this is apalling (NHS to refuse surgery to the obese and smokers)

[AlterEgo]

Not everyone has self-control

Then why should we feel sorry for them?

Boo hoo, all those poor overweight people, what victims they are. It's not their fault, etc, etc.

 

[richw]

From my experiences in the NHS it sounds eminently believable.



I'd been working in the NHS for about twenty years before I heard the word 'bariatric'. Whilst these conditions are there, they are not exactly common. Those of us who are in late middle age will remember a time when it was rare or unusual to see overweight people, especially amongst the young. In each year at school in the 1960's there was, on average, probably one overweight boy or girl in each year. The boy was always nicknamed 'Tank' and generally would play as a prop forward. They weren't unhealthy. I have a complete school photograph from 1969 - only one pupil looks significantly overweight from a total of about 400. I cannot believe that would be the same now.

Even at my age I only remember one large lad, again he played prop for the school rugby team. I was probably one of the last year groups before play stations and PCs became affordable. We spent most of our days running about playing sport. I gather teenage rugby teams are really struggling for numbers these days. In my youth even a small town team we had a squad of 20+ week in week out.

No I'm not that old, 28 this year!

 

[DarloRich]

Then why should we feel sorry for them?

Boo hoo, all those poor overweight people, what victims they are. It's not their fault, etc, etc.

what about smokers or drinkers or paragliders or those with exotic sexual tastes?

There is a vast increase in the treatment of sexual transmitted diseases in this country. Should people who have unsafe sex be bared treatment? Could you spell out which groups of people is it OK to treat?

 

[TheKnightWho]

Then why should we feel sorry for them?

Boo hoo, all those poor overweight people, what victims they are. It's not their fault, etc, etc.

So we should just go "f*** you" to people who are, by definition, unable to help themselves?

Yeah, I'm seeing a pretty major hole in that logic.
--- old post above --- --- new post below ---

Excuses, excuses. Always excuses.

They're called reasons. I know some of us need to feel superior to others to cope with getting through life, but frankly all I'm seeing is a bunch of people looking for others to target.

If you haven't grown up to the point where you understand that not everyone is exactly the same as you, I really don't know what to say. Frankly, seeing depression and malnutrition dismissed as "excuses" is just insulting.

 

[AlterEgo]

So we should just go "f*** you" to people who are, by definition, unable to help themselves?

Yeah, I'm seeing a pretty major hole in that logic.
--- old post above --- --- new post below ---


They're called reasons. I know some of us need to feel superior to others to cope with getting through life, but frankly all I'm seeing is a bunch of people looking for others to target.

No, we shouldn't go "eff you", we should extend help to people in those situations. Ultimately, it is willpower that makes people lose weight regardless of their circumstances.

Implying that people are victims of their circumstances, feeling sorry for them or making excuses for them will not help them lose weight.

Funny you assert that they are called "reasons", they were excuses earlier (which implies an avoidance or lessening of fault/culpability).

Another poster upthread talked of a class picture of 1969 where almost nobody was overweight. We know that obesity is a growing problem. We also know that poor self esteem and depression etc might be growing problems, but this is unlikely - more likely is the recognition that these issues are part of a medical problem. Both my parents, as children, were extremely poor, my father particularly so, to the extent that he never had a school photo. But photos of their neighbours or their contemporaries show no obesity epidemic, despite not having a pot to **** in.

It is fat people's fault they are fat, and only they are able to lose weight. We should be frank, honest and pragmatic about that.
--- old post above --- --- new post below ---

what about smokers or drinkers or paragliders or those with exotic sexual tastes?

There is a vast increase in the treatment of sexual transmitted diseases in this country. Should people who have unsafe sex be bared treatment? Could you spell out which groups of people is it OK to treat?

Where have I suggested they shouldn't receive treatment? I have little sympathy with people who actively put their own health in danger for no good reason but I would not suggest they shouldn't receive treatment.

The post and news article it was discussing was discussing elective surgery.

 

[fowler9]

Alright so we get that no one has any sympathy for drinkers, smokers, over eaters and anyone who makes poor life choices (Someone pointed out that these were choices ignoring the fact that they could be caused by mental illness). Can we move on to Autism? Almost every complaint I deal with in work involves someone with an Autistic child who needs the kitchen window lock or the garden fence fixing quicker. Surely many of these Autistic kids (Genuine or otherwise) had the MMR jab, a lifestyle choice.

