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Weight and the NHS - Ed's journal
sobrique
sobrique
Weight and the NHS
So what's hit the news this morning (well, and yesterday - I was probably going to waffle about it then as well) is weight. NHS 'inconsistent' on obesity ops about Gastric bypasses on the NHS.

Now, there's a bit of a waffle waffle about why it's a problem, why it might actually be inconsistent. The on that seems to have been missed is what is - in my opinion - probably the cause.

Prejudice.

I'm not going to say everyone has the problem, but it's definitely something I have run into - the assumption that 'overweight' correlates with stupid and lazy. That because you don't have a problem maintaining your waistline at 32 inches, anyone who does, is by definition, a lazy slob who does it to themselves.
What's worse, is I actually think that those in the medical profession do get caught out by the same thing, perhaps even a little more _because_ of their understanding of the human body. Y'know, a slight twinge of actual contempt that someone could 'let themselves live like that'.

What's worse, is that in some cases, it might actually be true - being overweight _is_ a result of consuming more calories than you burn. I guarantee you though, that no one is overweight by choice - at very best they're saying they don't care. But so what? EVEN if it were true. Even if EVERY SINGLE PERSON who's ever had a BMI over 25 _was_ lazy and stupid... so what? Do you really think bullying them about it is going to fix anything? Because it's not.
I think as a society we all benefit from everyone being fit, healthy and active. I think that if we stigmatize, bully and prejudge everyone who's gained a few kilos, we don't achieve that, any more than we 'cure' people of mental illness by flogging them.

It just doesn't work. It's a wide spread attitude problem, and it's something that _needs_ to change - don't marginalize the people who are overweight, any more than you'd marginalize the people who are diabetic or arthritic. Recognise that it's a problem, and one that can be dealt with, and is actually fairly easy to deal with - provided you give it the support it needs and the relevant background information.
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sobrique From: sobrique Date: January 22nd, 2010 11:32 am (UTC) (Link)
I'd find it hard to describe how I feel on that one. I mean, it's certainly a complicated subject, and something that can have a whole lot of different root causes.
Eating disorder/depression is one, but ... well, yes. I think the more common is just something rather mundane - that people are a bit different, and that some people eat just a little more on average - the 'feedback mechanism' of 'Hungry -> Eat -> Full' isn't quite correctly calibrated for some reason, and gradually, over time, that means weight gain.

But similarly, it're really very simple to fix - it's like being intolerant to a food group - you accept that it's a problem, and you just be a little more careful in future. It's not really a big deal that someone reacts badly to seafood, they just don't eat seafood any more.

So... hmm yeah. I think I'd come down that in the majority of cases 'weight gain' is a physical condition - that survival trait that let us 'store' energy for times of famine, just doesn't work so well in these days of relative food abundance.

There are still eating disorders, and there's definitely a mental feedback/addiction loop that can kick in (comfort eating -> gain weight -> feel guilty) but ... generally, I think it's actually far more simple than the 'industry' would give it credit. Not that 'simple' means 'easy' or anything mind - it's just there's far more money to be made telling people that health is really complicated and convoluted, and stigmatizing 'fatties' than there is just treating it as the fairly straightforward, but ongoing dietary constraint that it is.
forest_rose From: forest_rose Date: January 22nd, 2010 02:50 pm (UTC) (Link)
I think the attitude to this in medicine in general is getting better, although it takes time. And hey, some of us medics aren't as skinny as we used to be either! xxx
sobrique From: sobrique Date: January 22nd, 2010 03:55 pm (UTC) (Link)
Yeah, I daresay it is - my contact with the medical profession is sporadic and infrequent to say the least. I'm just concious that the last few times I've been to the doctor (one a medical, one going to see my GP about something) I've kind of caught a 'well have you tried not being so fat' sort of vibe.

I've even had someone berating me in the gym for being overweight, which I thought was a bit rich.

*shrug*. It doesn't get any easier, for all I've been at it for a year now - I reckon I'm quite a bit fitter/stronger than 'average' but I'm still on the wrong side of 'overweight'.
From: (Anonymous) Date: January 22nd, 2010 06:42 pm (UTC) (Link)
I personally think the reason the NHS are inconsistent is that modern medicine is expensive, complicated and there are competing priorities.

Surgery is also dangerous, and it has been proved that surgery on a person who is significantly overweight is more so. Also, in a significant number of cases surgery on those who are overweight to reduce their weight is not that effective as it doesn't address the reasons for gaining weight in the first place.

We need to be smarter about looking after ourselves and encouraged to do so. I do think doctors should be clear when weight is making a medical condition worse, or stopping it improving. I don't think anyone should be stopped treatment because of this, but addressing the weight issues should be part of the treatment (and no, I don't mean just telling them to eat less, it needs to be much more supportive than that. you wouldn't tell a depressed person just to cheer up).

No-one should ever be berated for exercising (unless they are a gym freak who is doing too much). That is beyond dumb.

And personally I disagree that it is mostly physical. Although it is entirely speculation my suspicion is that it is far more to do with how people think about food. Levels of obesity around the world are not correlated to food abundance. Ours are quite different from France for example.

Elaine
csi_ellie From: csi_ellie Date: January 26th, 2010 10:28 pm (UTC) (Link)
I say - FATTIES UNITE! IF THE WORLD CAN'T ACCEPT ME, WITH MY PROBLEMS, AS I AM, I WILL EAT THEM ONE BY ONE!!
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