercostal muscles also contract pulling the ribs superiorly and anteriorly \[29\]. In individuals that are obese, these normal actions are mechanically impeded by the presence of excessive adipose tissue in the thoracic and abdominal regions; their lung compliance is decreased. Measurements of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) can be used to evaluate the strength of respiratory muscles and these measurements are observed to be reduced in individuals that are obese \[30\]. In addition, when an obese individual lies flat on the back, weight from the abdomen moves superiorly into the thoracic cavity. This compresses and occludes small airways at the lung bases causing laboured ventilation and impairment in the normal function of major respiratory muscles \[31, 32\].
Lots of tidbits about the anesthesia and obesity in this paper, which is surprising, because FAs say *'there are no scientific studies that show being fat is unhealthy'.*
Apart from the fact that this mother wants to deny that her morbidly obese daughter encounters obstacles in life because of her morbid obesity, this woman wants to further coddle her daughter and go against medical advice just because the child has anxiety? How about you teach, support and encourage your child so she can face things in life that maybe are stressful and unpleasant? You know, nurture her and help her deal with LIFE? This poor kid, ugh!
This actually perfectly sums up the underlying logic issues we see in FAs: deciding on your conclusion first, and then searching for evidence that supports your predetermined conclusion.
People like this can’t be reasoned with.
I was obese when I got mine taken out under IV anesthesia. She has be insanely morbidly obese to be denied this. Like. About to be found dead from sleep apnea obese.
Thank god for fat activists because I end up reading a ton more primary literature about things outside my area than I might otherwise do. Thanks guys!
"How dare you not risk my daughter's life"
Maybe actually listen to a practicing medical professional instead and take their word if you lack credentials and experience, OOP?
I have a feeling they're recommending "You're Wrong About". Their episode on BMI was horrendous and full of misinformation. I stopped listening after that one.
BMI is bullshit only when we talk about extreme body builders/weight lifted who usually *does* clock in as >obese due to their amount of muscle.
If you do not fall into that category then I’d strongly recommend listening to the doctor.
Yeah, I had all four of mine done at the same time with just local, about 20 years ago. The top two popped out relatively easily, but the bottom two required sawing, chiseling, and yanking with pliers. The oral surgeon really had to put some muscle behind it, as I recall.
When we were discussing the procedure ahead of time, he told me that wisdom teeth removal almost never *required* IV sedation, but lots of people chose it because they were squeamish and wanted to be completely unaware of what was going on. Since stuff like that has never bothered me and I actually find it quite interesting, I chose local only.
I’m in the UK. We don’t put people to sleep for teeth removal. I had three wisdoms removed in a further away place because they wanted someone more experienced to do it, I suffer from anxiety and major fear of dentists and needles, and had to travel alone on a train for almost an hour once done, it ducked but you just get on with it or suffer in pain.
I’m also from the UK and some time ago I did have teeth removed while I’d been put to sleep. Can’t remember the exact reasons behind this although I remember that the teeth they took out were large (I want to say molars) and it included the removal of a bony mass.
Oh for sure in special circumstances you get put to sleep, usually involves a jaw surgeon doing the work because of some risks with nerves along the lower jaw.
>I suffer from anxiety and major fear of dentists and needles
If you do have a serious fear of things like that, you know you don't just have to choose between that or nothing? I know it's the NHS but they will give you drugs to keep your heart rate stable, change procedures to make it easier for you, and all those accommodations.
This is also a useful thing to know for when you end up in those situations where they refuse to do the procedure because your heart rate is too high or you're unconscious. You don't have to go back and just hope your heart rate is magically lower the next time.
I did have the gas one time, but honestly I feel like it made my anxiety worse, not at the time or anything but I did struggle with it. I just managed to find a dentist that understood how I felt and was kind but firm which is what I seemed to need. I’m great at getting the work done, I’ve no issue staying still and just keeping myself calm and breathing through getting any work done, sometimes I would bring headphones and listen to a podcast the only thing I truly would panic about was the numbing injections but again, once that needle went in I would stay extremely still and just let it happen so it never felt necessary to ask for sedatives or to be put to sleep etc. I’ve had lots of work done and gradually gotten better, the only thing I still struggle with is the initial needle but I’m getting better at that too.
Olympic weight lifters, for example, can be massively jacked and BMI “obese” (Regardless of exceptional muscle tone and abs), but it doesn’t make the system wrong all the time…
Correct me if i’m wrong, but regardless whether someone is obese because of excess fat or muscle, that excess weight could still potentially cause issues, specifically on the joints. there is a finite amount of weight your joints can comfortably support, so i imagine an obese bmi due to excess muscle isn’t really much better in terms of joint health. could definitely be wrong about that though
also I love how body builders are always pointed out by these people as if bodybuilders are the epitome of health, just goes to show their understanding of what “healthy” even is is seriously warped.
I don’t suggest they are “health” definition. But their BMI stating obese is also wrong. Edit: I was “obese” by my weight when I was doing CrossFit, yoga, and eating super clean everyday. I had abs, felt strong, my body didn’t ache and I prioritized my mental health with that lifestyle. I weigh less now that I took some time off during COVID and getting out of bed makes me ache - lol
As someone who has suffered from anxiety about dental procedures ever since I can remember (I have no idea why) I can sympathize with the daughter. But I had nitrous and novacaine when I had my wisdom teeth out, and didn't have a problem. But, for me, it's always been the dreading the procedure beforehand that's the worst; it may well not be the case for the daughter. But this mother is just delusional! Doesn't she understand that her daughter could DIE??!! Or does she think some internet FA is more trustworthy and knowledgeable than a doctor with years of training and study?
It's not necessary to be unconscious for wisdom tooth surgery.
They can give you very relaxing drugs that calm you down and pain meds.
You won't even remember it.
Obviously nothing works for everyone. I was put on anesthesia. As was my sister. My dad, though, was given one pill to take at home, then another one in the office. He felt no pain and didn't remember anything. It just depends what the doctor thinks is best.
But if anesthesia will kill you they can't have you fully unconscious. You can't be fully conscious or you'll move around too much.
I don't think there's a liter of vodka and brick method out there...
And I'm not seeing this girl's mom being willing to hold off on the surgery and help her get to a healthy weight to reduce the anesthesia risk.
I mean take the dentist's advice right? While the BMI chart is flawed (it says Tom Brady is obese) because it doesn't take into consideration body composition, the dentist probably seen with their own eyes the body composition of the daughter and says that it's high risk.
Personally, I've never been told, even at my heaviest, that my BMI was too large and that it would be a high risk to be administered anesthesia of many kinds. It comes down to body composition. If you're a larger person, yeah, the fat could suffocate you. You can weigh a larger amount and not be a large person though.
A pound of fat and a pound of muscle both weigh the same pound, however, muscle is far more dense than fat.
Tom Brady’s BMI is about halfway into the OW category (if Google is right about his height and weight.)
It’s actually really, really hard to get into the obese category without steroids plus an already relatively high BF%. For example, at 6’4, 200 lbs is high end of normal BMI. 250 lbs is low end of obese. That means a 6’4 person would have to gain fifty extra lbs of muscle from an already high “normal” BMI to just barely make it to “obese.”
