NHS Treatment for Obesity?

[Saracen]

My view on this is fairly simple ....

1. some seriously obese people are so because of genuine bona fide medical conditions that are not the fault of their own self-will. In that case, and if other less radical alternatives have failed, then yes, treatment should be available on the NHS, subject to the following ...
   
   
2. the point above is subject to the caveat that all treatments have to be paid for from a limited pot of money, and doing this means something else gets less funding. Someone (and it seems to be NICE) has to make the decisions about what gets done and what doesn't.
   
   
3. cost should not be the only, and probably not even the primary criteria for deciding on treatment availability, but it is simply the case that it is a criteria. We can't pretend it isn't, or at least, it would be naive to do so.
   
   
4. an obvious implication of 3) above is, as was raised by (IIRC) kalniel, that you not only has to take into account what the treatment costs to provide, but what it costs if you don't provide it. If it costs, for instance, £20,000 to provide the surgery, but the implications of not providing it were £7,000 a year for 30 years for diabetes treatment, and maybe £200,000 in future years for a liver transplant, then it puts the £20,000 into perspective
   
   
5. cost is only an issue because, by definition, the pot of money is not infinite and doing A implies not being able to fund doing B. Whilst we don't like to think of treating patients in financial terms, largely because it offends our sense of ethics, it does come into the calculation. Quite rightly, that decision should not be made my doctors actually training patients, but it is made, whether we like it or not and even whether we acknowledge it or not, at a policy level
   
   
6. even where the obesity is the result of "lifestyle" decisions, there is still a case for providing it if
   
   • all other alternatives have failed
   • it is a last resort, not just an easy option
   • it meets the necessary criteria for clinical need, and
   • it ranks sufficiently highly on the cost-effectiveness scale to be prepared to forego funding something else to pay for it.

This falls into the same category, in my view, as things like smoking treatment and even cosmetic surgery. On that latter, for instance, I support cosmetic surgery for the victims of accidents, burns or, as unfortunately is far too often the case these days, military casualties, but not because someone has a thing about needing bigger boobs or a bobbed nose.

In other words, just like cosmetic surgery, I don't think it's possible to give a thought-out considered response that either says "yes we always do" or "no we never do". The world, unfortunately, is never that simple.

[TooNice]

if restrictions are applied to the above, how about applying the same to sports injuries.

The difference, of course, is that sports are generally good for you (subject to the sports itself and how much you do). Overeating junk on the other hand is not. The correct analogy would be if a physician tells you to ease up because you are tearing yourself apart but you don't listen.

how about not treating people who "wear slippy shoes"

The difference here, and it applies also to the previous example, is that how many people injure themselves because they 'wear slippy shoes' or because they were careless while doing sports (as opposed to a genuine accidents)?

I don't mind some leniency, if you tell me that a few thousand obese people need an operation for no other reason than a lack of self-restrain, my reaction would be "Meh, I don't like it, but we all have our vices".

However, most statistics on obesity in the UK is not very flattering. Here's a report (http://www.dh.gov.uk/prod_consum_dh/.../dh_073033.pdf). I've not gone through it yet, but in 2003, 22% of male were obese, and 23% of female are obese. Furthermore, 43% of male are overweight, and 33% female. Those figures does not include the people who are obese, meaning that most of the population are above their ideal weight.

We are wealthier now than we were in the past, so in my opinion, it's a case of eating habit gone wrong. No doubt that some of those over 1/5 people have legitimate reasons for their conditions, and I do believe in helping them. But I -do- expect people to put a minimum efforts if they are going to receive subsidised help, it's simple courtesy.

So yeah, when half the population injure themselves on a regular basis because they wear slippery shoes or ovexert themselves with certain sports, and no messages seem to go through to those people's head that they need to wear safer shoes/ease up, it would also be time to re-evaluate IMO.

treatment for all, or scrap the NHS since it no longer fulfills its purpose.

All or nothing? The world hardly works in black and white, why scrap something because it doesn't fulfil one ideal? Truth is, we'll be better off if everyone take care of themselves, and the system functions as a safety net for when crap happens (e.g. accidents, and less predictable forms of illness).

