Fat of the Land

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Declaration of interest – I am obese and I have Diabetes Type 2 and my BMI is possibly enough to give one of the authors of the RCP report ‘Action on Obesity : comprehensive care for all ‘ (published January 2013) reason to refer me to a Bariatric surgeon tout suite (not that I want referring to a Bariatric surgeon…). I don’t have access to large amounts of stats and this blog is about my,  emotional, reaction to the report.

This report was mentioned on Twitter and I went over to have a look to see how the RCP see care developing over the next few years.  I see this report as part of the high level of concern (rightly) over the ‘obesity epidemic’. I was gladdened by the use of neutral language that was used throughout and the careful analysis of genetic issues (it does run in some families) and the high risk of obesity if you have type 2 diabetes (I believe that I have put weight on in the ten years since I was diagnosed) .  This is unlike the majority of generally ill informed coverage in the press which generally seems to stigmatise those who are obese (Indeed anecdotally the word obese is in itself becoming a word that immediately is treated as stigmatizing by lay individuals). Having said that – I was disappointed in a lot of this report.

  • Could they not find at least one expert patient to be included on their working group? Given that Obesity is such a personal and individual issue to treat, I would have expected that they could have found some patients who would have had an opinion on the formation of services around them. The lack of an authentic patient voice in this report really marks it out to me as coming from a very prescriptive, authoritarian mindset (more on that later).
  • In addition to no representative patients there were a number of individuals who had significant conflicts of interest. They were listed but still given the lack of a ‘patient’ voice…
  • There was little discussion of the idea of informed consent or indeed any sort of consent from the ‘patient.’  There was lots of diagrams on how ‘patients’ would move through the system both as secondary referrals and and referrals from GP services.  How GPs would stage patients etc and how other consultants would be able to refer their patients to Bariatric teams for care of their *obesity*.  Will obese patient be able to refuse to take part of this referral service or will it be assumed because they’re diabetic or sleep apnoea and above a BMI, they will have no choice?
  • The report also had specific things to say about NHS staff, about the importance of using Occ. health departments to active screening and support for obesity programmes (no argument there, looking after the health of employees is their raison d’etre). But as with the encouragement for GPs to routinely monitor weights of patients who are visiting for other reasons (you know they may actually have a health problem that is NOT linked to being obese), are they really proposing that health care (in the example quoted flu vaccinations) should be conditional on the recipient being weighed?
  • I know this was a report looking at service delivery and by necessity concentrated on the organisational aspects of service delivery but again it lacked the feeling that at the core of their processes and the very reason for their existence was that there was an individual.  And personally I hate the word ‘patient’ to describe us. We may have ill health issues but obesity is not an illness or is it. But it is the individual that will lose the weight.
  • Personally, and again this is individual, I really don’t like the placement of ‘treatment’ of Obesity within a hospital being placed under the Bariatric specialty. Personal to me – but it feels like obesity treatment is being put on the conveyor belt to inevitable and drastic surgery. I know that it has been of great value and help to individuals but…

Been watching Fat Ward (or whatever it is called) and noted with interest that the programme stated that a significant number of patients that had been counselled prior to surgery had been found to have longstanding issues that shaped their eating habits – which were a large cause of their weight problems.  I don’t want bariatric surgery, I don’t even want to be seen by a hospital team or be in a hospital, I want someone who can support me to break habits (longstanding and well reinforced habits) and remould them into new ones – not someone who looks at me as a stomach to be reduced in size…

Mindful eating, mindful exercise and mindful medical care – only the first two appear to be able to be influenced by the obese individual.

 

 

 

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4 responses »

  1. I think there’s a huge gap in service provision for psychological treatment of obesity. You can be referred for exercise, to slimming world (but only if your BMI is 30-35), or have orlistat but after that it’s over to the surgeons, which, while it can be a lifesaver in some cases, is kind of missing the underlying psychological & social point!

  2. Completely agree, Karin. The very woirst thing for me due to those psychological factors is for me to go on a diet, just makes me conscious and aware of food all the time – in a way it ups the ante for me!

  3. I am a comfort eater. While most people who suffer from depression don’t eat, or forget to eat, my brain associates food with comfort. So yes, me having bariatric surgery would be a waste of time without psychological counseling, might possibly even be harmful. It’s foolish of them to ignore the psychological factors behind eating.

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