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I'm very torn on this one. The liberal pragmatist in me sees a practical solution that might improve the quality of life for thousands of people and help reduce the burden on the NHS.
The less liberal side, says many people have found themselves in this situation because of poor lifestyle choices and should therefore pay towards the operation if they're in a position to do so - much as cigarette smokers pay through tax.
The trouble of course, is that many people don't have the benefit of choice. There's a lot of people around that have basically just let themselves go; or don't have the money/knowledge to eat well; or simply eat for comfort.
Complex...
The less liberal side, says many people have found themselves in this situation because of poor lifestyle choices and should therefore pay towards the operation if they're in a position to do so - much as cigarette smokers pay through tax.
The trouble of course, is that many people don't have the benefit of choice. There's a lot of people around that have basically just let themselves go; or don't have the money/knowledge to eat well; or simply eat for comfort.
Complex...
In reply to FrankBooth:
THe more that can be done to reduce the obesity problem in this country the better. However, I do worry that this may become seen as an easy option for those that would be better off just curtailing their consumption levels.
THe more that can be done to reduce the obesity problem in this country the better. However, I do worry that this may become seen as an easy option for those that would be better off just curtailing their consumption levels.
In reply to FrankBooth:
Yes, I know what you're saying. As a child of the fifties I am not aware that there was an obesity problem in those days. This was due, as much as anything, to the austerity brought about by the war years and the subsequent years. People simply did not have the access to junk food. They ate sensibly, exercised more and fewer people had cars. Children walked or cycled to school. Adults walked or cycled to work - unless it warranted a bus or train journey. At school I do not recall any of my peers being overweight.
I think there are so many factors that have contributed to the obesity problem - supermarkets(making more junk food available, failing to encourage healthy eating), lack of exercise etc., etc. that it's difficult to know where to begin.
Walking round town the other day I was depressed by the sight of relatively young people walking with sticks or riding mobility scooters due to their obesity. One woman WADDLED past me and was having to stop every few yards to get her breath - she appeared to be about fortyish and I suspect she weighed about thirty stone.
Yes, I know some people have a weight problem for other reasons but I think we are sitting on a time bomb and I can see the NHS imploding before long.
I don't know what the answer is; people just don't seem to understand.
Yes, I know what you're saying. As a child of the fifties I am not aware that there was an obesity problem in those days. This was due, as much as anything, to the austerity brought about by the war years and the subsequent years. People simply did not have the access to junk food. They ate sensibly, exercised more and fewer people had cars. Children walked or cycled to school. Adults walked or cycled to work - unless it warranted a bus or train journey. At school I do not recall any of my peers being overweight.
I think there are so many factors that have contributed to the obesity problem - supermarkets(making more junk food available, failing to encourage healthy eating), lack of exercise etc., etc. that it's difficult to know where to begin.
Walking round town the other day I was depressed by the sight of relatively young people walking with sticks or riding mobility scooters due to their obesity. One woman WADDLED past me and was having to stop every few yards to get her breath - she appeared to be about fortyish and I suspect she weighed about thirty stone.
Yes, I know some people have a weight problem for other reasons but I think we are sitting on a time bomb and I can see the NHS imploding before long.
I don't know what the answer is; people just don't seem to understand.
In reply to FrankBooth:
Where does that end though?
Climbers paying for rescues? Runners paying for injuries to be treated?
> I'm very torn on this one. The liberal pragmatist in me sees a practical solution that might improve the quality of life for thousands of people and help reduce the burden on the NHS.
> The less liberal side, says many people have found themselves in this situation because of poor lifestyle choices and should therefore pay towards the operation if they're in a position to do so - much as cigarette smokers pay through tax.
Where does that end though?
Climbers paying for rescues? Runners paying for injuries to be treated?
In reply to FrankBooth:
I'm not sure that anyone can claim these days that they don't know how to eat well, given the profusion of healthy eating ads on buses and food programmes on TV.