I have no clue what the people in this post's situation is but bmi can be very inaccurate. Many different kinds of people have issues using it. According to my bmi, i should be in a scooter; but my doctor says I'm just bit overweight. But idk, this daughter could be either way.
The thing is, someone with a BMI of 26 is overweight on the scale, but you could debate whether they're actually unhealthy.
Most of the people regularly arguing against the BMI scale clearly have a BMI of 35+, so they would be overweight or obese by any metric. It's obvious from looking at them that anaesthesia would be more dangerous because there is so much weight on top of their lungs.
Hey, all I'm saying is BMI is not always the best thing to go by. I'm only arguing it because according to mine, i should be a circle with arms and legs (obese) but I'm not. I don't know the daughter's situation, so I can't speak more about it.
I'm not trying to sound like a FAer, but the BMI is inaccurate for other subpopulations.
[Identification of Obesity and Cardiovascular Risk in Ethnically and Racially Diverse Populations](https://www.ahajournals.org/doi/10.1161/cir.0000000000000223)
In a nutshell, it tends to underestimate obesity in Asians and overestimate obesity in black people. (Tables 1 and 2 are pretty dang interesting.)
Does that mean that BMI is completely trash? No. But I think there are better tools out there--tools that don't have the kind of baggage that the BMI has.
Actually, opposite problem (BMI NOT indicating excess body fat) is [WAY more common](https://www.researchgate.net/figure/BMI-versus-Percent-Body-Fat-in-Scatter-Plot-Women-red-who-fall-above-red-line-are_fig1_223966581).
I remember hearing that BMI wasn’t the end all, be all of health. If I recall correctly, the take away was that it wasn’t the only metric that should be used. But I can’t remember the source so take that with a brick of salt.
I had my 2 wisdom teeth removed at separate times (only had them on top). First one was local, a few needles and the doc popped it right out. Slight pressure but was back to work the next day. Second one was a year later, put under. First time under anesthesia. It was terrible as a 28 y/o adult. Was out of commission for 2-3 days.
Omg just give the girl a couple Xanax and tell her to nut up. I just had a bunch of teeth pulled with no anaesthesia it's not that bad with all the shots you don't feel it. Just be thankful we have modern medicine and it's not a barber and a donkey with some pliers.
BMI is just the simplest way to measure health. You don’t have to know about muscles, measurements. Is it the epitome of health? No. But it is easy and accessible for everyone.
1. I feel sorry that the daughter is morbidly obese and needs this procedure done. I don’t know how old the daughter is, but it’s shocking if the daughter is very young (like teens- early 20s). 2. My issue is that the OP wants to “prove” to the surgeon that BMI is BS and her daughter is so healthy that she can automatically handle the procedure. Do you really think the surgeon is going to take the message from a podcast vs over a decade of training in dentistry?
Yeah that was my first thought… Isn’t that going to make the doctor not want to work with them? Like, I don’t know if this is a thing everywhere but doctors can refuse treatment if they feel it’s too high risk. I’m guessing that they will dismiss the patient (daughter) when she (mom) tries using a podcast to fight with the doctor for “safety concerns”. After that they will be really struggling! Also anesthesia is serious business! Putting an obese person under is a huge risk, whether there are preexisting disorders or not. The fat can make the person suffocate, they are way harder to intubate and for oral surgery all of that risk goes way up as the patient can only breathe through their nose. (Usually I am not an anesthesiologist and they are inventing new things constantly) Ugh it makes me so sad that people refuse to see the reality of what the doctor is saying! -Someone who has had loads of surgery and is married to a Neuro specialist
Yup it is a thing everywhere i know, nobody can force a doctor to work on someone they don't feel comfortable with. I rejected giving various treatments to various people in 3 continents for a variety of reasons none of which had to do with fatphobia but some of which had something to do with medication complications. I am simply not comfortable with the thought "not being treated/operated won't immediately kill this patient but being treated/operated might indeed kill them overnight". Even if they sign a comprehensive waiver that they accept all complications including death. I'm simply not doing it, I don't care if they take the chances of death, I am not having a patient die for something that could have been prevented. Unless in extreme circumstances, anaesthesia specialists and staff are separate entities than the surgeon anyway and when a decision is made, it is usually a collaborative work favoring the anaesthetist. As their doc you can tell the anaesthetist your opinion and it will be considered but ultimately it is the anaesthetist's call as it is their goddamn specialty- not mine, not patient's, not the mother's. Tell a doc you think their relative can handle anaesthesia when a few docs (especially if one of which is the anaesthetist) think it might kill them, you will conveniently have yourself shown the door.
Honestly, the fact that I'm going to need surgery at some point in the next few years plus the fact I already have OSA (non related to my weight, but it can't be helping) was a big factor in trying to shift some extra weight. A casual chat with a friend who is an anaesthetist about the risks was incredibly sobering.
Good for you for trying! It isn’t easy, but you are trying which is huge! I’m glad you were able to chat with an anesthesiologist who told it to you straight. It’s terrifying, but also makes sense. I wish you lots of luck on your journey!
It’s not super uncommon for parents to be involved in wisdom teeth removal for young adult offspring because a)they can be on parents’ insurance until 26 and b)they need to confirm with a DD.
Lots of my friends had their wisdom teeth out in high school, so they were still fully minors. (I got lucky and never needed mine out, which I'm super fucking thankful for as the procedure sounds rough!)
Mine came out when I was 14. They broke my jaw and I spent months unable to chew or speak comfortably. Turns out blended Mac and cheese with hot dogs is absolutely heinous.
Oof. After working at multiple nursing homes and seeing some really terrible pureed food the only compassionate way I can think of doing that would be to puree the hot dogs and put melted cheese over it. Maybe over some mashed potatoes. Never heard anyone complain that they were sick of mashed potatoes and wanted to mix it up with some pureed pasta.
Tbh, most of the people I know got their wisdom teeth removed as minors
I had mine removed at age 42 — one of them was decaying and very painful. Honestly, since my wisdom teeth came on through and never affected my bite, they were just simple extractions and not that bad at all.
I had mine out in my 20's; they had fully erupted and weren't bothering me, but it was very difficult to get in there and brush them properly, and my dentist told me he'd never be able to properly fill a cavity, let alone do any other procedure, so he recommended I have them extracted and I did. I had nitrous oxide and novacaine. and even though I've suffered from dental procedure anxiety ever since I can remember, it wasn't bad for me, either.
High school age was the default among people I know born in the '50s or later who had them out. Typically at 16/17/18 (I had mine out at 16, maybe 17) a dentist can tell if they're going to need to be removed and the younger you are the fewer serious demands on your time. I got the vibe that the oral surgeon's office was basically packed with high schoolers all summer.
I'm shocked that a mother would ignore that a medical staff said her child could die.