I know I am being ridiculous now but pretty much what anyone needs medical treatment for is as a result of a lifestyle choice if we look in to it deeply enough. Lets charge everyone or stop being such tight gets.

One of my favourite bands are called Death (Oddly enough). The vocalist Chuck Schuldiner died of a brain tumour after treatment was stopped when the money ran out from the families insurance. There is no way of proving his cancer was caused by his lifestyle choices. He died because of lack of money.

 

[Tetchytyke]

I have a complete school photograph from 1969 - only one pupil looks significantly overweight from a total of about 400. I cannot believe that would be the same now.

It's true, but not because people are eating more. Calorie intake among children today is lower than it was in 1955, as is fat intake. But- and this is where the problem lies- calorie output has dropped even further.

The issue is inactivity in a lot of children. They are driven to school, where all the playing fields have been sold off, and they're driven home, where they then play on computers. It's the same in adulthood. You drive to work and you drive home again, and even an hour at the gym twice a week isn't going to compensate for that.

I've put weight on since moving back north from London. I'm eating slightly less, but in London I was probably walking five miles a day, and up here- living and working right near the Metro- I don't. And I'm probably doing more exercise elsewhere (gym, cycling) than I was there.

As for activity levels, I can only say that the PE I received as school put me off exercise and sport until well into my mid-20s. As I was slow and couldn't catch a ball (defective sight in one eye) I was essentially routinely humilated. It took me a long time to get back to exercise, and even now I prefer solitary exercise, especially the bike. How we teach PE and exercise has a huge part to play in how active children are, and in many schools we seem to do nothing but teach kids that you shouldn't bother unless you're the next Beckham or Dallaglio.
--- old post above --- --- new post below ---

There is a vast increase in the treatment of sexual transmitted diseases in this country. Should people who have unsafe sex be bared treatment? Could you spell out which groups of people is it OK to treat?

I resent paying money to scrape some mid-life crisis bloke off the road and put him back together when he's been riding his motorbike at 90mph on the A65. Or the sort of idiots who go climbing Ben Nevis in trainers then need treatment for two broken legs and hypothermia. Shall we just leave them to it? They brought it on themselves, after all.

If the position was "we won't operate till you're thinner, so we've prescribed you a dietician and a gym membership" then I'd be all in favour of it. But it isn't. It's "sod off and lose weight or we won't fix your hip". Quite how someone is supposed to do enough exercise to lose weight when their hip doesn't work doesn't seem to have been considered.

 

[DarloRich]

If the position was "we won't operate till you're thinner, so we've prescribed you a dietician and a gym membership" then I'd be all in favour of it. But it isn't. It's "sod off and lose weight or we won't fix your hip". Quite how someone is supposed to do enough exercise to lose weight when their hip doesn't work doesn't seem to have been considered.

I agree - I also wonder if the whole life treatment cost has been considered. The surgery now may reduce the burden on the NHS later
--- old post above --- --- new post below ---

Where have I suggested they shouldn't receive treatment? I have little sympathy with people who actively put their own health in danger for no good reason but I would not suggest they shouldn't receive treatment.

The post and news article it was discussing was discussing elective surgery.

Whilst elective surgery is one thing the concern is the thin end of the wedge argument this starts.

 

[NSEFAN]

It is fat people's fault they are fat, and only they are able to lose weight. We should be frank, honest and pragmatic about that.

In that case, how do we properly motivate them to lose weight? If the problem is in the mind then having a go at people will hardly make them better. It'd be like telling a person with depression to "just stop feeling so sad".

 

[richw]

In that case, how do we properly motivate them to lose weight? If the problem is in the mind then having a go at people will hardly make them better. It'd be like telling a person with depression to "just stop feeling so sad".

If it's in the head, having a go at them could well make it worse. Encouragement?

 

[PHILIPE]

Who do you believe ? Recently have heard one so-called expert say that sugar was responsible for obesity and another so-called expert saying that it isn't sugar but fat that is to blame. I thought it was dependent on the calorie intake.

 

[Tetchytyke]

In that case, how do we properly motivate them to lose weight? If the problem is in the mind then having a go at people will hardly make them better. It'd be like telling a person with depression to "just stop feeling so sad".