Gastric bypasses seem to be fixing the symptoms, rather than the cure. I think part of the problem is calling obesity a disease instead of laziness or incompetence. Of course, some people do have a glandular or hormonal issue that makes keeping slim difficult, if not impossible - but that isn't the case for far too many people.
Edit: Cost isn't the issue - eating healthy food can be far cheaper than eating junk.
I'm not sure that anyone can claim these days that they don't know how to eat well, given the profusion of healthy eating ads on buses and food programmes on TV.
Gastric bypasses seem to be fixing the symptoms, rather than the cure. I think part of the problem is calling obesity a disease instead of laziness or incompetence. Of course, some people do have a glandular or hormonal issue that makes keeping slim difficult, if not impossible - but that isn't the case for far too many people.
Edit: Cost isn't the issue - eating healthy food can be far cheaper than eating junk.
Post edited at 12:03
In reply to FrankBooth:
I think people are pretty desperate if they're having a gastric bypass. Does it not mean you're eating a limited range of basically pureed food for the rest of your life.
I can't imagine never being able to have just one more roast potato at Christmas or other occasional food indulgence ever again.
Cheers
Toby
I think people are pretty desperate if they're having a gastric bypass. Does it not mean you're eating a limited range of basically pureed food for the rest of your life.
I can't imagine never being able to have just one more roast potato at Christmas or other occasional food indulgence ever again.
Cheers
Toby
In reply to FrankBooth:
Me: "Doctor, I have a sore finger."
Dr: "Easy, we'll chop it off - problem solved. NEXT!"
Me: "Doctor, I have a sore finger."
Dr: "Easy, we'll chop it off - problem solved. NEXT!"
In reply to FrankBooth:
With the criteria used by the NHS to make someone eligible for this, it is a very highly cost-effective intervention, the benefit on the health of the people who receive it means that on average the reduction in healthcare costs in future far exceeds the cost of the operation. There is no financial argument for not doing bariatric surgery with our current criteria (indeed some would argue the eligibility criteria are too restrictive).
Generally these people are very extreme cases (BMI over 40, or over 35 and suffering complications). I believe they also have to loose some weight before the operation to demonstrate an ability to make lifestyle changes (although I may be wrong on this - it's not my area of the NHS).
With the criteria used by the NHS to make someone eligible for this, it is a very highly cost-effective intervention, the benefit on the health of the people who receive it means that on average the reduction in healthcare costs in future far exceeds the cost of the operation. There is no financial argument for not doing bariatric surgery with our current criteria (indeed some would argue the eligibility criteria are too restrictive).
Generally these people are very extreme cases (BMI over 40, or over 35 and suffering complications). I believe they also have to loose some weight before the operation to demonstrate an ability to make lifestyle changes (although I may be wrong on this - it's not my area of the NHS).
In reply to whenry:
Gastric bypass (and other bariatric surgery) is an important and effective treatment, it reduces rates of type 2 diabetes and other obesity related complications. It is not simply about fixing the symptoms of body image.
(Also maybe half of the arsenal of drugs we use in hospital is directed at symptomatic treatment, because symptoms cause suffering and reducing suffering is good).
Punitive approaches to this sort of problem do not help, they simply isolate people and give them no motivation to change. Medicalising the problem helps people to recognise the problem, and access support.
I view obesity of similar to other illnesses where the person does things detrimental to their own health - alcoholism, drug abuse, depression with self-harm - because that I believe is the best way for these people to be helped.
> Gastric bypasses seem to be fixing the symptoms, rather than the cure. I think part of the problem is calling obesity a disease instead of laziness or incompetence.
Gastric bypass (and other bariatric surgery) is an important and effective treatment, it reduces rates of type 2 diabetes and other obesity related complications. It is not simply about fixing the symptoms of body image.
(Also maybe half of the arsenal of drugs we use in hospital is directed at symptomatic treatment, because symptoms cause suffering and reducing suffering is good).
