Should the NHS pay for weight loss surgery?
Is it right that seriously obese patients should get bariatric, or weight loss surgery, on the NHS? A new report shows that there was a ten-fold increase in the surgery between 2000 and 2007.
In pure economic terms it appears to make sense. A report in the British Medical Journal today quoted studies which suggest that bariatric surgery reduces hospital admissions and cuts the long term costs to the health service. So a procedure that costs upwards of £7,000 actually saves money in the long term.
The National Institute for Health and Clinical Excellence says the surgery should be available to the morbidly obese - those with a Body Mass Index (BMI) of 40+ or patients with existing health problems who have a BMI of at least 35 - and where all other treatment options have failed. The resulting weight loss leads to fewer health problems such as type 2 diabetes, high blood pressure and cardiovascular disease.
Surgeons and patients I have spoken to have all said it is not an easy option or a quick fix. Patients have to demonstrate a commitment to weight loss and go through a lengthy procedure before the operation is approved. One obesity expert said the requirement to have a very high BMI created a perverse incentive to gain weight in order to become eligible for the procedure.
I can understand that for medical teams dealing with obesity, weight loss surgery is a vital tool. But it does raise some wider issues about how we tackle our growing obesity problem. Bariatric surgery deals with the consequences of obesity, rather than the causes. Exercise and a balanced diet remain the best solutions to the epidemic of weight gain which is sweeping the globe.
I met a delightful woman today who recently had a gastric bypass. She has type 2 diabetes and her daily insulin intake has fallen by 75% since the surgery. Doctors no longer fear that she will need a kidney transplant. So she is a medical success story.
But I wonder what parents of children with type 1 diabetes will think? Some have been unable to persuade PCTs to pay for insulin pumps which cost around £3000. These have been shown to improve glucose control and so reduce the risks of complications, such as heart and kidney disease and blindness. These conditions can take decades to surface and so may be less pressing problems for the NHS.
Many cancer patients may also have a view. Earlier this week NICE refused the drug Avastin for people with advanced bowel cancer because it costs almost £21,000 per patient and typically adds an extra six weeks of life.
Bariatric surgery may make sound economic sense and produce significant benefits. But others denied treatment may feel that, somewhere along the line, the NHS has got its priorities wrong.
~RS~q~RS~~RS~z~RS~49~RS~)
I'm 
Comments
Sign in or register to comment.
No the NHS should not pay for the obese to have this surgery. I have muscular dystrophy for which there is no treatment, let alone a cure. There are far more urgent needs for the money. There may be some success stories for gastric bands but there are also failures. Perhaps some people who are very overweight because they have a condition which limits the exercise they can do and despite eating a reasonable diet cannot shed pounds could be considered.
Complain about this comment
If we refuse to fund obesity surgery then we will pay far more to treat the ill health consequences of obesity such as diabetes,etc.
The argument that obesity is the "fault" of the individual and therefore not worth funding is spurious and on that basis we shouldn't treat Road Traffic Accidents,Smoking related diseases,Sports Injuries,Liver Disease,etc,etc.
Obesity is a fact of life and where it leads to ill health which requires NHS treatment we should treat patients as cost effectively and compassionately as all others.Unfortunately Obesity is seen as a disease of poor people whereas Anorexia another eating disorder is much more middle class and therefore worthy of treatment?
Complain about this comment
.
Fergus,
You use the wrong words in your headline ............ "Should the NHS pay for weight-loss surgery?"
It's not the NHS that pays for this surgery, it is you, me and every other tax-payer.
This makes the question more immediate and relevant.
.
Peter (@ #2) says "Obesity is a fact of life..". It may be an undesired consequence of some genetic or physiological disorder in the great minority of individuals but, for the great majority of morbidly obese, it started out as a 'lifestyle-choice'.
Corrective treatment should not be available as a 'free good' (see Headline) on the basis that obesity is a Fact Of Life;
it should similarly be unavailable for treatment of a Lifestyle-Choice.
.
No, sir,
(i) some (elective) surgeries should be treated as a private choice only through private provision
(ii) if the lifestyle-choice is continued through to potential morbidity, this choice should be allowed to take its course with respect to the inevitable consequence, without intervention to the primary condition or any related, OR complicated/complicating UNRELATED conditions.
.
The NHS was created for the treatment of the common man within the common society. If an individual places him/herself 'beyond the pale' ie. outside the boundaries of public health provision, the treatment afforded should be paid for as Private Surgery.
.
Complain about this comment
So I presume that infertility treatment will also be privately funded as having children is a lifestyle choice?
Complain about this comment
The notion that obesity is a "lifestyle choice" is ridiculous.
If a morbidly obese patient seeks help, it should be available.
Complain about this comment
No the NHS shouldn't pay for weight loss surgery because there are far more pressing things the NHS need to do with its' money. The vast majority of people gain weight because they eat too much. Stop eating too much of the wrong types of food and lose weight - it's not rocket science.
Complain about this comment
Obesity and its medical complications fall within the remit of the NHS - the question is really should we (i.e. the state) try to persuade those who eat too much to moderate their lifestyle choice? Particularly when their choice leads directly to NHS expenditure.
We need to face the fact that we live in a society and we all have a responsibility towards others. This means that we have to accept limits to our personal freedom to do stupid things when these things hurt others - that is what being a part of society is all about. Liberté, égalité, fraternité if you like - the brotherhood bit is also about not doing things that harm the general good.
So a number of things flow from this argument about the limitations to personal freedom. All smoking, excessive alcoholic inbibation, excessive consumption of food, the use of mind altering substances, driving, cycling or riding a horse in a furious manner, climbing rock faces and crossing the road carelessly all can give rise to medical consequences which we all have to pay for. Whereas some of these activities are vial for life others are not. The ones that serve no life sustaining purpose must be suppressed, whereas when the question is the need to limit the excessive consumption then we are a bit more stuck in what society can expect.
