The Fat Doctor Podcast

When 'nice' isn't enough: The search for truly safe care

• Dr Asher Larmie • Season 5 • Episode 29

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Some healthcare professionals are nice. Some would go so far as to call themselves “body positive" or “HAES aligned”. But being pleasant doesn't make you safe for fat patients. There's a crucial difference between practitioners who are steadfastly kind while perpetuating harm, and those who actively work to counter medical weight bias. In this episode, I expose why often times anti-diet isn't enough, how well-meaning professionals can cause more damage than obvious bigots, and why fat people are trapped in an endless cycle of seeking help, getting weight loss advice, and avoiding care until they're desperate. I challenge anti-diet practitioners to move beyond good intentions and actually do the work to become weight-inclusive. Plus, I debunk the dangerous myths about anaesthesia safety that are used to deny fat people surgery. 

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Hi, everyone, and welcome to episode 29 of Season 5 of the Fat Doctor podcast. I am your host, Dr Asher Larmie.
I've just taken a little bit of a break for a week just because I can. And I'm back! It's September. Most of us that have kids or are in academia have that kind of back-to-school feel. Those of us who are fortunate enough not to have children or be in academia, maybe you enjoyed a bit of sunshine in the August weather. September has that feel to it, doesn't it? It's getting cooler, and it's time to take life a bit more seriously. Days are getting shorter. I love September, it is one of my favourite months. I am an autumn and spring kind of boy.
I'm enjoying it, I hope you're enjoying it, I hope you're having a good September. I've got 3 episodes lined up, I'll be recording them back-to-back, you'll be hearing them once every Wednesday, which has always been the case, because that's when my podcast episodes drop.
Today we're going to be talking about the search for safe care. The reason I'm doing this episode is because I keep getting messages either asking me if I could recommend someone, which I'm frequently asked, or telling me about this awful experience with somebody who was recommended as being a "safe practitioner."
I'm going to try not to ruffle any feathers. I know, don't laugh. I have a tendency to ruffle feathers. But I'm going to try not to. I'm very conscious that for a very long time, we're talking almost 20 years of my medical practice, I was doing harm, I was perpetuating harm towards my patients by practicing in a weight-centric way. So I have absolutely no business lecturing other people about causing harm to patients, because I have a lot of red in my ledger, for those who remember that quote from that movie.
So I am going to try not to criticize individuals. I'm not going to name any individual. All of the stories that I'm going to be sharing are very much anonymous, and the details have been changed enough so that you hopefully won't be able to recognise yourself in this, because I'm not trying to share information that was shared with me.
But I don't know, this is a common theme, and it makes me mad. It makes me mad, it makes me sad, it makes me angry, it makes me all sorts of feelings. Why is it that fat people should have to shop around for safe care? Why can't healthcare just be safe? That in and of itself is a problem. But in a perfect world, all healthcare practitioners would be safe for fat people, but they're not. So we go out and we look for the ones that we think are safe, and why is it that even when we look for the ones who are safe, we still get harmed by them? This kind of boils my piss a little bit.
So I get a message: "Asher, can you recommend a doctor, or a physiotherapist, or a dietitian, or a counselor, or a fitness professional in my area, who's not going to tell me to lose weight?"
And I get it. I feel the same way. I'm constantly looking for people that I feel safe around, haven't found any yet, but it's tricky. And the thing is, I really want to help, I do. But how can I trust these people? Just because they say that they're safe doesn't mean that they are safe. How can I trust them? And if I can't trust them, then how can I recommend them to other people? It's really tricky, because even if I have all the best of intentions, I don't want to cause additional harm. Harm reduction.
So the reality is that fat patients have been avoiding healthcare entirely. A lot of fat patients, just avoiding them entirely. Healthcare professionals just are dangerous, and therefore we avoid them due to past trauma.