Punitive approaches to this sort of problem do not help, they simply isolate people and give them no motivation to change. Medicalising the problem helps people to recognise the problem, and access support.
I view obesity of similar to other illnesses where the person does things detrimental to their own health - alcoholism, drug abuse, depression with self-harm - because that I believe is the best way for these people to be helped.
In reply to splat2million:
All pretty much as you say. See link for more info:
http://www.england.nhs.uk/wp-content/uploads/2013/04/a05-p-a.pdf
I also don't think this is an easy option. Living with a gastric bypass can't be much fun, but then I imagine it is much better than the alternative!
Still the whole thing is a tiny sticking plaster for a far bigger wound i.e. the need to improve public health - which will be a long drawn out and difficult challenge for many reasons
> With the criteria used by the NHS to make someone eligible for this, it is a very highly cost-effective intervention, the benefit on the health of the people who receive it means that on average the reduction in healthcare costs in future far exceeds the cost of the operation. There is no financial argument for not doing bariatric surgery with our current criteria (indeed some would argue the eligibility criteria are too restrictive).
> Generally these people are very extreme cases (BMI over 40, or over 35 and suffering complications). I believe they also have to loose some weight before the operation to demonstrate an ability to make lifestyle changes (although I may be wrong on this - it's not my area of the NHS).
All pretty much as you say. See link for more info:
http://www.england.nhs.uk/wp-content/uploads/2013/04/a05-p-a.pdf
I also don't think this is an easy option. Living with a gastric bypass can't be much fun, but then I imagine it is much better than the alternative!
Still the whole thing is a tiny sticking plaster for a far bigger wound i.e. the need to improve public health - which will be a long drawn out and difficult challenge for many reasons
In reply to IainRUK:
Your not comparing like with like. If a climber was grossly negligent then yes there would be an argument for them to pay for or at least towards any resulting rescue.
Becoming obese IS a choice.
> Where does that end though?
> Climbers paying for rescues? Runners paying for injuries to be treated?
Your not comparing like with like. If a climber was grossly negligent then yes there would be an argument for them to pay for or at least towards any resulting rescue.
Becoming obese IS a choice.
In reply to whenry:
Thats what concerns me.
> Gastric bypasses seem to be fixing the symptoms, rather than the cure.
Thats what concerns me.
In reply to Indy:
It's as good a cure for many people as any cure we have in western medicine:
It reduces their appetite
It reduces their ability to eat large amounts
It reduces their weight
It reverses insulin resistance and can even cure type 2 diabetes in some cases
Sounds like a pretty good cure to me. (Yes, I admit some people can continue maintain obesity after the operation but not the majority).
Is alcoholism a choice? Is self-harm a choice? Is anorexia a choice? I think over-eating causing severe obesity should be considered alongside other mental illness.
When we talk about NHS bariatric surgery we're not talking about slightly fat people who could do with losing a few pounds and going to the gym every now and again - we are talking about morbid obesity, some of these people can no longer even walk because they are so fat so they have long passed the point of being able to exercise themselves thinner.
Private bariatric surgery for less severe obesity is different, but those people are paying for their treatment anyway.
It's as good a cure for many people as any cure we have in western medicine:
It reduces their appetite
It reduces their ability to eat large amounts
It reduces their weight
It reverses insulin resistance and can even cure type 2 diabetes in some cases
Sounds like a pretty good cure to me. (Yes, I admit some people can continue maintain obesity after the operation but not the majority).
Is alcoholism a choice? Is self-harm a choice? Is anorexia a choice? I think over-eating causing severe obesity should be considered alongside other mental illness.
When we talk about NHS bariatric surgery we're not talking about slightly fat people who could do with losing a few pounds and going to the gym every now and again - we are talking about morbid obesity, some of these people can no longer even walk because they are so fat so they have long passed the point of being able to exercise themselves thinner.