[Lucio]

@Allen: The other way rings true too. I am not against some people having it done, but it should be last resort and only when the overweight person has shown genuine effort, yet could not overcome some underlying medical cause (if the cause is psychological, then that needs to be sorted first).

Show genuine effort? How exactly?

I'm obese, by a long way, as best as I can tell I don't have the same "hungry" feelings as other people, I'll go a couple of days eating very minimally (max of a sandwich and a packet of crisps), or I'll quite happily sit down and consume a 12" pizza. It's no different to my depression, as far as I can see, my natural instincts aren't the same as other people.


IMO, It's not something that can be "fixed", it's just the way I've been made and all the NHS can do is treat the symptoms....

[TheAnimus]

I'm sorry, but I really don't buy the poverty leads to obesity due to lack of money.

You can eat incredibly healthily on very little money, the problem is some cooking effort is often required. If someone is working 60 hour week, I can really sympathise with them not been bothered.

If someone is just been welsh and on the doll, then they can get off their fat arse and cook, they might even burn up some calories.

I find it amazing that cooking isn't something that is a required part of school (i'm not for a second saying you need to be tested on it) and that most schools don't do any of it until your really quite old.

There are plenty of 'excuses' for been overweight, I pilled on the fat when I was suffering impaired mobility, because I increased my calorie intake too in what would be classified as depression i suppose.

And this is to me, what is the problem with gastric bands on the NHS, it is a bit like treating the symptom, not the cause. If someone is a fat because they eat deep fried mars bars and drink loads, a band isn't the best solution, if someone is depressed, it REALLY isn't the best solution.

However i could see it been the cheapest, thanks to the way they would look at balance sheet costs, "oh their BMI is lower now, they will cost the NHS less" despite the fact they are drinking a bottle of whisky a day suffering horrific depression!

[G4Z]

All the arguments about wasting tax payers money are bunk. These operations SAVE tax payers money because the people treated then have far healthier lives and are much less of a burden on the system. In three years it pays for itself.

Whether it's something we should surgically 'correct' is another debate, but there shouldn't be any problem on the money front.

Not only on that front but if we are talking 'super size' obese we are also saving on potentintial social costs like incapacity benefit. They may also get back to work and be productive. My opinion is that the operation definately should be avilable to anybody provided there is a doctor is saying its required. I would also be in favour of more in the way of psycological support and I also don't understand why there isn't an NHS version of weight watchers. They do it to help people stop smoking and I think they should do it for obesity as well.

[Mike Fishcake]

What I don't get is why some people immediately think there's a blanket answer that covers all eventualities of any argument. Every time a contentious subject comes up, knees start jerking, fingers start righteously clattering away on keyboards, yet every single time, the answer should be "it depends on the circumstances"!

It's all too easy to make a bold statement saying "OMG KILL THEM ALL" without considering all circumstances and then dismiss any counter arguments as "politically correct" or "bleeding heart" - for christ's sake some commenters on the BBC Have Your Say site appear to base their entire lives on it, but there is never, ever, ever a one-size-fits-all (no pun intended) answer to questions such as this.

People are overweight for many reasons:

- They eat too much
- They're ill
- They're depressed
- They're not well enough educated
- Many other reasons, too many to list here.

How can the answer be anything other than "it depends on the circumstances"?

Technically, according to the BMI charts, I'm classified as "overweight", but FFS, everyone apart from the most self-righteous has their vices. I don't drink alcohol, I don't smoke, I don't take recreational drugs, I work full time, I treat other people as i'd hope to be treated myself, I've been faithfully married for nearly 11 years, I don't swear in front of people that may be upset by it, and I bring my son up with an appreciation for what's right and wrong, so people should just shut the hell up and let me eat my pizza without treating me like I'm utter, utter scum.

[floppybootstomp]

What I don't get is why some people immediately think there's a blanket answer that covers all eventualities of any argument. Every time a contentious subject comes up, knees start jerking, fingers start righteously clattering away on keyboards, yet every single time, the answer should be "it depends on the circumstances"!

