Too fat to be worth anything to society, except for the tax money.

December 17, 2005 11:42 AM

Lifestyle on the line. UK to allow hospital's opinions on personal lifestyle to define state healthcare decisions.
posted by shepd (39 comments total)

There was a Guardian article on it a while ago.

Don't think it would be such a bad thing if they restored the right to opt out of making National Insurance payments: then at least you could use the money to try to get private treatment. As it is though, it seems rather unfair that fat people have to pay for thin people's health care, but can't get treated themselves.

Also they could be a bit more consistent about "self inflicted" conditions. What about people who have made suicide attempts: you don't get much more self-inflicted than that, and further attempts are likely. Not to mention rock-climbers with broken bones, marathon runners with dodgy ankles, bicycle couriers injured in road accidents, sunbathers who get skin cancer... in fact, play it right and the NHS would hardly have to treat anyone at all...
posted by TheophileEscargot at 11:58 AM on December 17, 2005

The problem with your analogy TheophileEscargot, is that this is more of a quality-of-life issue, where as cancer and road accidents are very well life-or-death. This doesn't surprise me and illustrates the failings of socialist health care. No health care system is perfect, or will be perfect, as long as we have finite resources. I've heard interesting arguments that non-life threatening conditions can be exported to Thailand or similar third world country. These places have top notch healthcare, but how one is to get compensated for mal-practice is a big problem in international healthcare. Perhaps in an ideal situation those have made "bad lifestyle choices" are forced to go to less desirable healthcare options.
posted by geoff. at 12:16 PM on December 17, 2005

As the article states, people with bad knees or hips have a hard time exercising, and my experience is that exercise is a vital component of weight loss. Quite the Catch-22, that.

Of course if they made water aerobics available to these people, I'd not complain.

My body mass is 32 percent, but I have a lot of muscle and am fairly fit. According to them I wouldn't be worth the trouble. Nor would some athletes, if I recall correctly.
posted by konolia at 12:28 PM on December 17, 2005

The basic problem is the Brits are super-cheap when it comes to their healthcare program. They spend much less per-capita then the US or any other first-world state medical program.
posted by delmoi at 12:28 PM on December 17, 2005

konolia: You mean you have a BMI of 32?

Honestly if I were running a state medical program I would definitely have an issue with treating fat people, and people who don't take care of their bodies? The government could save a ton of money if people just maintained their health properly.

This illustrates the major problem with national healthcare. Once the government gets involved in providing healthcare, everybody starts thinking everyone else's' health is their business (because it is).
posted by delmoi at 12:33 PM on December 17, 2005

btw, I love the "fat graphic" they have on this bmi calculator. Heh. A BMI of 30 is not really that fat. Definetly not what you think of when you think "obese".
posted by delmoi at 12:37 PM on December 17, 2005

Let the fat people eat cake.
posted by sourbrew at 12:41 PM on December 17, 2005

Things this discussion hasn't mentioned yet:

1. Contrary to myths that seem to be widespread in the USA, private healthcare is available in the UK. So is private medical insurance. Everyone gets NHS coverage -- but there's nothing stopping these people from paying for treatment or insuring against needing it. (You may take the fact that less than 5% of the population bother with third-party medical insurance as a hint that maybe the NHS actually works, for most people, most of the time.)

2. Water aerobics are available at just about any goddamn municipal swimming pool in the UK. (Guess what? I'm overweight: I exercise by swimming.)

3. Some rationing issues apply to purely commercial health services as well as universal ones. Consider liver transplant policy, for example -- are you going to stick a -- scarce -- replacement organ into someone who nuked their own by o/d'ing on paracetamol (acetaminophen), or an alcoholic? Maybe you can if there are no other histocompatible recipients on the list -- but in the absence of a sudden breakthrough in obtaining supplies of donor organs, rationing is a fact of life (in both a state run universal medical system and a private system), and feeding in the patient's behaviour into the process of estimating the likely outcome isn't exactly controversial or innovative.
posted by cstross at 12:51 PM on December 17, 2005

Additional point that the original article missed completely: the current NHS funding crisis.

In a nutshell: NHS spending has been growing by around 7% compounded per annum for the past six or seven years, following 18 years of stagnation under the conservatives. But this isn't funded entirely by central government spending. One key element of Labour policy is to offload public sector investment onto the private sector via "private finance initiatives", in which chunks of work are funded by investors, who then need to show a profit on the business. (This has been criticized by some as privatization by stealth, and by others are being just plain dumb in the long term -- there are a host of PFI funding scandals brewing that threaten to dog Blair's successor mercilessly.)

Anyway, the PFI funding crisis (as private investors start expecting some payback) has left hospitals on the brink of bankruptcy and opened a sucking chest wound in the NHS budget for FY 2005-06. But there's no slack in the government budget with which to bail them out. Therefore the Department of Health has put the squeeze on the various trusts and is forcing them to cut costs in any way imaginable.

