Public Funding For Obesity Treatments?
Tuesday, April 26, 2011
In any public discussion of obesity, the prime concern appears to be about health.
Interestingly, however, the same public does not seem to actually support treating obesity like any other health problem – at least not in a publicly funded healthcare system.
This, perhaps not all that surprisingly, is the result of a study by Lund and colleagues from the University of Copenhagen, Denmark, just published in OBESITY.
Thus, in this representative survey of the Danish public (N = 1,141), although the majority supported prevention measures and ‘softer’ obesity treatments (read ‘diet and exercise’), more radical treatments like bariatric surgery only found limited support.
The best predictor of these attitudes to the treatment of obesity was the belief that individuals are personally responsible for their own obesity.
This is perhaps not surprising given that public health messaging as well as many ‘well-meaning’ health professionals continue to propagate the stereotype that obesity is largely a self-inflicted condition easily prevented or remedied by simply choosing to eat less and move more. The fact that this piece of ‘advise’ is largely ineffective and does little more than increase weight-bias and stigmatisation, still appears to fall in the category of ‘privileged information’.
What is particularly paradoxical about this situation is that every single health economic assessment to date supports the notion that obesity treatments (particularly bariatric surgery for people with severe obesity) are far more cost-effective than many of the other ‘health’ services routinely provided to patients.
Thus, you would imagine that anyone who pays taxes (or insurance premiums) for health care, would be far more enthusiastic about their taxes (or premiums) being spent on treating obesity rather than watching them disappear into the black hole of treating its many complications.
Apparently, this is not how most tax payers think – not in Denmark and probably not in Canada either.
Interestingly, based on my own conversations with patients, people with obesity pretty much think the same.
Thus, even people who suffer from obesity themselves (or have battled it all their life) are far more enthusiastic when it comes to raising money for breast cancer, heart disease, diabetes, or arthritis than for obesity itself.
Thus, for example, as I have blogged before, it is rather funny how, although obesity is one of the biggest drivers of post-menopausal breast cancer, virtually none of the money raised for breast cancer each year ever finds its way into obesity research (or better treatments).
In fact, it would be fair to assume that the same people, who will happily give generously to cancer research, will be appalled if any of their money found its way into researching better surgical treatments for obesity, a treatment that is known to reduce cancer mortality by 60%.
How can anyone ever expect the ‘public’ to support obesity treatments, when even people with obesity (and apparently their friends and family) themselves don’t seem to think this a worthwhile cause?
Where are the donors, the sponsors, the trusts, the foundations, the campaigns, the armies of volunteers when it comes to finding “the cure” for obesity?
Just wondering – that’s all.
AMS
Toronto, Ontario
Lund TB, Sandøe P, & Lassen J (2011). Attitudes to Publicly Funded Obesity Treatment and Prevention. Obesity (Silver Spring, Md.) PMID: 21512511
Tuesday, April 26, 2011
A really well written post, and it clarifies many of the underlying issues and debates regarding obesity and policy making.
MYL
Tuesday, April 26, 2011
Just from my experiences with WLS, and from what I’ve read of other WLS survivors’ experiences, treating us after we’ve had WLS can be more expensive than it would have been to treat us correctly without WLS. In other words, the complications from WLS can be more expensive to treat than the problems we may or may not have just because we’re fat.
In my case alone, before my WLS, my blood pressure, blood sugar, and cholesterol were normal but I had mobility issues. However, I could walk long enough to do my shopping in a Super Wal-Mart, even though my arthritic knee would be painful for a day or so afterward. After my WLS, I now have fibromyalgia, might have MS (no family history of it at all), have migraine headaches, my arthritis is worse, my mobility issues are worse, I have digestive issues (can’t eat high-fiber foods, fruits/vegetables, lactose-intolerant, can’t eat anything that’s the least bit greasy), I have to take extra vitamins and supplements, my teeth are rotting away, I have veinous insufficiency in my legs (they swell and my lower legs are permanently discolored from years of misdiagnosis). I can no longer stand for more than a minute or two without being in severe pain, and forget about walking anywhere to do anything – I either use a walker with a seat so I can sit down when my back starts to scream at me or I use an electric mobility cart. The funny thing (not funny haha, either) is, my blood pressure, blood sugar, and cholesterol are all still normal. The only reason I had WLS was because my NP told me that no surgeon would replace my knees when the time came because I was too fat (at 350 lbs and 5′ 8″). I’d been that fat, at the time, for almost 20 years, and it hadn’t harmed my health yet, but the WLS did more to ruin my quality of life than being fat ever did.
So, which is cheaper? Treating my arthritis and the few colds I had while fat, or treating all the problems I have now after WLS, plus the cost of the WLS? I would venture to say that most people who are fat and have WLS are probably in the same boat I was in – they’re basically healthy, but can’t lose weight, and have dieted themselves fatter over the years and their doctors have convinced them that if they don’t have WLS, they’re either going to die of some supposedly fat-related “disease” or that getting thin through WLS will magically improve their lives. Sadly, for a lot of us, that just doesn’t happen. The complications we have after WLS are just not worth it, especially if the WLS fails to keep us thin forever (and it sure failed for me).
Tuesday, April 26, 2011
I’ve been thinking about just this point since the article on how “costly” obesity is to the healthcare system. The problem is that although people usually talk about obesity in terms of a health issue they don’t actually believe it is. Its still overwhelmingly thought of as a moral problem: a problem of character weakness. Until that changes there’s won’t be any public money willingly put into the medical treatment of obesity. And yes, the majority of obese people have internalized this belief system as well. Its hard to let go of the hope that you can make yourself thin one day through will power. We still want deparately to believe its possible. The thought of bariatric surgury is frightening. We have a long way to go to bring obesity out of a dark ages mentality. You are leading what is hopefully the age of enlightenment however, so please keep up the great work.