I would hope that persuasion to avoid excessive consumption would suffice but as the cost benefit of gastric bands etc. is positive for society, as against doing nothing, I reluctantly think that the operations are right and proper. However, as with all smoking, all drug use and excessive alcoholic drinking we as a society must accept that it is right the we (as the state) must take all steps to suppress these activities as this has a positive benefit to everyone and this benefit to others is a necessary part of running a pragmatic society.
However the food police do not always do a good job particularly when they employ very crude measures such as BMI to determine such things such as obesity. The tyranny of the excessively skinny also needs curtaining and the underweight must also be taken in hand and persuaded to eat more as they too are a cost to society and the NHS.
Smoking (or drug taking) is a good example to consider using the arguments I have set out: If someone wants to smoke (or take drugs) they must accept that they will not get free NHS treatment - perhaps all smokers(and drug takers) should be required to take out private health insurance plans to cover their future care before we allow them to smoke (or take drugs) - rather like we insist that car drivers have to take out insurance before they drive a car! But I cannot see that we need to insist or even should insist upon those who engage in activities to excess to be similarly required to take out private health insurance.
Complain about this comment
No, the NHS certainly should not fund weight loss surgery. If you eat too much and/or eat unhealthy foods and don't exercise enough, you get fat. So eat less and more healthily and take some exercise.
Neither should taxes be spent on fertility treatment for those who think their life is not 'complete' without a child. There are plenty of people whose life is not 'complete' - those who are not good looking, the lonely who would like to be happily married, the poor who would like a more comfortable life style, etc. Why should those without children be given special treatment - and particularly those who already have one or more? Save the money for the truly ill and suffering.
Complain about this comment
Most obesity is entirely down to lack of willpower, and a need for instant gratification of the appetite. Why should I, as a taxpayer, fund treatment for conditions which are due simply to lack of self control? And as regards Peter at 4, yes, having children is a lifestyle choice- why on earth should infertility treatment be funded by the taxpayer? Infertility is an aspect of the human condition, not a disease. I'm not very tall- should everyone else pay to have me stretched a bit?
Complain about this comment
YES, the NHS should pay for surgery and pre-emptive treatments for the obese, in the same way it cares for smokers and other members of the public.
The difference with this, however, is that smokers fund the NHS through taxation on their cigarettes. In order to cover the cost of funding treating the obese we need to consider taxing fast foods, fatty ingredients, and other relevant items.
If you want to eat yourself into hospital, fine, by you should bear that burden on the NHS, not the general public, particularly those who save the NHS money by eating healthily and keeping fit.
Complain about this comment
Yes of course we should pay for it now, it will save money in the long run.
The NHS, funded by all of us, is not some fly by night private enterprise, it was started to benefit us all in the long term.
£3000 for an insulin pump, sounds a lot but in the long run it will save money, again, buy it, in fact buy a lot of them, in fact buy the company if it is a necessity, in the long run it will be cheaper.
How much does NICE think is a fair price for Avastin ?
How much is NICE prepared to pay for Avastin ?
How much of Roche's business is tied to the NHS ?
How much of Roche's business is reliant upon UK taxpayers money and cooperation from University research time to public guinea pig testing ?
If Nice say 10grand then that is the price, if Roche don't want to play ball then remove all public funds from Roche businesses, watch the share price plummet and buy Avastin from a competitor who has picked up the patent for a song.
Times are tough, Roche, either get with the program or be pushed out of the way.
(I'm not just picking on Roche here, all big Pharma spend an inordinate amount of their income on advertising rather than on research, it is about time that they focused on their core business and reduced prices accordingly rather than relying on patent protection)
Complain about this comment
#7 John John_from_Hendon wrote:
'Obesity and its medical complications fall within the remit of the NHS - the question is really should we (i.e. the state) try to persuade those who eat too much to moderate their lifestyle choice? Particularly when their choice leads directly to NHS expenditure.'
NHS expenditure has nothing to do with it, we should try to persuade them for their own benefit.
'We need to face the fact..[my editing]...things that harm the general good.'
'So a number of things flow from this argument about the limitations to personal freedom.'
'All..[activities]...can give rise to medical consequences which we all have to pay for.'
'Whereas some of these activities are vial [vital] for life others are not.'
'The ones that serve no life sustaining purpose must be suppressed'
none of the activities listed were 'life sustaining' although I'm pretty sure that the participants would claim that they were life enhancing in which case why should they be supressed.
'I would hope that persuasion to avoid excessive consumption would suffice but as the cost benefit of gastric bands etc. is positive for society, as against doing nothing, I reluctantly think that the operations are right and proper.'
Fair enough.
'However, as with all smoking, all drug use and excessive alcoholic drinking we as a society must accept that it is right the we (as the state) must take all steps to suppress these activities as this has a positive benefit to everyone and this benefit to others is a necessary part of running a pragmatic society.'
I disagree with this statement entirely, working in the Construction Industry is more dangerous than smoking, working as a North Sea Trawlerman is more dangerous then Construction, Riding a Horse is more dangerous than taking Extasy, should we supress all these actvities despite the obvious benefits to everyone of the built environment and cheap fish let alone the personal benefits of owning a horse.
'Smoking (or drug taking) is a good example to consider using the arguments I have set out: If someone wants to smoke (or take drugs) they must accept that they will not get free NHS treatment - perhaps all smokers(and drug takers) should be required to take out private health insurance plans to cover their future care before we allow them to smoke (or take drugs) - rather like we insist that car drivers have to take out insurance before they drive a car! But I cannot see that we need to insist or even should insist upon those who engage in activities to excess to be similarly required to take out private health insurance.'