This article on "rationing" should be read against a background of a fiscal crisis manufactured by the government trying to dodge around funding issues by taking out loans, and those loans now coming due: the hospital trust then takes it in the neck and has to find savings somewhere.

Indeed, it's quite possible that the negative spin in the article was applied by a health trust press relations officer in order to stick the knife into the DoH, in hope of getting some more money out of the government.
posted by cstross at 1:04 PM on December 17, 2005

Sorry, final post on this topic: from December 2nd, barely two weeks ago, a report -- hospital operation waiting lists at lowest level ever. "The number of people waiting for an NHS operation in England has fallen below 800,000 for the first time. ... The DoH said that the overall waiting list was now at the lowest figure recorded since data was first collected in this way in September 1988."

There's simultaneously a funding crisis, threats to operations for the lifestyle challenged -- and the shortest waiting lists for nearly 20 years. What does this mean?

What it means, is: trying to judge the health of the NHS from a single story is difficult, to say the least.
posted by cstross at 1:08 PM on December 17, 2005

it's just plain bad policy. and discriminatory too. everybody is in everyone elses business.
posted by brandz at 1:11 PM on December 17, 2005

I'm disturbed by what the linked article and TheophileEscargot seem to suggest - that our individual contributions to the NHS are what should lead to us being able to demand fair treatment.

It seems to logically lead to suggesting that those that have contributed the most should get the best care. Clearly neither the Theophile nor the quoted chair of Britain's Patients Association really think this (one hopes). If you want to argue that denying hip replacements or what have you to the obese is wrong you need to come up with a better argument than that.

What would seem a sensible compromise to me is to refuse the surgery if someone is obese (ignoring problems with defining it using the BMI) but provide the resources needed to get the patient down to a weight where the surgery is more likely to be successful, and where other health issues are likely to improve too.
posted by edd at 1:13 PM on December 17, 2005

konolia: You mean you have a BMI of 32?

Yes. Try being just five feet tall and not a toothpick.

I lost seven percent of my body fat in the last five or so months, and am carrying around quite a bit more muscle than before. I don't think that number represents me all that well.
posted by konolia at 1:19 PM on December 17, 2005

My body mass is 32 percent, but I have a lot of muscle and am fairly fit.

Is this the new version of "I'm not fat, I'm big boned"?
posted by spazzm at 1:32 PM on December 17, 2005

I was overweight. I started exercising. Guess what? My weight shot up 5%.

Muscle is denser than fat. Much denser. This is why a bunch of US Navy SEALs got themselves shitcanned the other year for being "obese" (they were way too heavy for their height, according to the tables).
posted by cstross at 1:41 PM on December 17, 2005

All that aside, BMI is a flawed concept.
Since volume (and therefore mass) increases with the cube of the height, BMI penalizes tall people since it assumes mass should increase with the square of the height.
posted by spazzm at 1:45 PM on December 17, 2005

Contrary to myths that seem to be widespread in the USA, private healthcare is available in the UK. So is private medical insurance. Everyone gets NHS coverage -- but there's nothing stopping these people from paying for treatment or insuring against needing it. (You may take the fact that less than 5% of the population bother with third-party medical insurance as a hint that maybe the NHS actually works, for most people, most of the time.)

Private medicine is available, but you still have to pay National Insurance for the state system.

Suppose the government instituted a Food Tax on your salary, and set up a network of shops and restaurants giving away "free" food paid for with your tax money. Maybe only 5% of people would choose to go to private restaurants, but that doesn't necessarily mean 95% prefer the National Food Service, just that they don't want to pay twice.
posted by TheophileEscargot at 1:58 PM on December 17, 2005

Wow, people are sanctimonious about weight. It seems to have a pariah aura to it. I suppose we should start handing out bells so people with a BMI over 30 can ring them and shout "Unclean! Unclean!"

And the idea of denying people medical care because they have conditions that make the care less likely to be successful implies that euthanasia by neglect might be okay, too. Heck, if you can stop treating fat people, why not old people? Especially old people with health problems. My mother is in her 70s and has Parkinson's. Does that mean she shouldn't be given dental care or mammograms any more? Sure. Heck, anybody with preexisting health problems should be denied care.

I had a BMI of over 30 once in my thirties, when I was suddenly inactive for the first time in my life, caring for a baby. Would I be ineligible for certain kinds of medical care during the periods when my weight was up?

Oh, a bell for me? Thank you.
posted by Peach at 3:30 PM on December 17, 2005

What about fat people that smoke?
posted by blue_beetle at 3:37 PM on December 17, 2005

Not covering overweight people is absurd. Despite what you may think, there are more reasons a person can be fat than how many ho hos they eat.

