What field is going to benefit most from the rising obesity rates?

[liquidcrawler]

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[Seces]

plastic surgery

 

[sella.turcica]

A lotta fields. Like, which won't is the better question.

 

[Little Green Mensch]

Dermatology, because they won't be crushed under the increasing numbers of patients who have increasingly severe chronic disease.

Vascular pathology is already really common, so vascular surgery will continue to be very busy. Endocrinology will probably get a decent bit busier given the relationship between obesity and T2DM. Bariatrics will definitely keep growing.

Although much hay has been made of the the diminished results the American healthcare system gets relative to expenditure (compared to Europe), obesity explains a lot of the difference. Our population isn't as healthy to start with, and there's not very much evidence that physicians move the needle substantially when it comes to altering unhealthy habits, c.f. the Cochrane review on motivational interviewing.

 

[DrSnips]

A lotta fields. Like, which won't is the better question.

Hospital medicine won't.

 

[VA Hopeful Dr]

Hospital medicine won't.

How do you figure?

 

[libertyyne]

Dermatology, because they won't be crushed under the increasing numbers of patients who have increasingly severe chronic disease.

Vascular pathology is already really common, so vascular surgery will continue to be very busy. Endocrinology will probably get a decent bit busier given the relationship between obesity and T2DM. Bariatrics will definitely keep growing.

Although much hay has been made of the the diminished results the American healthcare system gets relative to expenditure (compared to Europe), obesity explains a lot of the difference. Our population isn't as healthy to start with, and there's not very much evidence that physicians move the needle substantially when it comes to altering unhealthy habits, c.f. the Cochrane review on motivational interviewing.

Smoking and ETOH use rates in other industrialized countries are much higher. we also have a smaller proportion of people above 65 compared to other industrialized nations. The cost of services is much higher in the United States without actually providing better outcomes. Even after adjustment for health characteristics we dont really shine in cost, access, or quality.

 

[Psai]

bariatrics

 

[iqe2010]

Which types of physicians open weight loss clinics?

 

[TheIllusionist]

oncology

 

[Gurby]

 

[libertyyne]

 

[OrthoTraumaMD]

Obesity makes everything worse for me. The surgeries are longer and more challenging, and not in good ways. You add a few hours to every procedure because you are digging through inches of fat, other surgeries don’t get done. Outcomes are worse because of increased infection rates, sometimes barring surgery altogether. Infections for acetabular fractures with a morbidly obese patient are as high as 50%—I won’t operate on them because of that. And even in other Ortho subspecialties it’s bad—there are BMI cutoffs for joint replacement beyond which you can’t do it.


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[curbsideconsult]

View attachment 248086

One of my greatest fears. Right after being suffocated to death by a morbidly obese person, which has nearly happened to me. Twice.

 

[Goro]

I feel like psychiatry is benefitting immensely from positive cultural trends, such as the normalization of seeking help for mental illness. Another (negative) trend in healthcare is rising obesity rates. What field is best positioned to benefit from this? Or is it just going to cause strain and headache for the entire health system with no single speciality raking in the dough from an ever increasing obese patient population? Maybe interventional cards? Vascular surgery? While compensation is not, and should not, be the primary driver for speciality selection, I also think it's wise to survey the future for opportunity, because after all, I'm not trying to land in peds ID or nuclear medicine.

Bariatric surgery?

 

[doc05]

These changes, especially in cardiology and Vascular Surgery, are more from the aging population and also the aging physician workforce.

 

[alprazoslam]

Lol at all these DO schools touting “we need more primary care over everything”

 

[DrSnips]

How do you figure?

One word: placement. There just aren't that many SNFs with resources for multiperson assist. The SNF gets paid the same regardless of how heavy the patient occupying the bed is, so it hurts their bottom line to need to hire more staff to care for the same number of patients. Rising obesity rates will make for more dispo nightmares unless SNFs are incentivized to take these morbidly obese patients.

 

[libertyyne]

One word: placement. There just aren't that many SNFs with resources for multiperson assist. The SNF gets paid the same regardless of how heavy the patient occupying the bed is, so it hurts their bottom line to need to hire more staff to care for the same number of patients. Rising obesity rates will make for more dispo nightmares unless SNFs are incentivized to take these morbidly obese patients.

Wouldn't you still need hospitalists for inpatient admissions related to procedures?

 

[DrSnips]

Wouldn't you still need hospitalists for inpatient admissions related to procedures?

I don't see how that helps. Not being able to dispo patients means insurance denials and more time navigating poorly designed phone menus.

 

[curbsideconsult]

Wouldn't you still need hospitalists for inpatient admissions related to procedures?

I don't see how that helps. Not being able to dispo patients means insurance denials and more time navigating poorly designed phone menus.

I think "benefit" is being interpreted in different ways here.

