Obesity is not a disease

Pretending otherwise will stoke an epidemic and crush the NHS

12 October 2013

9:00 AM

12 October 2013

9:00 AM

‘Well, what diets have you tried so far?’ asked the GP, flicking through the patient’s notes. I was an innocent trainee doctor on my general practice placement at the time and watched the interaction carefully, sensing a row was about to ensue. ‘Look, I don’t want to go on a diet, I want you to prescribe me these,’ snapped the patient, bringing out a neatly folded page she had torn out of a magazine. The GP, rolling his eyes at me, took the paper but didn’t read it. I suspected he’d read it before. This was yet another example of what’s becoming a very British epidemic: obesity being self-diagnosed as disease.

The doctor attempted to explain that tablets really aren’t suitable in her case. As well as having some potentially nasty side effects, they’re expensive to prescribe, and don’t offer a long-term solution. This was clearly not what the woman wanted to hear. ‘Fine then, don’t help me, see if I care. I’ll get my sister to get them off her GP — he gives her whatever she wants’; and she stormed out. It struck me as bizarre that while some people using the NHS are dangerously malnourished, other people are desperate to take tablets to ensure that their food passes through their body unabsorbed, while the taxpayer foots the bill.

It happens all the time. The patients who are not interested in changing their diet in any way, demanding to have their cake, eat it and then pop a pill so that the calories never touch their waistline. And as a result, Britain now combines austerity with obesity. The majority of us are now overweight or obese — a third of children are considered too heavy. It costs an extra £5 billion a year, and 300 hospital admissions a day are directly due to obesity. To pick up the newspapers is to witness a country adjusting itself to losing a national battle of the bulge.

Take the East Midlands Ambulance Service. It emerged this week that it has been picking up so many fat patients — weighing in excess of the 28-stone maximum — that it needs a new fleet. It has, hitherto, been struggling along with just one ambulance for fatties (a ‘bariatric’ vehicle), but now thinks all 272 of its ambulances need to be upgraded with double-wide stretchers for patients who (it says) can weigh in at 55 stone. The plan will cost £27 million.

Once the obese patient is in hospital, a whole new set of equipment is required: reinforced operating tables, sturdier trollies, longer needles and even wider MRI scanners. There is a great demand for bariatric surgeons. One of them, Sally Norton, recently wrote in the Royal College of Surgeons’ house journal that without special equipment for the obese, there may be ‘enquiries into the potential use of veterinary or zoological scanners, with resultant loss of dignity for the patient’. There is a cost to all this: in the kit, and in operations like gastric bypass operations, which have increased sevenfold over the last seven years.

Moving obese patients out of their house can be too difficult for the NHS. Recently the fire service had to demolish two walls of a house in south Wales so that a 63-stone teenager could be taken to hospital. This required more than 40 emergency service workers at an estimated cost of £100,000. Over the past five years, fire services have been called to more than 2,700 incidents to assist ‘severely obese’ people, including some who had got stuck in the bath. Rescuing fatties is now a routine operation, with its own entry in the Fire Brigade incident reporting system (filed under ‘bariatric persons’).

So what to do? The government spends money asking us to eat ‘five a day’ fruit and veg, but it seems to have no effect. Nottingham, the fattest region in Britain, recently decided to spend £500,000 on replacing pavements in areas with particularly fat pedestrians, to try and encourage people to walk more. Our landscape is being, quite literally, reshaped in order to accommodate the obese. In the past few years, we have moved from being outraged about the epidemic to just planning around it. Like a middle-aged man deciding to eat what he wants and let himself go, Britain is pulling on a pair of tracksuit bottoms and heading to the fridge.

It need not be this way. For too long, my fellow doctors have pussyfooted around their obese patients, too scared to confront the, er, elephant in the room. They don’t want to cause offence. Unbelievably, draft guidelines announced last year by the National Institute of Clinical Excellence and Health (Nice) suggested that doctors should even avoid the use of the term ‘obese’ for fear that larger patients might be upset. Instead, Nice recommended advising corpulent patients that they should seek a ‘healthier weight’.

But nice euphemisms mean that people don’t confront reality. I’m not going to stop diagnosing cancer just because people don’t like hearing the dreaded word. So why should it be different when informing people that they are obese? Sometimes morbidly so. What Nice is delicately skirting round is what many doctors, nurses and dieticians will confirm: people don’t like being told that they are overweight, even if it’s objectively clearly the case. And by pretending that this is a disease, the doctors are making it even worse.

There’s something comforting about blaming obesity on genes. It enables people to relinquish responsibility for their weight, which can be seen as outside their control. It’s nothing new, either. Years ago, fat people blamed their ‘glands’. When I started medical school, I patiently waited for us to be taught about these magical ‘glands’ that made people fat. I’m still waiting. Even when people have problems with an underactive thyroid, which can slow the metabolism and result in weight gain, this can be treated with thyroid replacement tablets and the metabolism returns to normal. As a rule, however, fat people have one thing in common: they eat more than they need to.

Certainly some people metabolise food at a different rate to others, meaning they are more likely to lay down fat stores than other people. But this is a reason to eat less, not to become fat. You cannot get away from the basic biology of the human body — fat is simply stored excess energy, and weight gain is only possible when the total amount of energy consumed exceeds the total amount of energy expended. Even those who have a genetic predisposition to become fat are not slaves to their DNA.

An in-depth study published last year, which looked at the genes of more than 20,000 people and was conducted at the Medical Research Council’s epidemiology unit in Cambridge, found some people are predisposed to be overweight. But an active lifestyle and reducing food intake can counteract that. Simple. While some will be annoyed by this research, I find it empowering. The idea that our genes control us is profoundly depressing. After all, there is more to being human than a few strands of DNA.

The rate of people considered clinically obese has risen from around 1 to 2 per cent of the population in the 1960s to over 25 per cent now. Why? A simple answer would be lifestyle, but it’s actually a little more complicated. A fascinating survey conducted by the Department of Health compared data collected from 1967 and 2010. It showed that, while people back then were slimmer, they ate fattier foods and had access to far fewer gyms. We eat better now, we work out more. But we live relatively sedentary lives. Only three out of ten households had a car then, compared to seven out of ten now. While 75 per cent of people walked for at least half an hour a day in the 1960s, this is only about 40 per cent now.

What really stands out, more than the lifestyle differences, is the sharp contrast in the attitudes towards obesity between the two different eras. The 1967 survey found that nine out of ten people had attempted to lose weight in the past year, compared with barely half of adults questioned in 2010. Perhaps most tellingly though, 40 years ago only 7 per cent of those people who considered themselves overweight had failed to do anything about it, compared with nearly half now.

It would be easy to blame Britain’s fatness on lifestyle changes, but the worst of it is attitude. People just aren’t bothering to lose weight any more. Perhaps obesity is viewed as more normal. But this is also down to the attitude that we doctors increasingly encounter in our consulting rooms: the reluctance of patients to accept that ailments can be blamed on their behaviour, for which they are reluctant to take responsibility.

Patients blame obesity on the government, cunning food manufacturers, their parents and their genes. They demand fat-loss pills on the NHS and stomach-stapling surgery as a right. In a world where health care is becoming consumerised, patients see themselves as customers. There’s not much demand for hard truths.

America has severe obesity problems, and seems resigned to them. But Britain has a National Health Service, and therefore a far higher capacity to change. It ought to be easy. Doctors should be required to tell patients a blunt truth: if you’re fat, eat less, exercise more, or both. And if you keep guzzling the tasty treats, you will die earlier. It’s not a disease, it’s a mindset — and that means it can be changed. We doctors need to be a little less understanding, a little more judgmental, and realise that our oath — ‘do no harm’ — must come before our desire to save the feelings of our patients. The truth can be the hardest drug to administer. But holding our tongues, prescribing the fat pills and bankrupting the NHS in the process is the worst solution of all.

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Show comments
  • Margot

    Two local GPs were clinically obese – really obese.
    One of them to slightly overweight patient: Have you thought of losing some weight?
    Patient: Have you looked in a mirror?
    Doctor: In my case it’s glandular.
    Of course it is. Despite her ‘glandular’ condition she has now obviously gone on a diet and lost weight. The Colonel’s wife and Rosie O’Grady….Mammoth bargain crisp bags or de luxe handmade chocs produce the same results. Only the condition name changes

    • Jackthesmilingblack

      Those guys that came out of the camps. They were really skinny fellows. Not one was saying, “It`s my glands”, or “I`ve got big bones.” You are what you eat. Excuses are like @ssholes, everybody got one.

      • kalamere

        Yes you just proved your own point.

  • Ricky Strong

    As you rightly stated, you are obliged under oath to consider the patients health first and foremost, not their feelings. So if you need to tell someone that they are overweight, fat and clinically obese then have the courage to do so, what’s the worst case scenario, they energetically jump off the bed and make a dash for you?

    I am sick of hearing about government grants and local council initiatives to help the obese, why not help those who do look after themselves instead. A little help with my gym membership fee would be really appreciated.

    And if all else fails supermarkets and shops should store sweets, cakes, junk etc in a separate room with a narrow door.

    • Augustus

      Funnily enough that’s what the swankier bakers do in Holland, all chocolates and cakes (usually handmade by them) are stored in a separate air-conditioned room next to the main shop. But these items aren’t cheap so most people limit themselves to just a few ‘bonbons’ and cakes. Foreigners often tell me they have never seen so much cheap confectionery as is displayed in British shops.

      • Ricky Strong

        What a brilliant idea, we really need to get back to position where we treated sugar as a luxury, and I could add many other items to that. I love a bit of cake with my coffee like any good English man or woman but I understand that such a rich and sweet treat is best eaten with small mouthfuls, not 4 or 5 slabs of the whole bloody thing.

        • Schadenfreuden

          Yes lets return to 1945 when everything was so much better.

          • Ricky Strong

            Some things were better back then. People had an appreciation for food and didn’t waste it like we do now. Certain items were considered to be a luxury, unlike now where people believe they have some god given right to have access to every single product at the cheapest possible cost.

            I’m not saying everything was better back then, but our attitude toward food certainly was.

          • kalamere

            You don’t have a clue and have no experience of what people where really doing back then. You are a child.

          • Standardtoaster11 .

            “You don’t have a clue and have no experience of what people where really doing back then” It can be a shock to you but some people have education and there is something like history books and so on -_-, you must be a kid

          • 2trueblue

            When you are a child you notice what people do and it is when you acquire habits and learn things that remain with you for the rest of your life. Go figure.

          • Rocksy

            In all my 18 years of school, college etc. I encountered two somewhat overweight students.
            There was no obsession with nutrients, fat or sugar content etc. etc. No exhortations to exercise. No food allergies. No fat people.
            When I visited Niagara Falls, I couldn’t take my eyes off the enormous women and some men who waddled around. I’m not talking overweight. These people were enormous.The magnificent Falls barely registered.

          • RodCl

            You are absolutely right about the attitude to food though. I was 5 years old in 45. We were told that we could be prosecuted if we threw food on the ground. Fat chance of that! If you were lucky enough to have an apple, other kids asked if they could have the core when you were finished.
            British food from that period has a terrible reputation. I can’t speak for restaurants, obviously, but my mother was a terrific cook and I remember enjoying all my meals. Even state school dinners were acceptable and my kids (one a professional chef) and grandkids still ask us to cook a cheese and potato dish that we were served back to supplement the meat ration.