And we also recognise that there is a difference between nice practitioners and weight-inclusive practitioners, right? There are plenty of people out there who like to think of themselves as nice. "I'm nice, I'm kind." And when they say nice, what they mean is, "I don't have any explicit anti-fat bias. I don't have any explicit racial bias. I don't have any explicit anti-trans bias."
But by explicit, I mean these are the things that we know that we know. There are some people out there who genuinely believe that fat people are ugly, weak, incapable. Really nasty things, all sorts of assumptions, but they know that they know that, and they're quite happy to state it, especially in today's day and age. They'd be happy to state it on a live Instagram feed, or a TikTok video. There's no shame. We can say whatever we want in this day and age. So there are many people out there with explicit anti-fat attitudes, explicit anti-Black or racist attitudes. No shame anymore, right?
But then there are people out there who would consider themselves nice, because they don't have these explicit thoughts. They wouldn't be caught dead saying out loud, or even thinking to themselves, that certain people are inferior because of the way that they look. Of course not. But that doesn't mean that they don't have anti-fat bias, it just means they don't have explicit anti-fat bias, and implicit anti-fat bias is unconscious bias. And literally almost everybody has that. Almost everybody, because we live in the world, we've been conditioned to believe these things since we were so young, since before we had any kind of real control over our prefrontal cortex, so of course these things have been conditioned into us, so we all have an element of implicit anti-fat bias.
So being nice isn't good enough. A weight inclusive practitioner is aware of their implicit anti-fat bias and works in a way that is consciously working to prevent that implicit anti-fat bias from harming their patients. Instead of saying, "Oh, I'm a nice person, I would never do that," they acknowledge, "No, there is anti-fat bias all around us. Almost all of us have implicit anti-fat bias, and even if we don't, there is systemic weight stigma, especially in the healthcare profession. So I am going to work consciously, intentionally, at providing a safe environment for my patient to be in, in spite of all of those things."
That's a weight-inclusive practitioner, and they're rare finds, they really are. Well-meaning professionals who think they're body positive, or whatever, but actually lack the evidence, lack the understanding, and lack that kind of intentional practice, can sometimes be more harmful than they are helpful, actually, because they give the illusion of being nice. If you've got an arsehole sitting in front of you, treating you like garbage, at least you know they're an asshole treating you like garbage. If you've got someone smiling sweetly who gives the impression that they're an ally, and then it turns out that they're not, that's sometimes more harmful because you let your guard down, right? And that can be really harmful.
And I think there is a massive gap. I'm noticing a massive gap between anti-diet philosophy. I think more and more people are jumping on the anti-diet bandwagon. "Diets are bad for you." I see this a lot in dietitian spaces and fitness professionals. People who are focused on nutrition and exercise, that's their primary focus or source of income, even. So I'm seeing more and more people step up and go, "No, we don't do diets here."
Great! That's wonderful. Anti-diet is great, but that is not enough, as far as I'm concerned. Just saying "I'm an anti-diet professional" is a great start, but it's not enough for me to feel safe around you, as a fat person.
And the problem is, and this is nobody's fault, the problem is that anti-diet professionals often lack the medical credibility. Because most anti-diet professionals are not doctors or nurses. And so, even if you are somebody who is trying to be weight inclusive, it sometimes feels like, "But what about my health?" And then there's, "Yeah, I can't comment there, you know? That's not my lane, I'm staying in my lane," which is great, staying in lane is always a good thing, but then I can't comment because I don't have the medical credibility. So it gets really tricky.
And I want to give you some examples of this, and like I said, this is just taken from examples that people have given me.
The doctors who were recommended by Facebook groups. Don't know if you know, but a lot of people are out there on these Facebook groups going, "Can you recommend an orthopedist who isn't going to make me feel like crap in the Philadelphia area?" A lot of these groups are American, possibly Canadian. I know of less in the UK, but I'm sure they exist. And I don't know about other countries, probably they exist.
But you go on a Facebook group, and "Can you recommend somebody?" And then sometimes they're like, "Yeah, this doctor was really great to me."
