Why does this health camp have to be only in an ideal world? It could be run at a cost of £5000 per person, I would imagine.
If the surgery really does cost less in the long term and there really is no other way to help the individual - then what option does the NHS have.
But don't you wonder how much longer the NHS can survive like this?
There is no reason to suppose that fat camps work. People lose weight, go home full of good intentions, and put the weight back on.
A gastric bypass is for life. I wouldn't want one, but I haven't (touch wood) got diabetes. I wouldn't want painful ulcers for the rest of my life either, or to go blind.
In fact it seems odd to resist the idea. A health condition comparable, roughly, with angina in seriousness can generally be treated and sometimes cured via a single, fairly serious but survivable operation. I mean, if it was Parksinsons, there would be no debate, would there? Or MS, or heart disease. One operation, in suitable cases, problem probably solved.
No one quite likes to deal with the fact that people of South Asian descent are six times more likely, and those of Afro-Carribean descent three times more likely, than white people to develop diabetes. Because that threatens the comfortable justification that fatties deserve to die. White people with a BMI of 30 have the same rate of diabetes as South Asian origin people with a BMI of 22; no one so far has suggested that Indian and Pakistani people should not be entitled to surgery that might cure them on the grounds that they should never have got so brown.
Should we give smokers a £6000 treatment too (if one existed) to save them from the effects of smoke inhalation?
If there was a £6000 operation that would mean a smoker is far less likely to develop lung cancer or COPD and so saving the huge cost of treating those diseases?
Abso-bloody-lutely we should.
Yes, yes, in an ideal world there would be no smokers. But that brings us back to that world where there are no fat people and no diabetics.
It's asking whether the NHS should pay for people to have a treatment when the person could deal with the issue themselves.
Should we give smokers a £6000 treatment too (if one existed) to save them from the effects of smoke inhalation?
If it's all about saving money then tell me T1s should just put in the effort and make do with insulin pens instead of forcing the the NHS to pay for expensive pumps.
If a patient is unable to lose weight for whatever reason and they are at risk of life-altering, and even more expensive to treat complications, then they should be given the option of surgery, without prejudice.
If there was a £6000 operation that would mean a smoker is far less likely to develop lung cancer or COPD and so saving the huge cost of treating those diseases?
Abso-bloody-lutely we should.
Yes, yes, in an ideal world there would be no smokers. But that brings us back to that world where there are no fat people and no diabetics.
Wouldn't that give smokers less of a reason to give up?
They would say "I'll just get that free surgery in a few years" rather than taking control of their lives and becoming healthy the old-fashioned way.
I used to smoke. I used to drink too much alcohol as well. I knew it would kill me ... and there would be no one to blame but myself. So I quit - it's not easy, but plenty of people manage to do it (and many manage to lose 5+ stone too) and are happier for it.
If it's all about saving money then tell me T1s should just put in the effort and make do with insulin pens instead of forcing the the NHS to pay for expensive pumps.
Are you still going on about the pumps?
Insulin injections can be extremely inconvenient and pumps are generally more effective as a treatment no matter how dedicated the patient is.
Diets don't have to be hard - just buy a book of healthy recipes and use something like FitnessPal to monitor your calories. I would hardly compare that to coping with insulin levels 24/7.
Wouldn't that give smokers less of a reason to give up?
They would say "I'll just get that free surgery in a few years" rather than taking control of their lives and becoming healthy the old-fashioned way.
I used to smoke. I used to drink too much alcohol as well. I knew it would kill me ... and there would be no one to blame but myself. So I quit - it's not easy, but plenty of people manage to do it (and many manage to lose 5+ stone too) and are happier for it.
Maybe. But as we can see without this operation being in existence, some people just do not give up smoking. No matter what we do with health warnings and age limits and price increases, there will always be people who continue to smoke because for whatever reason they feel they cannot give up. Now I expect you will just be of the opinion that you gave up therefore everyone else should be able to. But there are people who get told if they do not quit smoking (or drinking, or eating, or not eating or using drugs) then they will die soon. And they still do not stop. That is clearly not a case of just being weak willed/difficult/stupid.