          • Ricky Strong

            Thank you.

            I am too young to have ever known what is was really like in 1945, however I was raised for the majority of my younger years by my grandmother and grandfather. It was through them that I learnt about post-war attitudes towards food.

            It’s really nostalgic to hear you talking about your mother being a wonderful cook and kids and grandkids cooking in the kitchen. For this is what I remember of my youth, being shown not only how to make a meal from scraps but how to cook proper homely food. I think if you can learn to cook from a young age then you will grow to appreciate food much more.

          • SmartOne

            It is hard to even find healthy entries on a menu! Even salads with healthy sounding entrees e.g. raspberry vinagreitte are loaded with sugar and calories. The food has to be swimming in flour and heavy cream sauces. We used to eat simple food and we walked. Weight was not a problem for any generation.

          • Ricky Strong

            You are right, though there have been instances throughout history where we have seen the consequences of a rich and over indulgent diet, Henry the eighth springs to mind.

            And I think it speaks volumes that we have to mask so much of our food with chemical flavours. I was reading an article recently describing how because McDonalds “beef” burgers contain so much reclaimed meat the US food agency allows them to be cleaned with ammonia!

          • SmartOne

            Well not to mention Renaissance period but even at that point the cherub looking goddesses would be only overweight according to the standards.

            The fact that we such huge percentage of 300+ pounders walking around makes me wonder why the alarm did not go off at 200 lb?

          • Blake

            Im not sure where you’re from, But yes, They used to do that in the USA but they dont anymore, They didnt really do it in other places. In fact that practise is banned in alot of countries

          • Robert

            Same thing in the US, what you do is eat out less, and exercise more. In the military I consumed up to 3 times what I do now, and lost 30 lbs in 2 months. I lost 7 in just one week in the woods training, while eating side dishes of kid you not rice covered in fatty gravy for empty calories to burn. Don’t blame the sugar, and calories, simply do a little cardio, even run in place for 10 minutes a day, and you can eat more. If you don’t do a lot eat less. I eat cheeseburgers, loaded chicken enchiladas, creamy beef strong enough, and a fist full of cookies every day, and when I turn the wii fit on for 20 minutes in the morning I find myself losing fat, and gaining muscle weight.

            I am a stay at home nanny so I have very bad options for exercise when I stopped doing Wii fit, I started playing with the toddler more, I know do curls with her, and blow on her belly, dance with her to music, and if she clings to my leg when I sit I straighten it hoisting her in the air. She loves every minute of it and it made excercise fun.

            Before that I simply worked jobs where I did labor, stocked cleaned etc. In the event I didn’t have a job like that I had a breif time with a body bag, took up bike riding, and short walks/rides to the corner store. All of these made it so I can eat my family fave hamburger gravy, country gravy with hamburger in it, poured over fresh biscuits. Fatting as hell but a great treat or excuse to ride a bike that weekend.

          • Fergus Pickering

            You are being funny I trust. The food was utterly disgusting and the cooking was worse. Things are much better now. There are a lot of fat people but what do I care? They will die young and that’s good too..

          • Andrew

            Are you fat by any chance?

        • kalamere

          Why don’t you start! Can I start deciding what you can buy?

        • Alan_McIntire

          No need to treat SUGAR as a luxury. Both sugar and protein contain 4 calories per gram. It’s the 9 calories per gram fat that adds those spare calories.

          • Joe Davis

            It is more complex than that, owing to the fact that our bodies handle calories differently depending on their source. My money is on sugar being the culprit. There is a lot of science to back that up.

          • Biochem Femme

            Carbohydrates are probably more responsible for weight gain than fat. It’s not simply a case of saying Y has more calories than X; it’s actually a much more complex and dynamic situation than that.

            But let’s put metabolism to one side and consider the layman’s perspective. Fat is something with which people make an immediate association with weight, so companies will cut the fat, advertise it is as ‘Less than 1% fat!’ whilst keeping it full of sugar, satiating our monkey brains with a generous dosage of assorted neurotransmitters (‘mmmmmmmmmm cake’). It creeps its way into a surprisingly heterogeneous array of foods (even healthier foods like fruit are full of sugar). People are simply less aware of it as a factor toward weight gain than fat, which is understandable really: ‘I am fat, I don’t want to be fat, so I will avoid eating fat’. In fact a commonly held misconception is eating sugar will give you loads of energy, which is actually totally wrong. Excess carbs will get converted into fat and stored by adipose cells (it’s actually quite an efficient process). If you were to carefully examine all the things you eat, count calories etc, you’ll probably be surprised to find that it’s actually the carbs that’re in excess rather than fat. Of course too much of anything will cause weight gain, but sugar is overlooked by the general public whilst being the main culprit in obesity.

          • CCCrazyPanda

            Yep, this nailed it. In fact, obesity is now considered just another symptom of the same cause, the way cardiovascular disease and diabetes are ultimately symptoms of something that caused them. Growing evidence is pointing towards carbohydrate overdosing as the underlying factor in obesity and cardiovascular disease.

            Specifically the problem is sedentary lifestyles with diets of chronically high glycemic loads (too much of high glycemic index foods). If you drink a bottle of Coke after a workout, it is VERY different than drinking it while sitting at your desk all day.

            Your glycogen stores are exhausted after a workout, so carbohydrates consumed just afterwards get used FAR more efficiently than if you were just sitting around doing nothing.

            Further, because diets are so low in fat thanks to the “war on fat”, people end up eating more carbohydrates than they should, just to feel full. Fat’s high calorie density, along with protein, makes you feel full faster and thus you don’t have to eat as many carbs. And because you have a mix of macronutrients in your stomach at that point, carbohydrate digestion is slowed down, thus it doesn’t spike your blood sugar levels as easily.

          • Ripple

            Coke Zero. Zero calories. I hate ‘pop’ but my husband loves it and the one he has contains no sugar — or calories, as stated.

          • Ricky Strong

            I also think the lack of proper nutrition in things such as ready meals and junk food plays its role.

            If your body is not getting the vitamins, minerals, amino acids etc from the food that you eat then no matter how much you consume it will keep telling you that you are hungry. Its a vicious cycle.

          • rorysutherland

            It is interesting how this man’s work


            seems to have been generally ignored for so long, while the low-fat, high-carb lobby were generally given free rein. These people were generally cardiologists, not endocrinologists.

            The food industry is also predisposed towards selling carbs, since they have a much longer shelf-life. Never mind the subsidies paid to US corn farmers.

          • Simon Anderson

            Read this book, it will change your view on sugar forever.

          • Craig Sweaton

            I absolutely agree with you and recently proved the truth of it.
            I used to exercise around 5 days pw but damaged my knee and spine and can no longer run or bend very much. I cut down portion sizes but still ate lots of carbs to feel more full, and gained a lot of weight!
            I now eat a tiny amount of carbs but fill up on protein and green veg and I’ve lost 12lbs in just 4weeks. I only got this advice from a specialist at the hospital though because my own gp was clueless about dietary problems.

          • Jason Dixon

            No, it’s the fact that you can pack sugar calories in so easily that’s the problem. A single bottle of Coke, which used to be misleadingly labeled by the serving (2.5 per bottle), contains 15% of your total recommended caloric intake per day. One of them. Just one. You don’t feel any fuller, the energy spike rapidly subsides, and it’s time for another, and another!

            I see miserable landbeasts at my university, hunched over because their guts prevent them from easily reaching the items on their table, sucking on soda bottles and looking no better for it. Two, three bottles later, and he’s had more than half of the calories he needs in a day, given his activity level. Only then do we start counting the pizza rolls and the burgers.

          • CCCrazyPanda

            It’s not just sugar or HFC though. Potatoes, pasta, white rice, most breads… any starchy carbohydrate tends to have a very high glycemic index, and since we are conditioned to think fat is bad, we end up consuming more of this processed high GI food, resulting in very high glycemic loads.

            Soda is a problem, but so is eating a box of spaghetti and pasta sauce.

            A 1lbs box of thin spaghetti here in the US contains about 320 grams of carbs. Because they’re not very filling, it’s quite easy to eat half the box as your dinner, meaning you just consumed 160g worth of carbohydrates in ONE sitting. Pasta sauce or butter doesn’t add much meaningful fat or protein to balance out the carbs, so that meal is effectively 90% carbs and 10% protein/fat (and not even good protein either…)

          • Simon Anderson

            Utterly wrong. Read the science. A sound place to start would be Professor Yudkin’s “Pure, White and Deadly”.

            Sugar has absolutely no nutritional value whatsoever, whereas protein aids tissue repair, especially after demanding exercise. It also fills you up far better and prevents insulin ‘spikes’, which create the sensation of hunger.

            As a marathoner (2hrs 50m – age 40) with a base mileage of 50-70 miles per week, I can reliably tell you that you don’t need sugar or carbohydrates. Eliminate them totally from your diet and within a fortnight your body reverts to burning fat more more efficiently.

          • This is wrong. Eating fat is not the main cause of body fat. Sugar causes body fat. It is insane to say that ‘fat’ causes body fat. Sugar turns straight into stored energy, or fat. Consuming good fat doesn’t do that. I lost 86 lbs to 150 lbs and have kept it off by cutting the sugar, gluten and carbs… eating MORE fat. I am living proof of this truth. http://wp.me/P3P5mL-ie

      • kalamere

        The expense is because of bad government not good choices.

      • Fergus Pickering

        Pies and chips seem to do the trick. |You don’t need sweets.

    • kalamere

      Why doesn’t the government come into YOUR house and do an inventory of what you buy? Maybe you have too many TV’s or the wrong car? Why don’t you tell all those who are mooches off the government to look after themselves instead? Why are so many mooches on food stamps buying drugs with the money?
      Why doesn’t the government ban drugs, risky sexual behavior, and every single cause of bad judgements and let’s start with you and your choices since you are perfect and never make a bad decision.

      • fdsaasdf

        If you decide to use government health services, provided by a government payer system, then you should accept them to look at your lifestyle choices.

    • SmartOne

      If we have a new business model, e.g. a store w/o processed carbohydrates and food with low cal and low GI index, do you think that the store would be packed with overweight, obese and morbidly obese? Yeah, I did not think so. Sorry dudes, you are not sick, just remove a donut from your beak and put a celery and you will be fine. I do not want to spend my money on a lazy whiner.

  • Jackthesmilingblack

    Blocking the drains, super large crematoria … consider the unintended consequences of gross obesity.

    • kalamere

      Yes think of all the unintended? consequences of having the government think for you?

      • Jackthesmilingblack

        Your name seems familiar. Have I offended you before?

        • Modernity

          Fat people will hopefully die sooner, freeing some cash for lean pensioners. They should be encouraged and saluted if anything.

        • Toby Esterházy

          Why do Orientals like you always have funny eyes?

  • anyfool

    The NHS is a porkers paradise, almost all the staff are overweight and quite a few grossly obese, no the wonder productivity is poor.
    In twenty years you will have in the NHS the staff that are overweight treating the staff that are grossly overweight.
    The only time you see any movement faster than a shuffle is when they go outside for smoke.
    Yes this is a bit tongue in cheek but it is rapidly moving that way, lift up your eyes and look, that is if your eyelids are not hooded with rolls of fat.

    • Colonel Mustard

      The baggy green trouser uniforms imported from the USA don’t help. I prefer the old smart uniforms. Oooooh matron!

