[Wysteria]

This link landed in my inbox this morning.

http://www.bbc.co.uk/news/health-10877140

Thought I would share

[bonnnie]

The author of this article is clearly a utilitarian - the best ethical decision comes from an analysis of what will benefit the most people. However, we live in a society that promotes deontological ethics - the opposite of the utilitarian standpoint. In our society, we create laws that apply to everyone because they are thought to be the best... for example, if you murder someone in order to save 5 other people, you are still - in most cases - thought of and tried as a murderer. Because murder is murder.

It is a popular christian principle to think that we cannot be the judge of how much value others contribute to the world. Only God can judge.

What really needs to happen, in my opinion, is reversing the effects of capitalism on our food (which makes our food really cheap and crappy, or 'more bang for the book).... I suppose capitalism would make one concession for another - leave food alone so that we can have healthier workers...... or we need to supply the demand for more bariatric surgeons (which is probably what will happen).

Maybe, in 50 years, one in three people will have had weight loss surgery. They will probably get really good at it, making it 'no big deal'. Maybe we will actually start having it after gaining only 30lbs, not 100. Interesting to think about....

[catherinef]

I read that article this morning, on my regular news-trawl, and I could not get past his repeated use of the word "deserving." It just enraged me. There is just so much contempt in his tone I can't get past it to even fairly evaluate what he's saying. I've had doctors like that, and they never helped a bit when it came to finally taking off my excess weight.

[Eliana]

What bothered me the very most was this paragraph:

What then should become of Doris? Physical activity is out of the question, dietary interventions won't scratch the surface, and most anti-obesity drugs have been removed from pharmacies.

I'm neither pro nor anti surgery, but if surgery isn't an option, how is it that "dietary interventions won't scratch the surface"? How can anyone say that? I think even the most obese of us who have tried everything would agree that if we could muster up what needs to be done, diet IS everything. The only way I can fathom that diet may not be helpful is in the case of food allergies such as my friend has. My friend is allergic to most fruits, vegetables, garlic and soy. That leaves her quite limited and she tends to eat junk. But even she would agree that if she deprived herself of foods she enjoyed and just stuck with basically chicken and cooked broccoli, she would lose weight. (Not that that's easy to do!! I feel so blessed that I love highly nutritious foods.)

The whole article was mind numbing to read, probably largely because of the blatant utilitarian perspective Bonnnie points out.

The caption under the picture reads "Surgery is needed before you get too fat"! I knew I was in for a bumpy ride when I read just that.

[goodforme]

Steaming!!!!!!!!!

There is something nauseating about some of the phrases in the article, most specifically that a man who is working-aged is "more deserving" of life-changing (possibly life-saving) surgery than a retirement-aged woman who smokes. Who is to say that based on age and gender alone, this man will go on to lead a productive life, make good choices, stay with his wife and help raise his children? What if he loses a boatload of weight, ditches the family, runs away to a balmy beach somewhere, and becomes "a drain?" Grrrrrr. . .

It could be argued that since healthcare is different across the pond, I'm looking from the wrong side of the fence, but let's leave playing God alone and start trying to equalize healthcare. . .

[kaplods]

I think to some degree, there's a legitimate point (or would be if the author wasn't such an *** about it). I think when resources are limited, some "triage" is necessary. If I only had one surgery "to give" I probably would lean toward giving the surgery to the person not who is most deserving, but for whom the surgery could have the most benefit (not only for the patient but for others, including the family). I would take into consideration the person's likelihood of compliance and success (there are a lot of good predictive tools and measures for this) and the impact to the family and even society. I would be more likely to give the surgery to a young, parent of small children.

These are some of the factors that go into deciding who gets organ transplants, so I don't see that there's a huge difference between that and wls.

However (and it's a big however), I think "palliative care" is a poor alternative. Preventive care would be a better idea (and less costly in the first place). Identifying at risk patients and intervening early seems a better idea. And the idea that behavior change (diet, exercise, even smoking) is essentially impossible seems extremely premature. We've never really given those options much of a chance, as most insurance and govt medical plans (I don't know if this is true in the UK) do not cover those types of intervention. Instead they (at best) give people a piece of paper telling them to stop smoking, start dieting and exercising with little assistance in doing so. No education, no support systems, no referrals to resources, little to no follow-up.