This is the problem. Who is doing the recommending? And more importantly, what size are they? Because some doctors, well, as we know, weight stigma, fatphobia, anti-fat bias, all of these things very much get worse the bigger a person gets.
So if you're somebody who's got a BMI of 31, technically counts as being the O-word, but people look at you and go, "Oh, you're a bit muscly, it's not your fault, we're not going to hold that against you," and they're really nice to you. Very, very different than if you weigh 300 pounds. Very, very different attitude from doctors.
So oftentimes, I've heard of people who were recommended a doctor, and they go and, "This person, this is the recommendation? They were horrendous. Really horrendous."
And so I will often say, "I'm very uncomfortable recommending doctors to other people." There's only one doctor that I know that I truly believe is safe in the UK. Sherry looks after children. And then there's only one doctor that I really know in the US that I really trust. The US is a fairly big country. So I'm not recommending doctors at the moment to anybody, because I don't care what other people's experience has been like, that doesn't necessarily mean that this doctor is a weight-inclusive doctor. Or even if they're not weight-inclusive, that this doctor isn't just a fatphobic bigot, as far as I'm concerned, so I'm just very wary.
But I don't know if that's ever happened to you, when you've just gone along thinking, "Oh, this person came recommended," and then just wondered why were they recommended?
There are lists of practitioners, and people can get onto these lists. They can say, "Oh, I'm a member of an organization." A lot of these organisations, by the way, are really happy to take on people in the field of "obesity medicine." I know, for example, the Association of Weight and Size Inclusive Medicine. A lot of the doctors who are part of that organization, and who can absolutely say, "I am a member of the Association of Weight and Size Inclusive Medicine," literally, their job is weight loss. That's worrying, isn't it?
And so there are people who can claim to be a member of an organization doesn't mean anything. It really doesn't.
And again, there is this kind of grouping of different types of fat people. So there are the small fats, the "healthy fats." "Oh, this person's fat, but they're trying to lose weight," different to "This person is fat and is not trying to lose weight," or "This person is too fat for my liking," or "super morbidly fat."
Again, just because a practitioner is okay with a small fat or a "healthy fat" doesn't mean that they're going to be okay with all fat people.
Healthcare professionals who use the term "HAES-aligned," H-A-E-S. First of all, HAES, Health at Every Size, is a trademark. That is a legal thing. I don't understand contractual law, but I know that the trademark is owned by ASDAH. If you live in the UK, I'm not talking about the supermarket, I am talking about A-S-D-A-H, the Association for Size, Diversity, and Health, promoting the Health at Every Size approach.
So that is their trademark. You can't use their trademark willy-nilly. So there are doctors out there who use the term, or professionals of all kinds, who use the term "HAES-aligned," and they have no business doing that. You can report them to ASDAH and say, "Hey, they stole your trademark." And then they can be forced to remove that trademark.
But I just see a lot, and again, this is in America, but maybe private practitioners in other countries as well, who use this as a means of attracting clients, patients, so they can get their money. But then, when their patients go and see them, they're actually super weight-centric.
I've had horrendous stories of people going to these "HAES-aligned doctors" and being lectured about their weight, or their diet, or exercise, or anything like that, and just being like, "What? I thought you said you were HAES-aligned!"
But then again, Health at Every Size, the actual studies, when you look at the Health at Every Size studies, or books, historically, and I'm not saying currently, because I have to say, the current leaders within ASDAH are doing a lot of work on this, so no shade to them, they're great. But historically, Health at Every Size has been problematic, in that it's still not inclusive to all fat people, and there is still a kind of line in the sand between "healthy" and "non-healthy" people. So it is problematic in of itself.
But to take it as far as to tell people that they need to lose weight, then you're just not HAES-aligned at all. Horrendous. Horrible.
I have heard many stories of clients having to break up with their therapists because their therapists are talking weight-centric nonsense. That really worries me. I have heard of therapists, actual mental health therapists, recommending people get the shots. You know what shots I'm talking about.
