Obese people to be refused surgery

[ReallyReallyNearly]

Isn't this just another form of discrimination, www.bbc.co.uk/news/uk-england-york-north-yorkshire-37265752
Argument seems to be on financial reason rather than health, do we stop nhs services for people who smoke, or those who drink too much etc. Where does one draw a line?!

I agree about public health and the government getting on board. We need to plough preventative resources into schools. We also need to look at how social services are working to support disabled adults. I see a lot of obesity related issues in my job (work with older people and those with physical disabilities) but we are so busy with crises that we don't get to address the things that important to people and many people would like to lose weight and improve mobility.

Obesity in mental health is a significant issue. I worked in a psychosis team; antipsychotic drugs and huge weight gain go hand in hand. We did fuck all to properly support those people who were distressed by the rapid weight gain. Every 6 months, we reviewed all patients on antipsychotics for side effects. I'd say that 99.9% of those reviews came out with "weight gain" as a side effect that caused distressed. They did collate the evidence but what they did with that information, I don't know. Not a lot, I'm guessing. I didn't stay there long. It was hateful working in a inner London mental health team. The deprivation and lack of services was heartbreaking.

There are plenty of opprotunies for society to provide preventative services as well as services to help those who are already overweight. If the government dedicated a few billion to this in the short term, it would save money in the long term.

"It's also worth pointing out that this will indirectly racially discriminate also. A higher proportion of obese UK adults are from black african groups."

Anecdotal, again, and I don't come from an ethnically diverse population by any stretch of the imagination, but as I said upthread, I'd estimate crudely that 80% of our intake are obese (and I'm not talking 'a bit chubby', I mean clinically obese) and probably 5% of our intake is from any black african group or any other minority group, with many of those being our slimmest patients. I'm not saying it's not a valid consideration, but it really isn't a reason to ignore the very real problem that obesity causes.

Obesity is quite literally an epidemic. I'm sat here typing with a BMI of 21.1. I'm 5'8" (172cm) and 63 kg. Yet, objectively, I know that I am fat. I'm not overweight. I have simply indulged in too much food that is high in sugar, carbs and fats and not done enough exercise to burn it off. It has all accumulated around my abdomen. So although the scales would allow me another 11kg (1st 10lbs) before I would hit a BMI of 25 and be officially 'overweight' and 25.5kg (4st) before I was 'obese', I can see the problem now. Most of the issue for me is a terrible posture post-pregnancy (x3) with non-existent core muscles and no exercise. I've lost 8kg simply by eating more sensibly - swapping out high processed carbs for complex carbs. Sticking to 1200-1400 cals per day.

But when you can put on another 4 stone before you are even hitting 'obsese' and then say 'oh but I'm only a size....' 'I'm not as big as...' - that's just pure denial. There is a meme on facebook that says 'I wish I was as fat as the first time I thought I was fat' People who are at the 'bit podgy and just damned greedy' stage, which is a stage most people go through, can change things so easily. It's people who are 6 or 7 stone overweight who I admire so much for even starting to diet, because they have to work so hard to see a change that they can be proud of.

V true and pertinent insight re mental health situation- Doggity! That remains a travesty!
Plus agree with the short sighted quick win government approach - rather than spend now to save in long term- that's why governments should be in charge of health! Short sighted gains to win votes - and constant game changing! Rather than real look at health of the nation.......

Removing bus stops is not a solution. At least not a sensible one. The word I think I am looking for is "ludicrous".

Yeah, let's make public transport even more awkward to use, and make driving the more realistic and attractive option!

Removing bus stops would equate to, in short: fucking over the disabled. Fucking over the elderly. Fucking over people without a car who get their weekly shop on a bus and have to carry it all the way home from one of the (close to each-other) bus-stops on the edge of their estate. Fucking over commuters and people who have a tight schedule that can't accommodate another five minutes' walk to the bus stop. You get the gist.

Want to benefit public health? Make public transport more accessible. Subsidise the companies so buses are more frequent on all routes and stay on time. Reduce bus fares. Get people walking to a bus stop at all, instead of only walking to their cars.

