It is an undeniable truth that prevention is always better than cure. Vaccinations have near eradicated polio and small pox, hygiene caused the dramatic disappearance of typhoid and cholera and just being generally healthier has resulted in a steady decline in TB. And at some point in the future HIV will ultimately be prevented through safer sex rather than medication and hopefully someone will find a way to prevent the spread of Ebola.
But right now we live in a world where many people are obese and the time for prevention for these people has passed. So we need a cure. The recent announcement that up to 2m people will receive weight loss surgery on the NHS indicates that obesity surgery could well be it. NHS watchdog NICE wants more people with type 2 diabetes to get access gastric band or bypass operations.
But are we ready for this last resort? Is surgery really the right way forward? And is it a good use of public money?
A last resort
In an ideal world people would eat less, do more and stay a healthy weight. Grab bags, takeaways, fizzy drinks and fast food would never have been invented and well lit cycle paths and wide pavements would make getting in the car a treat reserved for special occasions. But those days are gone and today’s world makes it so hard to eat less and so easy to do nothing that even with the greatest will in the world many people struggle with their weight.
Until we all have an epiphany and realise something has to change or governments grab the food industry and town planners by the horns and scream “enough’s enough”, prevention in traditional sense cannot help. We are at the last resort and cure has to be the way forward. But does it have to be surgery?
Is surgery the only option?
I teach and write about how obesity is a product of eating and exercise – in other words behaviour. I also teach about the many strategies that psychologists use to change behaviour ranging from complex interventions of CBT or relapse prevention to simple tricks of the trade such as planning, imagery and waiting for that “teachable moment” when someone is just more open to change.
And in my ideal world not only would people stay thin, these many strategies would work on those few that didn’t. But in the main this is just that – an ideal. And although we know that some people can lose weight using our tricks of the trade, the vast majority put it back on again and some end up fatter than they were in first place.
With this failure comes depression, low self esteem, self blame and a tendency to seek solace in food, the very cause of the problem. So much as I hope that one day psychology will come into its own with obesity as it has done in many other areas of health, I concede that now, in this non-ideal world, surgery is the best way to treat obesity.
A good use of public money?
When the government suggested paying people to lose weight the overwhelming response was “It’s not fair!” Obesity is seen as a self inflicted problem so surely it is up to the people themselves to make things better? “They don’t deserve public money,” was the message from that. And that was just about small financial incentives.
But now they are going have a free operation on the NHS costing up to £6,000. Surely this is just wrong? And if prevention is always better than cure and cures cost so much, maybe we should give up on those currently obese and just focus on prevention for the future?
But given the cost to the NHS of treating the health issues related to obesity is reckoned to cost the UK economy about £47bn a year – second only to issues related to smoking – it gives the surgery option a bit more context. According to some number crunching by Channel 4 News presenter Cathy Newman:
The government spends £638m a year on obesity prevention, but the taxpayer coughs up £6bn annually on medical conditions related to obesity, and a further £10bn on diabetes.
“Wow,” she says. And she isn’t wrong.
Obesity surgery is not only a cure but it is also a very successful form of prevention. People with obesity are far more prone to diabetes with all its associated vision, circulatory and nervous system problems. They are also more likely to need hip and knee replacements, develop certain cancers and have heart disease. All of which costs money – and that money comes from the NHS. And then on top of this, obese parents are more likely to have obese children and pass on ill effects to children, even when they are still in the womb storing up the same problems for future generations. So curing their weight with surgery, actually prevents a catalogue of problems in the future.
Prevention is always better than cure. And obesity surgery is a last resort for a problem that so far has no other solution. But it is also prevention if you think about it, and when the problems it prevents carry way on into the future, it begins to look like that £6,000 is well spent.