Not sure what you are saying here John, the NHS is insurer of last resort.
To take your car analogy, they don't base the premiums on you personally, they base them on your classification, eg Boy Racer, Modded Car, dodgy area = expensive premium.
They try to granuralise the categories to make your quote seem personal (and there is a whole industry based around insurance quotations) but at the end of the day it is about risk table and amortisation.
It is much cheaper administratively to just get everyone to pay a percentage of their income and treat everyone as being covered. (NI)
Any 'profits' should be spent on reducing the risk of paying out through education.
The NHS and the Education system in this country is the sole reason we can afford to keep 10% of our producive workforce inactive at any one time, name me one third world country that has a comparitive NHS and Education system.
Complain about this comment
I used to share a lot of the views expressed in the comments. Why don't fat people eat less and exercise more?- surely they will lose weight!
Actually it is not that simple. If you become obese the shear number of fat cells you have means that the hormone response to eating less puts you in a highly efficient fat storing 'starvation mode'. To lose weight you have to literally starve yourself for months/years and the slightest lapse will pile on the pounds much more efficiently than a slim person.
Bariatric surgery stops people from feeling hungry. Feeling really hungry is incredibly powerful- it goes beyond simple willpower to feel really hungry all the time whilst surrounded by food.
All the medical research done on diets and exercise regimes in obese people shows that even in the best trial environments, with education, support and supervision, significant weight loss is transient. Bariatric surgery is the only thing that will work for most people.
There are of course some people 'fit' enough to embark of tough fitness regimes which dramatically alter there muscle mass, metabolism etc but they are the minority.
Unfortunately most MORBID obesity starts in childhood and adolescence. Slim, fit people don't suddenly choose to become 'greedy and lazy' in later life. Bad food habits and energy dense foods are thrust upon children by their parents.
So, I do think we should fund this surgery. It is not an easy option but it does work. It saves money. However I think the government should be bolder in the public health measures it takes to curb childhood obesity.
Complain about this comment
The medical evidence - which is what ought to be paramount in medical decision-making - indicates that such surgery can be a Good Thing for certain types of patient. Hence I am in favour of such treatment when so indicated.
As for cost: I am happy to pay my taxes ONLY when the services for which I am paying are available for those who need them. If I cannot pick and choose which taxes I pay, or specify what they are used for, neither can the government if it wishes to meet the obligations that it incurs by asking me for money in the first place.
Complain about this comment
#12. BobRocket wrote:
Picking holes.....
"none of the activities listed [incl. eating and drinking] were 'life sustaining'"
Eating is, and drinking in moderation is, - so what are you talking about? Obesity and alcoholism result from the uncontrolled and excessive use of life sustaining activities - don't they? So what are you talking about?
"...working in the Construction Industry is more dangerous than smoking, working as a North Sea Trawlerman is more dangerous then Construction, Riding a Horse is more dangerous than taking Extasy, should we supress all these activities despite the obvious benefits to everyone of the built environment and cheap fish let alone the personal benefits of owning a horse."
BUT the construction and fishing industry has insurance to pay fro the results of their activities so why should smokers similarly not be insured? Why should the cost of addiction be on the general purse? (I'll ignore the other example activities that you gave.)
Let us look at the NHS and what we expect from ourselves for benefiting from it. Seeing it as just as insurance throws up interesting parallels, for example insurance premiums related to an assessment of risk and the costs of incidents is suffered by those who claim and those who do not. However excessively risky activities can sometimes be uninsurable, for example in shipping entering a war zone (or indeed if you read travel insurance - most policies do not cover you for some of the more serious catastrophes including war declared or undeclared.)
Let me re-explain my insurance argument: smoking is a predictable catastrophe (as is deliberateand wanton over eating or drinking, addicted or not.) Whereas smoking is not essential to life. Eating and drinking are - i.e. becoming a true breatharian is always fatal. [I would also include exceeding the speed limit and the designing of vehicles to exceed the speed limit with smoking.]
My argument logically moves on the who pays fro the costs of the activities? In smoking's case the tobacco industry; in exceeding the speed limit the car manufacturers, both of these industries avoid paying for the costs of their industry from which they have grown rich. Why is this acceptable to the rest of us? They should recompense the rest of society fro the costs that they force upon us all, shouldn't they?
The whole tobacco industry serves no purpose that is vital to life. The production of vehicles that exceed the speed limits set down and agreed by us all as legal is completely unnecessary and serves no purpose that is vital to life. My argument then logically moves to: if either activity is to continue it should pay at least the full cost of its activities - I chose to call it insurance, but you could call it a fine or a tax.
Do you follow the argument?
Complain about this comment
As somebody in this boat, I've just got a couple of things to mention. In a year of attending a dieting group I have only been able to loose 2 stone in a year. This includes going to the gym twice a week.
When I spoke to my GP about sorting my weight problem all he would offer was diet pills, something that would change the effect but leave the cause to still damage my system and I could only get further help from a dietitian etc. if I had complications from my weight.
The biggest problem I find about my eating habits is like unlike other addictive substances I have to go cold turkey 4 times a day. It is not pleasant.
I would also like to say that I also pay my taxes which go to the NHS so why shouldn't I also get the help from NHS with my abuse problems.
@ BobRocket there is an interesting blog post by Dr Ben Goldacre
http://www.badscience.net/2010/08/in-praise-of-anecdotes/
Complain about this comment
It should be available on the NHS only if there is no other option.