What the fuckity fuck is going on right now that therapists are recommending people take weight loss injections? But that's happening. I'm hearing stories of, "I'm breaking up with my therapist." I'm like, "Oh no, why? What happened?" "They're recommending intermittent fasting, or they're recommending this, they're recommending that."
They genuinely think they have their clients' best interests at heart. I genuinely think that these therapists believe they have their clients' best interests at heart. I genuinely think they are of the belief that they're doing their patients a favor. I don't think they're trying to harm their patients intentionally. I think they think they're doing a good job.
So it's not ignorance, because ignorance kind of absolves them of any responsibility. I don't know that therapists really have any business telling people to lose weight. I don't know when that becomes part of therapy, but I am not a licensed mental health professional. So, far be it for me to make such bold statements.
That being said, that is not weight-inclusive, and that can be really harmful. And so, understandably, fat people do not want to be in that kind of vulnerable space with someone who holds such anti-fat beliefs.
I've heard of dietitians who claim they're anti-diet, and then they recommend some "lifestyle changes" that feel very diet culture-y, and then people come to me and go, "I've just been working with this dietitian, and this is what they said, and I don't know if it's right or if it's wrong, it doesn't feel right, I'm not quite sure," and I'm always like, "Look, mate, I'm not a dietitian, but I'm telling you right now, if there's red flags, if you've got a funny feeling in your gut that's telling you it's not right, it's not right. If you're getting that feeling, then listen to that feeling. Your gut instinct isn't going to steer you wrong here. Your intuition isn't going to steer you wrong here."
But sometimes they'll tell me things, and I don't tend to comment too much, because like I said, I'm not a dietitian, I really do not have enough knowledge or understanding of nutrition to be able to comment on a professional's recommendations. However, oftentimes I'll listen, I'll be like, "Yeah, that sounds super diet culture to me, that does not sound weight-inclusive, that just feels like you're repackaging." What have I heard? I'm trying to think. People talk about having repackaged intermittent fasting in a weird way, and also people are sort of repackaging "Health at Every Size." They're like, "Here's a Health at Every Size program," and then they recommend ways to eat and ways to exercise, and I'm like, "That's just a diet, isn't it? If you're telling people how to eat and how to exercise, isn't that a diet?" I'm not sure, maybe, maybe not, I don't know.
But anyway, if that's what your intuition is telling you, then that's probably right. So I keep hearing these stories.
And I keep seeing this cycle being repeated over and over and over again. A fat person needs help. Professional help. So they seek professional help, and they get weight loss advice, and they are stigmatized. And it took a lot of effort to go to see that person in the first place, and then they're let down, and they're stigmatized, and sometimes they're traumatized. They feel dehumanized. And their bodies are pathologised. That's a lot of "-ised" words, but they feel like crap afterwards.
And so, that, once again, teaches their brain, their body, that it is not safe to seek professional help for medical or health-related problems. Do not seek care. So they avoid care, and then their health suffers. And then it gets to the point where they're desperate, and then they need to seek care again, and then they seek care, and they get weight loss advice, and they're stigmatized and traumatized and dehumanized, and so then they avoid care, and then their health suffers, and then they get sick again, and then we wonder why are fat people so sick?
It's kind of obvious, isn't it? It doesn't take a genius to work out what's going on here.
So today, I guess I am talking to the healthcare practitioners out there. If you're a doctor or a nurse or a physiotherapist, physical therapist. If you're a dietitian, a nutritionist, a mental health professional, social worker. A fitness professional, you know, let's throw out a wide net and draw you all in. I just want to let you know that being nice isn't enough. It's a great start. But it is not enough. Being anti-diet isn't enough either. Again, great start. You're nice, you're anti-diet. Already, you are better than most of your peers, so congratulations, but it's still not enough.
And I refuse to allow fat people to settle for less than enough. And I am not going to tell people, "Well, you should be grateful for the shitty care that you're getting, because at least it's better than the worst care that you could be getting." I'm not doing that. I'm not telling fat people that. No, sorry.