It's all too easy to make a bold statement saying "OMG KILL THEM ALL" without considering all circumstances and then dismiss any counter arguments as "politically correct" or "bleeding heart" - for christ's sake some commenters on the BBC Have Your Say site appear to base their entire lives on it, but there is never, ever, ever a one-size-fits-all (no pun intended) answer to questions such as this.

People are overweight for many reasons:

- They eat too much
- They're ill
- They're depressed
- They're not well enough educated
- Many other reasons, too many to list here.

How can the answer be anything other than "it depends on the circumstances"?

Technically, according to the BMI charts, I'm classified as "overweight", but FFS, everyone apart from the most self-righteous has their vices. I don't drink alcohol, I don't smoke, I don't take recreational drugs, I work full time, I treat other people as i'd hope to be treated myself, I've been faithfully married for nearly 11 years, I don't swear in front of people that may be upset by it, and I bring my son up with an appreciation for what's right and wrong, so people should just shut the hell up and let me eat my pizza without treating me like I'm utter, utter scum.

Take a bow.

I too tire of mob mentality, this baying for blood so typical of middle England Daily Mail readership but equally embraced by all classes with shouts of hang him high or worse, typically the most inventive and painful way to torture somebody to death.

Kinda gets my goat tbh. Scrape away the veneer we are back to the days of William Wallace or perhaps even the current day if some Middle Eastern and former Eastern European behaviour is anything to go by.

The British, it seems, do love to moan and criticise.

Bit sad, really.

[badass]

First point - this isn't a 'karmic' state and thank <insert religious figure of significance> it isn't! You can't justify the strain placed on the NHS by alcholism or smokers with the respective tax revenue generated from each? You're almost suggesting it's of insignificance, which it isn't.

second point... I'm not entirely sure what you're driving at with 'government subsidies' and 'fat farms'. One of the leading causes of obesity is poverty. If you don't have the cash to buy decent quality, varied and nutritionally balanced food, your diet and subsequently, weight/bmi/health.... suffers. Some people, believe it or not, despite working their backsides off, still find themselves below the poverty line and struggling to put the right food into their mouths. These people don't have government subsidies, so I'm curious as to what you'd do to help these people? I dislike the link you're apparently attempting to draw between being obese and being on benefits/in social housing.

The fact of the matter is, those who can pay NI, do. Those who can pay tax (most of the time), do. Those who can't, still receive health care. It's how Britain currently and always should (imho) work.

Behind each abused body is a story, a history and a reason for it's abuse, that's what we need to be focusing on and that's what we need to be working towards eliminating. Prevention is better than cure

Oh yes. I forgot. The bleeding heart types also love to put words in other peoples mouths as well.
Last but not least, because some people got that way through no fault of their own, we must do everything assuming that everyone that of hugely overweight is that way through no fault of their own. Newsflash: Most obese people are that obese simply because they eat too many calories and don't do enough exercise.

[TooNice]

Show genuine effort? How exactly?

Add some exercise to one's lifestyle. Take control of one's diet (ideally one proposed by a doctor/nutritionist), slowly but steadily. If there is a psychological reason for the overeating, then seek treatment at it's root.

I am sure that some people may still need a helping hand in the end. And I am fine with that. But do you believe that most of the 20+% who are obese in this country can't sort themselves out without surgery?

So just to re-iterate I am not against treatment being provided by the NHS, but I am concerned that (some) people who could have helped themselves decide that it is 'easier' to just opt for surgery if they make it too easy to obtain.

[Saracen]

Show genuine effort? How exactly?

I'm obese, by a long way, as best as I can tell I don't have the same "hungry" feelings as other people, I'll go a couple of days eating very minimally (max of a sandwich and a packet of crisps), or I'll quite happily sit down and consume a 12" pizza. It's no different to my depression, as far as I can see, my natural instincts aren't the same as other people.