      • Fergus Pickering

        I really don’t care if my nurse is fat. Anyway Matron was fat in the old days. She was Hattie Jacques.

    • skynine

      I had a big fat nurse weigh and measure me to tell me by BMI. I was dying to ask what her’s was.

    • Fergus Pickering

      Almost all the staff are NOT overweight. Do you just say the first hing that comes into your fat head.

      • anyfool

        http://www.theguardian.com › News › Society › NHS
        30 Jul 2014 – About 700,000 of the NHS’s 1.3 million staff were either overweight or obese, the newspaper claimed. To help address this, more gyms would.
        This is a drop from 2011.

        In my area the North East it is higher.
        You are quite right I do have a fat head, probably from banging it against a brick wall.

        • Fergus Pickering

          How many people in the general population are either overweight or obese? Do you know? And how many were obese? How many overweight? Do you know? What is the definition of overweight? Do you know? Share this with us?

          And I wouldn’t believe all you read in the Grauniad.

  • Telling people that their failure to get a grip on their over-indulgence causes them to be fat might conceivably be in breach of their human rights. This may appear to be a far fetched view but nothing would surprise me these days.

    • twinny

      I don’t doubt that someone would try it, but no judge would be insane enough to rule in their favour.

  • WhatMightBe

    Why isn’t there a simple pill that just kills hunger for 4 hours?

    We’ve got pills for everything else.

    But a simple pill to kill hunger?

    Stop wasting time telling folks they are fat – spend money on 1 simple pill that puts an end to obesity in America.

    Get your priorities straight………………..

    • Schadenfreuden

      Such pills already exist. You can get them in any chemist, you wont find them in the diet or weight-loss section though.

      • Simon

        We need to start putting it in the water like fluoride.

    • kalamere

      Yes let’s have a pill for liberals who need to get their head on straight and make good judgements about their lives instead of living off other peoples money.

      • Martin Forde

        That’s funny, because I pay my own bills, and have never lived off other peoples money. Have been absolutely dirt poor! Never collected any form of benefits. Never! Some call it a pride thing. Can you say the same? Prob. not.

    • Fergus Pickering

      There is such a pill but, like all drugs it has side effects. Like shortening your life.

  • wildrover4

    I read recent article that indicated medical science is beginning to come around to the idea that fat is an organ (in the same manner that skin is). Excess fat can be thought of a dysfunctional organ and actually changes the chemistry within the human body. Instead of telling people that they are “fat,” a fact that is probably not lost on them, perhaps sitting down and detailing the very real health risks caused by begin overweight and detailing specific strategies to address the issue would be more constructive.

    • kalamere

      Let’s have the government sit down with you and go over all of your risky behaviors. You should volunteer to have the government make ALL of your chices in what you buy.

    • Weaver


      Does Not Work….Does Not Work…..Does Not Work….

    • twinny

      Yes, doctors should tell patients why their obesity is risky, and how they can address it. I think that is more or less what the article is advocating.

    • Fergus Pickering

      I think people do that. And it doesn’t work.

  • Martin Forde

    Well, maybe it’s not a complete strangers business? But thanks for preoccupying your time with other peoples business.

    • tesla3090

      It does become a stranger’s business when that stranger has to pay a large percent of their taxes to help support that lifestyle…

      • kalamere

        You are already paying for Drug Addicts on disabilty, mooches who live off the government and illegal immigrants, why should the obese be discriminated against.

        • tesla3090

          Fair enough, just pointing out if you want the government to give you things like healthcare, then you shouldn’t be surprised if they take away your freedom to live how you want.

          • Martin Forde

            This has nothing to do with the government. This has to do with the constant ridicule fat people get because of their weight. Are you really that daft to think that we don’t recognize our own weight? Do you really think that a doctor or even someone like yourself pointing it out is going to magically cause us to lose weight. Do you go around telling midgets they are short as well? Maybe if you pour some water on them they will grow.

          • tesla3090

            It has everything to do with government. The article is specifically about how the additional demands on the NHS will impact the quality of care for everyone. If the British hadn’t nationalized their healthcare system then this wouldn’t even be an issue.

            I’m not trying to offend obese people, merely pointing out that one of the costs of a nationalized health system is the requisite loss of certain freedoms. It’s the same reason the NHS denies liver transplants to people who have drank alcohol three months prior to the transplant.

          • Daniel Maris

            I think you’ll find insurance companies have similar rules and clauses.

          • John Doe

            Actually, you don’t get enough ridicule. That was the point of the article. So why don’t you shut it (especially around the dinner table.)

          • Martin Forde

            Clearly your observational powers have been honed by years and years of medical school, John.

          • Daniel Maris

            Is it your contention that if, each day, you ate 100 calories less than the recommended calorie limit for a man you would not lose weight?

            That’s a genuine question.

          • Martin Forde

            sure. 2k calorie is a diet in its own right.

          • Weaver


            Maybe you don’t know, I mean, it must be hard to see the scales.

          • Martin Forde

            I was blind, but now I can see. Hallelujah! You opened my eyes. Thanks to you, I have used magic to instantaneously lose 40 pounds. Why didn’t I do this sooner?! Bravo. Most people just sit there and judge. Not you, my friend. You truly did something here.

          • Daniel Maris

            Why shouldn’t people judge? People judge all the time. “That’s a nice painting.” “That’s a good film.” “She looks pretty in that dress.” “Red doesn’t suit his colouring.” and…
            “He’s fat.”

            Sorry, that’s the way it is. If you want to be fat and put up with the judgements, that’s fine, that’s your affair. But you can’t stop other people judging.

          • Martin Forde

            where you raised in a barn?

          • SmedleyButler

            Fat people could lose weight. Midgets can’t just magically make themselves taller.

          • Martin Forde


          • Martin Forde

            i was more so saying that pointing it out doesn’t do much to change things. its as useful as as telling a midget to be taller. sure fat people can lose weight. but let’s not pretend like you are doing anything useful to that effect by being rude to someone.

          • Daniel Maris

            Martin, you are clearly an intelligent guy – you saw the weakness in your own argument. Lose some weight, and stop blaming others. If necessary take up smoking, because it is going to be a lot less damaging to you than being seriously overweight.

          • Martin Forde

            well i constantly have to deal with my weight. and for people to come along and deride me for it constantly and incessantly. have no idea what its like to lose 20 pounds and no one notices it. its constant negativity and ot has the exact same effect on motivation

          • unflattering

            Last I checked, healthy eating and regular exercise didn’t do a damn thing to make anyone taller…

        • Fergus Pickering

          I don’t want to pay for drug addicts either.

      • Martin Forde

        Excuse me, I pay for my own lifestyle thank you very much. You have not and never will pay for my insurance. So shut it.

        • tesla3090

          This article is about the NHS, any British citizen who pays taxes pays for the healthcare of anyone who uses the NHS. Obamacare has just made it so that any American citizen who pays taxes pays for those who receive the federal subsidizes.

          If you pay for your own insurance I have no desire to tell you how to live. If you want the government to pay for your healthcare through tax revenue, then don’t complain when they tell you what you can and cannot do.

          • Martin Forde

            So then shut it.

          • Rob Michael

            Stop being a miserable selfish person.

          • Martin Forde

            Oh, I’m sorry. I forgot, my weight is in all actuality about you. Wait … I’m confused.

          • Martin Forde

            “Obamacare has just made it so that any American citizen who pays taxes pays for those who receive the federal subsidizes.” No nO No and NO. You’re thinking of prior to ACA. Where hospitals couldn’t refuse services to people without health insurance. Whereas now, everyone is required to have health insurance. Literally, the exact opposite of what you are saying. But anyway, why are you talking about ACA? Is this story about ACA? Do you have private health insurance? Yes? Then why, oh why, does something that has little to no effect on you, bother you so very very much?

          • tesla3090

            Where do you think the insurance subsidy money comes from? It comes from tax payers. People are required to have health insurance, and those who can’t normally afford it are given taxpayer subsidies to afford it.

            Also this has great effect on me. My insurance premiums have skyrocketed. I’m not even remotely rich, so that hurts me financially quite a bit.

          • Martin Forde

            So where exactly does the money come from when a sick person goes to the hospital without health insurance? How is requiring insurance making this problem worse? Also my premiums have went down. Imagine that.

          • tesla3090

            I answered that in my previous post. Hospitals previously passed the cost on to other customers or settled with the patient.

            If you think it’s better that they force people to buy insurance that’s fine. Just don’t be surprised when they try to control behavior to control costs.

          • Martin Forde

            In the long run, I think ACA will reduce costs. At the moment there is no single payer option, so insurance companies can be somewhat resistant to change. The point is that insurance companies are raising your premiums, not ACA. ACA is just a publicly accessible exchange. Have you heard, insurance companies are afraid of ACA because of their profit margins! Why are they entitled to profiteer off of healthcare in the first place? And the whole thing about controlling behavior, insurance companies already do this (e.g., compare premiums for smokers and nonsmokers).

          • tesla3090

            Yeah, insurance companies do control behavior now. But the difference is I can switch insurance companies, I can’t switch governments, at least not easily. Insurance companies also can’t throw you in jail for non-compliance.

            You might be right about the ACA reducing costs long term. I’m more skeptical as it doesn’t do anything to address many of the underlying causes of the high cost, (costs of regulatory compliance and drug/device development, over prescription to avoid lawsuits, lack of preventative care and hospital acquired injuries/infections, etc. But the only way to know if it will help or not is to wait and see.

          • Martin Forde

            Yea, there is much to be done. I agree that the problems with our healthcare system are systemic. I don’t think focusing on insurers is really going to address the problem in it’s entirety. I do think it’s a step forward in the right direction though. The american people didnt get everything they wanted or, even for that matter, deserved with ACA. However, it is a framework to work off of. So I guess we will just have to wait and see how it pans out. But honestly, I think it’s irrelevant whether or not ACA is a success. If it isn’t people are going to continue pushing for more meaningful reforms. Everyone agrees that there is a problem. We just all disagree on how we go about fixing the problem(s). And we end up in a stalemate where nothing ever gets done.

          • Weaver

            You lost me when you put “profiteer” in the sentence.

          • Martin Forde

            Health insurance companies have been reporting record profits for years. I don’t not feel sorry for them. They are massively overcharging people simply because people have no real alternatives. Personally, I think the financial aspects of the US health care system are borderline criminal. But that’s just me.

        • Daniel Maris

          What about the A&E ambulance to take you to hospital? Extra wear and tear on pubilc roads. Extra fuel to fly you in a plane?

  • Wareagle82

    Treating something as a disease is a business. Treating the results of self-inflicted behavior as just that is not. When in doubt, follow the money.

  • kalamere

    Why don’t doctors tell people to stop promiscuous risky sexual behavior? Why don’t doctors tell people to mind their own business? Why don’t doctors diagnose liberals as insane?

    • Daniel Maris

      Well doctors should indeed tell people to stop promiscuous risky s exual behaviour. Telling fat people they are on a path to ill health and burdening their fellow citizens is not discrimination, it’s telling truth to flab.

    • Alexandrovich

      Why don’t you STFU?

      • Fergus Pickering

        If everybody STFU this place would be empty.

    • twinny

      Advising people on healthy weight or safe sexual practices are the doctor’s bailiwick. Suggesting political viewpoints is not. The job of the doctor is to help her patients become healthy, not to acquiesce to the whims of the soda-swilling cetacean who thinks he’s found a miracle weight loss pill and just wants a goddamn script. Also, as an NHS doctor she should also consider whether a given intervention is a frivolous use of taxpayer money.