Disordered eating and mental health issues are fairly frequently linked. People whose disordered eating is about not eating enough seem to get sympathy and treatment. People whose disordered eating is about eating too much don't.

I don't think many people wake up deciding they love being eighteen stone. I think a lot of people get bogged down in the feel crap, eat crap to feel better, feel crap, eat crap cycle. Talking about "fault" and "blame" isn't a solution and it is almost certainly a hindrance.

If comfort eating through sadness is their thing, and having a go at them for their weight makes them feel more sad, what do we think the outcome is going to be?

Who do you believe ? Recently have heard one so-called expert say that sugar was responsible for obesity and another so-called expert saying that it isn't sugar but fat that is to blame. I thought it was dependent on the calorie intake.

Calories in and calories out is the most basic way of looking at it. If you eat more than you burn then you put weight on. It doesn't matter if the extra calories are from cakes or apples, the same effect will apply. It's obviously easier to overeat on cake than apple, but that's by the by.

However we metabolise different calories in different ways. Carbohydrates that aren't burned fairly soon after consumption are converted into fat. Carbs that release slowly into the body are more likely to be burned up than carbs that release quickly. You also get the sugar rush from carbs that release quickly, as carbs are converted into sugars before being used, and that means you also get the sugar crash. And the sugar crash is what drives a lot of cravings.

Refined sugar and, in particular, glucose-fructose syrup, release very quickly into the body. They'll be converted into fat before you've a chance to use the energy.

 

[Bletchleyite]

As for activity levels, I can only say that the PE I received as school put me off exercise and sport until well into my mid-20s. As I was slow and couldn't catch a ball (defective sight in one eye) I was essentially routinely humilated.

I'm with you on that. Schools need to offer far more options than team sports, and they need to do it from a far earlier age. We had choices from year 10, and that was the point I started actually enjoying PE. I disliked rugby and cricket, because I can't throw and catch (though I'm better than I used to be, largely I think because of driving improving my coordination, but still pretty awful). I didn't mind athletics all that much, indeed I remember one of the teachers pushing me quite hard around the 1500m which I was pretty proud to finish - and indeed (not exceptionally fast) distance running is now one of my "things". But from year 10 we could play badminton (which strangely I'm not utterly terrible at despite being awful at most ball sports), or go to a local gym, or swim etc.

Too much school sport is about being fastest (I'm not), or the best at a ball sport (I'm also not) - but I can run a marathon (just) in a reasonable time (4:36 is my best so far), a half in a pretty consistent about-2-hours, and I'm trying a 50 mile ultra next month (scary!), and this despite being a couple of stone too heavy. If I'd been encouraged into distance running, cycling or rock climbing (which are what I do now) I imagine I'd have been a whole lot less of a podgy kid, and might have found it easier to keep weight off as an adult.

I resent paying money to scrape some mid-life crisis bloke off the road and put him back together when he's been riding his motorbike at 90mph on the A65.

You could, I suppose, lump all motor-vehicle-related medical costs onto motor vehicle insurance, as that's already there. At the moment there's only a small claimable amount, which the NHS often doesn't bother with.

Or the sort of idiots who go climbing Ben Nevis in trainers then need treatment for two broken legs and hypothermia.

The difficulty with that is that you would tend towards climbing insurance, which would no doubt *not* be taken out by the irresponsible people involved. And if TOCs can't manage to protect revenue on a closed system it's hardly as if you could practically make it a condition of accessing mountains in the UK.

If the position was "we won't operate till you're thinner, so we've prescribed you a dietician and a gym membership" then I'd be all in favour of it. But it isn't. It's "sod off and lose weight or we won't fix your hip". Quite how someone is supposed to do enough exercise to lose weight when their hip doesn't work doesn't seem to have been considered.

I do agree with your first point - the NHS is terrible at fixing what are essentially psychological issues, they are better at chucking out medications and fixing physically broken stuff. That really needs sorting, to a more proactive approach, and it might well be that switching to a European style mandatory social insurance system could be the only way to realistically achieve it by breaking down the monolith which otherwise acts in a rather supertanker-like manner in not changing course.

Regarding your second point, weight loss is mostly about restricting eating. Exercise is important and improves fitness and health, but it is surprisingly bad at making you lose weight - certainly moderate exercise (though if you can do it long[1], high-intensity exercise like running or very fast cycling is better - but this is irrelevant to those starting out).