IMO, It's not something that can be "fixed", it's just the way I've been made and all the NHS can do is treat the symptoms....

That sounds like it might be exactly what I was referring to in point 1) of my earlier list - genuine medical condition. There was a TV program a few years back about a condition where the "I'm full now" signal from the stomach fails to reach the brain, and as a result, the brain doesn't know to turn off the "eat" signal, and instead maintains the "hungry" signal, and the sufferer is perpetually hungry. Maybe you have some variant of that. If I remember correctly, and it was a awhile back, it was believed, though I think not proven, to be some problem with transmitter/receptor functions on the brain, a bit like some forms of clinical depression. Well, if "selective seratonin reabsorbtion inhibitors" (SSRIs) can be used to treat (*) depression, maybe some similar technique could (or is) used to treat that.

It does also suggest that we don't have quite the degree of free will that we think we do if the automatic signals we rely on without thinking about, or indeed often even knowing of the existence of, are determining what we regard as "natural" reactions, and are faulty with some people.

We don't suggest we shouldn't treat cancer patients because the cancer is the fault of their own genes, and we shouldn't suggest obesity is necessarily simply down to people not knowing when to stop eating or being too lazy to do enough exercise. It is, as has been said, more complicated than that.

As is often the case, you don't understand what a condition means until you've experienced it yourself, or at least, know someone well that has. As a non-smoker, for instance, I understand the both physiological and psychological addictions just fine on an intellectual level ... but that's a far call from having experienced what it's like as a heavy long term smoker to go through it and try to give up.

As a youngster, I didn't understand why some older people move so much more slowly and cautiously, and was probably a bit impatient about it at times. As an arthritis suffer now, believe me, I know exactly why I move much more cautiously and slowly, having experienced the excruciating pain that can result from moving carelessly.

We should all be a little careful in making pronouncements or judgements of people, whether it be obesity and the causes of it, or any other condition, because we very likely don't fully understand the issues.



So my guess is that it might be possible to address medical obesity via that signally methodology, but if not, then it may be that the only way to "treat" some people with medical obesity is surgery and, if so and as a last resort, then of course it should be considered.

I agree with two previously made points :-

- there is no "one size fits all" approach, because circumstances vary, and decisions need to reflect that.

- I suspect that "medical" obesity is the exception not the rule, and that in many cases, especially the less extreme ones, it's more to do with "lifestyle" choices than a medical condition.

In my own case, I'm certainly carrying some weight I shouldn't be, and while there are other mitigating factors, I couldn't dispute that my diet and exercise levels are a factor that I could do more about than I do.




(*) My perspective on SSRIs, for what it's worth, is that they are (or at least were) massively over-prescribed, often in entirely inappropriate situations and can be downright dangerous if they are, but they can also be highly therapeutic in the right cases. So messing about with brain chemistry is not without it's complications and is no easy or quick fix.

[Rave]

If you don't have the cash to buy decent quality, varied and nutritionally balanced food, your diet and subsequently, weight/bmi/health.... suffers.

Does it? When I lived on my own my diet largely consisted of peanut butter/chocolate sandwiches, corn/bran flakes, corned/minced beef and two pints of full fat milk a day, often with some chocolate or biscuits on top. I almost never ate any fruit or veg at all, maybe a vitamin pill when I remembered. I have never been overweight.

To argue that eating the 'wrong' food makes you fat is to ignore the basic scientific fact that eating too much of any food makes you fat. If calories in = calories out then you will not put on weight.

And anyway, anyone who argues that 'proper' food is expensive have obviously never been in a supermarket. Potatoes are about a quid for 2.5kg. Carrots 70p a kilogram, a big cabbage for under a pound, head of broccolli 50p etc. etc.

The fact of the matter is, those who can pay NI, do. Those who can pay tax (most of the time), do. Those who can't, still receive health care. It's how Britain currently and always should (imho) work.

