Sunday, 23 April 2017

Obesity and prejudice in the NHS

There's an excellent documentary currently available on BBC iPlayer looking at the prejudice obese people face trying to get treatment in the NHS. The mightily impressive Professor Rachel Batterham shines a light on some of the cutting edge medical science of obesity, breezily demolishing lazy tropes about fat people as she goes. Prof Batterham makes compelling arguments supporting increasing treatment of obesity, not just due to the positive medical outcomes but on the cold, hard economic basis that as expensive as intervention can be non-intervention is far more expensive in the long-term.

Along the way she highlights some of the counterproductive and even explicitly harmful approaches to obesity that give me concern. The lack of proper understanding of, let alone sympathy for, obesity from some medical professionals. The rationing of medical treatment on arbitrary BMI thresholds rather than case by case clinical assessment, the decisions that lead to Catch-22 horrors whereby sick people cannot access desperately needed treatments due to obesity, but are unable to meaningfully tackle obesity because they are denied those desperately needed treatments. There were some pretty disturbing examples of serious medical harm being done by NHS professionals deploying half-baked thinking or outright prejudice against fat people.

A key driver of prejudice is always ignorance. When it comes to obesity there will always be stupid twats who say things like 'it's your own fault your fat cos you ate too many chips'. In the programme professional gobshite Amanda Platell of Daily Wail fame pops up to represent said feckwittery. Now I don't deny there is an element of personal responsibility in obesity, but it's far from the simple dichotomy of the ignorant twat. There are fundamental issues around human physiology and sociology at play in the rise of obesity, which is why it is a growing problem globally. Humans evolved over hundreds of thousands of years but the recent shift to sedentary lifestyles and cheap and readily accessible calories took just a few hundred years. It shouldn't be a surprise to anyone who considers the issue seriously (who isn't a stupid twat) that modern life is incongruous with the way humanity evolved as a species (a recent blog post at Coppola Comment neatly addresses some of these themes). 

One of the most interesting parts of the documentary was a discussion with a representative of an NHS Care Commissioning Group (CCG) who attempted to defend healthcare rationing on the basis that it wasn't meant to be punitive (implicitly acknowledging it is), but intended to get people on the right health pathway (without acknowledging this is pure magical thinking). To be fair to the doctor in question he did at least step up to defend an unenviably weak position and it may be that unsympathetic editing made his arguments appear even more unconvincing, but I rather suspect no amount of turd polishing can make healthcare rationing look better than it really is. It appears a lot of the CCG's who use BMI thresholds completely bottled out of talking to the programme.

Towards the end Prof Batterham made a presentation to a group of CCG and GP representatives (including 'celebrity' GP Hillary Jones) on the serious science behind obesity, the hard economic case for medical intervention reinforcing why it is important to treat obese patients with dignity and respect. Again, giving credit where it's due the participants seemed to acknowledge the flaws in their past thinking, be it simple human prejudice or lack of professional awareness. But these are doctors; you'd expect them when faced with cool, rational and overwhelming evidence-based arguments to come round. Unfortunately it will always be harder to convince the proportion of the general public who are mindless, prejudiced twats. This is after all the post-truth era, and for the mindless twat 'you ate too many chips' is a personal truth that will always rank higher than any science. Let's just be thankful there are people like Prof Batterham leading the line against feckwittery! 

Saturday, 8 April 2017

Nightime peeing

Interesting story on BBC last week about how needing to pass urine in the night may be linked to excess salt consumption. For many years now I've found that most nights I wake in the early hours and find I need to wee, but it has become a little more noticeable over the last few years. These days I often find I wake again anytime between fifteen and thirty minutes before my alarm goes off, which is annoying as I invariably need to go when I wake, but that has only happened since I started my current job which requires regular early starts for the London commute.
I don't believe there there is anything unusual about waking in the night per se, the idea that it is natural sleep all the way through the night without waking is probably a modern myth. But I have pondered the issue of nightime peeing more since my GP warned about the risks of pre-diabetes and I subsequently read it can be sign of diabetes (I'm somewhat reassured by the absence of many other signs). I'd love to be able to sleep longer, I usually manage just over seven hours during the week and over eight at the weekend, but as hinted above this is due to daily routine rather than anything sinister. I do sometimes feel tired at work, but then staring at a computer screen for prolonger periods has that effect.
There are some obvious reasons for wanting to go for a wee in the night, firstly I'm getting older. Secondly, as a compulsive tea drinker I often drink a large cup in the evening not long before bed. Tea contains caffeine which is sometimes claimed as a mild diuretic, but as a regular consumer the effect on me is probably minimal. A third reason is that I always take a bottle of water to bed with me, which I sip from if I feel thirsty in the night, sometimes I hardly touch it, but every now and again I will consume the lot. But maybe a small contributing factor is the sodium bicarbonate tables I have been taking for for the last couple of years. I remember when the Consultant first put me on them, she gave me Furosomide so I would flush the salt out out first thing in the morning even though I laughed at the idea of needing any assistance going for a wee first thing in the morning! The diuretic tablets didn't last long as they only triggered gout attacks, but the sodium bicarbonate tablets have increased since then.