Obesity: How Prejudiced is the NHS?

[BarbaraG]

On BBC2 right now - a programme arguing that many more surgeries for weight loss should be carried out, and that prejudice against obese people is a barrier.

First patient they showed is T2D, and the morning after surgery his BG was between 5 and 6 (they didn't tell us what it was before). He was told he could stop his meds there and then.

Watching with interest to see what they say about diet.

 

[BarbaraG]

Ooh - next patient was referred to NHS weight management service and told to follow Eatwell Plate. She told them carbs were an issue, and was pressured to follow Eatwell. Gained 2 stone while under weight management service.

Just been approved for gastric bypass.

 

[Squire Fulwood]

NHS is prejudiced about everything if it gets them off the hook. If you are fat, lazy,smoke or have lifestyle they don't recommend then they would rather put the blame on you.

Their remit, however is to fix people.

When I take my car to the garage for repair the mechanic might say I have been driving it in a manner he does not approve of. Well, I pay the bill so fix it

 

[DavidGrahamJones]

First patient they showed is T2D, and the morning after surgery his BG was between 5 and 6 (they didn't tell us what it was before). He was told he could stop his meds there and then.

From what I have read and from what I remember when I attended the Bariatric Surgery Support Group, a Gastric bypass will "cure" (for want of a better word) type II diabetes, the small intestine spontaneously begins to produce a molecule called GLUT-1 (not present normally in the small intestine) that helps the body use glucose. Gastric bypass surgery helps resolve type II even before weight loss occurs

A gastric band does not seem to have the same effect.

Pleased to say I had neither, they were liquidising ice cream and mars bars to get their calorie intake up to 1200. I have since found out that this practice is no longer recommended.

Gained 2 stone while under weight management service.

Just been approved for gastric bypass.

In Bucks you are not considered unless you have a certain BMI, perhaps that extra 2 stone took her over the limit. (sarcasm) It's almost so that the surgeon has someone to perform surgery on. (even more sarcasm)

One of my great fears is ending up in a hospital bed, unable to tell them what to do with their Harris Benedict Formula and their eatwell plate.

 

[zand]

The programme brought tears to my eyes. One woman had the same health problems as me - T2, atrial fibrillation and obesity - and was refused a heart procedure to put her heart back into rhythm because she was obese. How lucky am I? I had 3 of these procedures and then another more intrusive one. My heart has been fine for 53 months now, meaning I have a better quality of life and can walk for much further than the 100 metres limit I had previously. I have walked as far as 14 miles a couple of times since the op. If I had been living in a different region then I would be going through the same as that poor woman. How on earth is this right? Atrial fibrillation can affect anyone, not just the obese. Why should the obese be treated like this?

 

[BarbaraG]

There certainly is a postcode lottery.

About 15 years ago, my diabetes care was from a GP who took a special interest and looked after all the PWD in the practice. After a couple of goes round the weight management system, he suggested I consider surgery - at that point gastric band was all the rage and he offered to refer me. It was so emotionally shocking to me that that was suggested, I didn't do anything about it.

A couple of years later, and having moved to a new area, I went to see my new GP and asked to be referred for surgery. He was not keen, talked about lifestyle, going to the gym etc. It took a while - but the following year I adopted healthier eating (cut out most of the **** and ate real foods - but not low carb) and lost 7.5 stone and got off all my meds before I stalled.

Mind you, in the first couple of months, not believe it I could stick with the changes, I researched WLS extensively. I had even decided which operation I would have (gastric sleeve) and with which provider. I was prepared to pay - I think it was around 6K - to have it done privately.

After the 7.5 stone loss and stall, I gradually - much more gradually than ever before - started to regain. Why? Because I let the **** back in. First occasionally, then regularly, then a lot. Over the course of 3 years I regained 6 stone and started back on metformin.

This brings us to my accidental adoption of low carb to " do something about my weight", then the discovery of keto and quite how good it is for managing T2. I've lost 4 stone, and stalled..... but I don't care, because I feel like I've found the key. If I'm destined to still be obese, so be it - I'm no longer morbidly obese, I am mobile and my labs are normal.

But just think - I had one doc try to persuade me to have surgery when I didn't want it, and another dissuade me when I did want it. We are so much in their hands, and at the mercy of their opinions.

 

[lindisfel]

If you ride the clutch Squire its best to stop it cos clutch changes cost a lot! D.

 

[lindisfel]

The programme brought tears to my eyes. One woman had the same health problems as me - T2, atrial fibrillation and obesity - and was refused a heart procedure to put her heart back into rhythm because she was obese. How lucky am I? I had 3 of these procedures and then another more intrusive one. My heart has been fine for 53 months now, meaning I have a better quality of life and can walk for much further than the 100 metres limit I had previously. I have walked as far as 14 miles a couple of times since the op. If I had been living in a different region then I would be going through the same as that poor woman. How on earth is this right? Atrial fibrillation can affect anyone, not just the obese. Why should the obese be treated like this?