Not eating as much and eating the right things as well as regular exercise should be at the forefront of any wait loss.
Reinforcing to the patient that only they can do something about their weight and it will take a lot of will power over many months and their future health is in their own hands.
Surgery should not be sean as a quick, easy and ultimately lazy solution.
Complain about this comment
All the same arguments on here from the same self righteous biggots as usual.
I don't smoke, Smokers are at risk so they should pay for themselves.
I don't drink, drinkers are at risk so they should pay for themselves.
I don't eat too much, fat people are at risk, so .... etc.
(1) I DON'T DO IT! Why should MY CONTRIBUTIONS help pay for OTHER PEOPLE who have health problems because THEY DID IT?
So how about people who do exercise and play sports. Rugby, Cycling, Martial Arts, Rock Climbing, Football, Hockey, Jogging, Skiing ...
- They're all lifestyle choices.
- They're all activities carried out by minorities of the population.
- They all carry more risk of injury than sitting at home.
(2) Why should the majority of us who don't do "...." pay for others who are injured or have health problems because they did it!
Then how about we add driving, riding a motorbike or a horse, sex, pregnancy, the list goes on and on, more lifestyle choices and they all have higher health risk than abstaining ...
(3) WE don't do "...." why should WE pay for OTHERS who are injured or have health problems because they did it!
Keep going and we could add virtually every activity to the list of things that people should pay for themselves. We've effectively argued away the whole point of the NHS!
I cycle daily and swim regularly now and I'm pretty fit but as someone who has been obese at times in my life I can guarantee it's much easier to stop all of those other voluntary lifestyle choices I mentioned than it is to lose weight.
So in answer to (1) (2) and (3). The NHS belongs to all of us! We all pay our NI contributions. We all make different lifestyle choices. Some of us have health problems because of the choices we make and that's what the NHS is there for.
Complain about this comment
The NHS should make up its mind about the treatment of self inflicted "illnesses".
Liver transplants are not made unless the patient has been alcohol free for a period of time.
Routine surgery can be denied to smokers.
Yet we are prepared spend money and resources, that could be better spent elsewhere in the NHS, to treat people who simply do not exercise enough and eat too much.
Please don’t accept their rubbish excuses of being big-boned or it’s my glands.
We should also insist that the overweight pay for 2 seats on a public transport rather that force the rest of us to have to scrunch-up.
So come on you “fatties” just eat sensibly, exercise and use will-power and life will be better for you, your family/friends and the rest of us and people with real illness can then be treated.
Signed
An Ex-fatty
Complain about this comment
This obesity argument is sadly a symptom of a National Health Service that is over-reliant on yesterday's answers and which needs to find, and quickly, answers to tomorrow's questions and problems.
The underpinning issue is that in the main the NHS exists to perpetuate itself and the existing ways of being NHS Managers, clinicians and nurses. The NHS - by virtue of the whole way it is organised and its administrative needs - is rarely a vehicle for bringing about significant social and/or life-style change.
Perhaps, the fifty odd year or so battle against smoking is an example. (The first Royal College of Surgeons report was, if I recall correctly, 1954 or thereabouts and we've only just banned smoking in public places by a couple of years or so).
The obesity problem, and the life-style and diet one, is very similar to the cause of some of the long-term unemployment. Young people learn by copying significant others and what they see around them.
So, some will learn how to eat badly, to have a 'couch-potato' life style from their family settings, just as some will learn to expect to never work and to live on benefits from seeing their parents and elder siblings do just that.
Some will also learn to 'comfort-eat' under times of stress or pressure.
Our ability to change these expectations and life-styles, to introduce an effective method of re-education which challenges the learnt status-quo's of these people, is probably limited and the NHS is unlikely too ever be a speedy way of doing it.
We need to find effective, faster ways which are not regarded as just mass social brain-washing exercises. (I accept that is hard. Only the other day we were discussing, basically, how do you change people's attitudes to the risks of sexual infection - which is a similar problem).
And, in that context, I wonder if the money being paid on these surgical procedures could be better used doing just that.
So, is it better for a small number of people not to undergo such surgery and the resources saved be used to ensure a bigger number of people never reach the stage where they need it in the first place? I'd vote yes to that.
Perhaps the surgeons could spend less time in the operating theatres and more time in schools and colleges showing the next generation of potentially obese people, in graphic terms, the reality of the health risks involved.
Complain about this comment
I am lucky enough to be having bariatric surgery next tuesday 31st aug and it has been funded by the nhs. I would have not been able to have this as I do not work through serious ill heath. I am really looking forward to the treatment and hopefully getting my life back on track again. My weight has escalated since I started taking a variety of medcines 4 of which cause weight gain. I would be more than happy to let Fergus follow my journey which started last january so please get in touch.
Complain about this comment
#18. Fujikid wrote:
"They're all lifestyle choices...."
Addiction is not a choice (once addicted).
Let me ask you a question: let us suppose that I make a gigantic profit out of getting you deliberately and knowingly addicted to a substance that in all probability will kill you at a huge medical cost to society then, is it right and proper that I pay nothing towards the cost of your care?
[This is my tobacco industry and motor industry excessively fast car argument.]
PS I support NHS treatment for obesity.
Complain about this comment
# 22
So what are you suggesting John?
Should food manufacturers pay for such surgical procedures, or the supermarket giants perhaps, e.g. Tesco's, Asda, Morrisons, etc?
Or maybe just some food manufacturers, e.g. confectioners, chocolate makers, bakers?
Complain about this comment
This comment was removed because the moderators found it broke the House Rules.
Solidus wrote:
It is upsetting to see fat kids with fat parents. So the challenge is to stop fat childless couples becoming morbidly obese parents.
