NHS Treatment for Obesity?

[TooNice]

Well no, because you'd be on the toilet all the next day.

Hah, I was going to edit in 'even if you can hold it in' after I submitted the last post.
Well, it's one point I can't agree. I find it hard to believe that experts in the fields (nutritionists, dietitians) are making up on the influence of complex/simple carbs on one's body/performance.

For instance, you said that you need to 'tolerate' hunger every now and then. It may well be a suitable option for you as you feel that you have a better tolerance to hunger than most, but if complex carbs can indeed make someone 'feel' fuller for longer, due to the longer time it takes to process, then it could be a viable solution option for someone who does not have the will power/tolerance to hunger you possess: for the same amount of calories in carbs, said person may be able to hold longer before feeling hungry, leading to lower overall calorie consumption which helps with weight maintenance.

I do think that we all have some individual difference. For a group of people of same height, weight and age, I am pretty certain that feeding them the same meal and doing the same exercise down to the quantity/intensity would still yields differences. Some may not see much changes, some may gain weight, some may gain muscle. Yeah, I am speculating here, yet I am sure we have at least one person in our lives (if not many) with seemingly surprising development (whether it is ease the person gain muscle mass, fat, or relative ease a person -lose- their muscle mass/fat). That's why I am usually weary of using any single individual as representative on this topic. That said, I do believe that average person (i.e. most people) can overcome the the variance by eat a little less/more, exercise a little more, a little healthier/smarter. But yes, in the goal is ultimately to find a sustainable way to balance calories in and calories out.

[TheAnimus]

I think the problem comes in to two camps, its where you draw the line.

Say you had someone who was a great sports man, then they have a car accident say. They are used to jogging a few km every day and accustomed to eating 3,500 calories, or 1,000 more than average joe should eat a day.

They get depressed because of their incapacitation, we know lethargy is linked with depression, and its common to see this happen to very physically active people when they suddenly can't be.

He keeps eating in the manner he is accustomed and his weight balloons. Its quite harsh to say that he should be cut off.

------- Now for the daily mail example -------
(you should add your own nazi subtext)
'Babies are always hungry,' she said. 'Sometimes it's easier to give them food that's already prepared.

Anyway, they don't always have junk food - sometimes I cook a microwave meal for them. My babies are healthy.'

The babies are of course horrifically overweight. It is this attitude which is purely ignorance that I think most people find reprehensible.

[Saracen]

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.

I agree that doctors shouldn't be making decisions about whether patients deserve treatment or not, but that isn't to say that society as a whole doesn't have a right to express and opinion. After all, it's society as a whole that gets the bill for it.

And society does indeed, in various ways make exactly that decision. And should.

For instance, in theory at least, only those entitled to NHS care, either by being British citizens on some some "leave to remain" arrangement, or those with reciprocal entitlements or treaties, should be getting anything beyond emergency care. Why? We otherwise, the British taxpayer would end up footing the bill for medical tourists from all over the world. And, of course, this is exactly the standard set by just about every other country, except where entitlement is a lot less and you get pretty much nothing unless you can prove payment in advance.

So, we do decide who we will treat, and to what extent.

Next, NICE decides what treatments are available, does it not? For instance, there;s something of a furore over NICE apparently deciding that some Altzheimers treatments are only available in the advanced stages on the basis of cost-effectiveness, despite some fairly convincing evidence they they could significantly delay the advance of the condition in some early-onset cases.

A front-line doctor, quite rightly, should be worrying about treating patients not about what the treatment costs, but I don't believe it's as simple as that. Medicine has always has a cost criteria lurking behind it. Why else is a GP expected to achieve an average consult period of a little under 10 minutes (according to a GP friend of mine)? Why do NHS dental contracts stipulate what types of treatment can and can't be used on the NHS, according to a dentist friend who, after many years fighting against going private, finally quit the NHS because he was tired of having accountants determine his treatment plans for him?

We should we end up in group wards, when many (maybe all, for all I know) private hospitals have been largely if not entirely based on individual rooms for several decades?

Ultimately, it's because we have to make decisions about what is available and what is not, whether it be a private room, or specific drug regiment for Altheimers or a given dental treatment option. We choose not to fund free glasses, and we choose not to provide free drug prescriptions except for those with specific treatments. We choose not to provide free nose jobs or boob enlargements for just anybody that wants it.

Decisions are, always have been, and probably always will be made about what the NHS pays for and what it doesn't because it simply doesn't have the money to provide 5-star treatment for any and all possible calls on its services. Money, therefore, is prioritised and that means someone makes the decisions about what we supply and what we don't, what we treat and what we don't.

And, like it or not, there are moral imperatives to this. Just how do we prioritise? Why do we decide that a cancer patient gets treatment if they're entitled to NHS care, but a foreign patient gets emergency care and gets sent home for the rest? Because we can't pay for everything, and if you treat all comers, regardless of entitlement or having contributed, we'll end up not being able to provide dental care or hip replacement surgery because the budget was exhausted treating the rest of the planet's heart patients.

And, of course, it's not front line doctors that do or should make those decisions, but policy makers. And the implication is that if policy makers decide we treat some patients and not others, then eventually it falls to front line hospital staff, albeit perhaps admin rather than medical, to determine if a patient is eligible of not. But regardless of who makes the decisions, the decisions do indeed get made, and many of them have a moral component, often overruled by pragmatism and budget constraints.

[daniel_owen_uk]

What's needed and what's available are never the same.

My road needs resurfacing as it has a pot hole or two in it, the council only has the money to resurface the road with 15 pot holes in it.

So the NHS deems someone fat (is that PC?) enough to get surgery, but doesn't have the funds to treat all those people, so it prioritises.

And that's a surprise to everyone?