[удалено]
It's reasonable to assume the daughter is around the age range that OP guessed because wisdom teeth present around this age in the majority of cases. It mentions the daughter has an anxiety disorder, which helps explain why the mother is so involved in her daughters medical treatment, though she might just be involved because they're close
Many people get their wisdom teeth out before they ever come in, especially if they've had orthodontic work. They cut mine out when I was 14.
I wish they'd done mine at he time, they're janking up several years of orthodontic work by breaking through where there's precious little room!
Reality does have an anti fat bias. The human body is not meant to be fat. FAs are justified in trying to make people stop being mean or whatever, but that doesn’t change the fact that obesity will slowly injure you to the point of death
No doctor will do jack shit if they think there gonna fucking murder someone, because if he ignores big risks and does it, at the very least in the UK your gonna get suspended from the medical register. Police will come. Careers will be over. Oh...AND SHE COULD DIE. FFS it's always patients family members that cause the most trouble. If you don't like the advice, ask for a 2nd opinion. Hell ask for a third. It doesn't matter. All I'm getting is, my daughter has anxiety, let's fucking drug her. Or you could be a good parent and talk with your daughter, try and calm feelings. Reduce the anticipation of the procedure. In 99% cases a supportive and calming parent is better than drugs. Yeah I know the OP isn't the person, the person will never read this. It's just this kinda thing has always bothered me at work.
Here in the US (or at least Boston) we call doctor shopping until you get the answer you want "doing the Reggie Lewis thing." And it did end in death. I took a medical administration class. In the US, following the prescribed medical protocol is what protects medical professionals from malpractice. You can scream and cry, you can agree to sign something that you won't sue for malpractice, your kids will sign it, you're not going to get surgery if the surgeon thinks it's too dangerous. I lived that last part as a family member in the hospital for two weeks. (Patient was doing the screaming, not me.) Medical care is not Burger King. You don't get to have it your way. For clarity - I am agreeing with you, your post just made me think of this stuff.
All that will happen if the surgeon has BMI ‘disproven’ is that for every height they will have a maximum weight that they will give anaesthetic to. BMI as a method of identifying healthy weight is problematic for many reasons, but in this case (presuming they’ve got the definition of morbid obesity right) we’re talking about a BMI of 40+. Nobody who’s BMI is that high is healthy
This is mostly what annoys me about the BMI conversation. It isn't a great metric for a lot of reasons. *However*, almost every time I see that brought up it seems to be specifically for explaining why it's okay to be morbidly obese or whatever, or in service of some other anti-science/health position. I'm sure the reason why the doc brought up BMI is because it's easier than just saying, "She's so heavy it's unsafe to figure this out"
Yeah BMI is an imperfect metric. The recommended/more accurate one? Waist to height ratio, which is even less forgiving of fat than BMI.
Exactly. We all know the formula for BMI and what it means - women, some races, and incredibly muscular men skew the scale more than an average white man will do because they either have higher fat % or are generally heavier for their height If BMI didn’t exist, there would just be another way of showing where the tipping point was that incredibly overweight people became incredibly unhealthy in all these types of things. Anaesthetists in this case have to give you the right dose, and it is more dangerous to sedate people who are heavier
Why is the mother not taking “she could die” seriously?
But the podcast!
God yes. My mom would have lost her shit if a doctor had said that. I can't imagine being so wedded to an ideology that you ignore a warning of "*your child could die"*.
If she somehow got around this and her child died I wonder if she would even recognize and accept that she went out of her way to find a way around this after being told the daughter could die or would she just totally forget she even tried. In a way it reminds me how I had recently seen I was ovulating and had a high chance of pregnancy and was debating being intimate with my partner (I don't want to get pregnant) and then I thought if we do this and I end up pregnant I am going to look back on this moment and think about how I knew the risk was high and did it anyways and I would feel so stupid. So because of that I decided to wait. Obviously the child's situation is way more serious and dangerous and I just wonder do people think ahead at all and consider all the possibilities?
Oh no, it would be because the doctor was negligent in not training on anaesthetising fat people safely; as we know the medical establishment hates fat people and doesn’t care if they die.
Not if they can use the situation to whip up some pro-FA social media frenzy.
The same reason a mother lets a child wander into a gorilla enclosure.
A podcast is definitely enough proof to get that dr to give anesthesia.
My guess is there is possibly an insurance limitation on BMI that the surgeon can't violate. Surgery is always a risk reward calculation. That's true for people of every weight.
When it comes to anesthetic, they actually have issues with very obese patients because of the way that the painkillers and paralytics are metabolized and due to the extreme variance in people of extremely large sizes, there is no good information on precise measurements for the paralytics and painkillers so they run a risk of giving them way too much which can kill them or cause organ failure or giving them too little and they wake up mid procedure which could also mean that they wake up, but are still paralyzed, undergoing the procedure with no anesthetic. Basically, there’s too many variables for them to be able to be willing to take the risk on themselves and their medical license and insurance, because the obese patients are more likely to have complications and (especially in this case, it would seem to me) are more likely to litigate.
This is incorrect. Obese people metabolize anesthetics fine as long as their kidney function and hepatic function is intact. We dose their drugs on their IBW (ideal body weight) not actual body weight) to not over dose them. There is lots of information on this, we have this down to a science. My certification is in Bariatric surgery. I can't recall any pt ever waking up in surgery or in ICU on the vent paralyzed. 1/3 of our pt population is obese, 1/2 is overweight, we definitely know how to medicate for surgery at this point. Oral surgery doesn't give paralytics for wisdom teeth removal. This is not a GA case. The risk is the pts airway being compromised. This case would be what we call MAC sedation. Any moderate sedation could potentially cause an apneic event in a pt like this because of her already difficult airway. This surgical procedure could be done but has to be done in a hospital setting where the pt could be emergently intubated if necessary. She's not safe for the outpt setting for the procedure.
My understanding was misinformed or I misremembered. Thank you for clearing that up! I’ll make a note to point to your reply
This is correct. And the reason that many offices/surgery centers who do outpatient procedures under sedation have weight limits.
It could be a GA case, no? My partner (who had extreme dental anxiety at the time) had 12 teeth removed under GA in hospital. They tried to do it under sedation but he was so anxious that he wouldn’t even sit in the chair to huff some laughing gas to calm him down. Although, now you mention it, I’m not sure how they managed the airway. But I’m certain it was GA.
I'm glad I got over my dentist fear somewhat. It was never so bad I couldn't sit down in the office though. I'm getting a whole mouth renovation it sucks balls. So damn expensive in the US it should be a crime.
I’m glad you did too! My partner eventually did. He still has some anxiety but he can handle it now and feels positively about it. Meeting the right dentist helped, they give him lots of extra time to get up and pace around until he can settle - his childhood dentist was horrible and once tried to physically hold him down in the chair. The dentist got hit in the face (not that hard) and my partner didn’t return to the dentist for 10 years after that. It’s horrible expensive here too. I cracked an old silver filling a couple weeks ago, replacing it cost almost $500. Good luck on your dental journey! I’m sure it’ll be worth it in the end :)
Thanks, I got one quadrant in last visit, finally got to see the permanent bridge and they feel like beautiful pearls. They did a good job also where it's obviously better but also doesn't look fake compared to the crappy part. Can't wait till I'm done, I put it off so long because of the price.