Behind each abused body is a story, a history and a reason for it's abuse, that's what we need to be focusing on and that's what we need to be working towards eliminating. Prevention is better than cure

Yes, maybe. But that line of thinking medicalises a problem which, in many (I would say most) is simply caused by people being too greedy. Like I say, I have never been overweight, and that's because I spend a few hours every day feeling hungry- either that or I do enough excercise to burn off the excess calories I've eaten. In my firm opinion, a lot of fat people are fat just because they lack sufficient willpower to overcome the minor discomfort of being hungry. These people don't really need medical treatment, they need to grow some backbone. I say this not to be rude- I merely think that all this soft soap stuff about it not necessarily being a person's fault that they're fat is counterproductive. They should be told that if they don't want to be fat, they need to learn how to put up with being hungry for part of the day.

Not that everybody who is overweight should have that rammed down their throat all the time- some people are happy being fat, and good luck to them, as long as they can sit next to me on an aeroplane or a train and not spill over into my space. I'm not fat but I drink far too much because I lack sufficient willpower to stop drinking when I'm merely tipsy- that's my choice in a free society and I don't expect to be constantly told that what I'm doing is wrong (but then again I don't expect to get a liver transplant on the NHS either).

Having said all that, I have no problem at all with gastric band surgery on the NHS, especially if the cost/benefit analysis is as positive as others have said. A colleague of mine had one fitted last year, the weight has fallen off him, and he looks much better and happier. You'd have to be a git to begrudge him that IMO.

[Saracen]

....

In my firm opinion, a lot of fat people are fat just because they lack sufficient willpower .....

My gut feeling (sorry about that ) is that you're probably right. I have no data to back that up, but I'd guess that the proportion with a genuine medical condition of the type I mentioned is probably fairly small. However, of course, none of us should jump to conclusions about whether any given individual has a medical problem or is just lazy, or to put it more delicately, lacking willpower.

....
.... to overcome the minor discomfort of being hungry. These people don't really need medical treatment, they need to grow some backbone. I say this not to be rude- I merely think that all this soft soap stuff about it not necessarily being a person's fault that they're fat is counterproductive. They should be told that if they don't want to be fat, they need to learn how to put up with being hungry for part of the day.

Not that everybody who is overweight should have that rammed down their throat all the time- some people are happy being fat, and good luck to them, as long as they can sit next to me on an aeroplane or a train and not spill over into my space. I'm not fat but I drink far too much because I lack sufficient willpower to stop drinking when I'm merely tipsy- that's my choice in a free society and I don't expect to be constantly told that what I'm doing is wrong (but then again I don't expect to get a liver transplant on the NHS either).

Having said all that, I have no problem at all with gastric band surgery on the NHS, especially if the cost/benefit analysis is as positive as others have said. A colleague of mine had one fitted last year, the weight has fallen off him, and he looks much better and happier. You'd have to be a git to begrudge him that IMO.

There's a couple of issues there, and I agree with you.

First, if someone is overweight unnecessarily and happy with it, then great. The issue is when it results in a burden, and sometimes a very substantial one, that the rest of us have to pay for. And it's a general principle, not one related solely to obesity. Should we treat conditions on the NHS that were entirely within the power of the individual to have avoided? Some of the obvious examples are drink-related illnesses as a result of chronic alcohol abuse, smoking related illnesses and problems derived from illegal drug abuse. The answer to that depends on what type of NHS we want, and want to pay for, and on just how caring our caring society is, and on how we decide, as a community, just how far we want to take that principle. For instance, if we decide not to publicly pay to treat "self-inflicted" injuries, should we refuse to set a broken leg caused in a football match because it's the player's fault for exposing himself to the "risky" lifestyle activity of playing football. If we refuse to treat alcohol (or obesity, etc) related illnesses because they;re the result of a "self-inflicted" lifestyle choice, then we're drawing a dangerous line, and exactly where we draw the line will no doubt get moved over the years.

Should we treat obese people with a medical cause? Clearly, yes.

Should we treat obese people where it makes economic sense and saves the NHS long-term costs? On an economic basis, obviously yes.

Should we force treatment on the obese that are happy to be so? Clearly, not.