 

[libertyyne]

I don't see how that helps. Not being able to dispo patients means insurance denials and more time navigating poorly designed phone menus.

Unless I am completely off base the point of the post was what specialties will see increase in demand as a result of the obesity epidemic. Even if there are more headaches for hospitalists there would still be more demand for them at the end of the day leading to the benefits of better pay, easier to find a job etc, etc. Obesity is not going to make any person's job easier.

 

[DrSnips]

Unless I am completely off base the point of the post was what specialties will see increase in demand as a result of the obesity epidemic. Even if there are more headaches for hospitalists there would still be more demand for them at the end of the day leading to the benefits of better pay, easier to find a job etc, etc. Obesity is not going to make any person's job easier.

Ah, well any increase in any condition linked to hospitalization will have that effect.

 

[getdown]

I would probably say Ortho due to increase need for total joint replacements. All that extra BMI aint good for the knees. But I'm sure endocrinology with high DM rates, cards and vascular with all the associated issues of obesity and diabetes. Renal too. But it's probably not as fun or money generating as a TKA.

 

[Angus Avagadro]

Actually, I believe more demand on PCP and PMR for Type 2 DM and joint problems. Going to see more denials for total joint replacement for obesity, so managing DJD and DM will increase.

 

[IMreshopeful]

Vascular, endocrine, cardiology - any disease where basically diabetes is a problem

 

[TypeADissection]

One of my greatest fears. Right after being suffocated to death by a morbidly obese person, which has nearly happened to me. Twice.

Sounds like a fetish? Go on...

 

[Tenk]

Lots will benefit but none so much as sleep medicine. I mean the whole specialty only took off due to sleep apnea.

 

[Dagrimsta1]

Obesity is highly correlated to diabetes.

Both cause pretty much problems in any and every organ. Safe bet to say that all fields will treat those diseases.

But I actually think that the way the country is moving towards more healthy food options, the obesity and diabetes crisis can shift downwards. Might not happen in a few years but long term, for sure.

 

[795722]

Podiatry will benefit a lot as well.

 

[RNthenDoc]

whichever specialty repairs CNA staff’s spinal cords will make the most $$$ from obesity epidemic

 

[curbsideconsult]

Sounds like a fetish? Go on...

Pah! Nope, nothing quite that interesting.

 

[Tchotchke]

pathology

 

[Oso]

pathology

damn, that was dark dude


but yeah

 

[Psai]

pathology

Nah you won't see much because of all the fat cells

 

[nimbus]

Bariatrics is actually down where I am. 15 years ago, we were doing 10 cases/day. Nowadays it’s more like 10-15cases/week. Seems like everyone who wants one already got theirs.

 

[Psai]

Bariatrics is actually down where I am. 15 years ago, we were doing 10 cases/day. Nowadays it’s more like 10-15cases/week. Seems like everyone who wants one already got theirs.

I wish we had the same problem. I've had days doing 6 in one room.

 

[evilbooyaa]

Vascular, interventional radiologists, cardiology, endocrine, bariatrics, general surgery (more fat fertile 40 females needing gall bags, more giant hernias), surgical/medical/radiation oncology (obesity/diet with esophageal and colorectal cancers, currently all tri-modality treatment regimens), PM&R, orthopedics, primary care. definitely sleep medicine

Then obese patients get more other problems so infectious disease, nephrology, hospitalists, emergency doctors

basically everything but peds. and maybe psych (non-sleep subset)

 

[sella.turcica]

basically everything but peds. and maybe psych (non-sleep subset)

Though fat people often have fat kids, so peds might "benefit" from rising obesity, too.

 

[Phaco]

Obesity makes everything worse for me. The surgeries are longer and more challenging, and not in good ways. You add a few hours to every procedure because you are digging through inches of fat, other surgeries don’t get done. Outcomes are worse because of increased infection rates, sometimes barring surgery altogether. Infections for acetabular fractures with a morbidly obese patient are as high as 50%—I won’t operate on them because of that. And even in other Ortho subspecialties it’s bad—there are BMI cutoffs for joint replacement beyond which you can’t do it.


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Obesity makes life difficult for even specialties that, at first glance, should not make a difference "there is no fat around the eye".
Fitting a large person into a slit lamp is difficult. Examination and measurements become less precise.
They have all sort of accompanying medical conditions which make surgical clearance more tricky.
For eye surgery, positioning is super critical. A large person often can't lie flat. (S)he also can't breath properly and moves a lot during surgery, often suddenly. 1mm can cause a beautiful outcome to be a bad outcome.
Sleep apnea increases risk for Glaucoma. Diabetic retinopathy/blindness is shockingly common. The list goes on.

 

[TheRealCookieMonster]

As i mentioned earlier, A high BMI is actually an automatic denial for joint replacement - you literally can’t do it above a certain BMI as it is not safe and doesn’t have good outcomes.