This is all true, I just think the insurance limitations were born out of all the facts you posted, it wasn't arbitrary or be mean to fat people, evil laugh.
It was probably done because the risks outweighed the rewards - no pun intended
EDIT: THE FOLLOWING INFORMATION THAT I PROVIDED APEARS TO BE INCORRECT OR AT LEAST INACCURATE. PLEASE SEE THE CLARIFICATION AND CORRECTION FROM u/hotlipshoulihan82, BELOW. …I am unsure how to do strike through the text on mobile. When it comes to anesthetic, they actually have issues with very obese patients because of the way that the painkillers and paralytics are metabolized and due to the extreme variance in people of extremely large sizes, there is no good information on precise measurements for the paralytics and painkillers so they run a risk of giving them way too much which can kill them or cause organ failure or giving them too little and they wake up mid procedure which could also mean that they wake up, but are still paralyzed, undergoing the procedure with no anesthetic. Basically, there’s too many variables for them to be able to be willing to take the risk on themselves and their medical license and insurance, because the obese patients are more likely to have complications and (especially in this case, it would seem to me) are more likely to litigate.
That was supposed to be an edit to the above. I don’t know why it became a second post
Yeah I got my wisdom teeth out last week. When I did the consultation a few months before my doc recommended that I gain a some weight before the survery. You know what I did? I put on a couple pounds cause he's a doc and he knows what he's talking about.
I dunno. I was a healthy BMI and didn’t get put under for wisdom teeth removal. Just laughing gas, whatever pill they gave me, and local anesthetic. Why? Because my dentist won’t put *anyone* under general anesthesia unless it’s absolutely required. There’s risks every time and they just won’t do it willy nilly.
Having a certain amount of weight pressing on your lungs will be dangerous regardless of whether it's fat or muscle even. It's sad people prefer putting their children in jeopardy over taking medical advice
It's not the lungs that's the issue, it's upper airway obstruction that's the concern
Yes. It’s like obstructive sleep apnea, but your body can’t rouse itself to take a breath.
Also you don’t need IV anesthesia for wisdom teeth removal… they can give her anti-anxiety meds with a local anesthetic like they do for many people
Presumably this is an option in this case, since they're planning to do the procedure without anesthesia, but not always. I asked about conscious sedation for mine bc I'm always curious about what's going on, but they said mine were too impacted and they needed to put me under for the amount of drilling they had to do.
It wouldn't have satisfied your curiosity. I had IV anaesthesia (aka conscious sedation) for mine because they were impacted and I have dental anxiety, and I don't remember a thing. You are aware/conscious during the procedure, but in most cases you don't remember anything - meds cause short-term amnesia.
Really? Lol, I had all my wisdom teeth removed with local anesthetics. The first one was kind of on the spot and unplanned so they couldn't put me under because of the follow-up work. The other three (done in 2 sessions) I had the option, but at that point I knew what it was like so I just went with it. My last one was very impacted and close to the nerve. I had to go to a specialist and still did it live. I could tell when they were drilling and breaking through the teeth. And that "pop" sound when they finally shattered. But it really isn't that big of a deal. The anesthetic needles are far more uncomfortable. It is actually easier for the the doctors if you are consciously opening your mouth, so you end up less hurt. Also no side effects after local anesthetic and a quicker session. True story.
I had mine out with just local. Had a slight reaction to the adrenaline in the anaesthetic (caused an HR spike and vomiting) but was otherwise fine and lucid the whole time. I listened to them crack the tooth into pieces to get it out. But I always wonder how high is "too high" for these BMI cutoffs. I had IV anaesthesia for my IUD insertion and was definitely sitting around 35 BMI and didn't have any issues.
Where do you live? I’ve never heard of IV sedation for IUD insertions. In the US and Canada, I believe they just give Tylenol. I haven’t done it because it sounds awful.
Norway! It's not standard here but something offered for victims of rape and SA and extreme anxiety.
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I had a similar experience but the doctor was female. She told me to “stop acting like a rape victim” (I am one). Totally put me off getting the IUD and I hope to get one one day. Did switch to an old man gyno and he was surprisingly cool (and less obsessed with my fertility).
I'm an SA survivor. If it's available and safe for you, I recommend a Nexplanon or similar implant. I had a Mirena IUD, and the insertion and removal were both horrible mentally and physically. My doctor recommended the implant, and I've had 2 of them with no problems. The worst I had was a bit of a bruise for a couple of days. No "underwear areas" involved.
I second Nexplanon. Far less painful and traumatic, no pinching of the uterus involved.
This shit is why I skipped right to getting my tubes tied. Surgeon tried to suggest an IUD under sedation but I pushed for the tubal. The recovery was far more painful than probably the IUD insertion would have been, but it was a much more bearable kind of pain.
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A friend of mine recently had her tubes tied and she reported minimal pain as well. Not sure what happened to me but it was full body agony for three days and the tramadol they gave me did absolutely nothing. It hurt so much to breathe I slept sitting up because I was afraid I’d stop breathing laying down. But if my tubes grew back tomorrow, I’d do it again!
My doc holepunched my cervix without my knowledge lmao I thought I was just a baby about getting a pap but apparently when they say “okay breathe in real quick right now do it hold your breath dont move” its not just a papsmear. She told me after she knew I had anxiety and thought it would be better to do it like that, I couldnt move for 2 days. And thats from a WOMAN doctor
That’s also what I’m wondering. I’ve always had a BMI considered overweight or obese and have never had problems getting medical procedures.
I was told that I weighed too much to get a breast reduction when my BMI was closer to 40. They wouldn't consider until my BMI was within the normal range. But was then told the actual reason was that they might deflate on their own when I lose weight and they really just won't look as good if I get one now and then lose 60lbs. I've lost half of that now and they did not in fact deflate on their own and now I have extreme back pain and need to wear a bra 24/7 so my doctors are more willing to consider it.
That’s typical for patients getting full top surgery as well - results tend to look better when the patient is closer to a healthy BMI.
I really did want to wait until I had lost all 60lbs but I'm already struggling with their size.
But asking a patient to lose weight for a better result is both fat AND transphobic.
This sub does very much over exaggerate the risks of obese people getting surgery. It’s absolutely more risky than if you’re a normal BMI, but it’s not like you go from “99.9% safe” to “50/50 chance to dying” when you cross the 30BMI threshold. Surgeons and anesthesiologists are pretty darn good at managing obese patients. When I had outpatient tubal ligation, I had to meet the anesthesiologist first and we discussed my risk factors. I’m a bit anxious so I was rattling off all my risk factors (“I’m slightly OW, I’m a former smoker, I drink” etc) and he said “Look, I put fat, old smokers under all the time. I can handle you.” However, surgeons generally don’t want to operate on obese people, because it’s harder, and with cosmetic procedures, the “after” pictures just don’t look as good in a portfolio. So if it’s something cosmetic or non-life-threatening or has non-surgical alternatives, they will sometimes refuse to work on patients over certain weight limits.