Private bariatric surgery for less severe obesity is different, but those people are paying for their treatment anyway.
In reply to Graham Mck:
This is really the key point: obesity is a big public health issue that needs to be addressed on a national level. Treating those who are obese and suffering as a result doesn't undermine this effort though.
> Still the whole thing is a tiny sticking plaster for a far bigger wound i.e. the need to improve public health - which will be a long drawn out and difficult challenge for many reasons
This is really the key point: obesity is a big public health issue that needs to be addressed on a national level. Treating those who are obese and suffering as a result doesn't undermine this effort though.
In reply to Indy:
no it can be.. it can not me.. any soloer could be argued to be taking undue risk…
> Your not comparing like with like. If a climber was grossly negligent then yes there would be an argument for them to pay for or at least towards any resulting rescue.
> Becoming obese IS a choice.
no it can be.. it can not me.. any soloer could be argued to be taking undue risk…
In reply to Indy:
Becoming a climber IS a choice.
> (In reply to IainRUK)
>
> Becoming obese IS a choice.
>
> Becoming obese IS a choice.
Becoming a climber IS a choice.
In reply to whenry:
I disagree strongly on this point as there is little agreenment on what healthy food or a balanced diet is. Here is my example list of SOME healthy food (see if you agree):
Organ meats, red Meat, chicken, fish, eggs, vegetables, fruit, milk, water.
List of some unhealthy food:
Margarines, soft drinks, cereals, bread (most kinds), juices and smoothies, pre prepared meals (inc weight watchers), baked snacks, confectionary, alcohol, skim milk.
Grey areas:
Red wine, cheese, artisanal breads & cereals (prepared in traditional ways), dark chocolate, coffee
> (In reply to FrankBooth) I'm not sure that anyone can claim these days that they don't know how to eat well, given the profusion of healthy eating ads on buses and food programmes on TV.
I disagree strongly on this point as there is little agreenment on what healthy food or a balanced diet is. Here is my example list of SOME healthy food (see if you agree):
Organ meats, red Meat, chicken, fish, eggs, vegetables, fruit, milk, water.
List of some unhealthy food:
Margarines, soft drinks, cereals, bread (most kinds), juices and smoothies, pre prepared meals (inc weight watchers), baked snacks, confectionary, alcohol, skim milk.
Grey areas:
Red wine, cheese, artisanal breads & cereals (prepared in traditional ways), dark chocolate, coffee
Post edited at 16:22
In reply to IainRUK:
I'm not going there as its a fatuous argument, theres risk in everything we do but just humour you for a moment if soloing as a specific part of the climbing scene was costing the NHS 10% of its entire budget then yes I'd be having problems with it.
> no it can be.. it can not me.. any soloer could be argued to be taking undue risk…
I'm not going there as its a fatuous argument, theres risk in everything we do but just humour you for a moment if soloing as a specific part of the climbing scene was costing the NHS 10% of its entire budget then yes I'd be having problems with it.
In reply to splat2million:
I'm not up on the in and outs of this sort of surgery but I thought that a gastric band helps people that are morbidly/chronically obese to lose weight by massively reducing there ability to consume food. I assume that at some point that the gastric band will be removed. Have and will theses people have learnt how to eat a healthy diet or will they be doomed to put it all back on?
Its also hard not to see that the Govt. welfare systems aren't becoming enablers into this downward spiral into morbid obesity.
Obesity = mental illness hmmmmmm
> It's as good a cure for many people as any cure we have in western medicine:
> It reduces their appetite
> It reduces their ability to eat large amounts
> It reduces their weight
> It reverses insulin resistance and can even cure type 2 diabetes in some cases
> Sounds like a pretty good cure to me. (Yes, I admit some people can continue maintain obesity after the operation but not the majority).
> Is alcoholism a choice? Is self-harm a choice? Is anorexia a choice? I think over-eating causing severe obesity should be considered alongside other mental illness.
