Posts Tagged ‘Obesity’

NHS sees ninefold increase in bariatric surgery

The Guardian - 30th August 2010 9:29 am

The NHS has seen a ninefold rise in five years in the number of surgical procedures performed on obese patients to try to reduce their weight.

The figures illustrate the challenge the government faces in trying to tackle the problem of obesity. In 2008-09, the NHS carried out 4,246 weight loss operations, including stomach stapling and fitting gastric bands, compared with 480 procedures in 2003-04, according to the NHS Information Centre.

Of the operations performed in 2008-09, 42 involved full or partial removal of the stomach; 1,378 involved fitting a gastric band to make the stomach smaller; 504 involved stomach stapling; 2,210 involved a gastric bypass; and 124 inserting a “bubble” in the stomach to fill it up. Patients may have undergone more than one procedure in the same operation. The upward trend in the data suggests the figures for 2010 could be higher.

Read more at The Guardian.

Telling people they’re fat won’t help

By Sarah Burnett-Moore - 11th August 2010 10:16 am

One of the non-paying jobs on Planet Sarah is that I do some broadcasting.

Most often this takes the form of a rather arid phone-in where I tend to say “obviously I can’t make a diagnosis over the phone, go and see your GP, blah dee blah…”.

The only amusing side of this kind of show is that someone will often ring in wanting help on a rash, which makes for terrible radio. The funniest call I ever got was from a woman, who wanted advice about whether a specific type of martial art would be good for her daughter. Apparently the local dojo offered something called ‘gangbang’. But I digress.

Occasionally I get to take part in a two hour phone-in, where we debate the hot topics of the week. I usually do something political, a piece on a celebrity buffoon like Cheryl Needy (thank you, Curtis Walker - stealing material works both ways mate!), and a medical story.

Enter the figure of ‘top GP’ Professor Steve Field, who has urged us to be more blunt with our patients when discussing their unhealthy lifestyles.

Aside from the fact that most ‘top doctors’ have precious little time for real patients, a quick google image search revealed that Prof Field could do with taking a bit of his own advice.

I imagined a typical encounter in Prof Field’s surgery.

Patient: “Hello doc.”

Prof: “Good morning you giant lard-arse, I see your gluttonous kids have waddled in behind you. I’m reporting you to social services for eating a packet of crisps in front of them. That’s child abuse that is.”

Patient, shocked: “Well, doc, do you have any advice?”

Prof: “Yes, M&S are now doing a plus size range for toddlers.”

It’s a battle for hearts and minds as Tony B Liar always used to say, and I’m not sure that insulting your patients works any better than it does with Afghans. The studio debate soon turned to whether obese was a less offensive term than fat. Doctor in the studio - obese more rude, stand-up comedian - less rude, which probably tells you something about the different way we use language.

One caller rang in to say that she didn’t think we should shame our patients, but she didn’t believe in sugar-coating. Her words, which is good as I know that sugar coating makes you fat.

I know how to save public money

By Katherine Teale - 12th July 2010 11:47 am

So, two months into the new age of austerity, how is it panning out for you?

Here, (what with the pay freeze and my husband’s pending redundancy), we’re struggling  a bit, as even severe efficiency savings - such as restricted visits to Costa and breaking my Boden shopping habit - aren’t going to produce the required budget reduction…

I think we’re looking at losing front-line services, particularly around the cleaning and gardening departments.

Fortunately, there has been plenty of material to take my mind of the financial gloom. I’m particularly concentrating on:

1.  Impending death by dehydration due to the fact that we haven’t seen one drop of rain in Manchester for at least 10 days - which hasn’t happened, apparently, since 1896.

2. An email landing in my inbox from the Prime Minister asking for ideas on how to save money in the public services. Fortunately I do have a cracking idea, which I sent back to him yesterday. I’m still waiting for the White Paper to follow. My idea is this (actually, it’s not my idea, because they’re already doing it in Denmark, but perhaps they don’t teach Danish at Eton): the public finances are in crisis and desperate times call for desperate measures so let’s admit that the country can no longer afford obesity.

Forget the tired old arguments about personal choices, individual responsibility, etc, and stick to pure economics. The fact is we can no longer afford to continue paying for the consequences. We’ve tried public education, we’ve tried self-regulation of the food industry, and the result is exponentially increasing obesity rates and an unsustainable burden on the NHS. As Einstein once pointed out - a sign of insanity is to go on doing the same thing, and expect different results.