Hi Zand I am thinking of having cardioversion but its only 20% successful at my age. I guess you underwent ablation to fix the problem? atb Derek

 

[CherryAA]

I just watched this program, some interesting stuff about the changes to hormones etc, I would be interested to see a comparison of the blood profiles and health markers of someone in nutritional ketosis, compared to immediately after weight loss surgery when one is likely to have been fasting for at least 30 hours by the time you can eat again, if not more. Also interesting to see that the guy eating tiny meals at then end is still making potatoes a staple of his food. It certainly seems like the surgery helps, but it could be so much more effective if people were advised to try low carb first .

 

[zand]

Hi Zand I am thinking of having cardioversion but its only 20% successful at my age. I guess you underwent ablation to fix the problem? atb Derek

The 2nd cardioversion worked for about 18 months. The 1st and 3rd didn't work. Yes, I had ablation. They were trialling a new method at the time. The old method used a lasso type of action whereas the new one could be used to pinpoint the exact place where treatment was needed. I was 54 at the time and I guess because I was fairly young for that type of procedure they kept going until they had reached all the places that needed working on. It took 6 hours, but I didn't need to go back for further treatment. I had been told it would take 3 or 4 attempts to finish the treatment. I am not sure they would do so much at once in an older person. I took a very long time to recover, and couldn't walk more than a few steps without needing to sit down again a day after the op. It was 2 weeks complete bed rest and then a gradual path back to health which took about 5 months.

Since then my heart has been out of rhythm a few times but a dose or two of magnesium supplement puts it back again. I wish I had known about magnesium years ago. I read that if you do excessive heavy work while you are low in magnesium this can cause AF. Well, I did just that, I shovelled about a foot of snow from our (longish drive) and was extremely breathless after that. A month later my GP told me I had AF.

Even the ablation was a lottery really. I had been to my GP for something routine and another doctor popped into the room to tell me to ask my heart consultant if I could have an ablation at a different hospital (they didn't offer it at my usual one). At my next consultant appointment she said they had done the 3 cardioversions and could do no more to treat the rhythm, now they could only slow the heart with drugs. I mentioned the op and she agreed to refer me to John Radcliffe hospital Oxford. Now I don't need heart drugs at all.

Are you on any drugs for the AF? Have you got as far as Amiodarone? Is your AF very bad?

 

[DavidGrahamJones]

Finally watched the program on iPlayer and delighted to see an old "friend", Professor John Wass, who I was referred to privately, several years ago. I had the same problem then as I do now, I eat much less than my RMR and even with exercise, I do not lose weight. His advice then was gastric surgery which I wasn't keen on but at least I took the time and made the effort to find out more before saying no.

That's when I discovered that in High Wycombe, they were liquidising mars bars and chocolate to get their calories up to 1200 cals per day (not current advice I'm pleased to say). They were also almost always fitting bands rather than giving bypasses and one of the reasons I declined a band was because I felt I could get down to 1200 cals per day without surgery and that's what I have been able to do.

I later discovered that the bypass works slightly differently, not just restricting food, and indeed, at the time, they weren't 100% clear on how it did work, especially with the BG and BP meds no longer being required.

In the program it was strange when the guy said that he had never been able to lose weight on any diet before and I'm hardly surprised, most formal dieting regime recommend only 500 cals less than RMR. Post op, he was down to a few mouthfuls and I'm assuming 1200 cals per day, which seems to be the bare minimum sensible for health reasons.

It was an interesting program though, if only they could say categorically how much people ate to become obese. I can go back through my food diaries about 8 years at least and there's many occasions where weight has been gained while eating less than my RMR.

I'm tempted to look at the gastric bypass again but I just want to lose weight by eating less and exercising more, just like they say you're supposed to be able to. I suppose I can dream.

 

[AndBreathe]

I watched the programme and found it as bit one-sided. Bariatric surgery was being promoted almost as a panacea for those carrying excess weight. I don't think I saw anything that really even mentioned any of the downsides.

Following a discussion on here a while ago, I found a pdf of potential side effects, over the immediacy of the op, within a few weeks and longer. It's not warming reading.

I did find the complete lottery in the process somewhat shocking, but we already see variations on this for a number of conditions, not relating to obesity. We see it increasingly in joint replacement stories, and so on.

I did feel for that poor woman who had struggled for years with her AF, never mind whether or not weight loss surgery was right for her.

 

[bulkbiker]

I just want to lose weight by eating less and exercising more, just like they say you're supposed to be able to. I suppose I can dream.

You're a bit of an old hand round here but I just wanted to say that this is quite old science and not necessarily correct. When you restrict calories too much but eat all the time your metabolic rate has been shown to slow down. Reducing calories isn't alway the best way to loose weight. I have no idea how much you have investigated all this but I was just reading about an interesting experiment on the ketogenic forums where one of the main guys fasted for 3 days lost 7 pounds then overfed himself on 5000 calories a day for the next three days and lost a further 3 pounds..your metabolism is very good at acclimatising to whatever you put in it. Mixing up up wth fasting and feasting may be better than restriction. Just a thought from a different perspective. I know myself from 2 1/2 decades of calorie restriction that it never worked long term for me.

