The Elephant in the Room.

Two of the core principles required of all doctors are beneficence and non-maleficence. Beneficence simply means actions which are carried out for the benefit of others. Non-maleficence, by contrast, can loosely be translated in to "do no harm". These principles are instilled in to all medical students the world over as they prepare to embark on their professional medical careers. It was therefore with great interest that I read a characteristically thought provoking piece by Max Pemberton in the Spectator this week. In his article entitled "The battle of the bulge", Max alludes to the growing crisis of obesity as it exerts its expensive impact on our faltering Health Service. Dealing with a subject much covered in these posts, Max refreshingly tells it like it is. For too long, we have hidden behind political correctness and created an environment of sympathy for overweight people. As he puts it, why should he diagnose people with cancer but skirt around telling people they are obese. This isn't finger pointing for the sake of it. There is a valid reason why doctors should be tackling this problem head on. If obesity is swept under the carpet, its growth will continue unabated. Max spells out the uncomfortable truth; the one thing fat people have in common is that they eat more than they need to. Max also points to an imbalance in our healthcare system. There are those patients using the NHS who are seriously malnourished (as evidenced by the news yesterday that one of the leading charities is to address the issue of food for the needy in the UK for the first time since the Second World War), and there are those patients desperate to take tablets to ensure their food passes unabsorbed while the tax payer foots the bill. The stark reality is that the UK now boasts austerity and obesity in tandem. It is a sad fact that a third of children in the UK are now deemed to be overweight. The obesity epidemic (and I use that word advisedly) now costs the Health Service about £5 billion per annum and accounts directly for about 300 hospital admissions every day. More worrying still is the revelation that the East Midlands Ambulance Service thinks it needs to upgrade all 272 of its existing ambulances. Up to now, they have soldiered on with just one bariatric ambulance but now realise the true enormity of their challenge. This will cost £27 million due to the need for double-wide stretchers designed for patients weighing in at 28 stone plus. That cost of course precedes the cost of dealing with such patients when they actually reach the hospital - that is where the real cost begins. Wider MRI scanners, reinforced operating tables, longer needles, sturdier trolleys, more bariatric surgeons - the list just goes on and on. One prominent bariatric surgeon even revealed that without new bariatric equipment, enquiries would have to be made to zoos and veterinary practices to access scanners. She fears this would impact on the dignity of the patient. Believe it or not, the number of bariatric operations has increased sevenfold in seven years. Although an extreme case, the fire service in South Wales recently had the onerous task of demolishing two walls of a house so that a 63 stone TEENAGER could be taken to hospital. It is estimated that this cost about £100,000. Over the past few years, rescuing obese patients stick in baths etc has become a part of everyday life for our fire crews. Nottingham has the enviable title of Britain's fattest region as Britons "pulls on a pair of tracksuit bottoms and heads for the fridge". If you can believe this, NICE last year suggested that doctors should avoid using the term "obese" for fear it might upset patients. Instead, they suggest that obese patients should be advised to seek a "healthier weight". This is just pussy footing around the existing problem and actually does the patient a great disservice. If we are to practice non-maleficence and beneficence, avoiding terms like "obese" will ultimately result in harm to the patient. The 2% of patients who were obese in the 1960s have now ballooned to 25% and the figure shows no signs of growing as our insatiable appetites continue unquestioned and unabated. In the 1960s, three quarters of people walked for at least half an hour a day. Today that figure is just 40% ie almost half. In the 1960s 90% of people had tried to lose weight. In 2010, that figure was 50%. 40 years ago, just 7% of those who saw themselves as being overweight had failed to do anything about it. Max argues that in our increasingly consumerised world, people now see themselves as being consumers of the healthcare system rather than patients. Myself included, people have blamed the food manufacturers, their parents and even their genes. Max argues that obesity is not a disease but a mindset suggesting that it is open to change. He also points out that the hardest drug of all to deliver to our patients is arguably truth. It usually takes plain speaking and brave words to start a debate and I hope he has started one here. If we continue to avoid talking about it, it will continue its inexorable rise. The US seems resigned to its obesity problem. It does not follow that we need to follow their lead. This isn't about being judgmental. This is about dealing with harsh facts which are impacting on everybody - obese or not. Lets start to talk about the elephant in the room.