Junkfood Science: Whose “need” are they referring to?

August 12, 2007

Whose “need” are they referring to?

The government has earmarked nearly 700,000 Britons for bariatric surgery, according to a new report in the news today. It’s part of the National Institute for Health and Clinical Excellence (NICE) guidelines — the clinical practice guidelines that doctors in the British National Health Services (NHS) must follow as part of their national contracts.

There is a perception among many Americans that under a nationalized healthcare system, we’ll be well taken care of, that government health agencies will decide what is best for us and that the guidelines they will mandate government-employed doctors to follow will be based on sound clinical evidence and be free from the corruption and influence of special interests. None of those have proven true for fat people in the UK.

As the Telegraph reported this morning:

700,000 obese Britons need stomach stapling

Almost 700,000 people are so fat that they need drastic surgery to tackle their weight problems, the Government's health watchdog has found...the guidance drawn up by the National Institute for Health and Clinical Excellence (Nice)...says that anyone with a body mass index (BMI) above 40 should be offered surgery if other attempts to lose weight fail after six months, and those with a BMI above 50 should go under the knife immediately.

Given the most objective mortality data available to date here in the United States, after five years of analysis, actual one-year death rates among bariatric surgeries average 4.6%. This means that the British government’s national guidelines, if followed, could cost about 32,200 British citizens their lives this year.

But, it appears that most of these people may be saved because the NHS is insolvent, as the Telegraph goes on to report:

However, obesity experts claim that PCTs are ignoring the guidelines and, because they cannot afford to pay for thousands of operations - which cost about £6,000 each - are imposing stricter restrictions of their own.... Obesity experts said that cash-strapped PCTs were desperate to avoid the costs of operating on the obese.

David Hewin, a surgeon at Gloucestershire Royal Hospital, said: “The numbers involved are huge, so PCTs are coming up with much more stringent criteria and moving the goalposts... Janet Edmond, director of the British Obesity Surgery Patient Association, said budgetary concerns were being exacerbated by a shortage of the specialists required to perform the procedures....

The article goes on to quote patients and obesity interests calling for more funding. It also reported that patients desperate for the surgery are going outside the country and pay out of their own savings. And are dying. Just yesterday, the death of a young bride was in the UK news. She had died six months after her bariatric surgery, done in Belgium, had left her body unable to absorb enough food to keep her alive. No attempt had been made to reverse her bariatric surgery, according to the Daily Mail. The coroner listed the cause of death as an accident but said it was “due to multi-organ failure, protein malnutrition and malabsorption due to weight-loss surgery.”

The expense of the surgeries has resulted in similarly tragic stories here, as growing numbers of American are also heading outside the country where surgeries are cheaper. As the Palm Beach Post recently reported, a young U.S. bride lost her life just eight days after her bariatric surgery in Mexico.

The new obesity clinical guidelines issued by NICE in the UK have been reviewed previously. They outlined a number of “urgent actions to stem the rising tide of obesity in England and Wales.” But until today’s news, those guidelines hadn’t been put into perspective and defined the number of fat people being targeted for surgery.

Clinical guidelines issued under a nationalized healthcare system aren’t necessarily developed free from the influence of vested interests or based on the most quality evidence, as we’ve seen. Professor Peter Littlejohns, Clinical and Public Health Director at NICE who led the development of the NICE obesity guidelines explained: “Obesity is the most serious threat to the future health of our nation. Its risks are as serious as smoking and urgent action is needed to tackle this problem now. For the first time we have brought together all the people that can help solve the obesity problem – not just health professionals, but also local councils, employers and schools – to produce a piece of work that sets out the steps we must take as a nation in order to tackle the obesity epidemic.”

[Lest you think it’s different in other European countries, the EU Commissioner for Health said nearly the identical thing, as the reach of the International Obesity Task Force is well, international. “Obesity is the major emerging threat to public health in Europe,” he wrote in a 2003 issue of Eurohealth. “Obesity is an issue on which the EU needs to pool its intellectual resources. Addressing obesity is a priority of the EU’s Public Health Action Programme for 2003-2008....Beating the obesity epidemic will require governments, stakeholders at all levels, local, national, European and international, to work together.”]

Those stakeholders consulted for the NICE’s bariatric surgery recommendations included multiple bariatric surgical interests and bariatric (such as lap band) manufacturers, including “Lowate AB BioEnterics Corporation, Mantis Surgical Ltd, Obtech Medical AG, Royal College of Surgeons, Association of Surgeons of GB and Ireland, National Obesity Forum, British Obesity Surgery Society, NHS Clinical Obesity Group, British Dietetic Association,” etc.

When a health “problem” has been predetermined and poorly defined from the start, when interests that stand to benefit from the solutions are developing the action plan, and when the political weight of the government is in charge of enacting the public health program, perhaps we shouldn't be surprised when financial and political concerns take precedence over the interests of patients.

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