extracting max profit from any situation does have its side effects.  I think one of the most significant in the upcoming decades will be overall competency of the people providing care. Things are already in pretty rough shape as you push further along to lower levels of oversight.  Positions often just don't pay enough to deal with the obese. Someone qualified to do so will often be qualified to find something with similar pay that's just in the periphery of direct care. And if they're not, that's one hell of a strong motivator to push toward it as an end goal. At the moment I think our culture is still inflated to some degree with people with a big enough heart to keep making excuses for the obese. Or who at least care about their other patients enough to put up with it. But that's not going to last forever.