The government’s recent proposal to reduce regulation and force food companies to spend a tiny proportion of their vast profits on public health advertising must surely represent the most pathetic example of this insanity. Instead, let’s try something new which is in keeping with the desperate times we find ourselves in: tax fat-filled and sugar-laden food and drink an extra 25%, and pay this to the NHS so that the food companies are at last forced to share in the consequences of their actions.

Why is this any more unthinkable than slashing 40% from the police or education budget, as has been proposed last week? Why is it more unthinkable than cutting pensions and pay in the public sector, or scrapping replacing crumbling school buildings?

I’m not holding my breath. Anyone else replied to Mr Cameron yet?

Obesity drug licence suspended in Europe

Pulse - 23rd January 2010 5:52 pm

The obesity drug sibutramine has had its licence suspended by the European authorities due to concerns over an increased risk of cardiovascular events with the treatment.

The Medicines and Healthcare products Regulatory Agency announced that a European-wide review had concluded the risk of heart attacks and strokes from sibutramine (Reductil) outweighs the benefit gained from weight loss.

NHS data show GPs issued over 330,000 prescriptions for sibutramine in 2008, but GPs have been advised not to issue any new prescriptions for sibutramine and to review the treatment of any patients taking the drug.

Both the European Medicines Agency and the US Food and Drug Administration announced reviews into sibutramine last December after a study found an excess of serious cardiovascular events in high-risk patients on the treatment.

Read more at Pulse.

Postcode rationing of bariatric surgery revealed

By Mike Broad - 10:36 am

Access to bariatric surgery is “inconsistent, unethical and completely dependent on geographical location”, surgeons claimed at a conference of UK bariatric surgeons.

A survey of UK bariatric surgeons for the conference revealed that two thirds of surgeons said patients who are eligible under NICE guidelines are refused surgery in their centres.

It also revealed that the criteria for surgery vary dramatically depending on geographical location and within the same Strategic Health Authorities. 

Some centres are treating patients with referrals from multiple PCTs with different eligibility criteria. Some patients with a BMI of 60+ are being refused surgery in the same hospital where others with much lower BMIs are being treated. Some PCTs, the survey reveals, are refusing to commission any obesity surgery altogether.

The surgeons are calling for greater consistency and transparency across the NHS so that patients are clear about what they are entitled to and doctors can treat all patients equally.

Mr Peter Sedman, bariatric surgeon and council member of the Association of Laparoscopic Surgeons, said:  “There is absolutely no doubt that some patients more needy of surgical treatment than others are being denied it. I will treat the patient, my hospital will offer the service, but unless the patient moves house they will not be referred and if they are the treatment is subsequently blocked.”

According to the NHS Constitution, published in 2009, morbidly obese patients - those with a BMI of 40 or more - have a legal right to be properly assessed for weight loss surgery under guidelines set out by NICE.

One million people in the UK meet the NICE criteria with around 240,000 wanting surgery yet only 4,300 NHS weight-loss operations were carried out last year. Consequently the delay in treating these patients is draining NHS resources, with obesity associated healthcare costs estimated at £7.2billion per annum.

Surgeons claim there is incontestable evidence that surgery is both cost-effective - with surgery costs recouped within three years as obesity associated costs are eliminated - and the only proven successful method of treating the morbidly obese.

Bariatric surgeon and the Royal College of Surgeons’ director of education, Professor Mike Larvin, said: “NICE guidelines are meant to signal the end of postcode lotteries, yet local commissioning groups are choosing not to deliver on obesity surgery. In many regions the threshold criteria are being raised to save money in the short term meaning patients are being denied life-saving and cost effective treatments and effectively encouraged to eat more in order to gain a more risky operation further down the line.”

Surgeons are calling for the Department of Health to invest in a long term strategy to ensure that all patients have equal access to treatment delivered by experienced multidisciplinary teams working out of properly equipped centres that can offer a full specialist assessment, an appropriate treatment and provide safe long-term follow up and emergency re-admission. 

Child obesity is “levelling off” new data shows

BBC Health - 3rd November 2009 10:55 am

Forecasts of a huge rise in obesity among children in England have been significantly downgraded following a new analysis of data.

The National Heart Forum found evidence that the rate of increase in childhood obesity may be starting to slow.

Its figures suggest that by 2020 the proportion of boys aged 2-11 who will be overweight or obese will be 30% - not 42% as previously predicted.

For girls of the same age the revised prediction is now 27% - down from 48%.

The revised predictions also indicate a big drop in the number of overweight and obese young people aged 12-19.

They represent the first sign of encouraging news for decades, as obesity rates have been rising in England - as in most developed nations - since the 1970s.

A similar trend has been recorded in several other countries, including the US, France and Denmark.