Unless you're talking like >400lbs people, denials are not happening at most medical centers. Or maybe you meant shouldn't do it? The vast majority of large (in the fat category) folks 200-400lbs are still readily able to get their joints swapped. And they are doing it at an increased rate. Ortho is getting a piece of the pie.

TLDR: You're wrong...

 

[OrthoTraumaMD]

Lol... Um... except you’re a premed, and I’m an actual orthopaedic surgeon, and I’m not wrong. Below BMI 40 is standard for most ortho practices; beyond that, they refer a patient to bariatrics before doing a joint replacement.

No reasonable orthopaedic surgeon actually wants to do a joint on a big person because there is a well documented increased complication rate.

So please refrain from giving people incorrect information.


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[Psai]

Lol... Um... except you’re a premed, and I’m an actual orthopaedic surgeon, and I’m not wrong. Below BMI 40 is standard for most ortho practices; beyond that, they refer a patient to bariatrics before doing a joint replacement.

No reasonable orthopaedic surgeon actually wants to do a joint on a big person because there is a well documented increased complication rate.

So please refrain from giving people incorrect information.


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Didnt you hear them? Tldr ur wrong

 

[OrthoTraumaMD]

Didnt you hear them? Tldr ur wrong

I know omg
The best part is that they felt a paragraph needed a tldr.

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[Keona]

Unless you're talking like >400lbs people, denials are not happening at most medical centers. Or maybe you meant shouldn't do it? The vast majority of large (in the fat category) folks 200-400lbs are still readily able to get their joints swapped. And they are doing it at an increased rate. Ortho is getting a piece of the pie.

TLDR: You're wrong...

I’m a pcp. I’ve had multiple patients told they can’t have a joint replacement at Elevated BMIs. Usually over 250 is where I see them denied the most.

 

[Raryn]

Lol... Um... except you’re a premed, and I’m an actual orthopaedic surgeon, and I’m not wrong. Below BMI 40 is standard for most ortho practices; beyond that, they refer a patient to bariatrics before doing a joint replacement.

No reasonable orthopaedic surgeon actually wants to do a joint on a big person because there is a well documented increased complication rate.

So please refrain from giving people incorrect information.


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To be fair, there's a lot of orthopods out there with a lot of different standards.

I've had patients who have BMIs well over 40 with uncontrolled DM who come tell me about their new knee and I scratch my head how they got that done.

Most orthopods want the patient to be well optimized, A1c <8%, weight as low as reasonably possible, etc before an elective procedure.

And then there's orthopods who seem to be absolutely anal and want everything perfect. I've had patients denied because of an A1c of 7.2% because the orthopod wanted it <7%.

 

[OrthoTraumaMD]

To be fair, there's a lot of orthopods out there with a lot of different standards.

I've had patients who have BMIs well over 40 with uncontrolled DM who come tell me about their new knee and I scratch my head how they got that done.

I buy that. Ive seen some questionable joint replacements too. Fortunately, they are getting more few and far between because the Academy is publishing a lot about complications...and they are trying to standardize joint replacement in terms of reimbursement, so the rules are more strict. Also, more unscrupulous people are getting pushed out because their patients have longer length of stay and complications and end up costing the hospital money and resources. Thank G-d for that... it used to be much easier to do whatever the heck you wanted as a surgeon. Now there are standards, especially if your hospital is doing bundling as part of their CJR program, because it becomes a quality performance issue — if a patient is readmitted for a complication like an infection because they are 300 lbs, the hospital is dinged.


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[OrthoTraumaMD]

awww snap! An ortho attending talkin about fatties on SDN

But for real dude read what you wrote, you're own statements are contradictory:




As Raryn alluded to, "shouldn't" and "can't" are not interchangeable. I just had to shadow one ortho surgeon to know if there's incentive surgeons will replace w/e joint you want. Weight loss or not. Sometimes they referred out or asked the patient to lose weight, but in the end that didn't work and the surgeon operated. As you stated replacement usually failed and the chubby ones were back for a repeat or different joint in a few years.

So please, please, please don't misinform our SDN community just because you are an attending. You are an attending after all...

Shadowed one Ortho surgeon and thinks he knows about the trends in joint replacement. okay.
I’m not about to get into a pissing contest with a premed. And I’m not a dude.
/end.


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[OrthoTraumaMD]

Premed who knows just enough to see that you made a blatantly incorrect statement.

No one asked you to piss with anyone. And I'm not a he.

Then maybe you should change your profile to something other than “male.”


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[Psai]

Wow... Unbelievable... My gender pronoun of choice is completely separate from my biological sex. Please don't oppress me with your language. I have every right to embrace my y chromosome and still be addressed as "they/them/their", ask any adcom. Please see the below example.

Dude just quit while youre behind. Stop ruining threads with garbage