So if there was an operation that could help those people and also mean less money spent on complex treatment, then of course it would be beneficial.
Insulin injections can be extremely inconvenient and pumps are generally more effective as a treatment no matter how dedicated the patient is.
Diets don't have to be hard - just buy a book of healthy recipes and use something like FitnessPal to monitor your calories. I would hardly compare that to coping with insulin levels 24/7.
I'm on about expense. You say you're so concerned about the NHS budget, but apparently only fat people should be left out in the cold- you lack empathy, sympathy and the courage of your convictions and you have an incredible amount of hubris passing judgement on how anyone goes about treating their medical condition.
Wouldn't that give smokers less of a reason to give up?
They would say "I'll just get that free surgery in a few years" rather than taking control of their lives and becoming healthy the old-fashioned way.
I used to smoke. I used to drink too much alcohol as well. I knew it would kill me ... and there would be no one to blame but myself. So I quit - it's not easy, but plenty of people manage to do it (and many manage to lose 5+ stone too) and are happier for it.
I absolutely promise you that more people manage to give up smoking than manage to lose and keep off over 5 stone. Guess what? One must be a lot easier than the other.
Wouldn't that give smokers less of a reason to give up?
They would say "I'll just get that free surgery in a few years" rather than taking control of their lives and becoming healthy the old-fashioned way.
I used to smoke. I used to drink too much alcohol as well. I knew it would kill me ... and there would be no one to blame but myself. So I quit - it's not easy, but plenty of people manage to do it (and many manage to lose 5+ stone too) and are happier for it.
and plenty can't manage and need help. Welcome to the real world.
It's asking whether the NHS should pay for people to have a treatment when the person could deal with the issue themselves.
Should we give smokers a £6000 treatment too (if one existed) to save them from the effects of smoke inhalation?
Yes the NHS should help, if this treatment helps them to loss weight , then they would be able and more likely take up physical exercise, some people are unable to do physical exercise till they have lost weight, and could cause more health problems by doing exercise. Its not all black and white as you seem to think things are, people can become over weight for lots of differant reasons. Being able to find the time to exercise can be very difficult some times. Not possable to walk to work as distants is to great, which has become a big problem over the years for millions of workers,
A fat person with diabetes, on the other hand, has a good chance of recovering from their illness by simply changing their eating habits and going out for regular walks..
Insulin injections can be extremely inconvenient and pumps are generally more effective as a treatment no matter how dedicated the patient is.
Diets don't have to be hard - just buy a book of healthy recipes and use something like FitnessPal to monitor your calories. I would hardly compare that to coping with insulin levels 24/7.
I inject myself 4 times a day and have been injecting myself every day for nearly 27 years. I don't find it inconvenient at all. It takes literally seconds to do the injection, so I just stop and do it, no matter where I am. I know that has nothing to do with what this tread is about but I just wanted to make that point!
So here we have the crux of the problem then – You seem to think that anything that applies to you is automatically applies universally to all. There are a whole host of reasons, both mental and physical, why different people react differently to various treatments, and why what’s effective for one person won’t be effective for another. Some people do have the will power to just give up something that’s bad for them, others don’t and require medical intervention. Welcome to a world of individuals.
See you know "Annie" will simply gloss over this post as if it was just forum static .. can't have common sense confusing "her" all too simplistic view of the world ..
I inject myself 4 times a day and have been injecting myself every day for nearly 27 years. I don't find it inconvenient at all. It takes literally seconds to do the injection, so I just stop and do it, no matter where I am. I know that has nothing to do with what this tread is about but I just wanted to make that point!
This is relevant! It highlights that we are all individuals and we cannot judge a person and their situation until we've walked in their shoes.
Insulin injections can be extremely inconvenient and pumps are generally more effective as a treatment no matter how dedicated the patient is.
Diets don't have to be hard - just buy a book of healthy recipes and use something like FitnessPal to monitor your calories. I would hardly compare that to coping with insulin levels 24/7.