  • Kathleen M. Ritter

    I am fat. And it’s my own damn fault. I eat too much and don’t exercise enough.

    • Captain America

      You get a gold medal on self-awareness. That’s a huge thing.
      It’s ok to be fat, know it’s your fault, and decide you don’t want to change that. I would guess the majority of people hate exercising. Life is full of trade-offs and it’s a rare person who ends up in an optimal place on everything.
      I’d rather be fat than really selfish or angry all the time or a dick. It’s hardly the worst thing in the world for a person to be.
      If you’ve never been a regular exerciser, you might be surprised how much you like it, and like the way you feel, if you just hang in there for long enough so that your body “kicks in” and you can really feel the difference. That’s all I would say about that.
      The bottom line: As long as it’s a conscious choice and you don’t blame others for it or expect the world to fix it for you — then it’s ok. You own it.

      • Ripple

        Lovely post, so true.

  • JojoXray

    This doctor seems like a real dummy. Since the good doctor likes to insult people with the pejorative “fatty”, thought I’d get in on the action.

  • El Suscrito

    what are you talking about? My doctors have been chasing me for years (if not decades) telling me I’m morbidly obese and need to lose some heavy poundage…however those leafy salads and other bs diets don’t cut it for me. Now if all you self appointed zars of food will actually do something that really matters: look into the food industry and all the garbage they pump into the food one finds at the supermarkets and see how much poison is in there…btw 1947 most veggies were grown locally and without pesticides and chemical fertilizers….so one could eat not too much but actually get nourished…now if Mr. O and his health plan will have coverage for gastric by pass surgeries I’ll be the first in line…don’t give me this walk and such…every time i walk my knees hurt…why? my weight…why did i allow my self to be this big? good life, friends and party…so don’t know which doctors you go to but mine they’re all over my backside when i go in to see them…but none will do me the favor of taken a scalpel and peel off the pounds of lard on my belly…wish they did…being this heavy is not picnic…and actually loath the day that I let my self go but it is what is….

    • Knives_and_Faux

      Eat less move more you fat bastard.

    • Ripple

      Eat what you like but half of the usual amount… and walk and move, every chance you get. When you do something requiring only your top half (e.g. washing up), find a way to move your bottom half as well. Use more of your body than is required for any given task. You’ll burn more fat that way and feel better, as well.

  • Captain America

    I think I can say this with confidence now — Britain has cleared the final hurdle for becoming a Red State in the United States of America!
    Welcome aboard, you fat ****s. I hope you like auto racing and buying abandoned storage lockers!

    • rorysutherland

      Um, I do, actually.

    • Ripple

      Hey! I’m American, too: show more respect!

  • Kathleen M. Ritter

    @Captain America — I know the value of exercise and frankly, love it. I’m an old high chool jock (MVP soccer, played a year in college, HS hoops, and as an adult was an avid mountain biker and long distance road cyclist). Always ate too much nonetheless, and struggled with my weight even when insanely fit. Then the osteoarthritis from old ACL tears got too much even for cycling — have been working on core exercises in physical therapy, but the laziness factor (and a kid) have creeped in over the past few years and I’m now officially fat. No excuses, though; work to be done; I’ve been there before and can be there again. 🙂

  • Tom M

    If somebody is fat then however it happened it’s their problem.

    What I do have an issue with is parents who allow their children to become obese. That is when I think someone should be having a serious word with them reminding them of their responsibilities.

  • SkyFell

    The NHS – what a joke.

    • Fergus Pickering

      Is that a serious remark or just a noise?

  • KeysorSozeII

    I can’t stand people like Mr. Pemberton.

    Let me explain it to you as a doctor……

    Patients are NON COMPLIANT. They smoke and they know they shouldn’t. They don’t take their meds as directed. AND…..

    They are fat and continue to have poor diets.

    I had a patient (later died) that had diabetes, was having his limbs chopped off, and was having heart attacks once a month.

    Yet he continued to smoke and refused giving up his powdered sugar donuts.

    The problem with people like Mr. Pemberton is they don’t understand the problem but think they have the solutions.

    • Weaver

      I don’t mind people being fat. I just don’t want to pay for the consequences of it in taxes.

      If people want to be fat they should have to take out supplemental private medical insurance. Same for dangerous sports and smoking. As it is the NHS encourages bad behaviour ‘cos you are never confronted with the real cost of your own actions.

      • Biochem Femme

        That’s a massively flawed argument that fails to take a lot of things into consideration. It sounds like you want people whose ‘fault’ it is that they’re ill to take responsibility for their ailments. Ok, I agree with you that people take the NHS for granted and that the system is flawed, but where do you draw the line? For instance, what do you consider ‘dangerous sports’? Things like skydiving, wind surfing, soloing, climbing..? Because those sports generate a HELL of a lot fewer injuries than football, rugby, tennis etc (think of all the sprained ankles, dodgy knees, torn ligaments, broken bones, tennis elbow then the resulting x-rays, physio and so on). How about people injured in car accidents? Well you shouldn’t have been driving, of course! How about people who pick up STIs? Would you just leave them to fester because it’s their fault they had sex? What about someone who develops a melanoma because they were sunbathing for too long? Would you let them develop cancer because of their irresponsible attitude toward UV radiation? If you stop treating things for which people are ‘liable’ then you’ll have cut out the majority of all medical cases.

        I would definitely like to see a greater level of respect for the NHS by the citizens of the UK, but simply saying ‘it’s your fault, you pay for it’ is a very unrealistic attitude.

        • Daniel Maris

          Skiiing has got to be the worst!

          I agree it’s difficult to get into the blame game.

          But I think it is reasonable to have some legal limits.

          We might say for instance that no parent should allow their child to go 50% over standard BMI or whatever society thinks is a reasonable limit. That will instil some sense of responsiblity.

          Likewise we should maybe set an upper limit on adults…beyond that they would have to submit to a medical regime or pay an insurance health premium.

          There might be an exception for proven genetic conditions.

          • vatefaire

            “There might be an exception for proven genetic conditions.”

            Here is the thing: we all have different propensity to weight gain/keeping a high body fat level due to genetic polymorphisms (i.e., “genetic conditions”).

          • Fergus Pickering

            What a unpleasant idea. Were you a secret policeman in a former life?

        • KeysorSozeII

          But where do you draw the line?

          Taking part in dangerous sports? Well pay for the consequences of your actions. Why is it my financial responsibility to pay for your broken bones?

          Driving? Most people buy insurance. So they do financially subsidize their participation in this dangerous activity.

          We are not “cutting off” people from medical care that make bad medical decisions. We are attempting to modify their bad behavior by linking their bad behavior to something that might actually cause them to alter this behavior.

          Hitting them in the wallet.

          For smokers, in the US we actually already do this. We tax the crap out of smokes.

          • Fergus Pickering

            But not as much as we do I think. What does a packet of twenty cost over your side?

          • Jackthesmilingblack

            Fags or condoms? Family pack was surely an unintended irony.

          • SmartOne

            LOL, I just wrote a similar point.

        • Weaver

          Biochem Femme.

          As a biochemist, you should surely be aware of the difference between risk per person year and population@risk per year. C’mon, biometricians pretty much invented that branch of statistics, along with actuaries.

          That’s your answer.

      • Sue Ward

        You are if you pay £7000 of your own money for a gastric band! But its worth it when you lose the 10 stone you put on after breaking your back in a horse riding accident, as I did. I got my life back and even ride again!

      • KeysorSozeII

        Well, in the US. People do not generally have to take fiscal responsibility for their poor health choices.

        And it is about time we make them.

      • Fergus Pickering

        Did you know that sex is injurious to health? I suggest a tax. Twenty quid a screw sound right to you?.

        • Ripple

          Actually, I think it often is. We assume (our times) that sex is always good as long as there’s consent. We (I use the term loosely, so to speak) give our bodies away too cheaply — to anyone at a loose end (so to speak) who is interested. We realize we’ve lost something. It didn’t measure up; it wasn’t worth the self-doubt afterwards. Sex is a very very risky business, soul-wise (never mind the privates, which is all that modern body-technicians can ever think of). This is why religion and philosophy take it so seriously: not because it is always so exalted (it isn’t), but because it can cause a person so much harm.

          • Fergus Pickering

            I agree with you. That’s partly why I suggested the tax. Shakespeare reckoned that every tme you had sex you shortened your life and we know that every baby a woman has shortens hers. Stay chaste and stay healthy..

        • Jackthesmilingblack

          That sounds about right. But quick tip, never bar-fine a girl with wet hair.

      • Flaming_Fairy

        You think obese people are “never confronted with the real cost of their own actions”? Really? They don’t notice the breathlessness, the aches and pains, the diabetes, the heart disease? Get real. People do bad and stupid things to their bodies. We can sit in judgement on people or we can just try and help. The two are mutually incompatible.

    • ifisch

      I don’t see what non compliance really has to do with this.

      I think it’s very possible to inform people that they’re obese in a non-judgemental way, so as not to scare them off.

      • KeysorSozeII

        You really think in this day in age I have to inform a patient with a BMI of 40 he/she is obese?

        If that patient wants to lose weight they have to diet. If I tell them after their third heart attack losing a 100 pounds is in their best interest and they don’t…..


        • Colonel Mustard

          Shouting doesn’t really help. Maybe, Herr Doktor, your bedside manner (if it is anything like the tone of your comments) is not very persuasive but instead makes your patients stroppy.

          • KeysorSozeII

            My bedside manner?

            You know nothing about my bedside manner based on a few comments on the internet. Especially to someone that doesn’t grasp the concept of non compliance.

            Again, my impression is that you are not a doctor but like to comment to professionals about how to take care of patients. You have no idea what you are talking about. Your “opinion” of me means nothing to me because you are clueless.

          • Ripple

            I wouldn’t have you as MY doctor. Mustard is right.

          • KeysorSozeII

            If you actually think my bedside manner “mirrors” my comments on an internet site…..

            Well you are a dope. Get a clue.

          • Ripple

            I’m not a dope, actually. And I would have taken back my comments, after having read the developed thread, i.e. a second time, but didn’t get around to it.

          • Jackthesmilingblack

            Bedside manner? Never tell a chick you`ve just screwed that she`s fat. Because in feminist UK she has been given carte blanche to scream “Rape!”. Which means slammer time beckons.
            Now that`s what gets you banned from the Guardian.

          • Toby Esterházy

            I think that you are idiotic enough to confuse “bedside manner” with “pillow talk”!

            I don’t blame the Guardian for banning you. I say, but I mean, you had already used up your one “get out of gaol” free card with the Guardian.

          • Sarah

            I think everyone is misunderstanding the intended meaning of “non compliant,” which is in the medical word very different to your interpretations.
            Medical professionals use “non compliant” on a daily basis, not because they are controlling, but because it is the medical phrase for when a medical treatment or management plan is prescribed or advised, and the patient chooses to not ‘comply’ with it.
            Perhaps the roots of the terminology are from back in the day where doctors role was to control, who knows, thats irrelevant.
            The point is, the focus of this article on the doctor not bringing up obesity with patients is perhaps not that accurate – I bring it up alot but my success rates in facilitating a change are pretty low.
            The thing is, a person has to be in a particular mindset to change. I try to inspire that mindset but it rarely works – smoething has to trigger it, or it comes from within. Some people never enter that mindset and no matter how much you try and persuade them, they;ll never change.

