Obesity(bariatric) surgery

Well after reading all the previous threads I still feel fat!! But take some consolation in the fact that I have exactly the same build as an aunt and my mother so I guess some of it is genetic. My family always call me "big boned" but I am still targeting an upper weight limit so have about 2st to lose.

Aka you said obesity as measured by BMI is linked to several life threatening conditions.
But the point the various articles make is that although obesity is linked to life-limiting conditions, BMI is not an accurate indicator of that obesity, so how can BMI be an indicator of these conditions?
You appeared to agree with that, with your reference to athletes in your earlier post.

The point is that the NHS is going to offer bariatric surgery to people based on their BMI, when it is not an indicator of morbid obesity for individual patients.

If it isn't as a measure of body fat what is it? It is currently used to provide an index on the basis of which it is decided whether a person is underweight, normal weight, over-weight or obese. As far as I know all these descriptions are defined by how much body fat that person has.

Yes, I agree that if your BMI is 30 it doesn't necessarily mean that 30% of your total weight is adipose tissue but if your BMI is 30 you are defined as obese and this is defined as having too much body fat.

Sorry, I have been thinking further. Just because there is a link between a medical condition and BMI when looking across whole populations does not mean that that risk applies when you apply that statistic to individuals. Because if a third of BMI measurements overestimate what weight group you fall into and a third underestimate they cancel each other out but the fact remains that two thirds of individual calculations are wrong.

This means that one third of people will be told that they are in the low risk zone for these medical conditions when they are actually in a high risk zone and should be taking action while another third will be told that they are at high risk when in fact they are in a lower risk zone and they may be put at risk of developing medical conditions like osteoporosis which are associated with low weights.

BMI is an economic statistic not a medical statistic and should only be used to calculate population averages, and not applied to individuals.

There was an article in the Times last week that said ( at last) that doctors should be tackling the psychological problems involved in obesity.,As you said
SueBailey, there must be emotional reasons why many people overeat.Alcoholics are presumably given support in dealing with addiction, as are bulimics and anorexics, but compulsive eaters seem to be viewed as the lowest of the low. Bariatric surgery surely won't get to the root of the problem, but perhaps some therapy might!

As I think we all agree, excess body fat is the issue. Especially visceral fat. JaneA I think you and I (and Flick?) agree that it is hard to measure body composition.

However we measure it, excess body fat is linked to certain life threatening diseases.

If there is a simpler way of measuring % body fat easily and accurately I'd welcome it.

Oops! The 7- year old GS has just pulled out a front tooth! Tooth fairy alert [ shock]

I don't care about what BMI measures, it is the simplest guide we can all use to get a rough idea of if we are overweight or not. We don't have any other equipment so this is an easy guide which is enough for most people.

You only have to stand in the supermarket queue and look at what fat people have on the conveyor belt so see why they are fat. It really is not complicated. I know as I have a thyroid condition which means I have to eat a lot less than most people so I do. We have had a big celebration recently and I have eaten too much, put on weight so need to eat less and go to the gym. It is my responsibility and I don't expect anyone else to deal with it.

I saw the comments that people won't have an operation if they can avoid it so why are there so many abortions? That is easily avoided.

I have a friend who paid for a gastric band herself and thought it would solve all her problems, it didn't, last time I saw her she was up to 18 stone again and she is only 5' 3".

IMO education is the answer, making people take ownership of their own issues.

I think that is the problem Aka - there isn't a simple way of measuring it, especially as you say, the visceral fat.

I just think the Department of Health and the NHS do themselves no favours in terms of credibility when they persist in almost bullying people with the use of a tool that isn't really fit for purpose.

Each patient deserves to be treated as an individual, not as a part of a population.

Crossed posts Nonnie. If by education you mean public health campaigns, I disagree.
I think many people who gain weight as a result of eating the wrong things are suffering from a form of addiction (especially to sugar) and need help and support, rather than 'being made to take ownership of their issues' as you put it.

Actually there is a simple piece of equipment to use as a guide to whether you're overweight - the simple tape measure. As well as being easily able to track your own measurements, there is an increasing body of opinion tending to the view that the waist/height ratio is a better indicator of true fat levels for an individual than BMI.

jane I agree that the tape measure tells us how big we are but that doesn't tell us how that is perceived in terms of our health so overweight/obese people can convince themselves they are not as big as they are.

What help and support would you suggest jane? I think that all addicts have to take responsibility for their addiction before they can be cured. That can be done by educating them.

I agree that anyone who has an addiction to anything, has to want to get better Nonnie, but I think they need counselling and mentoring, and helped to see the benefits of changing their lives, rather than just being told what to do.

I once suggested to someone that they might think about giving up smoking, and that there was help available to her - she replied that it was her only pleasure in life.

These problems are deep-seated.

I think you are agreeing with me jane education is whatever form is appropriate. Once people accept that they are overweight and that it will, or already is, affecting their lives and that they are the ones who need to do something about it then they have the choice to do so or not. However, while we live in a society where no one has to take responsibility for themselves there will always be people who refuse to acknowledge it is there own responsibility.

No point having invasive surgery if you are going to carry on as before, like my firend.

I think the "food industry" with its horrible additive-full, sugar-laden, chemically-enhanced rubbish needs to be held to account. Politicians need to completely free of any links to these companies, health advisers and advisory organisations should not have any sponsorship from them and the message "processed food bad, real food good" should be heard loud and clear.
Did anyone see the item on dental decay in children on Breakfast this morning? Horrifying.