There is a famous poem this reminds me of:
First they came for the Communists
And I did not speak out
Because I was not a Communist
Then they came for the Socialists
And I did not speak out
Because I was not a Socialist
Then they came for the trade unionists
And I did not speak out
Because I was not a trade unionist
Then they came for the Jews
And I did not speak out
Because I was not a Jew
Then they came for me
And there was no one left
To speak out for me

• See more at: hmd.org.uk/resources/poetry/first-they-came-pastor-martin-niemoller#sthash.oigfL4cH.dpuf. While we argue amongst ourselves, the Tories rip apart the NHS.They start with stopping some surgeries for "undeserving" & people agree because, hey its not them. A couple of year from now, will we be stopping lung cancer operations on life long smokers? Will that be ok as well, are they to, undeserving? Cancer treatment with less than 50%/ 40%/ 30% chance of success? Who has the right to make that decision?

And sort the bloody pavements out!!!

Bluegaloo that poem is about picking off marginalised members of society.

A) There are more obese people than non-obese people in society.
B) There are genuine risks associated with obesity and surgery.
C) If we, as a society, stopped harping on about discrimination and started recognising that we are quite literally sending people to an early grave by being complicit in the deceit that obesity is just cosmetic and people should 'love the skin their in', we could save millions of lives - more than any pill brought on to the market.
D) People who aren't ready to face their problem will blame the road surface/pavements, climate, anything rather than just eating less and moving more.

That's the bare facts. Yes, it is far harder for people with endocrine and metabolic disturbances. But it can be done. And many of those problems resolve once the weight is gone.

Bluegalloo that poem was written about marginalised people being taken to concentration camps and killed. To compare that to a few obese people being refused surgery until they have lost some weight, is just downright offensive.

we are quite literally sending people to an early grave by being complicit in the deceit that obesity is just cosmetic
This!
I'm not optimistic, obesity is becoming ubiquitous, it is increasingly seen as normal and inevitable

I have sarcoidosis. It is a nasty illness. When it gets bad and I need a doctor I know that when it comes to who get seen first I am behind a fattie having a heart attack.

I didn't do anything to myself to cause sarcoids... I was just unlucky. The obese case did contribute to their condition.

There is one caviet, sometimes obesity is a mask for some form of mental illness.

People denying that BMI is of any use whatsoever is part of the problem, too. Yes, it's not a perfect tool. Nothing would be.

But the people saying they dislike BMI as a measurement are rarely the "muscular rugby players" which are constantly trotted out as examples.

So many people on this thread saying BMI doesn't apply if you're muscular. Well, I had a look at the stats of the most muscular women I could think of, off the top of my head:
Caster Semenya, 5ft 10ins, 10st 10lb. BMI 21.5.
Jessica Ennis-Hill, 5ft 5ins 9st. BMI 20.
Laura Trott, 5ft 4ins, 8st 2lb. BMI 19.5.

I don't think carrying muscle is really the issue for most people with a BMI of 30, or even 25. It's easy to convince yourself otherwise - as I said upthread, I did, for a long time.

And BMI has a very broad range. The upper end of a "healthy" BMI is 11st for someone of my height, the lower end less than 8st. Is it so difficult to believe that, ideally, most women of my height should weigh within three stone of each other? That more than allows for differences in muscle mass. And I'm quite embarrassed to say I'm heavier than Jess E-H, despite carrying far less muscle than she does!

TaraCarter,
To make public transpirt work.... you need to first rebuild the entire road network... A bus is ferociously inefficient and time wasteful if you have to drive into a housing estate and drive out by the same road. Most housing estates and industrial estates are dead end roads.

I had a look at the stats of the most muscular women I could think of

Look at weight lifters and "throwers" who will me more muscular.

I said elsewherthough, if people can't tell the difference between an olympic athlete and someone who is fat, there is no hope. No one is going to look at the BMI of an athlete, the look at the person and say "you're obese"

Bluegalloo that poem was written about marginalised people being taken to concentration camps and killed.

Quite. As a member of an ethnic minority that is currently politically marginalized in this country, I actually feel quite sick that you'd quote this poem. Obesity is either an illness or a choice (I'm far from qualified to say which and to what degree). A person's ethnicity is neither.

Fucking over people without a car who get their weekly shop on a bus and have to carry it all the way home

Get a trolley. I remember shopping within mother and we used to walk down and up the steep high street filling the trolley and then walk phone. People are lazier now (and I include myself in this statement).

Of course this doesn't apply to the elderly or disabled.

With my mother. Not within her.

if people can't tell the difference between an olympic athlete and someone who is fat, there is no hope

Exactly, Soup. Yet that is the argument trotted out very time. "BMI is nonsense because it flags up some athletes as obese."
Well, are you an athlete? No.

And as my very unscientific and quick look at athletes' BMIs shows, most muscular female athletes will fall into the "normal" ranges anyway. It'll only be the weight lifters and shot putters etc that don't. Ie a tiny proportion of the most muscular women.