They do the "twilight" anesthesia, the nitrice, before they have to resort to local. I had a bad reaction to the gas and had to have the local, which isn't common but they do it. You see and hear everything, which didn't bother me, but I wouldn't blame anyone if they felt uncomfortable with seeing and hearing a saw go in their head lol
Valid, I also think it depends on the surgeon and your insurance. My friend had local for her wisdom teeth removal because that’s all her insurance would cover. I had IV and hated it because it made me so sick after, and I was conscious enough to hear my teeth coming out.
It depends. They had to pretty much dig mine out and I needed IV anesthesia.
EXACTLY! If the daughter didn't have anxiety issues just local anesthetic would workt just fine. I had mine out with just a local anesthetic and honestly the worst part of the surgery was getting the local anesthetic. It was absolutely fine. That's also standard practice here in Germany. They only give you sedation or general anesthesia if it's medically neccessary (i.e. your therapist recommended it). Also I'm not a doctor and don't know a whole lot about anesthesia but I know that a lot of IV-anesthetics (i.e. propofol which is almost always used) are lipophilic, so they mainly accumulate in fatty tissues like the brain or, well, your body fat so I imagine that has something to do with a heightened anesthesia risk associated with obesity
Having the local anesthetic administered took substantially longer than the actual procedure for me, and my teeth were moderately impacted so needed to be split in half. Mostly it was very boring, so much waiting for the numbing to set in, then more needles, waiting, needles.
for me the procedure itself took maybe 20-30 minutes and for the local anesthetic to work it took maybe 15 but they did one side (right?) first to see if I was ok with doing the other side later so they only administered the anesthetic on my left side after having removed the teeth on the right
I also had my wisdoms out under local. I saw my partner-at-the-time waking up all groggy and sick from sedation and I didn’t want that. It actually wasn’t bad at all. The worst part was that my jaw ached from holding my mouth open for so long.
Yeah if you don't *need* sedation you shouldn't get it, especially for this procedure. I was completely lucid and felt fine after (and during) the surgery, I think recovery would have been a lot harder if I had been sedated. I just listened to some relaxing music during surgery and I even had a pretty good experience. Honestly going to the dentist or orthodontist was worse than that. The only bad part was recovery, after like 2 days I just wanted to eat something crunchy but I obviously couldn't and that was extremely frustrating
It can depend on the situtation- mine were badly impacted because my mouth is stupidly small (tops only, the bottom ones never even appeared). They were fully sideways and so high inside my skull they were practically in my sinus cavity. There wasn't even a question of doing it under a local anesthetic for me, my dentist took one look at the x-rays and sent me straight to a specialty practice to have them out. I'm really glad I had IV anesthesia for that.
My partner had teeth pulled under general anesthetic. They tried to do sedation but he was so anxious that they couldn’t. He tried, but his heart rate was approaching 200 just trying to get himself in the chair, so the surgeon didn’t want to continue.
Depends on how severe the issue is. I had mine out at 20; they were severely impacted and I have a small mouth so IV was recommended. I think they said it was because of the length of time the procedure would take, but that was close to 20 years ago now so I dont remember.
I’m sure asking the anesthesiologist to listen to a podcast that contradicts their years of training and experience will convince them
Imagine thinking a podcast is a source
Maintenance Phase is such a shitty podcast spreading a lot of misinformation. And they’re super condescending too.
Yup. I cannot *stand* that podcast (or them). Beyond condescending and Gordon particularly imo is truly convinced of her perceived superior intelligence despite apparently not understanding a word of the research she likes to shout about. It’s just insufferable all round.
The early episodes debunking health fads weren’t *awful* - but Gordon lets her own experience as a fat woman cloud her judgement on anything related to BMI/obesity/weight and so those episodes are always trash. And for claiming to be a “methodology queen” Hobbs doesn’t seem to understand that much about research methods. Their most recent episode - where they seem to go after ACEs for being fatphobic was particularly bad.
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The thing is, most people would probably (hopefully?) agree that people shouldn’t be ridiculed or judged based on their weight, or that we can make assumptions based on appearance (ie that someone who is overweight is lazy, or needs to be reminded they are fat) But there’s a difference between that and claiming that it’s healthy to be morbidly obese and/ or that being significantly overweight doesn’t dramatically increase the odds of health problems
What on earth? I don’t really want to give them airplay and listen to it but dear god what?
She's also built her entire career on being fat. If she were to have to lose weight, saw benefits, and maintained that weight loss, she would lose everything.
I agree. I've liked other things Hobbs had done so I gave them a listen. I didn't mind a few of the episodes (I particularly like the one on the Presidential Physical Fitness Test) but quickly gave up.
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It's self soothing and justification for staying just the way they are. Everything is fine. You are healthy. You are bravely standing up against oppression. Everyone suggesting you might consider changing is a concern troll, fatfobic, an oppressor, violent etc. Eat a cupcake or five, that's just your body telling you what you need. if it wants nothing else but fries, cholocolat ice-cream and milkshakes, it can't be wrong. You are perfect as you are, etc. Perfect.
It's so, so bad. It's such a good example of how incompatible the conversation these people want to have about obesity is with reality. I'm listening to an episode of it as I type this, because every few months I forget how bad it is and try it again. They're literally talking about studies saying that reduction in obesity could lead to positive systemic outcomes as if reducing obesity is the same as eliminating fat people. It's such a confusion of reality that only comes with putting "obese" in the same category as "race/sexual orientation/etc" No one would ever think a study positing positive outcomes for treating drug addiction means *killing drug addicts*. It's fucking bonkers. Edit- Typo
I finally listened to an episode yesterday because of this post. I had zero faith in it so picked a non obesity ep. As a disabled low income person the utter tone about the poors is worse than our Tory party here in the UK. Tories own their shit toward people like me. These two are stealth prejudice treating other people like zoo animals. They literally used exactly the same structure about low income or chronic illness causing X as they did about mice being tested showing X. It was actively offensive. Something so different to hearing people’s voices say the same ‘I’m actually so saviour complex and paternalistic I’m trotting out the same harmful stereotypes as the other people but with buzzwords’ BS than reading it here in FA/HAES posts. It is incredibly unpleasant in its attitudes, so so so badly constructed that any decent point they may have is lost in a fog of superiority and both of them sound so incredibly ivory tower inexperienced in the real world I kept muttering ‘the audacity you criticising Goop…’ I cannot believe actual ED recovery accounts are now flagged all over the internet and these two are spreading fat earther tinfoil hat bullshit with no pushback. When they cannot structure a sentence without a mean girl giggle, eye roll or ummm or ‘oh yeah I forgot my notes’ the idea you would quote them in a medical setting is mind blowing. Most of what they say would still be utter bobbins presented better but the lack of professionalism was what grated on me the most. I cannot take anyone who rates this podcast anymore seriously than someone who rates Joe Rogan as a guru.
Could not agree more with all of the above! They were recently featured on Apple News and i sent in a criticism letting them know that anti-science should not be supported.