I think you're full of shit actually. What do you know about diets and obesity really? Apart from feeling smug because you're probably a normal weight (and probably don't have to endure insatiable hunger in order to maintain your current weight, but I digress...) Why are you so keen to promote diets? I know you like to read a little on the internet, so have a free link on me:
Proponents of dietary treatment point to the health risks of obesity. Amassing evidence that weight loss would be beneficial does not make treatment any more effective. Therapies with modest success rates are defensibly used when the prognosis for an untreated person is poor and treatment poses no additional risks. But in the case of dietary treatments for obesity neither of these assumptions is clearly met. Success rates are not even modest, and the health risks associated with untreated obesity remain controversial, largely because in societies in which dieting is common the effects of high weight are confounded with the effects of weight cycling.1, 9 Dieting not only fails the criterion of being without risk but has been implicated in increased morbidity and mortality in several large studies.1,9,10 Dieting often has negative effects on psychosocial functioning and can lead to eating disorders such as the binge eating disorder and even bulimia nervosa.11 Finally, dietary treatments are costly, unpleasant, and, when they fail, tend to damage self esteem."
And we're told that diabetes complications can be minimised by maintaining a healthy HbA1c. But for one reason or another, not everyone is able to get there. So what then? Let them languish, or help them?
I did not suggest letting anyone 'languish'. I merely pointed out th facts.
It's amazing how many people don't believe this though. And just think one treatment really would work for anyone.
Don't even get me started on the people who comment without knowing the difference between the types...
I'm used to hearing people say to me I must have the "bad kind" of diabetes. As if there's a good kind.
It's such a complex disease and there's so much confusion and misinformation. It's not even really enough to say that there are only two types- ketosis prone T2, MODY, LADA... we have the discovery of the Jack Sprat gene and the fact that it's not just T2 on the rise, but T1. The Joslin Center are currently studying a group long-lived T1s who have gone an amazing 50+ years without complications! What's their secret?
It can't be said enough, it's a multifaceted problem and there are no simple solutions.
I did not suggest letting anyone 'languish'. I merely pointed out th facts.
I'm not sure what your point was then.
The fact is, despite the OP's expertise, not everyone will be able to lose the weight and reverse their symptoms. Obese people are just as deserving of treatment as anyone else. But the OP disagrees.
I'm used to hearing people say to me I must have the "bad kind" of diabetes. As if there's a good kind.
It's such a complex disease and there's so much confusion and misinformation. It's not even really enough to say that there are only two types- ketosis prone T2, MODY, LADA... we have the discovery of the Jack Sprat gene and the fact that it's not just T2 on the rise, but T1. The Joslin Center are currently studying a group long-lived T1s who have gone an amazing 50+ years without complications! What's their secret?
It can't be said enough, it's a multifaceted problem and there are no simple solution
[Icompletely/QUOTE]
I completely agree with your BIB above. ALL of the male members of my familily have been diabetic. I am 55, overweight - think i was hugely overweight when I was pregnant- and am not diabetic
So -genetic factors DO come into this, but only the most entrenched must not exclude that they are exclusive?.
It's asking whether the NHS should pay for people to have a treatment when the person could deal with the issue themselves.
For heavens sake. WHAT could 'the person deal with themselves'? Are you still trying to suggest that if people with diabetes go for walks they will be cured? because that is plain wrong.
Either we offer the best treatment we have, or we tell people with diabetes that they deserve to suffer, recognising that some resulting conditions may be life-changing and extremely expensive. Which are you hoping for? .
Proponents of dietary treatment point to the health risks of obesity. Amassing evidence that weight loss would be beneficial does not make treatment any more effective. Therapies with modest success rates are defensibly used when the prognosis for an untreated person is poor and treatment poses no additional risks. But in the case of dietary treatments for obesity neither of these assumptions is clearly met. Success rates are not even modest, and the health risks associated with untreated obesity remain controversial, largely because in societies in which dieting is common the effects of high weight are confounded with the effects of weight cycling.1, 9 Dieting not only fails the criterion of being without risk but has been implicated in increased morbidity and mortality in several large studies.1,9,10 Dieting often has negative effects on psychosocial functioning and can lead to eating disorders such as the binge eating disorder and even bulimia nervosa.11 Finally, dietary treatments are costly, unpleasant, and, when they fail, tend to damage self esteem."