In the US at least, it seems unfortunate that wls is seen as the only "effective" weight management tool primarily because it's the only one that's seriously considered. If a person wants to lose weight through other means, they're entirely on their own. It's rare even for a doctor to suggest Weight Watchers or TOPS or other support groups.

To me, it seems that early intervention should be given more attention. I'm not saying that insurance or the government has to pay the entire cost of these services, but it would seem that if they're going to pay for wls, it would make sense to give some type of assistance or incentive for intermediate steps (even in the form of a tax break or a reimbursement plan if the person is able to maintain their changes for a specific amount of time - say 3 years).

I think there tends to be two responses from government the idea that the cost should be entirely bore by the individual, and the idea that money should be thrown at the problem.

When I went on disability, I was shocked by the medicare system. No one told us that there were ways we could save money and save the government money too. You get a set amount for drug coverage, but there's no guidelines for how drugs are chosen, or how much you pay for each (we discovered that the medications that Walgreens charged $30 to $200 for, other pharmacies might charge as little as $4). We also learned that Walgreens (not singling them out, other stores do it too) charges more for a drug (twice as much, in fact) if you have medicare or other medical insurance. If you have no insurance you get your meds at half cost.

Also, doctors tend to prescribe what they're familiar with (which tend to be the newest, and most expensive drugs). They (because they're human) often assume that newer is better, but some of the "improvements" are very small. For example, I discovered that one of the meds I was taking was an extended release. By taking two pills a day instead of one, I could save over $100 a month. If there were guidelines (at least for government programs) such as trying inexpensive drugs before, we could slash medical costs to an incredible degree.

I always assumed that there were good reasons my doctor didn't prescribe older medications (they couldn't be as good), but when I had to find a way to save money on medications, and my doctor switched me to as many of Walmart/Sam's Club $4 list - I found that all of my "new" $4 meds actually worked as good, and in many cases BETTER for me than the expensive medications (ranging from $30 to $200 per month for each medication). It makes absolutely no sense to me that my insurance company and then medicare were both willing to pay $200 per month for a medication - no questions asked, when a $4 med was available, and actually worked better than the $200 one (maybe for some people the $200 med would be the better choice, but shouldn't the $4 med be tried first, unless there's a good reason for it not to be. Shouldn't the patient at least be informed that there is a $4 option).

There seems to be only two (both flawed) perspectives from the political parties - "foot the bill and ask no questions" or "people should pay for their own medical care." Holding medical and insurance providers to standards that would save money without compromising health care, doesn't seem to be an option anyone is considering. When I see where and how the money is wasted, it just breaks my heart. So many more people could be helped, if the focus was on making health care more affordable. Drug companies would make less money, but only because patients would be more informed. But how can it be a bad thing for consumers to be better informed of their options and choices. Do drug companies have the right to make a profit on ignorance. What is the "downside" of informing patients that they have choices, and the cost of each choice including benefit/risk analysis.

[Justwant2Bhealthy]

Why are they so willing to pay out tens of thousands of dollars on risky WLS before even attempting to help people by other means -- a combination of counseling & therapeutic support (including meds if needed), plus nutritional & physio advice?

KAPLODS ~ I recall a suggestion you made in another thread some time back about A TEAM EFFORT , utilizing the resources we already have at our disposal ... doctors, psycho-therapists, dieticians and/or nutritionists, and physio-therapy or physical trainers.

I don't agree with his conclusion that WLS is permanent; it is not for many. I know several people personally who have had WLS and gained all the weight back a year or more after the surgery; no-one is keeping tabs after a year.

And, why does he say some people are more needy or deserving? Doris isn't needy? How can he say one is more deserving over another; they are BOTH overweight and for similar reasons! How come they mention Doris watching TV on the couch; the man probably does the same thing (don't most people?). He also said that the surgery was risky for Doris; it is risky for anyone.