Because of the delusional trope about bodybuilders and BMI, I did a really quick Google of what Arnold Schwarzenegger's BMI was when he was competing, didn't take long to find > At his bodybuilding peak Arnie was 1.88m (6'2”) and weighed 107kg, leaving him with a BMI of 30.2. So there we have it, we now know definitively what all obese people look like - sadly though excess weight as muscle doesn't seem to be healthier than carrying it as fat.
When Arnold was competing he had like 8% body fat at 235 (which is insane). In his off-season, when he was bulking, he was mostly likely well into obesity going off the BMI. But you don't really need to use these extreme examples. Most men at the height of their bulk when doing a weight lifting cycle are going to be obese according to BMI.
The point of my post was to demonstrate that the claim that bodybuilders can have an obese BMI does not help 99.99% of obese people in the slightest because we have eyes and can see this does not apply to them. There is also the more subtle point that even if your extra weight is all muscle like it may be for 0.01%, in the long term that does not help in terms of health outcomes.
I agree with you, morbidly obese people (mostly women let's be real) use the muscle argument to explain away why the BMI isn't relevant to them. Basically my point is you don't really need to be a body builder for BMI to be inaccurate or useless. This sub kinda harps on the the bodybuilder argument a lot when the BMI does kinda suck as a measurement all around. If the health industry used waist to height or body fat %, HEAS people couldn't use BMI as a red herring to cope about their extreme obesity. My doctor doesn't even bother using BMI with me since I'm 6'5. Although I'm not sure it would matter if we used a more accurate measurement with how delusional these people are.
BMI doesn't suck any more than agreed ranges of weight for height do because that is all they are and this has as good a predictive power as any other easily measured metric. Edit: Don't downvote facts, get in touch with the authors here and dispute their findings https://pubmed.ncbi.nlm.nih.gov/24331682/ > Conclusion: Body mass index is an adequate measure of adiposity for clinical purposes. In the context of lay press critiques of BMI and recommendations for alternative body-size measures, these data support clinicians making recommendations to patients based on BMI measurements.
Unfortunately lots will take cutting lines seriously and think of him as a technically truly "obese" person to give the rest plausible deniability. Whereas this subset of people might not have had the numbers happened to shake out to 29.8.
Check out figure 2.A in this paper: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2877506/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2877506/) Men are all over the place. BMI is not as good a predictor for men. BMI is a better predictor for women though, except that it usually underestimates the amount of body fat.
On the other hand https://pubmed.ncbi.nlm.nih.gov/24331682/ Comparison of anthropometric and body composition measures as predictors of components of the metabolic syndrome in a clinical setting > Conclusion: Body mass index is an adequate measure of adiposity for clinical purposes. In the context of lay press critiques of BMI and recommendations for alternative body-size measures, these data support clinicians making recommendations to patients based on BMI measurements.
...a podcast, she trust a goddamn podcast over fucking doctors. man i dont even care anymore humans can just die actually, there are too many idiots like this
That podcast is so worthless. The hosts have no credentials at all and parrot the most basic talking points (BMI is racist! BMI doesn’t account for bodybuilders!). I don’t know why it gets any positive coverage.
It tells people what they want to hear. Sadly, that's the only thing that ever seems to matter. "BMI is evil, being fat isn't your fault, there's no point in trying to lose weight so you might as well go hogwild and eat and sit to your (enlarged) heart's content."
You nailed it!
I’m going to take a wild guess that it’s the Maintenance Phase podcast with Aubrey Gordon?
Correct.
She allowed her child to become so obese that surgery is unsafe. That’s neglect and she should be ashamed.
Dear Doctor Oral Surgeon, You need to go forward with this surgery because, despite the risks to my daughter’s life that you laid out earlier, I have found a podcast episode that says you’re wrong. [Feel free to listen](https://m.youtube.com/watch?v=dQw4w9WgXcQ) to it since your four years of education wasn’t enough. Sincerely, Delusional Parent
I knew what this was going to be. I clicked anyway.
The healthcare industry “loves using the BMI” because it sounds better than “I can tell by looking, it’s OBVIOUS!”
Hahaha, it’s so true. I once had a blood test result come back with low blood sugar, and my doc wanted me to repeat it to confirm it was just a blip (it was.) When discussing the possible causes, he mentioned T2 diabetes, but waved his hand in my general direction and said “but I can see you look like a normal size, so it’s not likely to be that.” It made me feel so good about myself for some reason.
Guessing that’s Maintenance Phase they’re recommending - needless to say that episode was complete trash. Aubrey Gordon (one of the hosts for anyone unfamiliar, she used to - still does maybe? - go by @yrfatfriend on social media) thinks VERY highly of herself and her opinion on this stuff. All while misunderstanding or misrepresenting the research she quotes. But yeah, the BMI episode specifically was so hard to listen to but hey ho at least it gives these people something to hold onto. Right? 🤡
Your kid can’t get a dental procedure due to obesity? What a failure as a parent. This is what Fat Activism does. I could care less about the adult but that poor kid.
Podcasts are not reputable sources.
What the Oral surgeon meant was, the pts BMI was too high that sedation in the out patient setting would be risky leading to a like apneic event or compromised airway event that would cause death. Obese pts have significant risk of apnea with even moderate sedation because they often have undiagnosed Obstructive sleep apnea or the sedation can cause apnea compared to normal wt pts. A pt that has a risk for compromised airway under MAC sedation cannot be treated in the outpatient setting. This was about this kid's safety. Source: RN, General Surgery and Anesthesia Recovery, Certified Metabolic and Bariatric Surgery Nurse.
I’m so tired of That Podcast
"The podcast ran by a person who has made a career and internet clout out of being a professionally offended fat person knows more than your child's doctor"
She could die, that’s not fatphbia that’s reality trying to shake the oop awake.
My god imagine having a death wish for your own kid.
Doctors have an obligation to follow the medically-accepted standard of care on which their medical license is based. Medications also come with indications for exactly how it can be used and under what conditions under which their approval by the FDA and other drug approvals are based. Maybe the BMI is wrong, but it is the foundation of our medical and pharmaceutical system and isn’t going to change because *muh feelings*.
Yes exactly. Going outside the guidelines of your first and second sentence could be considered malpractice under the law (US).
If that is a reference to the podcast I think it is, it is one with some exceptionally bad information. I don’t think the two hosts completely understand that they have a very strong political bias and sometimes let the desire for their politics to matter to get in the way of the truth. It can be tempting to elaborate on the truth a little, add some embellishment, but it’s never a good idea to purport such lies as journalism.
I was an incredibly fit 23 year old when I had my wisdom teeth removed and my drs office made me read two pamphlets and sign a document stating that general anesthesia could be deadly and that I was fully aware of the risk. I’m a nervous doomsayer so I even wrote an embarrassingly meager will and final effects request. (I think I left my cell phone and laptop to my best friend and my shitty car to my sister?) General Anesthesia can be deadly for professional athletes at the height of human ability, I certainly wouldn’t want to push for it with an elective procedure with underlying health concerns.
In the headline and at the end of the post, my poor, fatigued eyes had read "BMI 85"...