Fascinating article.
I think recommending diet programmes is fatally attractive to GP's because:
a) It is virtually free;
b) Patients are eternally optimistic, and when the GP offers them a consultation with the dietician, they think that at last the magic wand may be waved;
c) When patients put all the weight back on, they invariably blame themselves, not the process, which gets the doctor off the hook.
It is hard to think of any other medical problem where the treatment of choice would be one with a 95% failure rate, and where there is evidence that long-term harm may be done.
I know someone who is very large and has diabetes, he is confined to a wheelchair now due to an ulceration of the leg. Unfortunately it is just not possible for people like him to get up and start running around. I guess he does try to control the problem with diet but being inactive means that it is very hard to lose weight.
Comments
There is no reason to suppose that fat camps work. People lose weight, go home full of good intentions, and put the weight back on.
A gastric bypass is for life. I wouldn't want one, but I haven't (touch wood) got diabetes. I wouldn't want painful ulcers for the rest of my life either, or to go blind.
In fact it seems odd to resist the idea. A health condition comparable, roughly, with angina in seriousness can generally be treated and sometimes cured via a single, fairly serious but survivable operation. I mean, if it was Parksinsons, there would be no debate, would there? Or MS, or heart disease. One operation, in suitable cases, problem probably solved.
No one quite likes to deal with the fact that people of South Asian descent are six times more likely, and those of Afro-Carribean descent three times more likely, than white people to develop diabetes. Because that threatens the comfortable justification that fatties deserve to die. White people with a BMI of 30 have the same rate of diabetes as South Asian origin people with a BMI of 22; no one so far has suggested that Indian and Pakistani people should not be entitled to surgery that might cure them on the grounds that they should never have got so brown.
If there was a £6000 operation that would mean a smoker is far less likely to develop lung cancer or COPD and so saving the huge cost of treating those diseases?
Abso-bloody-lutely we should.
Yes, yes, in an ideal world there would be no smokers. But that brings us back to that world where there are no fat people and no diabetics.
If it's all about saving money then tell me T1s should just put in the effort and make do with insulin pens instead of forcing the the NHS to pay for expensive pumps.
If a patient is unable to lose weight for whatever reason and they are at risk of life-altering, and even more expensive to treat complications, then they should be given the option of surgery, without prejudice.
Wouldn't that give smokers less of a reason to give up?
They would say "I'll just get that free surgery in a few years" rather than taking control of their lives and becoming healthy the old-fashioned way.
I used to smoke. I used to drink too much alcohol as well. I knew it would kill me ... and there would be no one to blame but myself. So I quit - it's not easy, but plenty of people manage to do it (and many manage to lose 5+ stone too) and are happier for it.
Are you still going on about the pumps?
Insulin injections can be extremely inconvenient and pumps are generally more effective as a treatment no matter how dedicated the patient is.
Diets don't have to be hard - just buy a book of healthy recipes and use something like FitnessPal to monitor your calories. I would hardly compare that to coping with insulin levels 24/7.
Maybe. But as we can see without this operation being in existence, some people just do not give up smoking. No matter what we do with health warnings and age limits and price increases, there will always be people who continue to smoke because for whatever reason they feel they cannot give up. Now I expect you will just be of the opinion that you gave up therefore everyone else should be able to. But there are people who get told if they do not quit smoking (or drinking, or eating, or not eating or using drugs) then they will die soon. And they still do not stop. That is clearly not a case of just being weak willed/difficult/stupid.
So if there was an operation that could help those people and also mean less money spent on complex treatment, then of course it would be beneficial.
I'm on about expense. You say you're so concerned about the NHS budget, but apparently only fat people should be left out in the cold- you lack empathy, sympathy and the courage of your convictions and you have an incredible amount of hubris passing judgement on how anyone goes about treating their medical condition.
My hubby's work colleagues both from india have diabetes both slim, not all are fat...
