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An Ethical Trap for the NHS

An Ethical Trap for the NHS

Are therapy and education more effective ways of helping obese people than surgery?

The Independent and

January 22, 2010

When the National Institute for Clinical Excellence (Nice) recommended in December 2006 that surgery be offered to grossly obese adults and children to control their weight, experts who attended the launch of its guidance said they expected “a few hundred” adults a year to have the operation – which costs 10,000 – rising to “a few thousand” in the future.

Yesterday, the Royal College of Surgeons (RCS) estimated that there were one million adults whose weight had ballooned to the point where they qualified under the Nice criteria and that 240,000 wanted surgery, yet just 4,300 got it.

The yawning gap between demand and supply goes some way to accounting for what the RCS describes as the “inconsistent” response of primary care trusts, leading in some cases to “unethical” behaviour. If you are expecting a queue of a few hundred patients and you suddenly find you have thousands, you have no choice but to cull the queue in any way you can.

That is what PCTs have been doing. The simplest way is to raise the bar for surgery from a Body Mass Index of 40 – the defining point of “gross obesity” – to a BMI of 45 or 50, which is what the RCS claims is happening.

It is a standard response when resources are short to ration care to those in the greatest need. It is also ethically desirable. It does not normally cause further ethical complications because it is not possible for patients to make themselves iller – and thus needier – than they already are. Obesity, however, is different. If you are not fat enough to qualify for surgery, you can always make yourself fatter. The RCS claims this is what some GPs are telling their patients to do if they want the National Health Service to help. Advising patients to make themselves fatter, however, increases their risk of diabetes, heart disease, joint problems and other ailments. That is unethical. Patients, their carers and the NHS are thus caught in a trap.

Surgery is one of the few measures of proven effectiveness for gross obesity. But its cost – and not inconsiderable risks – rule out its provision on a wide scale. We must look elsewhere for solutions to the epidemic.

© 2010 Independent, The; London (UK). Provided by ProQuest LLC. All rights Reserved.

A service of YellowBrix, Inc.

In a related article The Evening Standard focuses on using other methods such as therapy to help weight loss:

Obese told: Don’t have surgery – talk your way to weight loss

By Sophie Goodchild

Obese Londoners are being offered therapy instead of weight loss surgery.

Patients will be referred to a psychologist as a part of a programme to reduce the need for gastric band procedures.

The residential programme has been set up by St Ann’s eating disorder service at Barnet, Enfield and Haringey mental health NHS trust and GPs are referring patients from across the capital.

This comes amid claims that the national strategy on providing weight loss surgery is confused and operates on a “postcode lottery” system.

A report today by the Royal College of Surgeons warns that patients needing life-saving surgery are being refused treatment because of “inconsistent and unethical” hospital policies.

The investigation reveals that some doctors are even telling people to go away and put on more weight to qualify for weight reduction operations. Official guidelines recommend that morbidly obese patients with a BMI of 40 or more have a legal right to be assessed for weight loss surgery.

But some health trusts give priority to only the most extremely ill patients — those with obesity-related diabetes or a BMI of 50 or above.

A separate report also shows that the number of private patients taking legal action after paying for weight loss surgery has risen. An analysis by the Medical Defence Union reveals 35 negligence claims have been reported to it since 2003. Of these, 21 cases have been in the past two years alone.

The St Ann’s programme aims to curb the high rate of “relapse” after weight loss surgery and address any mental health problems which might be the cause of the patient’s excessive weight.

Those taking part in the treatment are given therapy both in individual and group sessions to identify the root cause of their weight gain. They are also given access to a physical trainer and dietitian. Research shows that a high percentage of patients have to come back for more surgery or even emergency surgery after bursting their gastric bands.

A total of nine trusts in London have set up special units for treating obese patients with the aim of completing at least 2,000 operations a year to reduce the burden on the NHS of weightrelated diseases.

Originally published by Sophie Goodchild Health Editor.

© 2010 Evening Standard; London (UK). Provided by ProQuest LLC. All rights Reserved.

A service of YellowBrix, Inc.

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