Hmm and I guess while we're at it we can stop dark haired people and short people and skinny people and thick people and ... Hang on didn't someone already try all this about 70 years ago somewhere in Europe?
Complain about this comment
I was climing up Mount Snowdon last weekend and I noticed an obese young girl struggling to climb the path. She eventually got to the top and I commend her for this and putting herself through the climb as it is not easy. She obviously had will and determination. Most people can't walk to their local shop never mind climb a mountain.
I think it absurd that because people can't stop stuffing their faces with junk food, the likes of the tax payer should fund it. If these fat people want any surgery on the NHS then they should pay for it themselves in a special fat clinic somewhere in the UK and stop clogging up waiting lists for the people that are ill or need medical help & advise.
When I was at school, everybody in high school attended home economics and learnt about foods. Pupils learnt to cook and this educated them some what in the subject and this is the problem. This has been pushed into the back ground of education. Fat kids have fat parents because they don't know any better or can't be bothered to cook.
Complain about this comment
Perhaps the fatty-haters should see the documentary Killer at Large: Why Obesity is America's Greatest Threat and Food Inc to see the connection between the obesity epidemic and the availability of cheap, low-cost and nutritionally poor food in industrialized countries before they start shipping the obese to fat concentration camps. The urge to eat was useful in a scarce food environment; now that we have 24-hour access to food we can't turn off the natural urge to eat; compile that with stress and the urge is over-reaching. What these people need is a team of helpers: (1) cognitive behavior therapists because many of them are depressed and use food to soothe; (2) exercise physiologists/personal trainers that specialize in the morbidly obese with other co-morbities; (3) GPs that are actually trained in these disciplines and are sensitive to this population; (4) on-call nutritionists that educate people on how to shop and cook on a budget. But doing it the right way is way too expensive, right?
Complain about this comment
FuliKid -
I am making two points: first how can we stop parents that are just fat (IE still capable of procreating) from putting on more weight after having kids and hopefully actually lose some so they can interact with their kids "athletically" - meaning no more than just playing with them. Can't see what's wrong with that point..
My other point is "morbidly obese" means just that, they die early, and leave their kid without a parent. Can't see what is wrong with that statement either. Both are upsetting consequences of being morbidly obese.
Complain about this comment
No way . I am on benefit and do not want to see my benefits cut so some people who do not look after themselves can have stuff they should not need. How can I bring up my kid on a decent income?
Complain about this comment
Weight loss surgery can help patients who will otherwise cause use of expensive treatments, special provision (beds/ambulances etc.) and all manner of other costs.
Rather than scrap weight loss surgery that will in the long term save money why not stop wasting million helping couples produce yet more babies for an overcrowded world (where there are heaps of unwanted children available for adoption), or perhaps cut the waste on removing tattoos?
I have also suggested that the department of health start lobbying for other obvious changes... why when they need people ot exercise off the fat do the local councils ALL charge you to use a gym (the cost of collecting the money often outweighing the income generated), or perhaps we could have school tennis courts open during the summer holidays so children can use them (they used to be when I was a kid - and they survived!). Perhaps the council swimming pool could also be free? School running tracks open? Sure some idiot will claim theres no insurance cover, why not therefore sort out the legal system - if you are on land and trip over breaking your arm it is tough luck, not something you can get compensation for? (When I was a kid I fell over at school, and later on a playing field, in both cases breaking my arm, in those days you didn't even consider going to court for compensation - after all I fell over.... no one else told me to!).
Of course, the department for health can't go talking to another government department - thats too easy, no, they just keep coming back with the same answeer - not our job govenor - whose job is it? It would be so easy to both save a lot of money and make our lives in the UK better, yet we seem to have a pile of jobsworths in government who quite literally are unable to think at all.
Complain about this comment
BTW
While a large number of obese are fat because they are lazy overeating layabouts, it is just not true for all. My Grandad was overweight and on diets for at least 30 years before they noticed his Thyroid was not working properly, once diagnosed and on the correct tablets the weight problem was no more.
Dave
Complain about this comment
Just over a year ago I qualified for bariatric surgery with a BMI of over 42. Today I am a UK size 10 after losing 7 stone in a year, and am running a half marathon in 12 days time. I used to feel like it was impossible to lose weight, but then found that it was just that I needed to exercise.
If you're obese, you really need to be shown what 'activity' really means - not just a few days in the gym, not walking a little each day, not doing 30 mins of something a day. I mean doing REAL exercise which makes your heart go a mile a minute and your body pour buckets of sweat, which you maintain for an hour at least, 5 days a week.
Do that and your metabolism goes through the roof and you will find that you can eat MORE food than you did before and STILL lose weight. No one needs to have surgery, we all just need to be less lazy and stop kidding ourselves. I get fustrated because bariatric surgery seems so dangerous, and you can lose weight naturally just as fast if you really exercise.
Instead of surgery and dieticians, why can't the NHS treat the obese with a personal trainer and a gym for a few months to get people started on the right track? I know I would have lost the weight a lot sooner if this option was open, and surely it would be cheaper and less dangerous than the surgery?
Complain about this comment
The answer really comes down to simple economics. Sure, surgery is a last resort, and will only be necessary in a minority of patients. Most can keep their weight under control with appropriate diet and exercise.
But for those who can't, the question is simply whether the costs of surgery are justified by the benefits. If they are (as they seem to be), then clearly the surgery should be available on the NHS.
The same consideration should apply to all treatments.
Complain about this comment
Hi Fergus
The focus appears to be on appearances. The morbidly obese person has the APPEARANCE of someone who is risking their life with their lifestyle choices. I have heard time and time again, from very slim people, that 'fat people eat too much' and that 'there were few fat people during the war years.'