[1] I did try it for a bit when I got into a silly competition with someone, but 10k running per day is enough for me to take a pound off every couple of weeks. It's also enough to destroy my knees and various other tendons around my feet, so I wouldn't recommend it as a sensible weight loss approach. I certainly couldn't do it for long. Most people couldn't do that at all; I'm only quoting it to demonstrate just how much exercise it actually takes if you do a sedentary job.

A Mars bar, just one, is 260 calories. To burn that off, you would need to walk for about an hour.

But most people who are very obese aren't very obese because they have a Mars bar on the train on the way home each day. It's because of chronic and continuous overeating.

A pound of fat is about 3500 calories. To burn that off, you'd have to do a *lot* of walking.

So a dietician would make a lot more sense.
--- old post above --- --- new post below ---

Who do you believe ? Recently have heard one so-called expert say that sugar was responsible for obesity and another so-called expert saying that it isn't sugar but fat that is to blame. I thought it was dependent on the calorie intake.

It is. Some types of food are more likely to be stored as fat and some more likely to up your metabolism a little to burn them, but if you eat fewer calories than you burn[1] you *will* lose weight, whatever the kinds of food that make up those calories.

[1] Complication: your metabolism can slow down when on a calorie controlled diet, so that figure is not static.

 

[Lankyline]

There are other consequences to the obesity problem, for example, the NHS has had to spend money on upgrading ambulances with tail lifts, replacing and upgrading patient transport, eg trollies, replace and/or upgrade hoists, chairs. Plus the financial impact of staff being off work due to "bad backs".

All I am doing is simply highlighting other consequences that obesity can cause, not placing blame.

And one last thing, I smoke and have done since I was 17, I have always led an active life and I am fully aware of the possible risks I may incur, so if you want to make comment on that, go for it, because I don't care, I've heard it all before.

 

[TheKnightWho]

Who do you believe ? Recently have heard one so-called expert say that sugar was responsible for obesity and another so-called expert saying that it isn't sugar but fat that is to blame. I thought it was dependent on the calorie intake.

Ah yes - when you hear a vastly oversimplified version of what the experts have said and they seem to contradict, it's obviously sensible to conclude that all experts have no idea what they're on about! This kind of arrogance is absolutely astounding, but sadly all too common at the moment.

If you hear something scientific that seems to not make much sense, you have 3 options:

1) All the experts are incompetent.

2) All the experts are in a giant conspiracy to deceive you.

3) The experts know something you don't.

Hint: it's option 3.

Sugar, fat and calorie intake are not 3 completely distinct things with nothing to link them. If you don't know that, you have absolutely no business casting doubt on people who've spent years studying this stuff.

 

[fowler9]

Ah yes - when you hear a vastly oversimplified version of what the experts have said and they seem to contradict, it's obviously sensible to conclude that all experts have no idea what they're on about! This kind of arrogance is absolutely astounding, but sadly all too common at the moment.

If you hear something scientific that seems to not make much sense, you have 3 options:

1) All the experts are incompetent.

2) All the experts are in a giant conspiracy to deceive you.

3) The experts know something you don't.

Hint: it's option 3.

Sugar, fat and calorie intake are not 3 completely distinct things with nothing to link them. If you don't know that, you have absolutely no business casting doubt on people who've spent years studying this stuff.

To be fair to him a lot of people get their info from the press and the press pick and choose who and what they quote so when we ask "Who do we trust" the answer is "Not the experts" just because of what they picked and chose. I suspect that most of us know a full English with cheese on toast as a side isn't great to eat every day for breakfast but the press keep pulling out stories about Power Lifters and saying "The specialists say eggs are alright now" with no form of context.

 

[LordCreed]

To be fair to him a lot of people get their info from the press and the press pick and choose who and what they quote so when we ask "Who do we trust" the answer is "Not the experts" just because of what they picked and chose.

And compounded by the fact that some newspapers would call someone an expert when they really aren't. Just because they've done a biology PhD doesn't necessary mean they've done anything dietary related.

 

[Tetchytyke]

And compounded by the fact that some newspapers would call someone an expert when they really aren't.

And compounded again by people calling themselves experts when they really aren't.

Dietitians can only register and call themselves dieticians with appropriate qualifications, and it is a protected name, meaning only qualified people can use the name. Calling yourself a dietitian without qualifications is an offence.