1. They may have a genetic disposition to being overweight.
2. They are most likely poor you may work long hours that don't allow much time for exercise.
3. You may not live in an area where exercising outside is a safe option.
4. You may have a lot of mouths to feed and can't afford to go to Whole Foods and get super healthy food. Suddenly 49 cent burgers at McDonalds look like a good way your family will be able to eat dinner tonight.
posted by corpse at 3:38 PM on December 17, 2005

This story is weeks old. And didn't I read somewhere it was largely bullshit? I'll have to go do some Googling.

Anyway, in my view the fundamental principle of a decent socialised healthcare system should be "from each according to his ability, to each according to his needs". Now where have I heard that somewhere before...?
posted by Decani at 4:05 PM on December 17, 2005

Wow, people are sanctimonious about weight.

Maybe. But some of us get a bit tired of the weak excuses people offer for being lardarses (see post above) rather than dealing with the fact that no matter what particular problems you might have with your metabolism or glands, fat doesn't grow ex-nihilo. If you're fat, you're eating too much, or an unhealthy balance, or you're not exercising enough. That's the bottom line.

Don't see too many people whose dodgy metabolic rates are making them fat in famine zones, do we? Odd, that.
posted by Decani at 4:10 PM on December 17, 2005

Many doctors/PCTs will not perform sex reassignment surgery on patients who are too large, because on a large person this particular surgery is not only more dangerous but more likely to lead to complications, resulting in further hospital stays, more pain for the patient, and more cost for the NHS. The patient will be told to go away and lose some weight and come back in six months.

This is not new. The NHS, as my dad would say, is not made of money.

See here for a less shrill account of this story.
posted by ArmyOfKittens at 4:26 PM on December 17, 2005

If you're fat, you're eating too much, or an unhealthy balance, or you're not exercising enough. That's the bottom line.

great! so let's punish them by denying them certain health procedures/benefits, even though they've paid into the system. people are so fucking caring these days, i want to vomit.
posted by brandz at 4:32 PM on December 17, 2005

Is this the new version of "I'm not fat, I'm big boned"?

It's not like I can snap my fingers and it all goes away instantly. My weight loss has been about one pound a week, and that takes time (I'm taking a break this month and just maintaining.) I'm down thirty-five pounds so far, I'm a size 14 now and heading to a 12 soon.

That's what gets me about people who are so judgemental about size. You don't know if people are actually working on it or not, now do you?
posted by konolia at 6:13 PM on December 17, 2005

Who cares whether they're working on it or not. Why should they have to? What is the horror--the loathing, the moral snottiness, the hypocritical judgment-- people have about excess weight?

My father in his 70s has purchased a motorcycle, which is injurious to his health and possibly hazardous to others. He has already dropped it on himself once.

Oh, but at least he isn't fat.

Any more.
posted by Peach at 7:10 PM on December 17, 2005

The whole "fat discussion" thing has never, ever, gone well on Metafilter. Just saying. Lots and lots of sanctimonious "fat is evil" people. People get their feelings hurt. Fights break out, grudges are held, feuds are started. It's ugly. Experience would suggest not having that discussion again. It cannot go anywhere good.
posted by dejah420 at 7:27 PM on December 17, 2005

I suppose we should start handing out bells so people with a BMI over 30 can ring them and shout "Unclean! Unclean!"

Good idea - that would get them some excercise.

You don't know if people are actually working on it or not, now do you?

konolia, my comment was intended to be humourous. Sorry if I offended you.
posted by spazzm at 7:37 PM on December 17, 2005

It's a difficult line to walk. I've been in America for over 20 years and I've watched the country balloon as time goes on. While I know that people have glandular conditions, are big-boned, etc., it's very hard not to see this as part of the greedy, junk-food, consumption mentality that I perceive as destroying the world.

More practically, every morning I get on the train and cannot sit. There are always at least two people on the train that are so fat that they use two seats. Perhaps some of them have some medical condition -- but 20 years ago you never saw them. You never, ever see these people standing -- for each of them who has a seat, two of us have to stand. I have a recurring medical condition that often causes me great pain in the mornings when I have to stand... the fact that you fairly often see these people eating junk food in the train doesn't make that part any better.

Now, I have to watch my weight fairly carefully. It's trivial for me to put on 10 pounds if I don't think about it. But I do. I want to live longer, I have my self-respect, I want to look at myself in the mirror and at least accept what I see.

If it were a few people, I'd be much more sympathetic. If I felt these people were otherwise working to help the world, if I didn't feel as if they were the car-driving, plastic-discarding, junk-food-gobbling, Republican-voting people who are sending this country into the Pit, I wouldn't be so ambivalent.

