# ACA, evidence based treatment and patient non-compliance



## HereticFA (Oct 3, 2013)

I've yet to see much discussion on Dimensions about the direct impact the ACA will have on us as a group.

There are provisions that will probably create a situation where many here with their newly received insurance may not be able to keep their doctor, or maybe even find a new one once they have been dropped for noncompliance. For an easy to understand background, please read this link on Reddit: http://www.reddit.com/r/explainlike..._exactly_is_obamacare_and_what_did_it/c537rqi

While some of you may complain that the link is over a year old, here are more recent links: http://www.post-gazette.com/stories/opinion/letters/patients-and-the-aca-691205/
http://www.theihcc.com/en/communiti...bad-for-doctors-awful-for-patie_gn17y01k.html
(Although I'm not sure about the date of the last one. It still touches on the issue of negative impact to non-compliant patients. This is a situation that is widely recognized in the medical community as an issue. )

With the AMA finally labeling obesity as a disease (long after the NIH and the WHO), patients who fail to lose weight may face being labeled non-compliant. Even if it's not 'obesity' being targeted directly, if your A1c levels, blood lipids or other generally accepted markers of health status associated with obesity are out of the accepted normative range and you are recommended to lose weight to improve those markers but fail to do so, you may be labeled as non-compliant. Add in the well known fat prejudice among doctors and this is not going to end well for us.

Is there any way to overcome this? I seriously doubt it. The stones for this path have been lain carefully and securely over the last three decades. I don't see a way to avoid being driven down the path by the government and the financial pressure they are putting on the doctors. Unless we can discredit the evidence used to develop the evidence based treatments, the outcome is predictable. Everyone WILL be forced to lose weight _or lose access to medical treatment_. After all, maintaining AFFORDABILITY of medical care is the main intent of the ACA. That means minimizing costs and fat patients have been proven to cost more.

Even discrediting the 'evidence' will at best probably only restore the previous threshold of 'overweight' (BMI between 25 & 30) as acceptable or preferred. Our only chance is by challenging the evidence of the treatments, They should be required to consider the complications of various weight loss methods as being just as significant as the diseases associated with obesity. The millions of former Phen-Fen users with heart and lung damage (at least the ones still alive), the millions who lose more than 70 pounds and mysteriously develop heart problems - that are promptly blamed on their previous obesity without any evidence of heart problems while they were fat to support the claim. The repeated hospital readmissions of many WLS patients well after their surgery (and their poor average compliance rate achieving a 'healthy weight'). Does weight loss actually dump fat soluble environmental toxins back into the bloodstream during weight loss? There are many, many issues that need to be examined and fought against _at least _as a patients rights issue if not a fat rights issue. 

What about those who want to stay fat for their own personal sexual preferences? Isn't it their right to be able to do so? Unless motorcycle riding, rock climbing, parachuting, BD/SM, body ink, or hundreds of other risky lifestyle choices are considered equally for noncompliance consideration, yes it should be their right. Unfortunately this 'fundamental change' has only just begun. It will take at least three to five years to fully understand the affects of the ACA on each of us personally.

If any of you encounters being labeled non-compliant and loses access to medical care, I hope you will post it here so we can keep track of how many it affects. Hopefully it never happens to any of us.


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