The tricky bit comes about whether the NHS should offer treatment to those that are obese, not happy about it and want help. Should we treat them? Yes, IMHO, partly because it's probably cost-effective in the long run, partly because it's the decent thing to do, and partly because if we don't, it sets a precedent that could be the start of a very slippery slope.

However, having decided to treat, then advice, dietary support, exercise programs, support groups (like AA, etc) and so on should all be tried and failed before more radical treatments become an option. And, of course, having decided to treat, we still have to decide a priority level, compared to other issues needing treatment, like cancer and heart care, geriatric services, maternity provisions, mental health care and so on, because what is patently obvious is that we simply can't afford to fund everything we would like to fund, up to the point where further funding would have no beneficial effect. The pot is limited and the demands on it are anything but.

[eshrules]

Oh yes. I forgot. The bleeding heart types also love to put words in other peoples mouths as well.
Last but not least, because some people got that way through no fault of their own, we must do everything assuming that everyone that of hugely overweight is that way through no fault of their own. Newsflash: Most obese people are that obese simply because they eat too many calories and don't do enough exercise.

bleeding heart types? words in mouths?

I'm not sure if you read all of my post, but you see the bit where I said this :

First point - this isn't a 'karmic' state and thank <insert religious figure of significance> it isn't! You can't justify the strain placed on the NHS by alcholism or smokers with the respective tax revenue generated from each? You're almost suggesting it's of insignificance, which it isn't.

second point... I'm not entirely sure what you're driving at with 'government subsidies' and 'fat farms'. One of the leading causes of obesity is poverty. If you don't have the cash to buy decent quality, varied and nutritionally balanced food, your diet and subsequently, weight/bmi/health.... suffers. Some people, believe it or not, despite working their backsides off, still find themselves below the poverty line and struggling to put the right food into their mouths. These people don't have government subsidies, so I'm curious as to what you'd do to help these people? I dislike the link you're apparently attempting to draw between being obese and being on benefits/in social housing.

If you look carefully, there's a few question marks there, opening it up for discussion and allowing you to comment. Would you care to offer some intelligent comments or will you call me by another heart-related name?

and in regards to your newsflash - what, then, would you do to help those people who eat a balanced, calorie controlled diet supported by regular exercise but yet still cannot control their weight?

Does it? When I lived on my own my diet largely consisted of peanut butter/chocolate sandwiches, corn/bran flakes, corned/minced beef and two pints of full fat milk a day, often with some chocolate or biscuits on top. I almost never ate any fruit or veg at all, maybe a vitamin pill when I remembered. I have never been overweight.

To argue that eating the 'wrong' food makes you fat is to ignore the basic scientific fact that eating too much of any food makes you fat. If calories in = calories out then you will not put on weight.

And anyway, anyone who argues that 'proper' food is expensive have obviously never been in a supermarket. Potatoes are about a quid for 2.5kg. Carrots 70p a kilogram, a big cabbage for under a pound, head of broccolli 50p etc. etc.

Don't get me wrong, I agree, in part with your points. Supermarkets are cheap and you can easily make a decent meal for an average family for what, £5? That's assuming the person doing the shopping knows how to make a balanced meal or rather, what it should contain and how it's ingredients are cooked.

Some people genuinely don't know how to cook, what a properly balanced diet should consist of or how to shop for it. Perhaps cheap was the wrong word to use, I don't want to use convenient either, because we'll get the "fast food" argument coming into play. The point I'm trying to make is that until we ensure people are growing up with dietry/culinary skills having as high an importance placed upon them as the typical education subjects as Maths, English etc... then we're going to be fighting what is, really, a losing battle. Prevention>cure, I've said it before and I'll say it again....

Yes, maybe. But that line of thinking medicalises a problem which, in many (I would say most) is simply caused by people being too greedy. Like I say, I have never been overweight, and that's because I spend a few hours every day feeling hungry- either that or I do enough excercise to burn off the excess calories I've eaten. In my firm opinion, a lot of fat people are fat just because they lack sufficient willpower to overcome the minor discomfort of being hungry. These people don't really need medical treatment, they need to grow some backbone. I say this not to be rude- I merely think that all this soft soap stuff about it not necessarily being a person's fault that they're fat is counterproductive. They should be told that if they don't want to be fat, they need to learn how to put up with being hungry for part of the day.

