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! 

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