I'm not up on the in and outs of this sort of surgery but I thought that a gastric band helps people that are morbidly/chronically obese to lose weight by massively reducing there ability to consume food. I assume that at some point that the gastric band will be removed. Have and will theses people have learnt how to eat a healthy diet or will they be doomed to put it all back on?
Its also hard not to see that the Govt. welfare systems aren't becoming enablers into this downward spiral into morbid obesity.
Obesity = mental illness hmmmmmm
In reply to FrankBooth:
Surely it would be cheaper to send the chronically obese to a "Fitness boot camp"!
If they REALLY want to lose weight and get fit this would be a better option than major surgery and potentially less cost/health risks.
If they are just looking for a "quick fix" to their problems then they are more likely to continue over eating after the surgery.
Surely it would be cheaper to send the chronically obese to a "Fitness boot camp"!
If they REALLY want to lose weight and get fit this would be a better option than major surgery and potentially less cost/health risks.
If they are just looking for a "quick fix" to their problems then they are more likely to continue over eating after the surgery.
In reply to mgco3:
As far as I'm aware these bands stay forever, reducing the stomach size with obvious effects?
I used to think it was a lazy option, but eating disorders are real like other forms of addiction.
The long term saving of the bands over for eg in the case of diabetes, amputations, hospitilisations, district nurse care etc, far outweighs the cost of the surgery.
Yes, most people never used to be fat, but times change.
As far as I'm aware these bands stay forever, reducing the stomach size with obvious effects?
I used to think it was a lazy option, but eating disorders are real like other forms of addiction.
The long term saving of the bands over for eg in the case of diabetes, amputations, hospitilisations, district nurse care etc, far outweighs the cost of the surgery.
Yes, most people never used to be fat, but times change.
In reply to mgco3:
Of course!
> Surely it would be cheaper to send the chronically obese to a "Fitness boot camp"!
Of course!
In reply to FrankBooth:
It's completely impossible to administer a regime that assigns blame for disease and treats/bills patients accordingly. People who think this is possible need to think a bit harder.
On the other hand, the NHS has finite resource, so those resources need to be rationed.
So clearly a middle way needs to be found. People need to be encouraged to sort out problems within their control, rather than turning to medical intervention as a first port of call. Expensive treatments need to be provided according to rational priorities, with an eye on long-term as well as short-term costs. Prevention and public health require investment.
Basically, I'd be surprised if a policy on these things better than what's already in place can be designed by the cleverest policy wonk (presumably lots of clever policy wonks are employed in precisely this field). UKC has rather less chance, even with the intellectual powerhouse that is mgco3 amongst us.
It's completely impossible to administer a regime that assigns blame for disease and treats/bills patients accordingly. People who think this is possible need to think a bit harder.
On the other hand, the NHS has finite resource, so those resources need to be rationed.
So clearly a middle way needs to be found. People need to be encouraged to sort out problems within their control, rather than turning to medical intervention as a first port of call. Expensive treatments need to be provided according to rational priorities, with an eye on long-term as well as short-term costs. Prevention and public health require investment.
Basically, I'd be surprised if a policy on these things better than what's already in place can be designed by the cleverest policy wonk (presumably lots of clever policy wonks are employed in precisely this field). UKC has rather less chance, even with the intellectual powerhouse that is mgco3 amongst us.
In reply to mgco3:
I spend a lot of my time trying to help people with little or no motivation to help themselves (I work in A&E so we see all the badly managed chronic problems). I find it quite depressing that people who are able to manage their weight (not to mention other things people can't manage to help themselves: alcohol intake / depression / drug use) have such a simplistic view of these things.
Morbidly obese people who continue to eat are usually depressed, have no control over much else in their life because they cannot work, and find it extremely difficult to even leave the house (both physically and psychologically). They eat large amounts knowing how much harm it is doing to them but they cannot stop. This is almost exactly the same as alcoholics who drink themselves to death.
