Tuesday, September 06, 2016

UK's @ValeofYorkCCG Launches World's Worst Obesity Policy

The UK's Vale of York NHS Commissioning Group has been reported to be planning to deny people with obesity elective surgeries for an additional year in a bid presumably to inspire encourage help whip and prod people into losing weight.

The policy's two primary presumptions are ignorant and misguided.

The first has to do with the value of BMI as a clinical tool. While it's true that the risks of medical complications and morbidities rise with weight, BMI is a measure of bigness, not health. Half of the NFL have been reported to have BMIs greater than 30, as did my friend and colleague Dr. Spencer Nadolsky pictured below in his wrestling days when he sported a BMI of 32.

The second presumption is that obesity is a disease of personal responsibility and choice. While no doubt weight can be dumbed down to eat less, move more, I still find it shocking that public health professionals and policy makers exist who believe that somehow people with obesity simply haven't absorbed enough societal guilt, shame, and discrimination to finally lose weight.

But putting those two erroneous presumptions aside, the notion that blame based medicine is something that the UK wants to adopt is plainly repugnant. Medicine's not about blaming and shaming. Life is complicated. Clinically useless truisms aside, obesity is complicated, and moreover we have yet to discover a non-surgical, reproducible, and uniformly effective plan for the management of obesity. And while there's no argument about the fact that in a ideal world everyone would take it upon themselves to live the healthiest lives possible, there's two problems with that argument. Firstly, not everyone is interested in changing their lifestyle, and secondly, statistically speaking, the majority of even those who are interested and successful with lifestyle change will ultimately regress. Meanwhile the burden of suffering that the elective surgery those with obesity are being denied may add to absenteeism, presenteeism, pain, depression, and more.

If someone from the NHS's Vale of York is reading this, I want to remind you of one of your stated values as it would appear as if it's been forgotten,

We believe that health outcomes should be the same for everyone. We will reduce unnecessary inequality."
For shame.

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