I agree with this and for every person who's legitmately in need of help, there must be another 10 who are bone idle and refuse to help themselves, I don't think (and I know there'll be a group sigh at this one) that celebrity influence has aided in this either... when you see the constant plastic surgery, if I were a big person, I can imagine how attractive it must be to go for lypo, rather than diet and exercise!

[TooNice]

Does it? When I lived on my own my diet largely consisted of peanut butter/chocolate sandwiches, corn/bran flakes, corned/minced beef and two pints of full fat milk a day, often with some chocolate or biscuits on top. I almost never ate any fruit or veg at all, maybe a vitamin pill when I remembered. I have never been overweight.

To argue that eating the 'wrong' food makes you fat is to ignore the basic scientific fact that eating too much of any food makes you fat. If calories in = calories out then you will not put on weight.

And anyway, anyone who argues that 'proper' food is expensive have obviously never been in a supermarket. Potatoes are about a quid for 2.5kg. Carrots 70p a kilogram, a big cabbage for under a pound, head of broccolli 50p etc. etc.

I would be, and am very, very weary of using one's personal experience as indicative of anything when it comes to diet. I do not doubt for a second that the -average- person eating what I eat, while exercising as little as I have in the last 2.5 weeks would very quickly turn obese. Yeah, I am one of those who claim that I eat for two or three but hardly ever notice any weight (and more importantly body fat) change. Perhaps you also have a faster than average metabolism, and needless to say, there is more to one's health than just body fat, and that's where fruits/vegs come into play.

I do agree that if calorie == calorie out, then one should not put extra weight, and eating too much of any food will make you fat. However, calorie out depends on one's physical activity (and metabolism), and that is influenced by the quality of food we eat. You can't drink two pints of sunflower oil and expect to run a marathon the next day (even if you are otherwise capable to run a marathon).

I do agree that poverty is not likely linked (or poorly linked) to obesity. No one is going to convince me that 60% of the UK is too poor to buy food of decent quality. If anything, the opposite is more likely true: China for instance is getting richer, yet fatter.

---------------------------------

DailyMail, blah blah aside, I am sure (or want to believe) that she's not representative of the average obese parents in this country, but I do find it frustrating: http://www.dailymail.co.uk/news/arti...st-months.html

If you want to abuse your body, fine. But I consider that nearly/as bad as giving your children alcohol/cigarettes.

[Powderhound]

I'm working my way through the wonders of the UK medical school admissions system at the moment, and questions along these lines frequently come up at interview, so I've already developed an opinion on it.

If we refuse to treat the obese on the basis that it is their fault, does that also mean that doctors should ignore the person who is wheeled into casualty after a hang gliding accident? How about the person with a heart condition who (Before the condition developed) decided that they didn't want to take statins as a preventative measure?
In my opinion, medical care should be on the basis of need, and it is never the role of doctors to moralise about whether the patient deserves care or not, because they can never fully understand the circumstances. It is quite plausible that they have a psychological condition which compels them to eat, and just saying "If they had more willpower they wouldn't be in that situation" is completely unproductive.

[Rave]

I would be, and am very, very weary of using one's personal experience as indicative of anything when it comes to diet. I do not doubt for a second that the -average- person eating what I eat, while exercising as little as I have in the last 2.5 weeks would very quickly turn obese. Yeah, I am one of those who claim that I eat for two or three but hardly ever notice any weight (and more importantly body fat) change. Perhaps you also have a faster than average metabolism, and needless to say, there is more to one's health than just body fat, and that's where fruits/vegs come into play.