You do not need BMI to know whether someone is overweight. Just look at them. Before BMI doctors twice warned me to lose a bit of weight (about 7lbs) and that was based on just seeing me in a state of partial undress in the consulting room. Photographs of me then show that I was indeed getting porky.

I also think the approach to helping people with weight problems is unhelpful. I watched a tv programme where doctors were 'helping' potential bariatric patients lose some weight and change their eating habits. One day they were at home eating 4,000 calories a day, a diet rich in sugar, fat and refined carbohydrates. The next day they were in a hospital receiving 1500 calories a day, a diet short of sugar, fat and refined carbohydrates and rich in vegetables and unrefined carbohydrates.

The failure rate was nearly 100%, which didn't surprise me. Those with weight problems and poor diets need to be helped to shift from a bad to a good eating pattern gradually, replacing sugar drinks with diet drinks, full fat milk, via semi-skinned to skimmed. They need to be taught to cook, how to make low-cal versions of their favourite take-aways, helped to make small changes that gradually move them towards habits that will bring their weight down and last a life time.

This is a really interesting debate.

The problem with the present obesity epidemic is

* who is going to tell these people they must lose weight?
* who is going to monitor/support their efforts?
* how are they to be motivated?

I agree the food indusurtry has a case to answer BUT no one is holding these people down and forcing them to eat junk food. Sometimes it's just laziness on their part (we all get the odd day where we just bung a ready meal in the oven) and sometimes they don't know how to manage a good meal on a budget.

* so who is going to teach them?

Short of having a fat tax (an extra 1p on basic level of income tax per extra kg overweight) or incarcerating the obese in Fat Camps I can't see a way forward.

only joking ... I think

The government could incentivise GP practices to run weight-loss clinics in the same way that they run smoking cessation, or dental practices employ dental hygienists to help patients improve their oral health, for a start.

But you have to pay privately to see the hygienist so I don't suppose many people do. I went last week and it cost me £150.

I agree with you Aka, not sure there is a way apart from making it socially unacceptable to be fat which is just not going to happen.

My diabetic friend has to go for a checkup every 6 months and she gets weighed each time but it doesn't make her exercise or lose weight. Not sure the GPs can do much more. Just like smoking, you have to want to do it.

If people refuse to see the problem I don't think there is much hope.

I'm off to Pilates!!

nonnie if you see a dentist under NHS contract, they should provide 'all care and treatment that is necessary to secure your oral health'. That includes seeing the hygienist if it is considered necessary.
The Chief Dental Officer thinks that what he terms 'cosmetic scales and polishes' are not necessary for oral health, and so NHS dentists sometimes charge privately.
However anyone with chronic gum inflammation should be entitled to NHS care, since it should result in an improvement in both oral and general health.

And, Nonnie, £150 is exorbitant!

The way in which the nhs dental care service has deteriorated has resulted in more folks going for a DenPlan type solution. £150 for a check up and hygienist sounds outrageous. My plan costs just over £200 a year. I have 6 monthly checks, 3 monthly hygienist treatments and only pay extra for special stuff. Just had a crown, cost £80 on top of my annual fee.

No doubt the difficulty many have in getting an nhs dentist is contributing to the fact that so many children are admitted to hospital with dental decay. I've worked with 4 year olds whose teeth were totally rotten, and a 6 year old who'd had all teeth removed due to decay. It can't be cost effective - children 'in care' or subject to sw involvement all have being registered with an nhs dentist as one of the essentials.

£150? We pay less than that per annum which entitles us to two checkups, two hygienist visits and 20% off any treatment.

Fat Camp - can you send me please aka, to shift the last pounds which are proving troublesome to get off!

There is so much information out there about healthy eating, plus GP referrals to Weightwatchers and exercise classes that really the only excuse is greed and laziness - and not being in the right frame of mind of course.
We eat healthily but I do like my food, I am probably greedy. And of course the demon , lager and beer is so much more available these days. I don't remember anyone drinking much at home when I was a child. DF used to have a beer, there was sherry for rare occasions and a bottle of brandy for medicinal purposes.
is empty calories.

Do not underestimate the profound ignorance of many people about nutrition and ignorance of what a good diet is. A significant proportion of the population are functionally illiterate. They do not read newspapers or magasines, watch the news or watch any television except soaps, games and celebrity programmes. They will not read anything pushed through their letterbox or given to them at a surgery or hospital. They can read but they don't. They really and truly do not have a clue.

Equally they have no idea how to cook. Even boiling an egg is beyond them. There was a news item today talking about children's knowledge of how food is produced. Less than 10% of children had visited the countryside in the last year. Nearly 50% had never visited a farm and around 10% suggested farmers variously grew mud, tractors and potato waffles. Many did not know that farmers grew vegetables.

I remember watching a programme once where the presenter interviewed a young mother and said something that just assumed her children ate pasta. The mother looked aghast and said 'We don't eat that, that's posh food.'

Many people are also self-indulgent, they simply will not do anything that inconveniences them or that they do not want to do. They know what they should cook and eat but are simply too lazy to bother.

Pasta - posh food?

I do remember seeing a programme a couple of years ago, can't remember what it was about, I think about teaching young mothers how to cook simple nutritious meals and sit around the table to eat. The child, who was about 4, had never eaten anything beyond chips from the chippie covered in cheese or sauce occasionally, she sat on the floor and ate out of the polystyrene packet with her fingers.

But this young mother must have gone to school, must have learnt something while she was there, surely?
Don't children go on school trips to community farms or similar places?
Whenever DH and I go out anywhere there is always a school trip on a visit!

I despair, people must go around with their eyes and ears shut.

maybe a magic wand would work. that's what I need