Monday, May 23, 2011

Britain moves to pay MDs to shame their "fat" patients

I hope my British readers forgive me, but over the course of the past few years, your country has rapidly surpassed the rest of the developed world in a bizarre quest to become the world's most backwards in regard to obesity policy.

And pip, pip, cheerio and all that rot, good chaps, your government's done a smashing job.

I used to blame it all on the asinine decisions of your Secretary of State for Health, Andrew Lansley, who among other brilliant decisions has helped to abolish your healthier school lunch program, scrap your front of package labeling program, turn over control of your national obesity strategy to the food industry, strip your food standards agency of their food labeling oversight, and has helped to include such things as processed cereal bars as part of your "5-a-Day" fruits and vegetables campaign.

Then there was your Under Secretary of State for Health, Anne Milton, who recommended doctors quite literally call their overweight and obese patients "fat", to "inspire" them to take more "responsibility" for their health.

Well your country's gone and done Anne's call to action one better.

Apparently now your physicians are not only encouraged with words to call their patients "fat", starting next year, they'll literally get paid to do so.

Never you mind that the vast majority of physicians the world over don't have a clue what to do with their obese patients. Never you mind that the weight loss industry is an unregulated morass of snake oil and false hope. Never you mind that there is as of yet no gold-standard, reproducible treatment program. Never you mind that studies show obese patients already face cruel discrimination by health professionals, and already receive substandard care.

Nope. Instead your country has determined it's in your best interests for your physicians to formally take on the role of the school yard bully in the presumptive hope that finger pointing, shame, and a free coupon for Weight Watchers is the solution.

I've got news for Mr. Lansley, Ms. Milton and the NHS. If obesity were truly treatable as a disease of personal responsibility the world would already be much skinnier. Obesity is a disease of the environment, and you folks across the pond are doing a dandy job making your environment more, not less, conducive to obesity with your 2012 Cadbury Olympics, your regulatory free food marketplace, your pulverized flour and sugary school lunches, and your food industry funded "healthy active living" campaigns - because guaranteed, in Britain, it won't be about modifying intake with Big Food at the helm, it'll be all about exercise.

Shame indeed.

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  1. You've succinctly expressed everything I felt when I first read about this. I wonder, will the patients be allowed to remark on their doctor's weight problems in return? After all, they couldn't possibly be aware of their rolls of fat if they haven't been pointed out by someone wagging a finger.

    What doctors should be taught, to be honest, is not to disregard the symptoms their fat patients present with. I was repeatedly told my gastric problems would clear up if I lost weight.

    I'm thin now! Because the cancer that they missed ate all my fat.

  2. I totally agree and I just have to add my comment here.
    I am European and I have been to Great Britain many times and I also happen to be obese.
    I'd hate to sound racist but I honestly believe that the British state seems to consider themselves rulers of the world and so much better than anyone else.

    About obesity, I think British people justify a lot of things by saying "oh we are less overweight than Americans" but fact is that England is 1st in obesity in the whole of Europe, including child obesity and they really have a terrible healthcare system and horrendous obesity policy.

    Again I am sorry if I offended anyone or if I sounded racist, that was not my intent.

  3. Anonymous9:15 am

    You would think physicians would realize that "shaming" often leads to feelings of inadequacy and depression, which many obese (myself included) react to by self-medicating with food. I'm guessing it will also lead to many people being afraid to go visit their doctors and receiving the healthcare they need. It's an incredibly stupid move.

  4. Anonymous10:09 am

    Doctors should only be allowed to deal with a patient's weight in such a manner, IF the patient has come to them FOR their weight problem. Otherwise, tit for tat... a doctor should be allowed to be that ignorant with a patient ONLY if the patient is allowed to promptly PUNCH them in the mouth after said comments are made.

  5. I know I'm fat - I don't need my doctor to point that out to me. What I could have used from my doctor was some help to figure out what the best way of eating is for my body. And please, not the usual "eat less, move more". If that had worked I wouldn't still be fat.

  6. Well said. If shame made people thin there wouldn't be a fat person anywhere. If 'eat less, move more!' worked, same. Even WLS doesn't always do the trick and it leaves people too often with debilitating life-long side effects. I didn't think anywhere could be worse than the States for fat-hate but the UK has taken the cake. I gave you a gold star for this post over at my blog.