To be honest, most of what I've read suggests the biggest risks are for clinically morbidly obese patients which according the NHS page is BMI 40+

This is what I thought too doggity and that's my point: if this cutoff point is to be 30 not 40, there should have to be robust evidence. It doesn't appear that there is, and even from the clinicians in this thread all I've seen is generalisations.

I'm guessing the justification there would be that the person who loses weight has shown themselves to be motivated and willing to work for the op and its benefits. They may then be more likely to engage with physio, exercise and diet post-op whereas the smaller person who has lost no weight appears to be unmotivated and now willing to play their part in improving their own health

None of which would make any difference if the problem is that the person's BMI is too high for the operation to be safe at the point of surgery, though. Which is what we're being told.

Thanks for the explanation about the visceral fat lougle but I notice you used the word 'potentially'. It would still appear, from what you've said, that the 10% rule could leave us in a position where someone who's lost 10% of their body weight is at more risk than someone who hasn't yet is still given the surgery. It's hard to imagine what the clinical justification for that would be. Also while I didn't care for the use of that poem either, there aren't more obese than non-obese people in society. That's just not true.

I wonder whose turn it will be to be judged tomorrow

There are some abhorrent people out there who need to judge and scorn others in a pathetic attempt to feel better. Unless someone has personally offended you why be so stuck up, nasty and wapish about them? Do so many people really go through their real lives hating on fat people? "oh theyre in the hospital queue before me" etc how the fuck do you know? & who says slim and skinny people who are ill haven't done something to cause their own illness, or does that only come into play when someone is fat? What do you do, side-eye people in the waiting room as they're fat and shouldnt be there?

I agree obesity is an issue to some extent but so many things deemed as issues here are to do with looks and vanity - so people stick their beaks into how big a person is, how much they eat, how they look.

The myriad of ways in which people strive to appear smugly perfect is crazy, maybe its a media thing encouraging self-absorption or narcissism that was always here but is more noticeable now they've got a platform. My neighbour has always been slim, worked on N Rail for years, she's been off work with a trapped nerve in her leg and is gaining weight steadily

There's probably some chump sat next to her and others like her in hospital reception area, looking down their noses as if they're medically qualified to know why someone is bigger than they should be

If health care was entirely in the hands of working class people we'd be fucked, because working class snobs would have a field day creating hierarchies, and revelling in "you can have treatment but you can't"

Nasty

most muscular female athletes will fall into the "normal" ranges anyway
yes, muscle is almost twice as dense as fat so if we compare 2 bodies of the same volume the one with more muscle will be heavier.
However no matter how much a person eats and trains and even if they are genetically predisposed to muscularity there is a fairly low limit to the level of muscularity which can be achieved (without the use of PEDs)

Not so fat, humans can store an enormous amount of fat tissue, so your high bmi might be in part due to a higher than average amount of muscle but most of it will be due to excess fat

Loads of people bring their medical complaints on themselves, though, so why single out fat people? How about people who drive too fast and have an accident, people into adventurous sports (they are thin so it's OK), drinkers, smokers, drug addicts, people who take on too much and stress themselves out and make themselves ill etc, etc.

I agree with this and I am overweight (probably in the obese range) , and an ex heavy smoker.
There is no excuse for smoking nowadays. None whatsoever.
As for obesity, yes we live in an obesogenic society but for the vast majority it comes down to eating too much, normally crap food, vs not exercising enough.
I'm lucky enough to be healthy, but I know my good luck isn't going to last for ever, and it's up to me, no one else.

MistressDeeCee
I think there are a lot more people out there that think obesity is a massive problem but don't spend their days harshly judging other people.

If I see someone who is obese I don't judge them as I have no idea why they are that way however I believe that there are a lot of people who need to loose weight and who would feel a lot better if they did.

I'm not medically trained but I'd bet that the vast majority of people with a BMI over 30 are overweight and would benefit from loosing weight.

For most people loosing weight is a simple way to massively improve their health. No one has said it's easy.

Loads of people bring their medical complaints on themselves, though, so why single out fat people?

I wonder if it's because there are so many, it's getting worse, reluctance to accept responsibility for it's becoming more entrenched and we're told that the costs are already crippling?

I'm no statistician, but when HCPs say that overweight folk as a group cost more than any other subset of people, I'm inclined to believe them. Also, for most but not all, this particular solution is a simple one: stop stuffing yourself with too much food (as I know only too well, having once been a fatty myself )