Being nice isn't enough. You actually need to be actively working to counter medical weight bias. Medical weight stigma. Weight stigma, in of itself, is very problematic, as I'm sure you know, weight stigma impacts all areas of life. It impacts employment, it impacts education, it impacts housing. It impacts the criminal justice system. It impacts just basic things that we need in order to be part of society. Clothes, travel. Weight stigma is very problematic.
And I don't want to compare weight stigma and employment to weight stigma in medicine. I don't want to say one is worse than the other, but medical weight stigma is over and over again comes up as one of the biggest forms of weight stigma, as the most problematic forms of weight stigma. You look at any study on weight stigma, you will see that weight stigma from doctors or healthcare professionals is listed very high. It's usually family, friends, co-workers, doctors. Those are the most problematic people.
And so just being nice isn't enough. Medical weight bias is a real problem, and it's not just that it's hurting people and harming people, it is killing people. It is causing actual physical harm to people. It is the reason that people are actively avoiding seeking healthcare and are becoming sick as a result.
So being nice is a great start, and it's simply not good enough. You need to be doing what you can to counter medical weight bias. And I hear that's not easy. It's very difficult to counter medical weight bias. I understand that. And just a willingness to do it is a really great start.
But good intentions are never going to compete with doctors' orders. Right. When you tell your clients, "You don't need to go on a diet," and then they go, "Yeah, but my doctor said," or "I have just been, you know, my blood pressure's a bit high, or my HbA1c was high this time, or they've just found fatty liver, or my joints are aching," they're going to come to you and they're going to say, "And I've been told that I need to lose weight," and so your good intentions, your anti-diet beliefs are not enough. They're a great start, but they're not enough.
And if you don't have the ability to counter medical weight bias, and again, this is not your fault. It's very difficult to do that. It's not like there's oodles and oodles of training available for you, so that you can just be like, "Oh, I'll just go and do a course, and then I'll be able to counter medical weight bias." It's not that simple.
But if you are unable to do that, then you could fall into the trap of inadvertently reinforcing weight stigma. Like, for example, a person comes to see you, and you go, "Oh, you don't need to diet," and they go, "Yeah, but my doctor told me that I needed to," and you're like, "Well, if your doctor told you, then maybe you should diet," you know, that kind of thing. That's just reinforcing weight stigma.
And the burden, therefore, lies on the fat patient to educate their healthcare practitioners, or the professionals that they're working with. And that's also not fair. We have a duty of care to our patients, our clients, etc. We can't rely on them to educate us.
So there needs to be a solution. And I have been thinking about this for a while. I've been thinking, "Okay, it's all well and good to say that people need to be able to counter medical weight stigma, but how are they going to do that?" I have thought about this for a long time, and I am in the process of creating something, I have already created something, I guess I should offer a little teaser, a little bit of a slow reveal, as it were. That I have created, I am in the process of creating, I have created, depends on when this is aired. Of course, for professionals who want to really do the work. And there has to be a willingness there, doesn't there? You have to be prepared to do the work. It's not an easy peasy, 2 hours, that's it, here's your certificate, off you go. It's a proper course for any anti-diet professional out there that wants to do the work, to go from just being nice to being someone who can confidently counter medical weight bias. Who can take their clients' real genuine medical concerns and provide them with answers. Signpost them to advice, etc. Who have more than just good intentions, who want to have more than just good intentions. Who do not want to reinforce weight stigma inadvertently, unintentionally, even with the best of intentions. Who do not, who genuinely believe that the burden of educating health practitioners should no longer lie on fat people. That you, as a professional, recognise that this is your responsibility, not theirs. Who want to help break that cycle that I was talking about, the cycle of fat person seeks help, gets weight loss advice, stigmatized, avoids care, health suffers, until the point where they need to get help again. If you see that cycle over and over again, you're like, "I want to do something to break that cycle." Then this course is for you.