  7. Steady on old chap, this almost sounds like dissent in our western colonies!

    I think we have to look behind the spin and headlines. Firstly the minister was not talking to doctors,patients, or people with weight concerns. She was talking to her constituency of right wing reactionaries. Her comments are a reflection of ignorance and stigma in a nationalised health service under political control. As an example, over here we have state funded television, if we want to watch TV we legally have to purchase a license. The organisation who runs this funded service, the BBC, is however independent.No such arrangement exists for our national health service, and each new government uses the NHS as it's own political football. The government in power at the moment (fiscally fans of Mr Chr├ętien) seem to feel such need to make statements to appear 'tough' and speaking 'common sense' to their supporters. There is an increasing number of Randian muppets in the Tory party, influenced by the intellectual luminaries of the US right wing. England weeps.

    Anyway, back OT. Primary care in the UK uses target driven funding. GP's will receive monies if they ensure a certain percentage of their patients get vaccinated, screened for certain cancers etc. Obesity and weight management is looking to join this list, which I think will be a good thing, both in terms of raising the profile, and hopefully delivery of care of obesity management.

    I would ask readers to have a look at the National Institute for Clinical Evidence (NICE) guidelines online. The powers of which used to govern NHS clinical spending to some extent, and whose powers have been diluted by the new government.

  8. I am British, in fact I am sat in Britain as I type. Guess what, I am not overweight either. But I have been in the past, and I didn't need my Dr. to tell me so. I knew it and sadly I also know the misery it causes! There is a really big problem in this Country, sorry no pun intended. You can go into a supermarket and buy a bag of 10 donuts for £1.00. As of last week a fresh cauliflower was £1.26. A bag of reformed, breaded, chicken parts will cost you £1.00. A whole free-range chicken costs at least £5 or £6. The price of fresh fruits and vegetables seems to be increasing daily, whilst procressed carbs are always cheap and plentiful or on buy one get one free, that sort of thing.
    As for the food companies and sports sponsorship, that is just a joke, do people REALLY believe that our athletes are chowing down on Cadbury's chocolate between laps of the track or pool, and while I am on the subject, I don't believe for 1 second that Chris Hoy eats Branflakes either!
    I have no faith in the health profession and their dietary advice. For example, my Mother, who is glucose intolerant, was told by an NHS dietician that Cornflakes were a suitable breakfast for her. The whole situation is laughable.
    Actually, you forgot a couple of things from your list of remarkable things our governments past and present have done. In previous years they allowed numerous school playing fields to be sold off for housing projects. And, in order to meet the government target for active schools, the children have to take part in at least 2 hours of PE per WEEK! I almost fell over when I heard that! 2 hours a WEEK! 2 hours a day would be more on the mark IMO.

    Rant over.....

  9. Fat Shaming caused increase in weight gain in this study.

    Perceived weight discrimination and changes in weight, waist circumference, and weight status

    To examine associations between perceived weight discrimination and changes in weight, waist circumference, and weight status.

    Data were from 2944 men and women aged ≥50 years participating in the English Longitudinal Study of Ageing. Experiences of weight discrimination were reported in 2010-2011 and weight and waist circumference were objectively measured in 2008-2009 and 2012-2013. ANCOVAs were used to test associations between perceived weight discrimination and changes in weight and waist circumference. Logistic regression was used to test associations with changes in weight status. All analyses adjusted for baseline BMI, age, sex, and wealth.

    Perceived weight discrimination was associated with relative increases in weight (+1.66 kg, P < 0.001) and waist circumference (+1.12 cm, P = 0.046). There was also a significant association with odds of becoming obese over the follow-up period (OR = 6.67, 95% CI 1.85-24.04) but odds of remaining obese did not differ according to experiences of weight discrimination (OR = 1.09, 95% CI 0.46-2.59).

    Our results indicate that rather than encouraging people to lose weight, weight discrimination promotes weight gain and the onset of obesity. Implementing effective interventions to combat weight stigma and discrimination at the population level could reduce the burden of obesity.