I used to think that I had a high metabolism, but having actually measured what I eat, it turns out that the reason I never put on weight is that I generally consume about 1700-2000 calories of food a day, plus 10-15 units on average of alcohol. I'm not a genetic freak, I just don't eat too much. Maybe I'm lucky that I can tolerate hunger better than most people. When I'm doing a late shift, I can wake up at 12pm and not eat till 7pm. My wife for whatever reason can't manage that. She has to have breakfast, and has to have a snack when she's hungry. She's been trying to lose weight since I met her, and she's never managed it for more than a month or two. That's fine and I love her as she is, but it pisses me off that she's constantly buying diet books and overpriced diet food ("more money, fewer calories") when what she really needs to do is learn to just put up with being hungry.

I do agree that if calorie == calorie out, then one should not put extra weight, and eating too much of any food will make you fat. However, calorie out depends on one's physical activity (and metabolism), and that is influenced by the quality of food we eat. You can't drink two pints of sunflower oil and expect to run a marathon the next day (even if you are otherwise capable to run a marathon).

Well no, because you'd be on the toilet all the next day. I've lifted some heavy weights (E.G. squatting well over my bodyweight 25 times) having eaten almost no carbs that day. I put on 1 1/2 stone of mostly muscle on a very low carb diet when I started working out properly. Calories are calories at the end of the day, whether you take them as carbs or fat makes a difference to how you can immediately use them, but it makes no difference in my experience to how big you end up.

I do agree that poverty is not likely linked (or poorly linked) to obesity. No one is going to convince me that 60% of the UK is too poor to buy food of decent quality. If anything, the opposite is more likely true: China for instance is getting richer, yet fatter.

Amen. The problem we have is that humans evolved several thousand years ago from hunter gatherer predecessors. We were not genetically designed for a society where basically unlimited food is available to anyone who can afford to pay for it (which is, in this country, the vast majority of people). If we simply follow the signals we get from out stomachs then all of us will get fat- though some more than others.

If we refuse to treat the obese on the basis that it is their fault, does that also mean that doctors should ignore the person who is wheeled into casualty after a hang gliding accident? How about the person with a heart condition who (Before the condition developed) decided that they didn't want to take statins as a preventative measure?
In my opinion, medical care should be on the basis of need, and it is never the role of doctors to moralise about whether the patient deserves care or not, because they can never fully understand the circumstances.

I totally agree.

It is quite plausible that they have a psychological condition which compels them to eat, and just saying "If they had more willpower they wouldn't be in that situation" is completely unproductive.

In that situation it is unproductive, yes, but I'd suggest that most obese people don't have such a psychological condition, they just either like eating a lot, or can't put up with being hungry. As a borderline alcoholic, I can't possibly judge people for having a lack of willpower, nor deny them surgery- I.E. a gastric band operation- that takes willpower out of the equation.

Nowadays, I think, Gastric Band Surgery is a laporoscopic procedure, and complication rates are coming down. I read some time ago that the mortality rate was 2%, but googling doesn't back that up. It does however suggest that the risk of complications is still 5%, I.E. a 1 in 20 chance of something going wrong. I posted before about my colleague- I'm very pleased for him- mainly because he had an invasive surgical procedure on the NHS and came out without MRSA or the like.

I personally have had major, life saving operations on the NHS twice - http://en.wikipedia.org/wiki/Mastoid..._and_treatment . And it was really horrible, both times, which is why when they offered me an operation to replace the bones in my left ear that got munched by bacteria, and hence restore my hearing, I said no, I'd rather just keep buying hi-fi equiptment with a balance control, rather than have my skull sawn open again.

I don't think there's any inherent contradiction in believing that most fat people are fat because they lack the willpower not to stuff their faces, and supporting any and all weight loss measures being available on the NHS. I just think that everybody should know- and should hear it from their doctor- that for most people, not being fat entails feeling hungry some of the time. It seems that that's a truth most people are simply unprepared to face. All the diets I see advertised sell themselves on the idea that if you simply change what you eat you'll lose weight without feeling hungry. In my experience, that's bollocks- but people would rather have a major surgical procedure to stop them feeling any hunger, ever. Maybe I should have a wire put in my brain that I can tap when I want to feel drunk, any time I like.