        • Algernon_the_Sceptic

          Ve hef veys of meking zem follow ze orders, jah?

          • KeysorSozeII

            You don’t have to “follow” my orders. Your thoughts that non compliance “bothers” me is hilarious.

            I make suggestions. 9 out of 10 times the patient’s don’t follow them. The suggestions are things the patient really knows. Smoking is bad for you. Overeating is bad for you. Doing drugs is bad for you.

            And I don’t suffer the consequences for the patient’s bad decisions. The patient does.

            Ultimately, the patient’s health is the patient’s responsibility.

            Your Nazi comments are some short of bizarre projection to me. Might want to see someone about it.

          • disqus_JXTaH3N9kU

            I am rather confused. I have read the original article and I have read a number of your posts on here, Keysor Sozell. It seems to me that what you are saying and what Max Pemberton is saying is more or less exactly the same. So why do you have a problem with his article ?

          • KeysorSozeII

            With one exception.

            Dr. Pemberton is assuming that doctors don’t bring up obesity.

            Many of us do. The issue is that the patients are fat not because doctors are refusing to address the issue.

            The patients already know what they are doing is not healthy. They also ignore suggestions by their physicians to lose weight.

            The issue is medical non compliance. Something Dr. Pemberton didn’t address in the article.

          • Ripple

            People object to your term ‘compliance’ as if this were a tax audit or something. It sounds clinical in a nasty sense — indeed, coercive. The goal may be worthwhile, but people will not respond well if treated like cattle.

          • KeysorSozeII

            Medical compliance and medical non compliance are words that medical professionals use to describe their patients.

            As far as how to treat the problem….

            I have spent hours doing cognitive behavioral therapy on these “cattle”. Some get it. Others don’t.

          • Ripple

            Yes I understand that — now. I was just saying that for those of us not in the profession, who are also used to doctors abusing their position of knowledge and power (they have the thing you need), it has a suspicious whiff of authoritarianism at first glance.

          • KeysorSozeII

            Doctors = Authoritariansism.

            I guess when you need a plumber he is an authoritarian too. Or an automechanic or an electrician.

            You buy the services of people everyday. Doctors are no different. If you don’t like your doctor, go see someone else.

          • Fergus Pickering

            I don’t understand why all these people do not understand what you are saying. I take it you are saying that people are free to do anything they like that does not harm other people. That is J.S. Mill’s position and mine. And yours..I wouldn’t mind if you were my doctor, except that I prefer female doctors. Less hectoring, don’t you know. But that is not directed at you..

          • SmartOne

            They do not WANT to understand what he is saying, which is typical of fat or as we have to call them ‘obese’ people, actually morbidly obese are what most of them are.

            This is rather typical, deflect and find something you can focus on and be angry about us not having ‘fat acceptance’. Ironically, as doc said, the obese are the ones who will have host of issues, including arthritis, diabetes and heart attack, which will all lead to a premature end of 13 years less of life.

            My motto is live and let live to a point. If I have to pay for other people responsibility that is not right. Just like my car insurance that goes up if I mess up, these guys should be held responsible for their ‘reckless driving’. It has been proven that that monetary benefits for doing the right thing work. Maybe in the case of obese, if this ALSO does not work, punish them with paying if they stuff another pound on their oversized frames.

          • Edward Haskett

            I suppose car insurance is a legal requirement, maybe make life insurance the same?

          • SmartOne

            In Canada, the obese have right to ask for two airplane seats and get to only pay for one. It is not a disease in most of the cases, it is behavior. I got my obesity with my behaviour and healed my obesity with my behaviour. Unless the treatment is locking them up and tying them down to a table and feeding them small portions until they lose weight then sorry, remove triggers from your home, increase protein and decrease carbs to next to nothing. And walk. Go everywhere by walking.

          • Ripple

            And you might want to see about getting a sense of humour implant.

          • KeysorSozeII

            Yes you have tons of insight on my sense of humor from a few comments I have made on the internet.

            And maybe I should start my stand up career on the 350 pound that dies from congestive heart failure.

            Because that is what we are talking about and it really isn’t a very “funny” topic.

        • carrie

          I agree with what you are saying, however, I would like to ask doctors, “do you think your patients haven’t tried to diet?” I’ve been overweight and dieted, lost weight, and like 95% (or more) of people that lost weight, I have gained it back and then some.

          • Sarah

            I am a doctor and I know it takes a hell of a lot of self control. So when an overweight patient tells me they’ve tried, I believe them. It’s bloody hard for most overweight people to lose weight.
            Keep trying though. If you stop trying, in 10 years time, your weight could have doubled, and you’ll wish you were how you are today. Even if you stop gaining, rather than LOSE weight, that is much much better than giving up.

    • Colonel Mustard

      “Patients are NON COMPLIANT”?

      Your real name isn’t Josef Mengele by any chance? Doctors used to tend and advise not judge and condemn. Like many other public “servants” they appear to have succumbed to the delusion that their role is to control people.

      • KeysorSozeII

        Smoking is bad for you right?

        Yet people do it everyday.

        Being overweight is bad for you right?

        Yet people do it everyday.

        People are non compliant with what will make them healthy.

        I can tell people until I am blue in the face you might want to give up that two pack a day habit, or give up eating at McDonald’s everyday.

        The bottom line it is the patient that has to make the decision. I can’t make people do healthy things.

        You don’t understand the issue. You either went to a crappy medical school or don’t practice medicine at all.

        • Colonel Mustard

          People do lots of things that are bad for you. Politicians keep projectile vomiting legislation that is invariably bad for you. People drink alcohol in prodigious amounts that is bad for you.

          I understand enough to know that you sound like a bad tempered control freak, Herr Doktor, and I’m glad I’m not one of your patients, “compliant” or otherwise.

          • KeysorSozeII

            The story is about why doctors don’t bring up to patients that they are fat.

            I comment, the author is clueless because he doesn’t seem to understand the concept of non compliance.

            Your comments that I am a control freak are hilarious. You are completely missing the point and are arguing a non sequitor.

            A lot of doctors bring up to their patients that they should quit smoking or lose weight or stop doing drugs. The patients don’t listen.

            The author accuses me of not bringing up the issue. I do. The author doesn’t seem to understand non compliance.

            Somehow you think this bothers me because I want to micromanage people’s lives. You so misunderstand the issue. Ultimately the patient’s health is the patient’s responsibility.

            Get a clue.

        • Algernon_the_Sceptic

          Perhaps it’s a cultural thing, but here in the UK, the phrase “non-compliant” implies that the patient is not following orders. No one likes being given orders, and in the UK you are more likely to be told to fcuk off, even if they agree with your rationale (which in the UK they probably would).

          From a Dr’s viewpoint, poor patient response to sound medical advice may be irritating, but it does not necessarily mean the patient is being obtuse, it may be more that the patient is in the grip of an addiction either to the stuff consumed or to their neurochemical response to what they consume.

          • KeysorSozeII

            Poor patient responce to sound medical advice is not “irritating” to me. You should check your projection or counter transference at the door.

            Having spend multiple hours applying CBT techniques to patients with poor eating habits, or a 1-2 pack a day habit, or a drug problem, your condescension that I don’t understand the “neurochemistry” is funny.

            The bottom line from my perspective. Most of my fellow doctors bring up these issues. The assumption the author made is wrong. The issue isn’t lack of effort on the physician’s part, it is non compliance on the patient’s part. And if you want to attribute this non compliance to “neurochemistry” fine. Whatever.

            Ultimately, the patient’s health is the patient’s responsibility.

          • Ripple

            Or that the patient doesn’t like being tyrannized by a doctor. I have had more than one doctor abuse his/her position with respect to me, by ordering a test I specifically said I didn’t want, or by requiring an examination of me that was invasive and unnecessary but which I had no way to argue with at the time (i.e. I wanted contraception and the doctor had all the power). Doctors have needed putting in their place for a long time. You are technicians of the bod, nothing more.

    • Fergus Pickering

      And your patient died. That was the solution. Very neat too. My father in old age was told he needed to have his leg amputated or he would die of gangrene. he didn’t fancy a one-legged old age so he said no. And died. God on him..

    • Ripple

      Maybe your patient didn’t like his life. I doubt it was the Garden of Eden. Many people commit suicide without anyone acknowledging that that is what they are doing. Life is supposedly a gift, and god forbid that anyone should ever contradict that assumption.

  • jkendi

    I believe obesity, in many cases, is linked to depression or other mental health issues coupled with effortless access to awful processed food that makes them feel temporarily better. Doctors don’t ask their patients if they are self-medicating with food because if they say yes, the doctor doesn’t really have any tools to handle that. Worse, the current science in mental health is woefully behind other medical areas so if they refer the patient to a psychologist, not much will happen there either. It’s a damn shame. I can’t in good conscience berate fat people any more than others who medicate in other ways to escape depression. To do that is simply kicking people when they’re already down. Kids, yes, that is more complicated because not only do they see examples of poor nutrition and watch stupid commercials about French fries, there’s TV and video games that kill their natural inclination to play. But at the same time they probably have inherited tendencies from their parents that play into it. The obesity epidemic is a product of many things, not one thing, and certainly not weakness and sloth. I have friends who have stayed on diets, starving so long that it’s hard for me to comprehend how they do it. I couldn’t live on 900 calories a day for months–I don’t have that kind of willpower. But sadly, after all that work and deprivation they often gain the weight back because the real problems have not been solved. I would just say get a heart and press for solutions.

    • Daniel Maris

      The “real problems have not been solved…” True, but they did start eating again…it wasn’t the Fat Fairy who made them fat again.

      • Sue Ward

        When you have tried eating 900 calories per day for months, please let us know. Unfortunatley once people become morbidly obese they only have a 3% (yes, 3%) chance of losing the weight by dieting and keeping it off for more than 5 years. These figures were given me by a leading bariatric surgeon.

        • KeysorSozeII

          Learn CBT techniques to fix the problem.

          If you don’t get an evidence based approach to solve the problem you shouldn’t think the problem is going to magically fix itself.

          I have seen many patients get gastric bypass, subsequently stretch their stomachs by continually overeating after the gastric bypass surgery and not lose weight. Why? They didn’t address the reason they overeat in the first place.

        • Fergus Pickering

          That only means that only 3% do. And with sureons whose livelihood depends on these very fat people, that’s no wonder. I suggest not dieting but starvation. That should do it. What would be the result of nothing to eat for a fortnight. I mean nothing at all. Would the patient die? What of?

          • Flaming_Fairy

            Excellent idea – and perhaps, in order to make sure these worthless fatties don’t eat anything, we could starve them in special camps which would concentrate the population of fatties in certain areas, away from the morally superior thin people like you. We could even call them concentration camps, where those terrible obese people would be starved and worked until they lost weight. Or died. But if they died, who’d care? They’re just fatties after all.

          • Fergus Pickering

            Who said I was thin? I am not thin.I like beer and pork pies.

          • Weaver

            Unfortunately, they’d die. The body can’t draw down fat reserves that quickly; its like a limited withdrawal bank account.

            Near-starvation on the other hand….

          • Fergus Pickering

            That’s what you scientist chapsare for. As you say, then.