Nutritonists, on the other hand, have no such regulation: anyone can call themselves a nutritionist, and frequently do. As shown with "Doctor" Gillian McKeith, a woman whose PhD (in "holistic nutrition") was from a non-accredited US college and who has been so comprehensively debunked by Dr Ben Goldacre.

 

[Lankyline]

Ok then, should the NHS refuse to treat me because I smoke and have done since I was 17, yet I have cost them more money in sport related injuries (inc 6 operations), whilst willingly participating in sports that could be considered as a danger to my health, but are seen as "healthy" and therefore meet with approval because I am exercising.

Yet I have not cost the NHS a single penny in anything that could be linked to a smoking related health issue. Because smoking is seen as the root of all evil, I would suggest that wilful obesity, eg not genetic related, is a far bigger danger to health and has more far reaching financial consequences than smoking, not just in treatment but as I mentioned in a previous post, in new equipment etc etc.

I know the possible consequences of smoking in just the same way I know the dangers in crossing the road, both are a potential danger to my health, yet I make choices like this everyday that could have the same effects.

Frankly this is just another soundbite

 

[Xenophon PCDGS]

To be fair to him a lot of people get their info from the press and the press pick and choose who and what they quote so when we ask "Who do we trust" the answer is "Not the experts" just because of what they picked and chose. I suspect that most of us know a full English with cheese on toast as a side isn't great to eat every day for breakfast but the press keep pulling out stories about Power Lifters and saying "The specialists say eggs are alright now" with no form of context.

Are you old enough to remember the phrase used in an advertisement quite a few years ago...."Go to work on an egg"?

 

[Butts]

Are you old enough to remember the phrase used in an advertisement quite a few years ago...."Go to work on an egg"?

Or for Lankyline above.."You're never alone with a Strand"

 

[Lankyline]

Or for Lankyline above.."You're never alone with a Strand"

I've heard of "do the Strand" by Roxy music, but never a cigarette by that name, certainly not in Marlboro country

 

[Butts]

I've heard of "do the Strand" by Roxy music, but never a cigarette by that name, certainly not in Marlboro country

"Come to where the flavor is........"

You are probably to young to remember Cinema Advertising of Cigarettes..Silk Cut was one of the best with a load of "Zulus" dancing about praising the benefits of "The Mild Cigarette from the good old Benson and Hedges fag making company in the UK -England" - in suitably Black and White Minstrels type vocabulary. - that would blow the PC brigades minds.

If you do succumb to a fag induced illness don't feel guity about treatment you have paid through the nose in taxes to enjoy you tabs ( unless like me you buy them in Luxembourg )

 

[DynamicSpirit]

Who do you believe ? Recently have heard one so-called expert say that sugar was responsible for obesity and another so-called expert saying that it isn't sugar but fat that is to blame. I thought it was dependent on the calorie intake.

It's dependent on both total calorie intake and the form in which those calories are taken. It's not an either/or situation. You also have to remember that research and understanding of these issues is constantly developing, so advice will subtly (probably not dramatically) change over time.

It looks to me from your posts like you're getting information from sources such as newspapers - which almost invariably give you very simplistic, and often misleading, views of what the 'experts' are actually saying. I also notice from your posts that you seem (not unreasonably IMO) keen on people taking responsibility for their own actions. Might I suggest that you adopt that approach yourself - and take responsibility for getting a better understanding of health advice - by seeking out and reading some books that that might cover the issues in a more informed manner than newspapers, magazines and social media posts tend to do?

 

[Xenophon PCDGS]

Or for Lankyline above.."You're never alone with a Strand"

I was about 14 years old when this advert appeared on TV in 1959 and remember it being quite atmospheric, W,D. & H.O. Wills produced these cigarettes and the advert lasted for only a few years.

 

[meridian2]

And compounded again by people calling themselves experts when they really aren't.

Dietitians can only register and call themselves dieticians with appropriate qualifications, and it is a protected name, meaning only qualified people can use the name. Calling yourself a dietitian without qualifications is an offence.

Nutritonists, on the other hand, have no such regulation: anyone can call themselves a nutritionist, and frequently do. As shown with "Doctor" Gillian McKeith, a woman whose PhD (in "holistic nutrition") was from a non-accredited US college and who has been so comprehensively debunked by Dr Ben Goldacre.

Agreed, but I always put McKeith down as the nutrionist equivalent of Simon Cowell.