I'm going to be talking about it more in the coming couple of weeks. If you are signed up to my newsletter, then you'll get some information. If you are not, then why not sign up to my newsletter? I'll only email you once a week. Occasionally twice. I'm being really cheeky. But I send out a newsletter, and I share all of this important information.
But I want to encourage people who are listening who are not health professionals or anti-diet professionals. I'd love to know how you go about finding safe practitioners. I'm really interested in that. Let me know, send me a message or comment under the video if you're watching YouTube. What do you do to find safe practitioners? Can you find safe practitioners should probably be the first question. And then how do you go about doing it? I'm really interested.
I'm about to finish this podcast episode, but before I do, I got asked a question on YouTube. I did say, "Ask me anything." If you ask me something, I'll try and cover it. And this person asked me a question about anaesthesia, and hey! I am nothing if not a man of my word, so here we go.
The question was about anaesthesia, and queries about whether it's safe in fat patients. We are often told it's a reason to deny people surgery: "I'm fat, that means anaesthesia's not safe." Absolute bullshit.
Anything they say is really grossly exaggerated. Or, even if it is true, can absolutely be managed, you know, this is not unmanageable at all, it's perfectly manageable. So it's really bullshit.
And there are plenty of studies to support this, but just to be a little bit more specific, rather than just going, "Oh yeah, that's crap."
Some of the lies they'll tell us is that if you're fat, you're more likely to have a difficult or even impossible airway. That's not true. There's lots of studies that show that that's really not true. It's nothing to do with your size. There are reasons why some people have airways that are harder to manage, but being fat is not one of them.
There's a lie about respiratory complications in fat people. I think a lot of this comes from COVID. "Oh, we can't intubate fat people, oh, they're much harder to manage in ICU." Fuck off. If you can't manage fat people's respiratory complications, I suspect that has something to do with you not being able to do it. Is it challenging, possibly? I don't know, I don't work in ITU, ICU, but the evidence is quite clear that respiratory complications in fat people, it's grossly exaggerated. If in fact that's true at all.
There are perhaps some issues with drug dosing, so people will say, "Oh, you know, the medications that we give you to put you to sleep." A lot of those medications are fat-soluble, so the more fat you have, the more that they'll sort of last in your tissues and potentially could last longer, so that's true, I'll give you that. That's just simple pharmacology. It's kinetics, I think, because it's time? Anyway, sure, I give you that, but that's why the recommendations just make it clear that when we're dosing for fat people, instead of for most drugs, not all drugs, depends on the drug. Instead of dosing your actual body weight, we should be dosing for your "ideal body weight." So we should be using lower doses because they're fat soluble. In most cases. It does become tricky when it comes to opioids and pain relief, but there are ways to manage that. There's actual guidelines of just how to manage it, so it's not difficult, it just requires you to have read the guidelines. And I read the guidelines, and it took me 30 minutes, so it's really not challenging.
Are there technical challenges? Yeah. Sure, so some of the challenges. For example, I've read, and again, I'm not an anesthesiologist, I've never really worked in anaesthetics, so this is all the stuff that I've read, about intubation, and sometimes it can be more challenging, due to the size of the neck and movement of the neck, and so the recommendation that I saw was that you need to have the head elevated at 20 degrees, and the way to do that, they've said is there is this special pillow thing that you can use, or just use a folded-up blanket.
That was a recommendation, just fold up a blanket. Pretty sure that's easy to do. You don't even have to move the table, just fold up the blanket. These are the kind of things that I just think, "Okay, sure, maybe there are technical challenges, but they're absolutely easy to overcome," you know, it doesn't take a genius, you just need to know what you're doing. And of course, if you haven't been told that, if you haven't bothered to read the guidelines, that's understandable.
There were some guidelines out in 2015, it was the British society of anesthesiologists, and I can't remember exactly who it was, but they came up with some guidelines in 2015, specifically for people who were having bariatric surgery. And so, of course, this kind of lends some credibility, doesn't it? To the fact that anaesthesia is safe in fat patients. Because we're recommending all fat patients have weight loss surgery, and in order to have weight loss surgery, you have to be put to sleep.