 

[Mr_Pot]

When I take my car to the garage for repair the mechanic might say I have been driving it in a manner he does not approve of. Well, I pay the bill so fix it

Your analogy might be ok if you paid for private treatment but all taxpayers are paying for NHS treatment so it's not unreasonable to expect patients to make some effort themselves.

 

[Pipp]

The arguments for and against bariatric surgery aside, the most telling thing for me is that the medical professionals who attended the presentation on it admitted that they had preconceived ideas about people with obesity problems. Almost justifying to themselves the denial of treatment for other medical problems.
Treatment that would be available to those patients with BMI consideraed normal is being denied to obese people. Decisions are not being made on the clinical prognosis, merely on a patients size.

 

[lindisfel]

The 2nd cardioversion worked for about 18 months. The 1st and 3rd didn't work. Yes, I had ablation. They were trialling a new method at the time. The old method used a lasso type of action whereas the new one could be used to pinpoint the exact place where treatment was needed. I was 54 at the time and I guess because I was fairly young for that type of procedure they kept going until they had reached all the places that needed working on. It took 6 hours, but I didn't need to go back for further treatment. I had been told it would take 3 or 4 attempts to finish the treatment. I am not sure they would do so much at once in an older person. I took a very long time to recover, and couldn't walk more than a few steps without needing to sit down again a day after the op. It was 2 weeks complete bed rest and then a gradual path back to health which took about 5 months.

Since then my heart has been out of rhythm a few times but a dose or two of magnesium supplement puts it back again. I wish I had known about magnesium years ago. I read that if you do excessive heavy work while you are low in magnesium this can cause AF. Well, I did just that, I shovelled about a foot of snow from our (longish drive) and was extremely breathless after that. A month later my GP told me I had AF.

Even the ablation was a lottery really. I had been to my GP for something routine and another doctor popped into the room to tell me to ask my heart consultant if I could have an ablation at a different hospital (they didn't offer it at my usual one). At my next consultant appointment she said they had done the 3 cardioversions and could do no more to treat the rhythm, now they could only slow the heart with drugs. I mentioned the op and she agreed to refer me to John Radcliffe hospital Oxford. Now I don't need heart drugs at all.

Are you on any drugs for the AF? Have you got as far as Amiodarone? Is your AF very bad?

Thanks Zand, I'm pleased you got sorted, I don't think I would survive at 78 in June. My Afib is permanent but I don't have palpitations just missing beats or heart stopping moments. I got a pacemaker three years ago for bradicardia and repeated 4 Sec pauses over night , so I have a slow heartbeat but my pacemaker doesn't let it drop below 60bpm. I can walk 3miles OK but have bad days when I'm knackered! I'm on Pradaxa and eplerenone (the aldosterone antagonist) no other meds.best wishes ,D.

 

[BarbaraG]

I just watched this program, some interesting stuff about the changes to hormones etc, I would be interested to see a comparison of the blood profiles and health markers of someone in nutritional ketosis, compared to immediately after weight loss surgery when one is likely to have been fasting for at least 30 hours by the time you can eat again, if not more. o much more effective if people were advised to try low carb first .

I had similar thoughts. It seems that the mechanism by which gastric surgery works is that changes to hormones make the people less inclined to eat - as well as the restriction and malabsorption. They end up eating fewer calories, but without effort or hunger.

It seems that the mechanism by which keto works for weight loss has to do with changes in hormones, which make people less inclined to eat, so they end up eating fewer calories without effort or hunger.

Ok, there is some effort. You have to be quite vigilant about avoiding the starches and sugars. But if you do that, you can pretty much eat as much as you fancy and the weight comes off and the BG stays down.

 

[Resurgam]

I have read of people who started to do low carb to prepare for surgery, and lost so much weight so quickly and easily that they decided not to have the surgery after all - thank you very much, not now they had found out what the secret to controlling their weight had always been but they were never told it before their lives were in danger.
Low carb has been around for well over a century - but it seems to make some people crazy just to mention it.
I had a slimming club organised almost weeping over my imminent death as I explained that I was losing 2 Kg a week on Atkins.

 

[Bluetit1802]

After watching one of TV programmes on diabetes when bariatric surgery was featured the patients had to follow a very low calorie diet akin to the Newcastle Diet for 6 weeks and lose weight before they were given the go ahead.

If they can manage this then why not the full ND and avoid the surgery?

 

[Bluetit1802]

Your analogy might be ok if you paid for private treatment but all taxpayers are paying for NHS treatment so it's not unreasonable to expect patients to make some effort themselves.

Obese people also pay for it. Smokers and regular alcohol drinkers pay even more.