Obesity - Illness or Just Plain Stupid?

If you click on the title of this entry, it will take you to a BBC news article about Professor Tony Leeds - an obesity guru at Central Middlesex Hospital. His underlying concern is that "The impact of Britain's obesity epidemic continues to increase, and so does the cost, both human and financial. Obesity now costs the NHS around £4.2bn annually, and the wider economy a frightening £16bn."

Though it's not why I feel compelled to put pen to paper, I do wish people would say "it costs YOU and ME £4.2bn (assuming YOU like ME are a taxpayer). He argues for an "fully-funded army" of obesity specialists in every GP practice. He talks about "obesity management", "surgery" and a "fully-integrated national scheme" and much more.

Apart from the fact that Professor Leeds obviously lives on another planet as he has no idea what's going on with NHS funding here on Earth, I am growing ever-more exasperated by the NHS's preoccupation with helping people to lose weight. Whatever we do and however much we spend, I reckon over 90% of it is a complete waste of time and YOUR money.

How many overweight people do you know who don't also know:

• about healthy eating?
• about the risks of excess weight?
• about the benefits of exercise?
• somebody with diabetes?
• somebody with heart disease?
• other people who are overweight?

Exactly. We all know what to do and how to do it. Most of us simply don't! It's a choice we make and I don't see why spending even more taxpayer's (yours and my money) will make the slightest difference.Don't get me wrong - I am worried about obesity. I am 14st 10lbs (92kgs) and underneath my well-built exterior is a skinny bloke. I reckon my healthy weight should be 26 lbs (12kgs) lower than that. Clearly I am not that worried!

Both of my offspring are overweight and they know it too. Where I work, half of the staff are overweight and some of them meet the (BMI>30) definition of obese. We cannot claim ignorance - we watch patients arriving everyday seeking help for the damage caused by years of over-indulgence.- and most of our team talk about their concern but clearly they are not that concerned.

Looking around us, London seems to me to be the crap food capital of the world. We seem to have more places to eat fatty, greasy, and decidedly dodgy fast food than anywhere but the United States (and look at what's happening there!). These outlets wouldn't be there if they didn't make money but they do, especially immediately after school finishes when they are filled with the next generation of podgies stuffing chicken 'n chips, coated in salt, dipped in sugary ketchup and washed down with a sugar-filled carbonated drink.

Our PCT spends over £2 million a year on "weight management and obesity" which includes prescribing orlistat and then bariatric surgery (gastric banding). Only the latter works; the rest is a complete waste of time and money. Our patients tell us they want to lose weight, and next time they come they might have lost (or gained) a kilo or two. We rarely succeed in helping anyone do anything significant about their weight.

What do I think we (i.e. the NHS) should do?

Nothing!

I think our job should be to treat the symptoms and leave dealing with the causes to somebody else. Somebody else that is who has a billion or three that their government is prepared to cough up.

We could also:

• apply a supplementary levy on all fast-food outlets;
• discriminate against fat people in the workplace (they cost employers a lot more than skinnies);
• price transport tickets by passenger weight;
• ban unhealthy foods in places in schools, hospitals, government offices;
• insist that all radio and TV broadcasts a set amount of anti-obesity propaganda;
• fine parents that don't feed their children properly.

Too radical for you? Well, I guess so.

But the problem is not medical,; it's social and that's where we need to supply the solutions. The best thing that GPs can do is scare the pants off fat people but too many GPs are way too squeamish for that.

Don't believe me. Those of you who remember Harry Secombe will recall him as the jolly, rotund "Goon". Suddenly he lost a lot of weight. A LOT!

Why? Because a doctor (not in UK) told him if he didn't, he'd be "dead in six months"! He freely admitted that up until then, despite being told about the consequences, nothing had worked.

The current government has increase the financial pressure on the NHS that was first exerted by their predecessors. Don't you love creative English? For "financial pressure" read REDUCED FUNDING. So we have less money to care for more people, living longer and getting ever fatter. If it was your money and your relative that needed a hip replacement, spinal surgery or renal dialysis, or it was your local A&E that was closing, I'm sure you wouldn't mind that part of the reason was that while you and I just kept on eating chips, health bureaucrats kept spending money on you and me, even with the knowledge that £90 million in every £100 million was a complete waste of money.

Let's think the unthinkable - smoking

In the 1970s, I spent a great couple of weeks in Bristol learning about "Operational Research". This was the original name of what is now called "Applied Statistics" - using statistics to solve a specific "here and now" problem. The course lecturer had formerly worked on the great technological white elephant that was Concorde.He explained that he watched the Concorde project abandon financial commonsense as delays, overruns, modifications all added to the bill. That's the trouble with big numbers. They start to reach a size where we loose our grip on reality. Once you start talking "billions", then £0.05 billion seems like petty cash.

But it isn't. It's fifty million quid!

Our lecturer explained that he kept his sanity by converting all these overspends into Mars Bars. He knew the volume of a Mars Bar and how much it cost. It was fairly simple arithmetic to represent the "latest cost overrun on the Concorde undercarriage system" into enough Mars Bars to fill three aircraft hangars - floor to ceiling .. wall to wall! You may think he was potty but it kept his cost accounting feet firmly rooted on the ground instead of in project-financial fairyland. I have taken advantage of his wisdom ever since. It helps me to ensure that cost projections, financial forecasts, etc. can all stand up to real world scrutiny.

Which leads me to the NHS expenditure on helping people to stop smoking. Why are we forking out MILLIONS of pounds for smoking cessation treatments? People smoking a packet of fags a day are spending £42 a week on the habit. They could afford to buy any of the various OTC patches and potions for a fraction of that. I've checked on Amazon and patches vary in price from £1.05 each up to £1.75 or in cigarette terms that's between six and eight ciggies a day. If they do give up, then they will reap the financial benefit for the rest of their lives.

By this point, any "health professional" reading this will have marshalled the forces of righteous indignation to attach me as an inhumane and illogical idiot (which may be true but that's not the point). Helping people to stop smoking saves the taxpayer money. You've all see the headlines. Smoking costs the NHS £1.5bn, £3bn, £5bn a year (what's a few billion matter here?). Don't believe me? Just click on this link to Google and see what numbers pop up for "smoking costs NHS". Read the headlines for yourself.

Increased likelihood of coronary heart disease, lung, throat and mouth cancers, respiratory disease, etc.etc. are all consquences of smoking. However, there are also savings to the NHS and the taxpayer.

• The excise duty on cigarettes is vast: excise duty in 2010 is estimated at £8.8bn and VAT is a further £1,7bn. (Tobacco Manufacturers' Association). That's ten percent of the total NHS budget of £103.8bn
• The biggest cost to the NHS is in treating the effects of getting old. If smokers (on average) die sooner, then whilst they still incur the costs of their chronic conditions but save on the costs of elderly care.

If the NHS wants to have a financial debate about smoking, then perhaps it should consider encouraging us to smoke. It looks as though there's a net gain in terms of revenue and expenditure here! Even if I'm wrong, about the big picture, I still don't see why we should be subsidising people who want to stop smoking any more than we should subsidise people who want to stop biting their nails or sucking their teeth.

The NHS is running out of cash. We have more important things to do than this.

(for the record: I use to smoke - sixty-a-day in fact. So did my son. He now runs marathons and I get my exercise watching him occasionally).