I absolutely promise you that more people manage to give up smoking than manage to lose and keep off over 5 stone. Guess what? One must be a lot easier than the other.
Diabetes doesn't always cause obesity but the cases in which people have both are often more expensive.
and plenty can't manage and need help. Welcome to the real world.
That has basically been what I've been trying to say and I think it's going in one ear and out the other.
Yes the NHS should help, if this treatment helps them to loss weight , then they would be able and more likely take up physical exercise, some people are unable to do physical exercise till they have lost weight, and could cause more health problems by doing exercise. Its not all black and white as you seem to think things are, people can become over weight for lots of differant reasons. Being able to find the time to exercise can be very difficult some times. Not possable to walk to work as distants is to great, which has become a big problem over the years for millions of workers,
Not a cure but it certainly helps.
I inject myself 4 times a day and have been injecting myself every day for nearly 27 years. I don't find it inconvenient at all. It takes literally seconds to do the injection, so I just stop and do it, no matter where I am. I know that has nothing to do with what this tread is about but I just wanted to make that point!
See you know "Annie" will simply gloss over this post as if it was just forum static .. can't have common sense confusing "her" all too simplistic view of the world ..
This is relevant! It highlights that we are all individuals and we cannot judge a person and their situation until we've walked in their shoes.
It's amazing how many people don't believe this though. And just think one treatment really would work for anyone.
Don't even get me started on the people who comment without knowing the difference between the types...
I think you're full of shit actually. What do you know about diets and obesity really? Apart from feeling smug because you're probably a normal weight (and probably don't have to endure insatiable hunger in order to maintain your current weight, but I digress...) Why are you so keen to promote diets? I know you like to read a little on the internet, so have a free link on me:
http://www.bmj.com/content/309/6955/655
"Health effects of dieting
Proponents of dietary treatment point to the health risks of obesity. Amassing evidence that weight loss would be beneficial does not make treatment any more effective. Therapies with modest success rates are defensibly used when the prognosis for an untreated person is poor and treatment poses no additional risks. But in the case of dietary treatments for obesity neither of these assumptions is clearly met. Success rates are not even modest, and the health risks associated with untreated obesity remain controversial, largely because in societies in which dieting is common the effects of high weight are confounded with the effects of weight cycling.1, 9 Dieting not only fails the criterion of being without risk but has been implicated in increased morbidity and mortality in several large studies.1,9,10 Dieting often has negative effects on psychosocial functioning and can lead to eating disorders such as the binge eating disorder and even bulimia nervosa.11 Finally, dietary treatments are costly, unpleasant, and, when they fail, tend to damage self esteem."
I did not suggest letting anyone 'languish'. I merely pointed out th facts.
I'm used to hearing people say to me I must have the "bad kind" of diabetes. As if there's a good kind.
It's such a complex disease and there's so much confusion and misinformation. It's not even really enough to say that there are only two types- ketosis prone T2, MODY, LADA... we have the discovery of the Jack Sprat gene and the fact that it's not just T2 on the rise, but T1. The Joslin Center are currently studying a group long-lived T1s who have gone an amazing 50+ years without complications! What's their secret?
It can't be said enough, it's a multifaceted problem and there are no simple solutions.
I'm not sure what your point was then.
The fact is, despite the OP's expertise, not everyone will be able to lose the weight and reverse their symptoms. Obese people are just as deserving of treatment as anyone else. But the OP disagrees.
Either we offer the best treatment we have, or we tell people with diabetes that they deserve to suffer, recognising that some resulting conditions may be life-changing and extremely expensive. Which are you hoping for? .
Fascinating article.
I think recommending diet programmes is fatally attractive to GP's because:
a) It is virtually free;
b) Patients are eternally optimistic, and when the GP offers them a consultation with the dietician, they think that at last the magic wand may be waved;
c) When patients put all the weight back on, they invariably blame themselves, not the process, which gets the doctor off the hook.
It is hard to think of any other medical problem where the treatment of choice would be one with a 95% failure rate, and where there is evidence that long-term harm may be done.