        • SmartOne

          I am eating under 500 cal daily and am under doctor’s supervision in weight loss. I am 1 lbs of being in ‘healthy’ weight and shedding 60 lbs in 4 months. It is a matter of if you want to be sick or whiny. Many fat people at the clinic who are like me paying a fortune to be monitored, just talk about how they ‘cheated’. I don’t get it. It is fine, I just don’t want to hear that this is a disease.

          I gained weight because of an injury and one thing lead to another so weight cause severe arthritis in my lower spine so I gained some more. And even though I am now entering ‘healthy category’ I still have about 20 lbs to lose (clinic actually said 30 but I am a mesomorph so I probably have more muscles than other body types). The irony is that everybody is telling me ‘You are crazy, you should not be losing anymore ‘, ‘You are anorexic looking’ (still have 155 lbs and 37% of body fat that has to be shed so yeah, the clinic goal might the right one, ‘Como’n you are tiny’ (I am still a medium size, albeit small medium but medium and I should be large small size.

          So in a society we are more fat and now we ‘expect’ others to look like ‘fat person’. This is why we should never declare obesity as sickness but reward people who are doing the change and who are healthy.

        • JDDurr

          Sue, I don’t want to be discouraging. It’s excellent that you’re watching what you eat and (hopefully) exercising more. That’s healthy regardless of your body size, so keep up the good work! But your surgeon is correct, according to an article published in the prestigious scientific journal Nature: http://www.nature.com/ijo/journal/v34/n11/abs/ijo201094a.html

          Take someone who is 5’10”. To be morbidly obese, this person would have to weigh ~280 pounds. For them to have a normal weight, then, they would have to loose about 100 pounds. That would be a 36% reduction in their weight. According to the Nature study, only 4.4% of people are able to maintain a weight loss of 20% over the long term. Frankly, the 3% figure your surgeon cited may be optimistic.

          Until an adequate pharmacological and/or environmental intervention to this problem is found, I’m afraid the only real long-term solution for most obese people is medical intervention, first and foremost, combined with supplemental diet and exercise.

          • Ripple

            FYI: The word is ‘lose’ with one O.

          • Jackthesmilingblack

            Surprising how many make that mistake. Or perhaps not when you consider how crap basic education is in Trash culture UK.

        • Daniel Maris

          You’ll lose weight if you eat 1800-2000 calories a day and exercise.

          • Ripple

            It could be a lot less than 1800, depending on a person’s height etc. The standard number is 3500 cals a week that must be lost for slimming.

  • CFL68

    Just make it quid pro quo at some level. Its ok to be fat, but you will have to pay more for healthcare. It is your choice. BMI might be too simple, but set up some sort of health index and based on where you on the scale (pun?) you will pay higher or lower premium.

  • Quancho

    Great article for #FatShamingWeek!

    • AHodges

      Should we pretend like being obese isn’t a danger to a patient’s health? If this was about smoking, most people would agree that we need to take responsibility for our poor choices. If you go in wheezing and showing signs of emphysema, the doctor wouldn’t be doing his job if he didn’t tell you to stop smoking. I fail to see how this is any different.

  • Simon

    You can’t call a fat bastard a fat bastard nowadays.

    • Modernity

      ‘Fatso’ is endearing down under

  • Joe Davis

    Let’s see if they let me link this talk: http://www.ted.com/talks/peter_attia_what_if_we_re_wrong_about_diabetes.html

    It is from a doctor on TED MED who had a similar attitude about obesity, but has since realized that the problem is more complicated than we give credit.

  • disqus_KdiRmsUO4U

    It seems to me that in today’s non judgemental environment the problem will only get worse.
    People need to be told that to ensure further help weight loss is a MUST.
    Probably not likely but as far as I can see the only road to a solution.
    Emollient attitudes will fail just as has happened with crime and recidivism..
    Absurd anti drug laws dont help there !
    On a cost effective basis the earlier you die the less you cost the welfare state.

  • ESNYC80

    Speaking as someone who has been overweight and predisposed towards being fat, I can tell you that it is both difficult and entirely possible for people to control their weight. I was borderline obese 9 years ago, when I was fortunate enough to overhear an attractive young woman passing me on the street tell her friend, “I hate fat people,” just as she caught me checking her out. I could have been angry, but instead it occurred to me that I had control over this, and resolved to lose weight. I began reading about diet and exercise and committed to making a change. I learned that it only takes about 28 days to form a habit, and I promised myself that I’d spend one month eating well and exercising intensely at least 5 days a week.

    The pounds started coming off quickly. I lost almost 10 that first month. Every time I saw people I hadn’t seen in a few weeks, they’d ask if I lost weight and tell me I looked a lot better. With 6 months I’d lost over 50 pounds and was trim. In the last 9 years, a week hasn’t gone by in which I haven’t exercised vigorously for at least 30 minutes 5 days within the week (I hate when people claim they don’t have time to exercise – I work 100+ hours a week and I still find time – there’s always time for something that’s a genuine priority). My diet is now quite healthy – I haven’t had a soda, added sugar to anything, or eaten fast food since that day in 2004. The cravings took a long time to subside. I have days where I’d like to be lazy (especially when I’m sick). It’s not always easy, and as I’ve gotten a little older, I have to work out a little more and eat a little less each year, but I’ve managed to stay quite thin and according to medical standards am in the “ideal” range of fat (meaning that I’m not only not overweight, I’m actually in the healthiest possible range). I don’t quite have a ripped six pack, but I can see my abs.

    I gain a few pounds around Christmas and have to work it off, as I gain fat easily, but just as being fat was my choice, losing weight and keeping it off was my choice, too. It was empowering, and it was the beginning of entirely changing my life. The realization that I had a responsibility for and control over my own body made me take control of my life and accept that I could. I was depressed when I was fat, and I had a job that was far below my capability. I had no girlfriend, and, as in the case of that woman I’d love to go back and thank, attractive women had no interest in me. I am now about 50 pounds lighter, married to a beautiful woman, and am CEO of a company I founded. My life is entirely transformed, and if it weren’t for that pretty young woman and her fat-shaming remark, I’d probably be fat, lazy, unhealthy, and miserable right now instead of living a life that I truly enjoy.

    We shouldn’t coddle people in fear of their being offended. We should let them know they’re fat and that they have control over themselves. Some may be angry, but others may take control of their own lives. Both individuals and society in general would be a lot better off if we all took control of our own lives and accepted responsibility for something as fundamental as our own bodies. Obesity is not a disease, but it certainly seems like denial and lack of accountability are a social disease desperately in need of a cure.

    • Daniel Maris

      A “soda” tells us you’re American – with a can-do attitude. 🙂

      I don’t disagree with anything you say. People are way too fearful of offending others’ sensibilities. If you look at primitive hunter gatherer tribes you won’t see an inch of fat on them, but they rarely go hungry – they aren’t denying themselves. It’s a question of balancing exericise (what used to be hunting) and eating.

      There’s certainly ought to be a law against feeding anyone who can’t get out of their house. That is like slow murder of the person. The best you can do for them is to stop feeding them.

      • carrie

        Just curious, what do the British call ‘soda’?

        • therealguyfaux


          • carrie

            oooh, i like it!

    • Sue Ward

      Well that girl may have been attractive on the outside but she was pretty damn ugly on the inside to make such a comment about someone that they were likely to overhear. Good for you on your weightloss though.

    • Fergus Pickering

      You are right but a word of advice. Don’t be so born again. Your weight is your business but other people’s weight is their business.

      • Ripple

        He didn’t say it isn’t.

    • Ricky Strong

      I really do take my hat off to you Sir. It is the overweight people in the gym, those running on the roads or those that go to exercise classes that I have the most admiration for; not the idiot stood in the gym checking themselves out every minute.

      This post should be at the top of this page.

    • Craig Sweaton

      What a lot of tosh. If you really work 100 hours per week then you’d have zero time to get fat! I think you just made your story up to gain a few “likes”

  • JDDurr

    This, my friends, is why doctors should not pretend to be scientists. Of course we should all exercise more. Of course we should eat less. Of course we shouldn’t pretend that obese patients don’t have a serious condition. But the actual science clearly indicates that obesity is overwhelmingly a genetic condition. One recent study, for example, found the broad-sense heritability of obesity to be as high as 77%: http://ajcn.nutrition.org/content/87/2/275.full.pdf

    The bottom line is that our environment has become increasingly “toxic” in recent years because our jobs tend to be more sedentary and our food tends to be less nutritious. Some people have the genes to deal with these “toxic” circumstances better than others. How is demonizing “fatties” for their genes any different than demonizing black people because of their race, which is also genetically determined?

    Exercise and improved diet can help somewhat, so they should be encouraged. But to blame the patient–to call them “fatties”–is obvious bigotry.


    A Real Scientist

    • Fergus Pickering

      What are you a real scientist of? And what do you expect your being a real scientist should get you in debate?

      • JDDurr

        I’m a real scientist in a field call “Biomedical Sciences.” At least, that’s what it says on my PhD. Since biomedical sciences is my area of expertise, I’m qualified to comment on questions related to biomedical sciences. Don’t know how to explain it more clearly than that…

        • Fergus Pickering

          You shoul have explained it in the first place instad of waving the ridiculous ctach-all word scientist about. You could hve been a climate-change scientist or some such mumbo-jumbo Yup.Pass, friend.

          • JDDurr

            Yeah, you’re right. Sometimes I get so caught up in my own work that I forget there are other kinds of scientists out there too. 🙂 Thanks for your clarifying question.

    • lucillalin

      Let me just slide in a history student’s two cents: we have never had as many healthy options in food stores before as we do now (if you bother cooking yourself) and office desk jobs for masses have been around for quite a long time now. Yet the sudden jump in obesity is very very recent.

      • JDDurr

        Not that I agree with your version of “history” (there are far more unhealthy foods and sedentary jobs now than there have been in the past), but even beyond that, what exactly is your point?

        Our environment has clearly changed over the course of the past hundred years, and those changes have certainly accelerated in recent decades. Some people are better equipped to deal with those changes genetically than are others.

        That’s not to say people shouldn’t be watching what they eat and exercising. That kind of vigilance is healthy regardless of body size. But the simple reality is that studies have shown time and time again that obesity is mostly a genetic issue and that the vast majority of obese people, especially morbidly obese people, cannot maintain adequate weight loss over the long term without medical intervention, no matter how dedicated they are.

        There’s no need to make some convoluted, highly speculative appeal to history to try to advance a poor argument. I know people like to shame the obese, but that does not change the facts. Science has demonstrated (repeatedly) that the obesity epidemic is primarily a result of biology, not insufficient will power/personal failings.

        • carrie

          I wish science would be a little louder about this! You would think that knowing that 95-98% of people who lose weight will gain it back (plus some) would show that there is something more at play than just will power, but the majority of people (even the overweight) still believe it is all about will power.

          • Jane Hayhow

            because the Diet Industry stands to lose their fortunes unless they keep the overweight, overweight. I will not use fat because it is offensive in the same way that I wouldn’t dream of calling my dear friends n*****ers. As well as the Diet Industry it’s a pretty good time for the Bariatric Surgeons too. And as for earlier comments made about this so-called ‘Medical and nutritional help’, it’s a joke. When I went to the Dietician with my 100% honest food diary she said I ate more healthily than she did and sent me home.

    • Ripple

      So if you have a disposition to gain weight you ought to do more about it.