My argument is that there are OTHER factors causing obesity with the resultant risk of heart failure, diabetes, kidney trouble, atherosclerosis etc. etc.
I am glad that some people have the option of gastric surgery as they must be quite desperate to change themselves in order to lead a normal life within the expectations of the society they inhabit.
So...what is going on when a very slim person develops the symptoms of heart failure, kidney damage, atherosclerosis etc. and has to have a quadruple heart bypass?
One would think that the question would be fairly easy to answer by a bit of research on the Internet.
Not so. Causes and effects are so complex that as one finds an answer to a particular question, a contradiction arises.
One of the factors in developing symptoms of one of these modern disease processes appears to be the consumption of refined sugar in the form of high fructose corn syrup. Apparently, apart from spiking your blood sugars, it makes you crave for more food. Where is this substance? Just about every processed food contains high fructose corn syrup.
http://en.wikipedia.org/wiki/High-fructose_corn_syrup
If the government are not regulating the use of such sugars and other known and apparently harmful substances in basic foodstuffs, then the government have the duty to at least pay for the damage caused by them. Just as, when cigarettes were considered 'safe' in the naive past, those who developed illness from such consumption were treated in hospital. Wards used to be crammed with patients coughing and spluttering copious amounts of sputum while some suffered from gangrene of the legs as their circulation began to fail, usually in conjunction with uncontrolled diabetes. Below knee amputation of the legs was the choice surgery then, when all else failed.
I hope my long winded ramblings will at least inspire you all to research on the internet and find out just how complex these issues are. There is no straightforward easy answer.
Complain about this comment
#3 Geoff Ward wrote: "Corrective treatment should not be available as a 'free good' (see Headline) on the basis that obesity is a Fact Of Life;
it should similarly be unavailable for treatment of a Lifestyle-Choice."
I am going to assume, quite generously, that you are not in favour of dismantling the NHS. I cannot see how any treatment on the NHS can discount lifestyle factors for any medical complaint other than congenital conditions. A couple of years ago I badly injured my ankle playing football. Did I deserve NHS treatment, having chosen to play? After all, the obese patients next to me in the A&E waiting room had wisely avoided such risky activities.
Does "lifestyle choices" really just mean "people who are different from me"? Your "beyond the pale" remark certainly makes me think so. We simply must ignore the voices of anyone, like you, who opines that others should be left to die. If you were to become the majority, heaven help us all.
Complain about this comment
No, Tim @ 35,
....not left to die.
The nation, through NICE, has chosen to prioritise within an increasingly scarce resource.
If an individual chooses self-harm, this may influence the priority.
If not selected for treatment, the individual has recourse to the private medical sector in this country or elsewhere.
A sensible individual might have taken out private insurance prior to the development of the morbid condition.
If necessary, the individual might sell assets to buy treatment, in the same way as old people buy places in an old folks home.
Complain about this comment
GeoffWard at post 36
Private medical insurance is out of the reach of most people on a low wage. In some cases, obesity is the result of basic malnutrition. The cheapest food and most filling food is that with the least nutritional value. To eat correctly costs money. The special offers in stores require a person to buy double the amount of food to get the discount and if the food is there, they will eat it all. Many people have no assets to buy treatment because they are on a basic income.
My investigations are mainly primary sourced. I have talked to many people on a low income. I see the psychology of why they buy particular items and i see how certain food chains exploit this weakness to offload their low cost, low food value items. I have also watched carefully, at first hand, what happens when an obese person makes food choices in a self serve restaurant. I have compared what the obese person and the non obese person chooses to eat. Both types of people indulge in the same high fat high calorie food. Some people are lucky enough to get away with it and others are not (well at least not superficially)
Jamie Oliver was also studying the eating habits of people and he has, thankfully, changed the content of school dinners.
We need more regulation in the food industry and a fat and sugar tax. Excess fats and sugars should be taxed like alcohol and cigarettes and the taxes raised to be used in the National Health.
Complain about this comment
I don't know what bugs me more about this whole debate - that our supposedly impartial state broadcaster has decided to join the populist media in cheerleading for this surgery and attempting to normalise it in the public perception, or the much wider issue of how the public have come to accept the conception of a pathological model of obesity framed as an 'epidemic' and a 'public health crisis' seemingly without ever pausing to question many of the underlying assumptions on which this approach is founded.
It is quickly becoming apparent to those not blinded by a bizarre and obsessive fantasy of a world without fat people that weight loss surgery is anything but a miracle cure, and most of those who say it is are either involved in the enormous anti-obesity industry that's sprung up in the last few years or are patients, still in the honeymoon period, who are heavily 'invested' in justifying their decision by encouraging others to follow the same path. The reality of this surgery is that it is enormously risky - actual death rates seem to be a closely guarded secret, but estimates put it at about 2% on the table and around 5% within the first few months, whilst even those who survive face a lifetime of difficulties eating, malunutrition, arthritis, osteoporosis, nerver damage, neurological problems, chronic malnutrition - all of which will themselves eventually cost the NHS as much as the alleged diseases of obesity. And then to cap it all, many of those who had the procedure 10-15 years ago before it became widespread are generally reporting a regain of between 50 and 80% of their initial loss. Some of these never fell out of the 'obese' BMI category. Furthermore, it is becoming apparent that even the 'reversal' of type II diabetes that is listed as one of the major benefits of the surgery and used to justify its application to smaller people is in many cases only temporary. Indeed if this is such a miracle cure, why are many of those who had it done years ago now either having reversals (an even more dangerous and complex process than the initial surgery) or further surgeries in an attempt to again reduce the capacity of the stomach which eventually stretches and allows the consumption of normal quanitities of food? The idea currently being pushed by Tam Fry, David Haslam and others that it should be universally available, including to children / teens and as a pre-emptive measure, glosses over the fact that it is so risky that many surgeons won't operate on the 'extreme cases' for whom it is alleged to be life-saving because of the increased risk of death in theatre and the resultant threat to their 'success' rates.