So someone out there has been trained in putting fat people to sleep for weight loss surgery. So if they exist, if those anesthesiologists exist, and they have the training, and they're perfectly confident doing it, they can do all surgery, right? I mean, there's no reason why they can't pass those skills on to other anesthesiologists so that anybody can be put to sleep for any operation. Seems reasonable.
There is this idea that people who are fat will have an extended post-operative recovery, not necessarily from the anaesthetic, possibly from the surgery, that's true, and there's lots of reasons for that. But when we say extended, we're talking usually a few hours. Calm down. Stop it. Stop getting upset about an extra hour. I mean, I was reading a reason not to perform a cholecystectomy, which is a gallbladder operation, in fat people, is because surgery time is longer. I was like, "Oh, well, you know, okay, extended surgery time. The longer you're under the knife, typically, the worse the prognosis." So I was like, "Well, you know, how much?" On average, it was 6 minutes. And I was like, "No, sorry, you can't deny somebody a gallbladder removal because of 6 minutes." That's just not okay. It's just not okay, an average of 6 minutes. Fuck off.
So extended post-operative recovery is often grossly exaggerated. There are assumptions that are made about, "Well, if you're fat, then you're obviously unhealthy." Again, fuck off. Don't assume somebody's unhealthy because they're fat. Also, don't assume someone is healthy because they're thin. Neither of those two statements are true.
Some people have comorbidities. For example, they'll use sleep apnea. "Oh, fat people, they all have sleep apnea." Not all fat people have sleep apnea. Also, when you look at the actual studies that have looked at the general population, and who meets the criteria for sleep apnea, you'll see that it actually is almost 50% of all men meet the criteria for sleep apnea, and therefore, it's not just fat people. It's just all people. And even if sleep apnea is more common in fat people, which it's not, but let's just say for a moment it is. Doesn't matter, because if someone has a diagnosis of sleep apnea, doesn't mean you can't perform surgery. In fact, once you know that they have sleep apnea, make a few adjustments, and then perform, you can do the anaesthetic without any problems.
It's the people we don't know about that we should be worried about. It's the ones that have sleep apnea and were not diagnosed prior to surgery.
So there are some people who say we should treat everybody as if they have sleep apnea, there are some people who say we should treat all fat people as if they have sleep apnea. There are some very sensible people who say, "We should screen everybody for sleep apnea before we put them under," seems rather simple. Some people say we should only screen fat people for sleep apnea before we put them under. Do you know what? I am not going to argue the minutiae with you, I'm just going to tell you that just because the person may or may not have sleep apnea, that is not a reason to deny them an anaesthetic, and that's certainly not a reason to deny them surgery.
So, again, fuck off.
And then sometimes you just hit people making these just vast claims, just completely nonsensical claims, "Anesthesia's just not safe." That's not true.
So there are some really good studies out there, and when I say really good, I would give you NAP4 and NAP5 as two examples. If you don't know what NAP4 and NAP5 are, that's okay. You can Google it, or not Google it, and just listen to Asher. Either way, these were national audit projects done, again, in the UK. The NAP4 looked at anaesthetic complications specifically and proved that being fat does not increase your risk of anaesthetic complications!
So that's the end of that. You know, statistically speaking, it doesn't. So stop saying anesthesia is not safe for fat patients. Of course it is! There's an entire chapter in the NAP4 document that talks about how it is safe for fat patients, and actually, when they look at the reasons why anaesthesia is not safe, it's almost always because the person performing the anaesthesia is not up to par. It's not good enough. They, the reason anesthesia is not safe is because somebody made a mistake.
So, hope that answered your question.
That's me for the day. Next week, I don't know what we'll be talking about. I do, but I don't. It'll be a surprise.
So I look forward to seeing you next week, and until then, take care of yourself. Bye-bye!