      I have known, intimately, obese people, as I’ve said elsewhere on this thread. They ate the wrong things (graduate school bachelor in one case; poor person trying to feel better and enjoy life in the other case), and they didn’t exercise enough to offset the fat-storage. One person saw what was happening and fought it; the other fought intermittently but made excuses for herself and gave in to a life of permanent obesity, ugliness, and premature death.

      It’s not genes, it’s state of mind, rationality, and aspiration for happiness.

      • JDDurr

        I understand the reluctance to acknowledge genetic factors that contribute to obesity. It’s the same reason people who hate homosexuals often don’t want to acknowledge biological factors that may explain gay behavior. In both cases, if there’s a biological explanation, it’s more difficult to shame people who you find disgusting, right?

        Of course people who have a predisposition towards weight gain should try to loose weight. No one should just give up. Besides, healthy living is good for you regardless of body size. But the simple reality is that the vast majority of obese people will not successfully maintain substantial weight loss over the long term, regardless of their dedication. I’m not expressing my opinion here. I’m stating scientific fact.

        You may think you understand the reasons why people gain and loose weight, but let me assure you that, unless you’re about to win the Nobel Prize because of some secret research you’ve been doing in your basement, you don’t. Some of our greatest scientific minds are working on this question. Study after study has shown that obesity is predominantly a question of biology, not will power, but the root causes, which are far more complex than simply eating too much and not exercising enough, are still being worked out.

        The fact that you know a guy who managed to loose weight does not constitute scientific evidence. That’s what we call anecdotal evidence. Well-controlled studies of large cohorts do not support your anecdotal conclusions. Most obese people will not be able to maintain a normal body weight over the long term by simply eating better and exercising more. Again, not my opinion. Scientific fact.

        • Ripple

          If it’s about genes and not about metabolism (or else input and output of energy), how then do you explain the fact that people in the recent past were very much slimmer than people now? We all came out of the womb the same. Yet obesity is a MODERN problem, of the past two to three decades. That’s too short a time to suggest that genes are the culprit. I’m the daughter of an obese woman and I’ve never been overweight in my life: but I exercise, and she doesn’t, and I eat consciously, and she doesn’t (or, if she does now, the fat’s there already and it’s not going away). I might have help from my genes but I share half of them with her — and again, why was there no mass obesity explosion until now?

      • Fergus Pickering

        Don’t tell anyone what he ought to do. Leave that to his wife.

        • Ripple

          I wasn’t telling him, silly: I was making an observation.

    • carrie

      True, doctors are pretty useless when it comes to nutrition and weight loss. Well, I guess I should clarify that American doctors are useless in that regard. I don’t know if British docs get more training in nutrition and weight loss, but I know American doctors get virtually zero training on it and then they pretend to be experts. Then the advice, “Eat less, move more” comes from that. If that is such good advice, why is it so ineffective.

      • Ripple

        Probably because the patients are still eating more of the fat-storage items than they should, and because they overestimate the fat-burning capacities of their exercise. It takes a great deal of exercise to burn a rather paltry number of calories, and many people don’t know that. And when they DO work up a sweat, they reward themselves afterwards with a treat.

  • lump1

    I also wouldn’t advise euphemistic talk at the expense of being truthful with patients. But that seems to be the crux of the plan outlined in this article: Tell the fatties they’re fat and they need to exercise.

    What will come of it? Is this like dentists telling me: You’re not flossing enough, floss more! Of course the dentist is right, but just how much power does her admonition have over my behavior? About as much as a doctor who tells a fat patient to walk more and eat less.

  • RayJ

    It bears pointing out as well, that you can tell someone they need to make some lifestyle changes and lose some weight or they are going to encounter serious health risks without calling them a fatty.

  • CCCrazyPanda

    Excellent article. The issue is indeed that obesity is considered normal now, because political correctness has effectively silenced those who point out people’s flaws. I find it most interesting that those who promote collectivism are the first to recoil in horror at the idea of society as a whole, nudging certain behaviors by judging individuals.

    If we are indeed in it for more than just ourselves, then I have a moral obligation to tell fat people they’re fat, that it’s NOT ok.

    What’s amazing is a Canadian airline has gone so far as to grant obese customers a free extra seat on the grounds that obesity is a medical condition. Talk about enabling, and at the expense of other passengers no less.

  • Eddie

    Why are doctors afraid to tell people they’re fat?
    Maybe because a lot of them would be nurses…?
    As Joan Collins wrote in her autobiography, one used to have to visit a circus to see the fat tattooed lady – now they’re everywhere!

  • Dan Brumm

    I think shows like the Biggest Loser are a big part of the problem.. They discourage people to lose weight by telling them that they need to run their tubby arses into the ground just to shed kilos. This is untrue. Exercise is great for you for many reasons, but losing weight is not one of them. The body is very efficient at holding onto stored energy but less efficient at shedding it. So a lot of exercise will only burn a small amount of calories, less than eating an extra cookie will put on. The exercise however will work up a huge appetite and make you more likely to over-eat (after all you deserve the ice cream, you just did a 5k run, right?) SUGAR IS THE PROBLEM. Particularly the fructose half. It is making us fat. Chart the introduction of sugar into the diet compared to soaring obesity rates (not to mention diabetes, heart disease, dementia, cancer) and you’ll see an undeniable correlation. Read David Gillespies Sweet Poison, and you will learn how to shed tons of kilos while still eating as much butter, steak and bacon as you like.

  • Igniss

    Thank you for this breath of fresh air. There will be widespread outrage from fatties and their supporters, to be sure, but you have done a great thing. Searing and substantial article.

  • harleyrider1989

    The Medicalizing of America

    Part I: The Numbers Game

    Medicalize: “To identify or categorize (a condition or behavior) as being a disorder requiring medical treatment or intervention,” American Heritage Dictionary.

    Responses to virtually all questions, medical and otherwise fall into two categories: 1. Those having a finite number of answers, including yes, no, or in-between, for example “are you hungry?” or “are you sick?” and 2. Questions having a range of answers or values. Biologic and other scientific measurements fall into this latter category and include such things as weight, age, height, blood pressure, blood chemical values, such as glucose, cholesterol, PSA, etc. Where we get into trouble is in deciding, particularly in medicine, what is indeed normal and what is not. No matter where we place the dividing line or cutoff point, we are faced with an irresolvable medical dilemma.

    If we make the cutoff between normal and abnormal too low, we include too many normal in the abnormal group (called false positives, a Type I error); if the cutoff is too high, we include an excess of abnormal in the normal group (false negatives, Type II error). In the first instance we call too many well people sick, and in the latter, too many sick people well. (We are assuming the spectrum of low to high corresponds to the range of normal to abnormal; sometimes this range is reversed.)

    Over the years, various cutoff points for normal values have been based on generally accepted statistical and common sense clinical grounds. For example we have “normal” values for fasting and non-fasting blood sugars, upon which the diagnosis of diabetes is based; the “normal” level for blood pressure, defining the condition, hypertension; cutoff points for weight, defining obesity; and “normal” levels of blood lipids (HDL,LDL and total cholesterol) which for some even define the presence of heart disease (sic!). In what appears as a fatally misguided hope of extending treatment benefits to as many citizens as possible, various professional societies as well as Government Agencies have indeed changed our definitions of disease with unforeseen consequences. Specifically, in the present climate of change driven by a perceived need to keep us healthy and long-lived, these cutoff points have been lowered progressively and so drastically as virtually to create a nation of patients.

    In a revealing article in Effective Clinical Practice (March/April 1999) Lisa M. Schwartz and Steven Woloshin conclude that the number of people with at least one of four major medical conditions (actually risk factors) has increased dramatically in the past decade because of changes in the definition of abnormality. Using data abstracted from over 20,700 patients included in this Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) conducted by the National Center for Health Statistics, the authors calculated the prevalence of diabetes, hypertension, elevated cholesterol, and being overweight under the old and the new definitions and calculated the net change (i.e., number of new cases). Here are the results reported in the above article.


    Old Definition: Blood sugar > 140 mg/dl
    People under old definition: 11.7 million
    New Definition: Blood sugar > 126 mg/dl
    People added under new definition: 1.7 million
    Percent increase: 15%

    The definition was changed in 1997 by the American Diabetes Association and WHO Expert Committee on the Diagnosis and Classification of Diabetes Mellitus.


    High blood pressure is reported as two numbers, systolic or peak pressure and diastolic pressure when heart is at rest) in mm Hg.

    Old Definition: cutoff Blood Pressure > 160/100
    People under old definition: 38.7 million
    New Definition: Blood Pressure > 140/90
    People added under new definition: 13.5 million
    Percent Increase: 35%

    The definition was changed in 1997 by U.S. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

    Prehypertension, a new category created in 2003: blood pressure from 120/80 to 138/89 includes 45 million additional people! If one includes this category, we have a grand total of 97.2 million total numbers of hypertensives and prehypertensives (whatever that is).

    High (Total) Cholesterol:

    Old Definition: Cholesterol > 240 mg/dl total cholesterol
    People under old definition: 49.5 million
    New Definition: Cholesterol > 200 mg/dl total cholesterol
    People added under new definition: 42.6 million
    Percent increase: 86%

    The definition was changed in 1998 by U.S. Air Force/Texas Coronary Atherosclerosis Prevention Study.


    Body Mass Index (BMI) is defined as the ratio of weight (in kg) to height (in meters) squared and is an inexact measure of body fat, though it supposedly establishes cutoff points of normal weight, overweight, and obesity.

    Old definition: BMI > 28 (men), BMI > 27 (women)
    People under old definition: 70.6 million
    New definition: BMI > 25
    People added under new definition: 30.5 million
    Percent Increase: 43%

    The definition was changed in 1998 by U.S. National Heart, Lung and Blood Institute.

    “The new definitions ultimately label 75 percent of the adult U.S. population as diseased,” conclude the two researchers. They add cautiously that “…the extent to which new ‘patients’ would ultimately benefit from early detection and treatment of these conditions is unknown. Whether they would experience important physical or psychological harm is an open question.”

    We seem to live in an equal opportunity consumer culture tyrannized by the fear of growing “epidemics” going by the leading risk brand names, High Blood Pressure, Obesity, Diabetes, and High Cholesterol. Just read the papers, peruse the Internet, or turn on your TV to learn what the Government watchdogs, the consensus insurgency, and the other image makers have to say about our disastrous state of health.

    Several related questions arise when we consider the implications of these new definitions of disease (actually disease risk-markers). First how did these official and semi-official watchdogs achieve their status of “guideline-makers,”who appoints them and why, and how powerful an influence do they wield in terms of medical practice? Finally, one has to wonder what is the rationale for adding over 86 million new “patients” (not counting 45 million “prehypertensives”) to our already staggering over-the-top healthcare cost.

    Coming soon, these and other issues will be examined in our next newsletter.

    Martin F. Sturman, MD, FACP

    • KeysorSozeII

      Want to talk about medicalizing of America?

      Read the DSM-V.

      • harleyrider1989

        DSM-5 Field Trials Discredit the American Psychiatric Association

        The $3 million DSM-5 Field Trials have been a pure disaster from start to finish. First, there was the poor choice of design. The study restricted itself to reliability — the measurement of diagnostic agreement among different raters. Unaccountably, it failed to address two much more crucial questions — DSM-5’s potential impact on who would be diagnosed and on how much its dramatic lowering of diagnostic thresholds would increase the rates of mental disorder in the general population. There was no possible excuse for not asking these simple-to-answer and vitally important questions. We have a right to know how much DSM-5 will contribute to the already rampant diagnostic inflation in psychiatry, especially since this risks even greater overuse of psychotropic drugs.