Nevertheless the medical establishment and Government are trying to get us to accept this as being akin to a cosmetic procedure - something that can be done laporoscopically in one's lunch break, and which is suitable for people with ever-lower staring weights. Celebs appear in tabloid rags rowing about having it done to lose a couple of stone of baby weight, and because we're such sheep in this country, millions of ordinary, predominantly women are now also demanding access to it. And why wouldn't they, in a world where in what Spiked magazine called 'the unpeopling of the obese', to be fat is almost to be non-human - for the Right, an irresponsible symbol of a hedonistic Broken Britain; for progressives, evidence of our enslavement by Big Food and the motorcar and yet another 'social problem' that demands to be 'fixed' through the usual Left tactics of heavy-handed top-down interference and the policiticisation of the minutiae of people's individual lifestyle choices.
Of course, there is another view, albeit not one you'll find represented in the mass media - that being fat is just one end of the spectrum of natural human variation and indeed may confer an evolutionary advantage with the current age of plenty drawing to a close; that the illusion of control over weight has distorted society's view of fat people as lacking in self control and thus morally lacking in terms of our protestant ethic; that increasing life expectancy figures discredit doomsday claims of a generation that will die before their parents; that the 'obesity epidemic' is based on a flawed and inflexible BMI scale, the thresholds of which have been manipulated over the years to 'construct' an epidemic, that the collective aversion to and aesthetic dislike of fat people that has driven the war is culturally conditioned rather than innate as claimed; that the alleged threat to the NHS is being exaggerated over others who incur a cost including but not restricted to amateur sportspeople and those who live well into old age; that even if it were possible or desirable to eradicate 'the obese' some would still always be bigger than others and therefore liable to criticism and attack; and that given how so many people remain stubbornly fat in the face of thousands of media articles about the health risks and social implications of being so, that only a level of official compulsion, intrusion and interference that is completely incompatible with a liberal democracy that generally accepts and tolerates difference would have any impact on our collective waistlines, at massive cost in financial and civil liberties terms.
Or in short, the 'obesity epidemic' is a myth, a social construction on the part of public health researchers (who having generally been successful in eliminating the genuine threats to public health are now forced to justify their existence) in which a natural human variation has been pathologised and demonised in order to create social division by providing a new scapegoat for the world's ills, using junk science and the repetition of falsehoods to instigate a moral panic and reduce fat people to the status of folk devils and make their continued position in society increasingly difficult. Personally and in the middle of an unprecedented recession that's forcing the reassesment of spending priorities and the limits of the State, I'd love nothing more than to see the pathological model of obesity subjected to the same levels of scrutiny and skepticism as the more extreme assertions of the climate science movement, a ceasefire called in the war on fat people and a new culture of tolerance and respect for people of all shapes and sizes, but whilst fat people would stand to gain a great deal in terms of social acceptance and the tolerance of a currently brainwashed public, too many powerful people in the media, government and medical / research establishment would lose out for it ever to be a realistic prospect. I fear that it is only a matter of time before we see the emergence of a two-tier society, where access to work, jobs, housing, healthcare, family life, medical treatment and basic respect will become conditional on size and weight - and the biggest tragedy of all will be that many fat people, brainwashed as they are like everyone else into accepting society's low opinion of them, will probably welcome it as yet another incentive to fight their biological programming and lose weight.
Complain about this comment
richie at post 79
Wow! I like it.
Tolerance and respect for people of all sorts of shapes and sizes will only happen when standard measurements are replaced by adaptable measurements. Measurement of space is defined by a set of rigid architectural rules. We are each allocated a standard space so that we can successfully perform our daily tasks. Those of us who do not conform to those regulation sizes suffer as a consequence.
Hands up if you are:
too tall
too short
too fat
too thin
left handed
short sighted
long sighted
hands up if you can't:
read the small print on the packet
reach the higher shelves in the supermarket
use standard tools
squeeze through a doorway
comfortably move around in a public loo
get your wheelchair/pushchair through a shop door
sit comfortably on a standard sized sofa or standard sized chair
reach the steering wheel of a car without a whole lot of alterations
find cloths that fit correctly
find shoes that fit correctly
get through a standard size space without bumping your head
The list goes on and on. We will eventually have to conform to size like supermarket fruit and vegetables. Our DNA will be modified to conform to a set of expectations. Those who do not conform to the regulation size will not be allowed to reproduce in such a utopia. The brainwashing begins at architectural planning level and then seeps through all of the other layers of our society.
Complain about this comment
Hi, Grannie, my sensible old friend!
Thanks for your comments – rooted in good sense, as usual.
.
My posting at 36 that elicited your comment (@37) was one of a thread that kicked off about ‘rights to free treatment’ and ‘the FREE National Health’. There is much un-reconstructed old-socialist thinking still out there; people now with no political home and a need to assert their ‘rights’.
.
I hope you will agree that, without private Health Insurance, the non-availability of NHS surgical treatment will necessitate sale of assets to realise costs; that, or no treatment.
.
On the ‘good food’ front, the problem is not mal-nutrition, it is mal-purchase and mal-desire to use a cooker. Here in north Brazil, where we live for half the year now, the Cesta básica (Basic Basket) is available for the poor in all main food outlets. This contains, at the cheapest cost, all the staples for a balanced, healthy basic diet (rice, beans, flour, dried meat/fish, milk, tomato, bread, coffee, banana, sugar, oil, butter) = 75.00 gbp per month (equivalent) = 90 hours work equivalent per month at minimum wage. The population of the poor has been healthy and with the correct BMI.
