Daily Mail - 13.08.2019

Daily Mail, Tuesday, August 13, 2019 Page 37

‘CALLING IT

A DISEASE

MAKES THE

PROBLEM

WORSE’

at an earlier stage — people often

feel embarrassed about seeking

help, are worried that they may be

blamed for their condition, and

typically delay discussing their

obesity with a GP by an average of

six years, with serious implications

for their health.

Chronic obesity causes more

damage to the body the longer it

goes on; if it was recognised and

treated early, those people could

avoid developing life-threatening

conditions such as heart disease

and liver disease.

If obesity was seen as a medical

condition, there would be no

blame attached and medics could

get on with helping someone

get better.

It is argued that the

reclassification would be a step

towards the medicalisation of

obesity, with people being given

medicines such as orlistat [a

prescription-only drug that

reduces the amount of fat absorbed

from food] they don’t need.

In fact, losing weight may reduce

the need for medicines to treat

other problems, such as diabetes

and high blood pressure.

Yes, in some cases, when the

situation is chronic and severe, it

may be appropriate to treat

someone with medication and

weight-loss surgery, but in the vast

majority of cases, the mainstay of

‘treatment’ will still be lifestyle

changes with the right support.

Another argument against

treating obesity as a disease is

that it means removing personal

responsibility — I don’t think it

will do this. Many other diseases,

such as asthma, require someone

to take responsibility to manage

their condition. A doctor could

provide advice and referrals to

obesity specialists and, as with

asthma, it would be down to the

patient to follow guidance on life-

style and to attend clinics.

Of course, we don’t want to be

seen as the ‘fat police’, telling

people in such clinics they have to

lose weight. And, to a degree, it

will also be down to the patient’s

own health and how they feel.

But the fact is, what we have

done until now hasn’t worked — so

we need to try something else.

thousands of people with a BMI

of over 30, meaning they are

obese, with a greatly increased

risk of type 2 diabetes and other

conditions that may shorten

their lives — but I’ve never told

a single one of them that they

have a disease called obesity.

Obesity is a problem that has

many causes, including

environment, education, poor

diet, inactivity and genetics.

This can be improved with the

right support, primarily around

lifestyle measures but also

sometimes medication

and weight-loss surgery for

some who are classed as

morbidly obese.

One of my main concerns

is that if you give people a label

like this — that says they have

a disease — then you run the

risk of disempowering and

demotivating them.

Time and again I have seen

people given a label, such as

diabetes or heart disease, and

as a result they become

medicalised, believing the

answer lies in drugs and procedures

and that this is now primarily the

responsibility of the medical

profession, particularly the GP

sitting in front of them.

People with a high BMI often

have low morale anyway, because

of the stigma surrounding obesity.

The last thing we want to do is

make this worse.

I’ve always found that if you give

someone autonomy and ownership

of the situation, helping them to

feel it is under their control, you

can achieve amazing things.

Over the past two or three years,

I’ve been practising more of a ‘life-

style medicine’ approach in my GP

clinics and I’ve been spending a lot

of time talking to patients about

the importance of things such as

sleep, a balanced healthy diet and

physical activity, relaxation and

connection with other people.

We encourage activities such as

attending self-help classes, health

walks and weight-loss groups.

The results have been amazing

and many of the people I see have

reduced their weight, reversed

symptoms of pre-diabetes and

reduced their blood pressure to

normal levels. And they are

typically a lot happier for it, too.

There is good evidence to support

the effectiveness of healthy life-

style changes in preventing heart

attacks and strokes, reversing

coronary artery disease, reducing

the risk of cancer, dementia and

death rates from all causes, as well

as prolonging healthy lifespan.

Doctors do try to counsel

patients this way but the time we

have is very limited (less than ten

minutes in general practice) and

prescribing a drug or sending the

patient to a specialist can be the

easy option.

But if you classify obesity as a

disease, you can be sure there will

be a rapid escalation in the use

of pills and procedures to ‘cure’

the ailment, which is how the

medical establishment usually

treats diseases.

Classifying something as a

disease tends to result in guidelines

being produced. It often involves

people or organisations with

vested interests in this area (for

example, pharmaceutical compa-

nies or ‘experts’ who have financial

or career-related interests) and

also pushes doctors to behave in a

particular way for fear of falling

foul of the guidelines and being

labelled a bad doctor.

A

CTuAllY we already

know what treatment

should be recommended

for obesity and that is,

initially at least, behaviour change.

Pills and procedures have their

place as a last resort in the most

extreme cases and we already have

guidelines for this, without a

disease classification.

Medical treatment is no panacea;

in studies, the failure rate of

weight-loss surgery can range from

25 per cent to 70 per cent (‘failure’

is where a patient doesn’t manage

to maintain excess weight loss of

50 per cent or greater over 18 to 24

months). Complications of

weight-loss surgery include

persistent nausea and vomiting,

intolerance to solid food and, in

rare cases, death.

Classifying obesity as a disease is

also a quick way to hugely increase

the market in obesity medication,

which would push up share prices

of some pharmaceutical companies

and incentivise hospitals to carry

out more weight-loss surgery,

costing the NHS more money.

In the u.S., where obesity is classed

as a disease, there is a massive

industry surrounding treating

obesity — but obesity rates con-

tinue to rise, raising the question

of just how cost-effective this

approach is.

I agree that, for a small number

of people, obesity is indeed a

symptom of an underlying health

problem, such as the genetic

condition Prader-Willi syndrome,

which is present from birth and

means someone cannot regulate

their appetite properly.

But for most people, genetic

predisposition plays a very small

role and it’s not really a good idea

to tell them they’re overweight

because they inherited this

disease, as they may stop trying

to lose weight themselves,

thinking that being overweight

is unavoidable.

Much more important is what

they eat and how physically active

they are. Of course, your environ-

ment is hugely important, too.

There is no doubt that people

growing up in poorer areas with

fewer resources are more likely to

be overweight or obese.

That makes it more important

that we try to tackle problems in

target areas including improving

housing stock, access to advice

about health and wellbeing,

making it easier to walk and cycle,

and the availability of cheap, fresh

fruit and vegetables.

We should avoid being distracted

by the debate over whether obesity

should be classified as a disease.

Reclassifying obesity is not a

magic bullet: much more impor-

tant is that we identify people who

are obese or at risk of becoming

so, and have the community

services in place to give the right

advice, support and treatment to

help them help themselves.

Interviews by

THEA JOURDAN

Dr RichaRD Pile is a GP with

a specialist interest in

cardiology who also works for

herts Valley clinical

commissioning Group.

I CAN’T imagine a time when I

would call obesity a disease; my

fear is that if we do this it will take

power and responsibility away

from patients and open the flood-

gates to pills and procedures, with

rising costs to the NHS as well.

And the fact is, it’s not a disease.

I’ve been a doctor for 20 years and

in my consultations I have seen

D

?

1993

Height

Waist

Weight

BMI

93.2cm

(36.7in)

78.9kg

(12st 5lb)

25.9

2017

174.4cm

(5ft 7in) (5ft 7½)

175.3cm

97.8cm

(38.5in)

84.9kg

(13st 5lb)

27.6

1993

Height

Waist

Weight

BMI

161.1cm

(5ft 2¾)

81.7cm

(32.1in)

66.6kg

(10st 6lb)

25.7

2017

161.9cm

(5ft 3in)

89.4cm

(35.1in)

72.8kg

(11st 6lb)

27.8

obese

16%

obese

13%

30%

obese

27.4%

obese

AVERAGE FEMALE

AVERAGE MALE

MY, HOW WE’VE GROWN!