This story was obviously biased becuz of the man's potential to earn $$$ down the road. Is that our criteria -- one's tax-paying potential? That is disgraceful ...

The major criteria should always be improvement to their health and quality of life! Isn't that what doctors are supposed to be doing? Saving and improving people's lives, however & whenever possible? Everyone's life!

PREVENTION ~ could save millions if not billions of dollars a year and has never been attempted yet. We have all been left on our own to try to find out the answers without any help. My doctors rarely mentioned my weight over the years; and when one did, he didn't have any ideas for me.

The doctor I have now used to believe that WLS was the only thing that offered a viable a weight-control solution, even though I have lost over 85 lbs and kept it off for 5 years. He wasn't patient enuff to wait for me to get the rest off on my own; and was bugging me to get WLS to take the rest off. I said, "NO -- this is working; you don't need to fix what isn't broken with risky WLS!"

After discussing WLS procedures with him, I discovered that he really didn't know anything about it. He had a bunch of erroneous ideas about WLS -- ie he thought it was permanent and that you don't ever have to diet. He had never researched it himself, but got me to do that on the net and then I explained it to him.

Why do they wait until someone is obese or very obese (over 300 lbs) to even mention it to their patients? I don't think there is enough training for doctors about this subject. I think that all options should be covered by insurance plans. We won't know if they work until we try them all; maybe a combo-approach is the answer (and it's the one they haven't tried). I noticed that in Canada they only bring up counseling if you get WLS.

I think help should be offered to all patients all the time, esp if you see a parent come in with an overweight child. Help the parents get nutritional counseling so they can help their family be healthier. Explain to them what will happen to their health down the road; in detail ... and yes, scare the heck out of them if you have to. It worked with ciggies ...

In Canada, we used this tactic and millions of people have quit smoking. Most people I know now don't smoke (they have quit); it used to be the opposite 20 years ago. Adding taxes to them also helped too; having to pay $10.00 for a pack of ciggies has had a huge impact on the decision to quit for many people. Maybe the government should hike the taxes on fast food and junkies and see what happens.

Now as for regular food, one of the best things we can do it supplement the cost of healthier foods; right now the unhealthier foods are cheaper (so tax them). Making it more affordable to buy lean meats, veggies, fruits, dairy, and whole grains, etc could help too. Just some ideas I have ...

[JayZeeJay]

Originally Posted by Justwant2Bhealthy

How come they mention Doris watching TV on the couch; the man probably does the same thing (don't most people?).

This was the first thing I noticed about the author's hypothetical situations. I am willing to grant that there is some necessity to the concept of triaged advanced procedures. But the author's prejudices are polluting whatever form of truth this article might otherwise contain.

[4star]

Yes this article is infuriating for several reasons. First, they act as if dietary interventions won't do anything when WLS is just a method to limit that amount of calories a person can take in. So Why then would a dietary intervention not work besides that it depends on the patient following a structured plan? They will have to follow one after surgery anyway. Second, WLS isn't definite and any reliable doctor would tell you that you can out eat any WLS they can perform and put the weight back on. Lets face it, you could have WLS and sit and graze on chocolate and not lose any weight. It's just a fact. It's the things like knowing the impact on your health that makes people watchful of what they put into their bodies. Why are they trying to convince people that WLS is the only option? It's major surgery being done, not for a physical correction of a problem but for the correction of a behavioral problem.

As far as what is deserved, do people really "deserve" a surgery that will make them never able to eat normally or do they deserve to be taught that weight control is within their control and be taught how to control it. I agree with preventative care. It empowers people to learn about their bodies and when they see the benefit to controlling their bodies it's motivating.

I have known more than one person who's doctors said "lose the weight or you will die", "lose the weight or get a heart condition and be diabetic" and they went home and followed controlled calorie diets(one had to do 800 calories a day b/c of being confined to a bed) and changed their fate. Why aren't people being put on doctor monitored calorie-controlled diets first and being offered surgery only as a last resort? Why are they ignoring the behaviors and habits that put people in these dire straits?