Tuesday, April 26, 2011
Well, this one isn’t hard to fathom. Here’s the reason: there are no treatments for obesity that actually work long-term. Even weight loss surgery, with all of its risks and negative effects, often doesn’t result in permanent weight loss.
There are other reasons as well. Maybe people know deep down that this whole anti-obesity thing is primarily about appearance and not health. There’s also no evidence that fat people who have lost weight live longer or healthier lives than people who remain fat. Obesity is at worst a risk factor for heart disease, diabetes, and some types of cancer (it has a protective effect when it comes to other types), and obese people have relatively normal life expectancies. We don’t invest tax dollars in trying to move other types of people from a higher risk group to a lower risk group. For example, men have a shorter life expectancy than women, but we don’t encourage them to have sex change operations to become healthier. Taller people are at greater risk for some conditions, but we don’t try to make them shorter. It’s almost impossible to make fat people permanently thin and really, why would that be necessary? If you look at population-level mortality statistics, it’s obvious that the effects of obesity on health have been greatly exaggerated.
Weight loss surgery is basically butchering a healthy system and is probably worse for most people than being very heavy. I sure wouldn’t want my tax dollars subsidizing it.
Tuesday, April 26, 2011
THere are various WLS options , each with different risks and success rates. In my case, I paid entirely out of pocket, no complications whatsoever and have saved the Canadian medical system at least what I paid if not more, and certainly as time goes on I am sure the savings to the system will accumulate. The economic rationale is an interesting one, but for a person such as myself suffering with MO for 3 decades, the improvement in quality of life from WLS is PRICELESS.
Wednesday, April 27, 2011
Simply, Dr. Sharma, the field is too young (and still rife with more misinformation than information), so your request is premature.
Before you can or should expect public funding for obesity treatments (beyond HAES), the obesities need to be better understood and the onus is on you and other bona fide experts to discover and provide that clarity. Among the issues you cite, for example, the benefits of “bariatric surgery for people with severe obesity,” and yet vested interests like Allergan are redefining “severe” and lowering the acceptable age for undergoing the procedure, simply to boost profits. The public is skeptical of putting up its money for good reason.
Were tax-payers asked to support the leach gatherers in the 1800s when we had an epidemic of bad humours? Hmmm. We now know that there are medical uses for leaches, but much more limited than what the leach gatherers guild likely portrayed in its ad campaign.
Please be careful with whom you cast your lot, Dr. Sharma. Using an Alberta Attitude will not advance your agenda. We here in the states know all too well that when Democrats use Republican logic and try to act more Republican than Republicans, it only serves the Republicans. Your current campaign is serving those who would discriminate and stigmatize. I know that’s not your intent.
Wednesday, April 27, 2011
Why little interest in funding obesity research?
1. The stats you quote on the health dangers of obesity are drowned out by the claims that fat is not really that bad – body types are naturally different and people can be fat and quite healthy.
Why spend money (especially taxpayers money) if people can be HEALTHY At EVERY Size.
2. An effective anti-obesity campaign would have people up in arms about “fat bias” and “fat discrimination”.
If there was a massive campaign about the dangers of obesity, similar to the campaigns on the dangers of smoking and drunk driving, then overeating to the point of obesity would be no more socially acceptable than smoking or getting falling-down drunk.
And, just like there are people who lose their drivers licence for drunk driving who drive anyway and feel they are unfairly treated, there will be people who will feel oppressed and discriminated against if they face social pressure to be a healthy weight.
Some people still smoke, some people still drink and drive, but change in social mores means fewer people do these things. Smoking – caused ling cancer is less frequent, however now smokers suffer discrimination and anti-smoking bias. Is that an acceptable trade-off, or would it be better to revert to attitudes of 1940’s, just so smokers feel comfortable.
3. The idea that obesity is inevitable and untreatable except for surgery, the idea that diet and exercise can’t prevent weight gain or reduce weight.
Most people don’t believe those ideas – especially people who as children were taught from an early age to eat properly, to avoid overeating and to deliberately maintain healthy weight. They live every day in a way that is supposed to be impossible. When they are told “eat less and move more does not control weight”, they are sceptical because they are normal weight and have kept themselves that way by routinely monitoring their weight and controlling what they eat.
People are skeptical about doctors who claim diet and exercise won’t control or reduce weight – but who, guess what, can offer an extremely expensive medical procedure to cure obesity!!
And to provide cosmetic surgery after!!
No surgery is offered, of course, until people are extremely obese and sick. To offer surgery to people in that state is good medicine.
To NOT put in place an all-out campaign to prevent obesity, is cynical and good only for clinics and doctors in the business of bariatric surgery.
4. Medicine has little to offer in the way of weight loss and weight control except bariatric surgery. Their own stats show their other approaches are ineffective, or they don’t consider weight itself a problem until it gets extremely bad – until then, the reaction is “you’re fat, you’ll always be fat, just get used to it and try not to get fatter ” (in tactful medical terms, of course )
Wednesday, April 27, 2011
Anonymous, if you think that there’s no stigma associated with being fat, then you must be living on a different planet than I am.
Also, how do you know that your efforts to stay thin would work if you had a different genetic profile? You’re taking credit for something that is not entirely under your control.
Think about it this way. Someone stays out of the sun and wears sunscreen and a hat and carries an umbrella whenever they’re outdoors, and also happens to very pale skin. They think pale skin is better than dark skin, and if everyone else just adopted their habits, then everyone would have the same pale skin that they do. But that isn’t the case. People’s natural skin tones actually vary widely, and although avoiding sun exposure will make any given person lighter than they would be otherwise, it will not turn a dark skinned person into a light skinned person. Get it?