To make an analogy -- alcoholism is a disease, but also one that was caused by personal behavior. You sometimes see drunks passed out in the subway, and you don't sit next to them -- you feel sorry for them. But if there were passed out drunks on the car taking seats every time I got on, my sympathy would rapidly evaporate.
posted by lupus_yonderboy at 9:40 PM on December 17, 2005

Hmmmmmm. As a fat man (37.5 according to the above calculator) with bad knees, things like this bother me.

Of course, if one was to observe the fact that both conditions seem to run in the families, and that I generally only eat one average size meal a day and the knee/ankle/shoulder/wrist problems I suffer, coupled with a geographical inability to find anything fitness I think I could practice (my goal was tai chi) effectively, along with odd work hours making traditional gyms infeasible, then I guess my weight is all my fault.

I guess it's time for the chocolate icing diet to make me feel better.
posted by Samizdata at 10:05 PM on December 17, 2005

Good.
posted by matkline at 10:14 PM on December 17, 2005

The long and short of it is simple: deny orthopedic leg surgeries to people based upon their BMI and you'll simply create a class of people who have been sentenced to a lifetime of pain, immobility and a significantly diminished quality of life, all of which will only grow worse over time, while simultaneously denying them an important means of making any measurable reduction in their BMI.

So you're going to not only have a class of medical pariahs, you're going to have a class of medical pariahs who are going to cost money in lost time from work, and are going to end up hitting the NHS till for continued drug therapies for their orthopedic conditions, mobility assistance, treatment for insomnia and depression and even sexual dysfunction.

Yeah, that'll save money in the long run, I'm completely sure.

Short-sighted, party of one, your table is ready.
posted by Dreama at 1:32 AM on December 18, 2005

Of course, the fact that being severely overweight greatly increases the risks associated with general anaesthetic has nothing to do with it, right? Or the fact that it's probably going to be harder to fix something when it's surrounded by lots of unnecessary fat? *shrugs*

Dreama, the solution is simple; you change the antidepressant prescription for one that causes insomnia and perpetual twitchy restlessness, and all of a sudden the weight just drops off! Anyone managing to stay like that for a month without killing themself will be able to qualify for the surgery, no problem! [/very very bad taste humour]
posted by Lebannen at 9:56 AM on December 18, 2005

I certainly don't think fat people are evil. I just think that those who make weak excuses for their fatness are in denial. Or lazy. There's a certain weakness about people who make excuses for their behaviour instead of accepting responsibility for dealing with it. I think this is why there's often a certain level of... shall we say impatience? Disrespect?... levelled at fat people who bang on about their genes/metabolism/glands instead of getting their fat arses down a gym, or on a bike, and laying off the bloody cheetos and pies a wee bit.
posted by Decani at 12:31 PM on December 18, 2005

Decani -

I eat neither Cheetos nor pie. By personal desire, I tend to live on an extremely high protein, low carb diet. And, as I mentioned, generally one meal a day.

So, although I hate being nasty here...

Bite me, you sanctimonius prick.
posted by Samizdata at 3:27 PM on December 18, 2005

Samizdata, that one meal a day thing plays heck with your metabolism. Would it be possible for you to split that up some? And breakfast really does jumpstart your engines, so to speak.

If you are interested in what worked for me, email me-otherwise I will MMOB. ;-)
posted by konolia at 4:34 PM on December 18, 2005

Konolia -

Most interested, thank you kindly. Will email you once, ummm, I'm not actually at work. (grin)

Cheers!
posted by Samizdata at 4:39 PM on December 18, 2005

Private medicine is available, but you still have to pay National Insurance for the state system.

National Insurance is for pensions and unemployment benefit. The NHS is taxpayer funded.
posted by cillit bang at 6:00 PM on December 18, 2005

I certainly don't think fat people are evil. I just think that those who make weak excuses for their fatness are in denial. Or lazy.

I don't make any excuses for my fatness just like I don't expect thin people to make any excuses for having thin bodies. But I do get so tired of people assuming that we are lazy or in denial or overeating or underexercising or both.

For the record, you get a variety of lifestyles in both fat and thin people. Just like you get thin people who don't exercise and don't exist on rabbit food, you also get fat people who aren't lazy and don't overeat. Don't assume that fat people must be eating a lot just because you'd have to eat a lot to be that size. It doesn't work that way.

I happen to be a fat person who eats averagely (not undereating but not overeating either) and who exercises a lot. Don't use the "she must be in denial" excuse for an argument, this isn't just my view. Quote about me from a friend of mine: "She makes the Duracell bunny look idle". Quote from another friend of mine, an expert in psychology "She has a really sensible attitude to eating". These are from people who lived with me for several years so had the opportunity to really know thorough what my lifestyle is like.

You can't imagine how fed up I get of people assuming things about fat people just by looking at them. It really doesn't help us get good healthcare when we go to the doctors'.
posted by SharonC at 10:25 AM on January 16, 2006