There are currently 1.5 million children in England who are overweight or obese - leaving them at increased risk of health problems such as type 2 diabetes, cancer and heart disease.

Read more at BBC Health

Sympathy runs out for world’s fattest man

By Sarah Burnett-Moore - 21st October 2009 1:20 pm

Seventy stone is a lot. In new money, it’s 445kg, or the equivalent of 1,780 packs of lard. If you put ‘what weighs 445kg’ into a search engine, you get the following answers: a fourteen hand racehorse in tip top condition, a marble slab that nearly killed a construction worker in Canada, a fully grown musk ox and a fat bloke in Ipswich.

At that weight the ox can run at a speed of 37 miles an hour, but Mr Ipswich hasn’t even got out of bed for the past eight years.

The last time he left the house, to go to his local hospital, they removed a window, and got him out with a fork lift truck. Now he needs to be transferred to Chichester for a gastric band. He’ll be winched out the window frame, and placed in a specially adapted ambulance, at a cost of £90,000.

You may be wondering: What’s wrong with a removal truck? And why is there no bariatric surgery centre closer to home? But the real question is, not how did he get so fat, but how did he stay so fat?

I had a patient recently with a BMI of 52, small potatoes compared to this chap, but she was also bedbound. After retrieving my ultrasound probe, and indeed entire arm, from the depths of the folds of fat, I thought: “Hang on. Who’s bringing her food?”

It turns out the Suffolk sperm whale - who’s on benefits and been getting fat at our expense - had a secret accomplice. His dear old mum. For the last 2,922 days, she brought him 21,000 calories of nosh a day. That’s over 61 million calories. Which is 266,791 Mars bars, including 3,201kg of fat.

I can’t even imagine what you would have to eat in the space of a day to get to that calorific total, but it’s more than seven times normal. And yet this frail, little old lady (I picture her miniscule, bird-like) continued stuffing god knows what into her growing little lamb.

Not any more. She popped her clogs six weeks ago, and since then it has taken two carers to look after him, and draw attention to his plight.

When Winnie the Pooh got so fat on honey that he got stuck in the doorway to Rabbit’s house, his friends were sensible enough to starve him until he lost enough weight to escape. They didn’t give him even more honey. Now if small, stuffed, and indeed imaginary, farm animals have that much common sense, why don’t we.

It has got to be cheaper to set up a care unit in his own home, and take advantage of his helplessness to support him through some initial weight loss. I’d be surprised if there are even laparoscopic tools long enough to get through the layers of blubber to put the band in.

It might be useful to install a fatcam, so his predicament is available on the web, as a lesson to us all. We could then send messages of support on You Tube as we watch him shrink before our very eyes.

I’m sure one of the satellite channels could make a compelling 24/7 reality show, Really, Really, Really Big Brother, with a natty Geordie voice over. “Day 1,493 and Mr Ipswich can finally wipe his own bum.”

“Obesity is an ever expanding problem,” says lazy journalist

By Mike Broad - 5th August 2009 5:29 pm

What I love about the psyche of many obese people is that someone else is nearly always to blame for their predicament. It couldn’t possibly be because they eat too much and don’t do enough exercise. 

Unfortunately, the basic premise that it’s someone else’s fault is also keeping too many health journalists and medical researchers in lattes and digestive biscuits.  

A quick glance at recent headlines suggests it’s the “influential” obese which are causing all the problems. Prof Michael McMahon says James Corden, Beth Ditto and even housewife favourite Eamonn Holmes are at fault. They’re making “dangerous” weight gain appear normal.

This week, it’s porky teenagers who are copping it. Earth shattering research suggests that adolescents with fat friends also tend to put weight on.

Fortunately, we’ve got the National Obesity Forum’s Tam Fry to tell us what to do with our obese friend. “You do not stop seeing people because they are fat but you might be able to influence them into leading a healthier lifestyle,” he said. Phew, thanks Tam!

Healthier lifestyle is high up the agenda in the US with President Obama coming over all Jamie’s Dinners by encouraging schools to introduce healthier lunches and relevant education. Pucker! The Onion, as usual, makes a weighty contribution to the debate. 

“If a fat person falls in the woods, do the trees laugh?” It’s a joke but, importantly, not one that should be told by a doctor in front of a patient. Or indeed by anyone, including me. The laughter police, otherwise known as medical ethicists, are on the case“Humorous but cynical comments about obese patients perpetuate the belief that obese people are entirely to blame for their predicament, ignoring environmental and biological factors. This prejudicial belief can lead, even subconsciously, to a lower standard of medical care,” they say (after having cracked some quite funny fat jokes).

That’s me told. Next week: short people, featuring an interview with Randy Newman.