Bariatric surgery (there are several types: bands which may or may not be permenant, balloons which are temporary, bypass which is permenant) carries a significant risk of death (I think its about 1 in 200 although again this is not my area) or other major complication because these patients are not ideal candidates for anaesthesia. People do not undertake it lightly, and it is no quick fix, but it is an effective treatment.
Why deny someone who is unable to help themselves (due to their own psychosocial factors) a treatment which can help them?
What would be next? Withdrawing alcohol and drug services from the NHS? (Incidentally the treatments in this area are far less effective than bariatric surgery)
> If they REALLY want to lose weight and get fit this would be a better option than major surgery and potentially less cost/health risks.
I spend a lot of my time trying to help people with little or no motivation to help themselves (I work in A&E so we see all the badly managed chronic problems). I find it quite depressing that people who are able to manage their weight (not to mention other things people can't manage to help themselves: alcohol intake / depression / drug use) have such a simplistic view of these things.
Morbidly obese people who continue to eat are usually depressed, have no control over much else in their life because they cannot work, and find it extremely difficult to even leave the house (both physically and psychologically). They eat large amounts knowing how much harm it is doing to them but they cannot stop. This is almost exactly the same as alcoholics who drink themselves to death.
Bariatric surgery (there are several types: bands which may or may not be permenant, balloons which are temporary, bypass which is permenant) carries a significant risk of death (I think its about 1 in 200 although again this is not my area) or other major complication because these patients are not ideal candidates for anaesthesia. People do not undertake it lightly, and it is no quick fix, but it is an effective treatment.
Why deny someone who is unable to help themselves (due to their own psychosocial factors) a treatment which can help them?
What would be next? Withdrawing alcohol and drug services from the NHS? (Incidentally the treatments in this area are far less effective than bariatric surgery)
In reply to splat2million:
A & E is not the place to "Fix" 'badly managed chronic problems'.
>Morbidly obese people who continue to eat are usually depressed, have no control over much else in their life because they cannot work, and find it extremely difficult to even leave the house (both physically and psychologically). They eat large amounts knowing how much harm it is doing to them but they cannot stop.<
Teaching someone the motivation and desire to improve their lifestyle and assisting them to score acheivable goals is the way for them to fix their own problem long term.
Gastic band surgery wont fix the underlying issues that cause the obesity.
>Why deny someone who is unable to help themselves (due to their own psychosocial factors) a treatment which can help them?
What would be next? Withdrawing alcohol and drug services from the NHS?<
Again, A & E is not the place to fix these issues long term. These problems are not "fixable" by expensive surgery onthe NHS so I fear are "off subject" of this post.
Psychosocial factors cannot and should not be fixed by surgery.
A & E is not the place to "Fix" 'badly managed chronic problems'.
>Morbidly obese people who continue to eat are usually depressed, have no control over much else in their life because they cannot work, and find it extremely difficult to even leave the house (both physically and psychologically). They eat large amounts knowing how much harm it is doing to them but they cannot stop.<
Teaching someone the motivation and desire to improve their lifestyle and assisting them to score acheivable goals is the way for them to fix their own problem long term.
Gastic band surgery wont fix the underlying issues that cause the obesity.
>Why deny someone who is unable to help themselves (due to their own psychosocial factors) a treatment which can help them?
What would be next? Withdrawing alcohol and drug services from the NHS?<
Again, A & E is not the place to fix these issues long term. These problems are not "fixable" by expensive surgery onthe NHS so I fear are "off subject" of this post.
Psychosocial factors cannot and should not be fixed by surgery.
Post edited at 17:28
In reply to Jon Stewart:
And gastric bands help them lose weight and enjoy exercise.. The solution is often a number of strategies ran together...
Some on here have fantastical simplistic views of the world..
> Of course!
And gastric bands help them lose weight and enjoy exercise.. The solution is often a number of strategies ran together...
Some on here have fantastical simplistic views of the world..
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