.
BUT, recently, the Brazilian social service provision has been expanded to capture some 70 million poor to receive the Bolsa familia (Family Grant). Thus, social class C and below now consider that they are the ‘provided-for’ society; they no longer provide for themselves, and the Grant is sufficient to buy pizzas, Big Macs, KFCs, sugar-based drinks, etc.
.
The result is – fatness, obesity, and morbid obesity amongst the poor. I watch people that I have known for the last few years ballooning before my eyes, believing that they have joined the Modern World, and because all their friends are ballooning they view it as a positive state of being.
.
Really sad that this fat-based social construct amongst the poor should come about by social funding emplaced to win election votes for the Party Of The People.
.
Complain about this comment
HI, Geoff
You know, I think the answer to all of this is staring right in our faces. If the poor are reluctant to cook at home 7 days a week, why not cook for them? I am sure that MOST people would be glad of a break from cooking, to enjoy the ambiance of communal eating. What is wrong with that! How about community restaurants that serve healthy, cheap basic food? The recipes could be freely available in the restaurants so that the consumers could attempt to imitate the meals at home, on their nights in. If the basic food was presented in a more glamourous way, it would soon catch on. My daughter wanted to set up a community meal centre within a very poor housing estate but there were no local resources or funding to enable this. Schools and colleges have the resources but there might be issues about security, and also, schools are not the most enticing of places.
The way to change people's eating habits is by good example and a bit of glamour. But, to hike up the prices to match the glamour status would be unfair.
Are there any ministers reading this with suggestions of how this could be achieved?
Complain about this comment
Good Morning Fergus, I have to say that, knowing your interest in our research in the past, I am surprised that you have not picked up on our recent investigation showing that infant formulas are significantly contaminated with aluminium, published by BMC Pediatrics late last week.
http://www.biomedcentral.com/1471-2431/10/63
It cannot be acceptable to be loading the most vulnerable members of our society, preterm and term infants, with aluminium.
Complain about this comment
The reasons for the rise in obesity is obviously multi factorial therefore it needs to be tackled at many different levels.
Research shows that the NHS is not effective at tackling obesity with some studies showing their patients lose on average 2kg per year! Dietitians in the NHS are not given the time, support or funding to help patients effectively and the extreme approach of bariatric surgery (which is not appropriate for everyone) is seen as the only way!
The NHS should support multi disciplinary approaches to weight loss, incorporating dietitians, exercise, psychology, with the Doctor at the steering wheel. There is a lot of evidence to support the use of VLCDs and obesity. If the evidence (including the NICE guidlelines and NOF guidelines) supports this then why are the NHS/ the government not getting behind it!
Dietitian
Pronokal
London
Complain about this comment
Smokers are already refused treatment, fat people soon will be, then people who do not exercise and so on . Can't the doctors just try to fix us. Since when has their opinion been asked for - we are all human and all have our vices and shortfalls. If we carry on into this abyss we will come out the other side like identical automatons equal in every way and best suited to our role as consumer units in the growth fevered world engineered by the collective and soul less corporate mind.
Complain about this comment
I've recently read some related information and I would like to share with you. Britain's National Health Service could save millions of pounds a year by offering more weight-loss surgery for obese patients, a medical study said Wednesday.Around a million people in England meet recommended criteria for so-called bariatric surgery, but only 3,600 NHS weight-loss operations were carried out last year.Obesity and related medical conditions directly cost the NHS 4.3 billion pounds a year, while the impact on the wider economy runs into millions.The Office of Health Economics estimates that 1.3 billion pounds would be saved within three years, if a quarter of those eligible underwent surgery.Savings of between 35 million and 150 million pounds could also be made in welfare payments as people return to work, the study, titled "Shedding The Pounds", said.Source:Weight-loss surgery 'could save millions' in UK,(AFP)
Complain about this comment
This comment was removed because the moderators found it broke the House Rules.
No. I am overweight and the reason is that I have eaten too much in the past. A start would be tackling the manufacturers of convenience foods and stopping the spread of fast food outlets in this country. Most of us are inherently lazy and if there is a quick easy solution we will take it every time. The only way to lose weight is to burn off more than you are putting in your mouth. I have dusted off my old bike and am starting to get fitter again. People are always too ready to blame others for their problems instead of taking ownership. Finally we should also stop paying benefits to those too fat to even walk and have to travel in a mobility scooter. Its pathetic!
Complain about this comment
No. Nor should it pay for cosmetic surgery or fertility treatment. The NHS is there to deal with sickness, nothing else. Fat people are not sick, or rather, 99% of them are not. The very few who have some form of glandular or other problem should receive help, but otherwise, no. There are far more important things on which to spend the money.
We actually need a large increase in the numbers of the obese, who will die prematurely and save paying out all that money on pensions. More smokers and binge drinkers would help, too, and think of the long-term environmental benefits!
Complain about this comment
This comment was removed because the moderators found it broke the House Rules.
This comment was removed because the moderators found it broke the House Rules.
It seems a rare event that doing the best thing for a patient is the right thing to do economically. If giving a morbidly obese person a gastric band saves the NHS money in the long term then im all for it. Ive worked in hospitals with bariatric patients and can easily understand how a long spell in hospital can cost a fortune. However I also feel that much more needs to be done to prevent the situation arising in the first place, educating people in healthy eating habbits and [Unsuitable/Broken URL removed by Moderator]
nutrition should be given higher levels of attention.
Complain about this comment
View these comments in RSS