Too large?

Scott Birdby Scott Bird | November 23, 2005
Filed in News | 9 comments

The NHS (National Health Service) here is currently looking at ways to save money. One of the more unusual proposals is to deny several of the less life-threatening operations to people who are overweight. Setting aside the debate over healthcare and obesity for a minute, an obvious problem arises when you realise that the means of determining the level of obesity is the BMI.

I’m skeptical to say the least.


Bending

Ready to bend some steel? Grab a copy of the Diesel Crew's Bending eBook. Superb.



Enjoy this post? digg it.

A few others you might like :



Go on, you know you want one.
Strongergrip.



Discussion

Leave a comment below, or discuss it in detail in the SttB Facebook Group.

Comments

1

Why not deny stuff to people who smoke or drink? It’s no different in my opinion.

Posted by: Stinn | November 23, 2005 6:59 PM

2

I agree. You could rule out just about any group of people based on something-or-other.

Posted by: scott | November 23, 2005 7:19 PM

3

Before I get going i’d like to say i’m classified as obese according to the BMI for most part of the year, despite my BF being fairly low…

Im not going to get into whether BMI is a good measure or not but the fact is that within the medical literature most studies examine the relationship between BMI and risk of disease. The BMI is one of the best generalised indicators that exist.

In short i’m glad obese people will be denied operations for non-life threating conditions, hopefully those free resources will be diverted to education to prevent obesity (cheaper on a per person basis anyway)…

Actually I think in general its a good idea, and not just for BMI but for heavy smokers, alcoholics, drug abusers etc.

rant over.

Posted by: john yeo | November 23, 2005 8:20 PM

4

John, I would agree that doctors should be concerned about obesity, alcohol abuse, smoking etc; however I’m not convinced that surgeries are the right forum to express their opinions. Surely the NHS is there to help members of the public, regardless of their current situation.

Treating people differently based on obesity strikes me as being no better than any other form of segregation (often racial) tried throughout the world. The fact that the NHS does not even promote a healthy lifestyle just adds to the hypocrisy of this.

Posted by: scott | November 24, 2005 2:44 AM

5

your up late scott! you bring up some interesting points.

i agree, the NHS doesnt do enough to promote a healthy lifestyle. its a health service and should provide just as much emphasis on preventative measures.

one of the problems is that the NHS is somewhat of a blackhole for funding as treatment is effectively free, and there are no real incentives to be healthy or to stop abuse of the system.

anyway… in the worst case if you’re in this position, say you were refused a hip replacement, and you really think you should get one, then you lose weight (its not much to ask that a patient makes some effort to reduce their risk factors, besides the NHS already provide guidance from nutritionists for the clinically obese).

in general i think its good because it shifts some of the burden of responsibility for health back onto the individual, and away from the NHS - as it is ultimately the individual’s health.

segregation is normally based upon factors which people have no control - a whole other argument i guess ;)

would you be as critical if the government announced that everyone who passes a ‘healthyness test’ will pay less taxes?

Posted by: john yeo | November 24, 2005 8:46 AM

6

It’s a pity that the NHS - despite the name - doesn’t do more to promote a healthy lifestyle. I still feel, however, that until it does start doing this, it can’t reasonably ask patients to lose weight. After all, if an elderly patient needs a hip replacement, and is not told how to get healthy, I really can’t see them suddenly going jogging (which is the first thing a lot of people think of when it comes to weight loss - together with a crash diet).

On the subject of paying taxes, I tend to put personal beliefs above a bit of pain. After all, that’s why we all lift weights :)

Posted by: scott | November 24, 2005 9:38 AM

7

Even aside from whether the NHS should be making this kind of decision, you’ve got to scratch your head over why they would pick BMI as the only criterion for judging obesity.

http://www.ajcn.org/cgi/content/full/79/3/379

I think the title says it all: “Waist circumference and not body mass index explains obesity-related health risk”

I can’t find the link right now, will post it if I do, but I remember one study that showed for a given waist circumference, having a higher BMI was protective.

Which sort of makes sense when you consider that for someone to be heavier with a given waist circumference, he/she likely has more lean muscle mass (which doesn’t accumulate at the waist) or has more of a “pear” distribution of fat (accumulating fat at the hips, as opposed to an “apple” where the fat accumulates at the waist) which is associated with lower health risk.

Posted by: bdckr | November 24, 2005 8:04 PM

8

In the editorial “Don’t throw the baby out with the bath water”, some of the problems with that study’s conclusions and using WC as an indicator are highlighted, such as the fact that they did not consider other risks (diabetes, sleep apnea, cancer, and osteoarthritis).

http://www.ajcn.org/cgi/content/full/79/3/347?lookupType=volpage&vol=79&fp=347&view=short

i agree that BMI is a very generalised indicator…

Posted by: john yeo | November 24, 2005 11:28 PM

9

Point well taken. It was looking specifically at cardiovascular disease risk.

The editorial is right: Ignoring BMI in favour of waist circumference is a bit extreme (and we don’t have enough info to do that yet), but the decision to ignore waist circumference (by the NHS) is just as unreasonable.

If they can justify rationing health care dollars this way (and that’s a big “if”), it still boggles my mind why they would base it just on BMI, instead of using BMI and waist circumference. Easy, cheap, more accurate…

Posted by: bdckr | November 24, 2005 11:47 PM

Post a comment

(If you haven't left a comment here before, you may need to be approved by the site owner before your comment will appear. Until then, it won't appear on the entry. Thanks for waiting.)