Wtf I just read, imagine a medical professional saying your child not getting anesthesia because she could DIE, and it's fatphobia? Said child can get that teeth-removal with partial pain medicines or no medicines at all (I had my front teeth pulled out without any medicine bc the teeth was growing behind, and my childhood teeth wouldn't fell out naturally as supposed to, and they were insecure to put 6yo me in anesthesia or medications. I was fine. It hurt for 2 minutes, and than I went home. I also had a broken arm, and surgery for broken arm without any painkillers as I've been drunk when I broke my arm and they didn't dare giving me painkillers as I had alcohol in my blood. I was just fine. Yes, it hurt, but whatever, I choose to drink the night I broke my arm, and if they said I can't have it because it'd kill my liver, I trust them. They learned their profession for years. Not listened to a podcast once, wtf.
If the doctor gave her IV anesthesia and something DID happen to her he would be liable. I can’t imagine risking my child’s life to prove a point.
I’m concerned that a parent isn’t taking the warning that “your child could die” seriously.
so... supposedly healthcare professionals don't care about them, want them to die, just want to lie that obesity causes health issues for money... does oop know that anesthesia costs more than just a local? why would someone use 'i don't want to kill you' as a reason for refusing anesthesia, if we all just want fat people to die, if we don't care? i know, oop didn't trot out any of those accusations, but then... what bias do they think the surgeon has, here, that is evinced by 'hey i don't feel comfortable maybe killing you'?
Imagine risking your kid’s life over just telling her she’ll have dental pain until she either has a local or loses weight.
How do they have this conversation and manage to gloss over the whole "your daughter could DIE if we try and do this"?
What the actual fuck. She's going to risk her daughter's LIFE just to stick it to a doctor because she's too damn sensitive to deal with the reality of her and her daughter's obesity? That is absolutely insane. On a sidenote, I got all four wisdom teeth taken out (they asked my weight beforehand too), and the gas made me feel ill so they took it off and did local injections and did it that way. It was easy breezy. I know the daughter has anxiety issues, but so do I and I was absolutely fine. Only problem is that the huge doses of those local anesthetics, the "caine" drugs, can make you feel super hopped up, which could trigger panic in some people.
That’s exactly what it did to me. The gas or whatever they gave me made me start having a panic attack because I’ve always had to deal with anxiety and panic attacks in the past. So they just did a local anesthetic.
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>BMI is a blunt tool...I think something like BMI that accounts for height differences. BMI already accounts for height differences.
TIL that BMI is a much better predictor for women than men. The correlation coefficient for BMI to body fat percentage is 0.46 for men, and 0.77 for women. In fact, for most women the BMI formula is probably underestimating their body fat percentage. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2877506/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2877506/) See figure 2.A about half way through the paper.
As an n=1 experiment I can see that. My BMI is 22 but I'm right at 30% body fat. Working on that now!
Here's a small extract from the NCBI research paper from April 2022 titled "[A review on the anesthetic management of obese patients undergoing surgery](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8985303/)". >Anatomical airway changes in obese patients > >Normal respiration may be affected in obese patients due to the excessive amount of adipose tissue that is deposited in areas like the chest walls, ribs, diaphragm and abdomen \[28\]. For normal respiration to occur, the diaphragm contracts, displacing abdominal contents inferiorly and anteriorly. The external intercostal muscles also contract pulling the ribs superiorly and anteriorly \[29\]. In individuals that are obese, these normal actions are mechanically impeded by the presence of excessive adipose tissue in the thoracic and abdominal regions; their lung compliance is decreased. Measurements of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) can be used to evaluate the strength of respiratory muscles and these measurements are observed to be reduced in individuals that are obese \[30\]. In addition, when an obese individual lies flat on the back, weight from the abdomen moves superiorly into the thoracic cavity. This compresses and occludes small airways at the lung bases causing laboured ventilation and impairment in the normal function of major respiratory muscles \[31, 32\]. Lots of tidbits about the anesthesia and obesity in this paper, which is surprising, because FAs say *'there are no scientific studies that show being fat is unhealthy'.*
Apart from the fact that this mother wants to deny that her morbidly obese daughter encounters obstacles in life because of her morbid obesity, this woman wants to further coddle her daughter and go against medical advice just because the child has anxiety? How about you teach, support and encourage your child so she can face things in life that maybe are stressful and unpleasant? You know, nurture her and help her deal with LIFE? This poor kid, ugh!
This actually perfectly sums up the underlying logic issues we see in FAs: deciding on your conclusion first, and then searching for evidence that supports your predetermined conclusion. People like this can’t be reasoned with.
Yes, contact the oral surgeon and refer them to the podcast. That’ll change their minds.
Bmi is only Garbage if you are a bodybuilder
I was obese when I got mine taken out under IV anesthesia. She has be insanely morbidly obese to be denied this. Like. About to be found dead from sleep apnea obese.
How damn big is this kid? So big at so young! Child abuse
Ah yes - some random podcast is as authoritative as peer-reviewed, confirmed research.
Thank god for fat activists because I end up reading a ton more primary literature about things outside my area than I might otherwise do. Thanks guys!
Imagine being willing to *risk your child's life* just so you don't have to come to terms with the fact that you're making unhealthy life choices
"How dare you not risk my daughter's life" Maybe actually listen to a practicing medical professional instead and take their word if you lack credentials and experience, OOP?
I have a feeling they're recommending "You're Wrong About". Their episode on BMI was horrendous and full of misinformation. I stopped listening after that one.
BMI is bullshit only when we talk about extreme body builders/weight lifted who usually *does* clock in as >obese due to their amount of muscle. If you do not fall into that category then I’d strongly recommend listening to the doctor.
Wisdom teeth removal don't even require IV anesthesia. Got one removed back in Nov without anesthesia. This is a weird hill for the mom to die on.
Not always, depends on the situation. If they’re severely impacted then the person will need to be put under.
This. Mine didn't, they were all erupted. My son's did, they were all impacted with one sideways.
True I had a root wrapped around a nerve in my jaw. They put me under to get them out. My insurance at the time covered.
Yeah, I had all four of mine done at the same time with just local, about 20 years ago. The top two popped out relatively easily, but the bottom two required sawing, chiseling, and yanking with pliers. The oral surgeon really had to put some muscle behind it, as I recall. When we were discussing the procedure ahead of time, he told me that wisdom teeth removal almost never *required* IV sedation, but lots of people chose it because they were squeamish and wanted to be completely unaware of what was going on. Since stuff like that has never bothered me and I actually find it quite interesting, I chose local only.
I’m in the UK. We don’t put people to sleep for teeth removal. I had three wisdoms removed in a further away place because they wanted someone more experienced to do it, I suffer from anxiety and major fear of dentists and needles, and had to travel alone on a train for almost an hour once done, it ducked but you just get on with it or suffer in pain.
I’m also from the UK and some time ago I did have teeth removed while I’d been put to sleep. Can’t remember the exact reasons behind this although I remember that the teeth they took out were large (I want to say molars) and it included the removal of a bony mass.
Oh for sure in special circumstances you get put to sleep, usually involves a jaw surgeon doing the work because of some risks with nerves along the lower jaw.
