I'm a medical student and I have some direct experience with this. Sometimes, the difference between the surgeon who will do the procedure versus the surgeon that won't do the procedure is the availability of specialized facilities and equipment that they have access to. An elective surgery (i.e. not an emergency surgery) can go from routine to very high risk depending on the amount of adipose tissue the patient has.

And it's not just a matter of the fat tissue overlying the surgical site. Morbidly obese patients are much more likely to have things like sleep apnea which can make anesthesia more risky and might require more specialized equipment than a particular surgeon/hospital/anesthesiologist might have access to. The "morbid" part of "morbid obesity" also refers to the fact that people above a certain threshold of weight are much more likely to have other health conditions like heart disease that make anesthesia more risky.

The reason for that is that surgeons are rated based on their success percentages meaning they'll recommend against risky surgeries.

The upside of this is that surgeons aren't operating willy-nilly on people and will make a proper risk assessment. The downside is that overweight people have an inherently higher risk of complications from surgery, so some surgeons will pass.

It's not because they think these people don't need it, it's because they think it's too risky. They're usually not wrong about that, you just need to find a surgeon willing to take the risk or, if possible, reduce the risk by losing weight.

Look. Shitty doctors exist, but when 1/3 of the US is overweight, there are underlying issues that need addressing. I only hear horror stories when an addict, alcoholic, or overweight individual in my life is feeling insecure or defensive about a prognosis. Too many people deflect and it's enabling a much larger issues. Our basic instincts are being exploited.

When talking about obese individuals, the fat very easily gets in the way of surgery. Compared to a healthy patient the risk of complications during surgery is much greater and really not worth chancing it (most if the time)

Similarly - if you are trans and on HRT, every problem is due to your hormones.

My mother had a doctor that refused to move forward with knee surgery because she was so depressed and refused to do therapy because it hurt her knee so much to move around.

I guess I understand, why go through the trouble of surgery if she's just going to be a bummer couch potato afterwards and never change her ways?

But at least she'd be a bummer couch potato whose knee didn't threaten to give out on her whenever she tried to do laundry in the basement.

If I take my car in for new brake pads, don't refuse me service because the transmission is on its way out.