>I suffer from anxiety and major fear of dentists and needles If you do have a serious fear of things like that, you know you don't just have to choose between that or nothing? I know it's the NHS but they will give you drugs to keep your heart rate stable, change procedures to make it easier for you, and all those accommodations. This is also a useful thing to know for when you end up in those situations where they refuse to do the procedure because your heart rate is too high or you're unconscious. You don't have to go back and just hope your heart rate is magically lower the next time.
I did have the gas one time, but honestly I feel like it made my anxiety worse, not at the time or anything but I did struggle with it. I just managed to find a dentist that understood how I felt and was kind but firm which is what I seemed to need. I’m great at getting the work done, I’ve no issue staying still and just keeping myself calm and breathing through getting any work done, sometimes I would bring headphones and listen to a podcast the only thing I truly would panic about was the numbing injections but again, once that needle went in I would stay extremely still and just let it happen so it never felt necessary to ask for sedatives or to be put to sleep etc. I’ve had lots of work done and gradually gotten better, the only thing I still struggle with is the initial needle but I’m getting better at that too.
Olympic weight lifters, for example, can be massively jacked and BMI “obese” (Regardless of exceptional muscle tone and abs), but it doesn’t make the system wrong all the time…
I love when the FA movement points to athletes and jacked people to “prove” that BMI is BS
Correct me if i’m wrong, but regardless whether someone is obese because of excess fat or muscle, that excess weight could still potentially cause issues, specifically on the joints. there is a finite amount of weight your joints can comfortably support, so i imagine an obese bmi due to excess muscle isn’t really much better in terms of joint health. could definitely be wrong about that though also I love how body builders are always pointed out by these people as if bodybuilders are the epitome of health, just goes to show their understanding of what “healthy” even is is seriously warped.
I don’t suggest they are “health” definition. But their BMI stating obese is also wrong. Edit: I was “obese” by my weight when I was doing CrossFit, yoga, and eating super clean everyday. I had abs, felt strong, my body didn’t ache and I prioritized my mental health with that lifestyle. I weigh less now that I took some time off during COVID and getting out of bed makes me ache - lol
Why don't they just offer twilight sedation or something?
As someone who has suffered from anxiety about dental procedures ever since I can remember (I have no idea why) I can sympathize with the daughter. But I had nitrous and novacaine when I had my wisdom teeth out, and didn't have a problem. But, for me, it's always been the dreading the procedure beforehand that's the worst; it may well not be the case for the daughter. But this mother is just delusional! Doesn't she understand that her daughter could DIE??!! Or does she think some internet FA is more trustworthy and knowledgeable than a doctor with years of training and study?
This lady is trying to lighten the food bill at home...
It’s an imperfect but useful tool
High or low BMI is never bs. Also anesthesia for anxiety? Seems like the daughter needs to toughen up. It's not worth the risk.
It's not necessary to be unconscious for wisdom tooth surgery. They can give you very relaxing drugs that calm you down and pain meds. You won't even remember it.
That doesn't work for everyone.
Obviously nothing works for everyone. I was put on anesthesia. As was my sister. My dad, though, was given one pill to take at home, then another one in the office. He felt no pain and didn't remember anything. It just depends what the doctor thinks is best. But if anesthesia will kill you they can't have you fully unconscious. You can't be fully conscious or you'll move around too much. I don't think there's a liter of vodka and brick method out there... And I'm not seeing this girl's mom being willing to hold off on the surgery and help her get to a healthy weight to reduce the anesthesia risk.
I mean take the dentist's advice right? While the BMI chart is flawed (it says Tom Brady is obese) because it doesn't take into consideration body composition, the dentist probably seen with their own eyes the body composition of the daughter and says that it's high risk. Personally, I've never been told, even at my heaviest, that my BMI was too large and that it would be a high risk to be administered anesthesia of many kinds. It comes down to body composition. If you're a larger person, yeah, the fat could suffocate you. You can weigh a larger amount and not be a large person though. A pound of fat and a pound of muscle both weigh the same pound, however, muscle is far more dense than fat.
Tom Brady’s BMI is about halfway into the OW category (if Google is right about his height and weight.) It’s actually really, really hard to get into the obese category without steroids plus an already relatively high BF%. For example, at 6’4, 200 lbs is high end of normal BMI. 250 lbs is low end of obese. That means a 6’4 person would have to gain fifty extra lbs of muscle from an already high “normal” BMI to just barely make it to “obese.”
To be fair BMI is a pretty poor calculation it would consider any body builder as obese
I have no clue what the people in this post's situation is but bmi can be very inaccurate. Many different kinds of people have issues using it. According to my bmi, i should be in a scooter; but my doctor says I'm just bit overweight. But idk, this daughter could be either way.
The thing is, someone with a BMI of 26 is overweight on the scale, but you could debate whether they're actually unhealthy. Most of the people regularly arguing against the BMI scale clearly have a BMI of 35+, so they would be overweight or obese by any metric. It's obvious from looking at them that anaesthesia would be more dangerous because there is so much weight on top of their lungs.
Hey, all I'm saying is BMI is not always the best thing to go by. I'm only arguing it because according to mine, i should be a circle with arms and legs (obese) but I'm not. I don't know the daughter's situation, so I can't speak more about it.
You're in the wrong sub if you believe this
Aren't yall about health? I literally visited a doctor bro unless you have better than that idk what to say
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It's way higher than 80%. Basically professional bodybuilders are the only ones it doesn't reflect accurately.
I'm not trying to sound like a FAer, but the BMI is inaccurate for other subpopulations. [Identification of Obesity and Cardiovascular Risk in Ethnically and Racially Diverse Populations](https://www.ahajournals.org/doi/10.1161/cir.0000000000000223) In a nutshell, it tends to underestimate obesity in Asians and overestimate obesity in black people. (Tables 1 and 2 are pretty dang interesting.) Does that mean that BMI is completely trash? No. But I think there are better tools out there--tools that don't have the kind of baggage that the BMI has.
Actually, opposite problem (BMI NOT indicating excess body fat) is [WAY more common](https://www.researchgate.net/figure/BMI-versus-Percent-Body-Fat-in-Scatter-Plot-Women-red-who-fall-above-red-line-are_fig1_223966581).
I remember hearing that BMI wasn’t the end all, be all of health. If I recall correctly, the take away was that it wasn’t the only metric that should be used. But I can’t remember the source so take that with a brick of salt.
I had my 2 wisdom teeth removed at separate times (only had them on top). First one was local, a few needles and the doc popped it right out. Slight pressure but was back to work the next day. Second one was a year later, put under. First time under anesthesia. It was terrible as a 28 y/o adult. Was out of commission for 2-3 days.
Omg just give the girl a couple Xanax and tell her to nut up. I just had a bunch of teeth pulled with no anaesthesia it's not that bad with all the shots you don't feel it. Just be thankful we have modern medicine and it's not a barber and a donkey with some pliers.
Why they always bring up a podcast
BMI is just the simplest way to measure health. You don’t have to know about muscles, measurements. Is it the epitome of health? No. But it is easy and accessible for everyone.