        Second problem — the design of the DSM-5 field trial had a byzantine complexity that could be dreamed up only by people with no experience in real-life field testing. One look made clear that there would be serious implementation problems and that it would be impossible to complete within the time allotted. The first stage of the field trial limped in eighteen months late, having taken twice as long as was scheduled. APA then had to choose between delaying the publication of DSM-5 or canceling its planned second stage of field testing that was meant to provide for desperately needed quality control. APA decided to cancel the trial and instead is rushing ahead with the premature publication of DSM-5 next May — publishing profits clearly trumped concern for the quality and integrity of the product. Fiduciary responsibility was thrown out the window.

        Now, we have strike three. The DSM-5 leadership has reported the results of its field trial in a distressingly misleading paper.

        According to the authors, 14 of the 23 disorders had “very good” or “good” reliability; six had questionable, but “acceptable” levels; and just three had “unacceptable” rates. Sounds okay until you look at the actual data and discover that the cheerful words used by the DSM-5 leaders simply don’t fit their extremely disappointing results. The paper is a classic example of Orwellian “newspeak.” When DSM-5 failed to achieve acceptable reliability by historical standards, the DSM-5 leadership arbitrarily decided to move the goal posts in and lower the bar in defining what is “acceptable.” In fact, only the five of the 23 DSM-5 diagnoses that achieved kappa levels of agreement between 0.60-0.79 would have been considered “good” in the past. DSM-5 cheapens the coinage of reliability by hyping these merely okay levels as “very good.” Then it gets much worse. The nine DSM-5 disorders in the kappa range of 0.40-0.59 previously would have been considered just plain poor, but DSM-5 puffs these up as “good.” Then DSM-5 has the chutzpah to call acceptable the six disorders that achieved lousy, absolutely unacceptable reliabilities with kappas of 0.20-0.39. DSM-5 finally finds unacceptable the three diagnoses that were below <0.20 (which is barely better than chance).

        Major Depressive Disorder and Generalized Anxiety Disorder were among those that achieved the unacceptable kappas in 0.20-0.39 range. This makes sense for GAD because its DSM-5 definition was so very poorly done. But how to explain the ridiculously low levels of agreement for MDD. DSM-5 had made no changes from the MDD definition whose reliability has been studied hundreds of times in the past 30 years and has always achieved rates about twice as high. The only possible explanation for the egregiously poor MDD result is amateur incompetence in how the DSM-5 field trials were conducted — and this throws in doubt all of the other results (and all of DSM-5).

        It is sad that the American Journal of Psychiatry agreed to publish this sleight of hand interpretation of the remarkably poor DSM-5 field trial results. Clearly, AJP has been forced into the role of a cheerleading house organ, not an independent scientific journal. AJP is promoting APA product instead of critically evaluating it. Scientific journals all have some inherent conflicts of interest — but this is ridiculous.

        The DSM-5 field trial fiasco and its attempted cover-up is more proof (if any were needed) that APA has lost its competence and credibility as custodian for DSM. A diagnostic system that affects so many crucial decisions in our society cannot be left to a small professional association whose work is profit driven, lacking in scientific integrity, and insensitive to public weal.

        Allen Frances is a professor emeritus at Duke University and was the chairman of the DSM-IV task force.


  • Judy Olsen

    “Even when people have problems with an underactive thyroid, which can slow the metabolism and result in weight gain, this can be treated with thyroid replacement tablets and the metabolism returns to normal. ” Pig ignorance, if you don’t mind me saying so. Can be treated. May return to normal. May not remain normal. May be accompanied by other deficiencies and may be associated with other autoimmune diseases that the GP doesn’t know to look for. There are thousands – probably tens of thousands – of under-medicated and badly-medicated thyroid patients out there. The Scottish Parliament is currently hearing evidence about this issue. In any case, if you are lucky enough to respond well to T4 (levothyroxine) treatment, you still have the weight piled on in the years before diagnosis. To boost the metabolism to get rid of it would mean making patients hyperthyroid. That should be obvious. But no, apparently all of this is no problem, just take the tablets and all will be fine. Oh, that’s as long as you are a winner in thyroid tablet roulette and don’t experience a sudden dip in thyroid due to varying levels of active ingredients, as happened to me last year. And let’s ignore all the most recent research on the complex hormonal pathways involved in obesity, and let’s ignore the relationship between government health advice and sugar addiction, because it’s much easier to blame fat people than look for the real causes.

    It should be blindingly obvious that people haven’t changed, but their weight has. The population hasn’t got lazier or greedier. Something else has changed, and we need to look for that something.
    This article is the obesity equivalent of telling a depressed person to pull their socks up. Utterly shameful.

    • Lucy

      I think you’re living in a dream world! Anyone with a thyroid problem CAN lose weight if they build muscle and stop eating so much. My cousin used to blame her 18 stone weight on her thyroid and go on about how healthily she ate and how unfair it was, while ignoring me when I told her to get some weights and build some muscle. Finally after a bad break up she asked for my help and I got her started doing weights four times a week for 30 mins, swimming twice a week and on a 1400 a day healthy eating plan. She’s now 10 stone and a size 12. Probably she would be a size 8 if she didn’t have the tthyroid stuff going on but a 12 is just fine. There’s no excuses – NOBODY should be above a size 14, thyroid or not. People are fatter these days because they eat more and move less. Very simple. People couldn’t afford to eat like fat pigs 50 years ago – they cooked at home from scratch – not eating crappy processed foods that affect the hormones and mental health. I personally only eat wholefoods and yes I eat cake, but I am not lazy – I bake it myself at home from organic ingredients from scratch and I save myself two pieces and share the rest with my neighbours. I don’t drive – I bike everywhere. I do weights, I walk. Never gone above a size 8 or 10. It’s not rocket science. It’s just laziness.

      • Judy Olsen

        It must be such fun to live in a world where science doesn’t exist, allowing you to judge other people from such a pinnacle of self-regarding ignorance. Your poor bullied cousin.

        • Lucy

          How do you know what I know about science. For all you know I am a doctor and I spent ten years studying the science behind what I am saying. Nobody bullied my cousin, I just can’t stand people who complain without doing everything they can to fix a problem. My cousin was just saying the other day how happy she is, how much more confident and asking why she didn’t just listen to me earlier. Most people with a thyroid problem in my experience have not spent 3-5 hours a week lifting weights to build muscle and help the problem and have not switched to a low calorie, wholefood diet. If they did they would almost all be a reasonable size. It’s like diagnosing someone with diabetes – then they have no choice – quit sugar products or risk serious medical problems. But for people with thyroid problems it’s harder to make them cut down to 1400 calories and start working out properly. Sadly in my experience, most of them use it as an excuse for being fat. If any of them HAD been on 1400 for six months and lifted weights and done enough cardio and STILL had not lost any weight I would be frankly dumfounded. They come all the time telling me they only eat 1200 calories a day. I feel like saying, yes and with no muscle you will never burn all that fat off – go and life some weights. Sadly though, that harshness is not allowed.

          • Judy Olsen

            Silly woman. Go and eat some organic cake and stop bothering the grown ups.

          • Lucy

            I wonder if you’d be happier and thinner if you followed my advice…..most probably….but like most, you won’t

          • Judy Olsen

            Sorry. I took an oath not to follow the advice of idiots.

  • Juan Antonio Navarro Jimenez

    My fat pills http://www.endomondo.com/workouts/193816697/2709823 three times at week. 44 kgs lost.

  • MrHarryLime

    There’s nothing in this article I disagree with, but it’s a shame it characterises all fat people as being like the patient in the opening anecdote. I’m now a fat middle-aged man, but was thin until my 30s. I got fat because I started eating more after giving up smoking. That’s no-one’s fault but my own, and I don’t want tablets or (heavens forfend) surgery to sort me out. I just need to be a bit more disciplined.

    It’s not easy though. I’m acutely aware of the differences in the way people treat me since I became fat. People have a default dismissiveness towards fatties, and I can see why: if someone lacks the self respect to stay in shape, why should anyone else respect them? I hate the way people behave towards me in my fatness, but I haven’t yet managed to get my act together and lose the weight. It’s a tough ask.

    This article talks a lot about mindset without acknowledging the downward spiral of mood that makes it difficult for fat people to correct their bad eating habits. Yes, ultimately we’re greedy and need to pull ourselves together. But I find losing weight much harder than quitting the fags, the booze, or any of our other unhealthy modern foibles. If I have a very disciplined week I will lose maybe 3% of the weight I need to shift…it’s slow progress, and so easy to relapse. I have no doubt that if I were transported back to my 30-year-old body I would feel determined to keep fit. But getting back to that weight from such a depressing starting point…

    • Ripple

      Dear sir, I wish you the best. You CAN do it: my husband did (he grew very fat — totally round — after having been very thin as an undergraduate). Similar age to you, he took another stab at the problem, first by using an Atkins approach (protein & fat, very little carbohydrate) and walking, and then shifting to a more veggie-salady diet but still committed to walking. He lost at least 80 lbs that way. There came a point when he was much more motivated and enthusiastic about the progress he was making, than being daunted by the journey still to go.

      The important thing is to find a form of body movement that you find pleasant or that you can combine with a pleasant activity (sight-seeing, or reading an e-reader book while on the treadmill, for instance). Once you get started, you’ll start to look forward to exercise because not exercising won’t feel as good: you’ll feel the urge to move, and to move harder and faster. So what I’m saying is: it’s self-feeding. It’s tough to start, and there will be setbacks and slip-ups, but weight loss and exercise do develop a sort of momentum.

  • Stephen Griffiths

    Yes of course there are obese people about in this country.Yes there are people who are reckless and ill-disciplined with what they eat.
    However,there are huge number who are judged obese or overweight by some arbitrary measurement concocted by the people who have most to gain by judging that people need treatment for those conditions.
    My BMI is 31.8 which makes me obese.I asked my doctor at a recent check-up was I obese.He turned his nose up and shook his head at me.
    I cycled 33 miles on Wednesday.I am nearly 55.
    A work colleague completed a half marathon a few weeks ago and he is “overweight”.
    Complete and utter nonsense the BMI.

  • Ripple

    And this is in an age of sucralose (e.g. Splenda), which is the best sugar-substitute I can imagine: it actually tastes sugary!

    I’ve known two obese people: mother and husband. Husband struggled for years but did win, through sheer determination to eat salads above all and to WALK. The musician Jerry Garcia, who was heavily overweight and had diabetes, said that he ‘couldn’t do exercise’, though he knew he should. It IS hard to exercise when you’re feeling unwell. But surely anyone can put one foot in front of the other. Walking is probably the best thing you can do if exercise seems too challenging but you still want to lose weight.

    Mother is still obese and will remain so (though she was thin and even underweight as a young person). She simply gave up and gave in — blaming it, in part, on aging. My husband got his good looks back; my mother has permanently lost hers.

  • Lucy

    Like everything else in Britain, it’s liberal policies destroying the country. No supermarket should be allowed to sell junk food or processed food, no obese person should be allowed NHS care (private health insurance if your BMI is over 25), no smoker should be accepted on the NHS and no alchoholic should get treatment. Same with immigration, welfare etc. Nobody should get anything unless they are working and no benefits for people who want to have big families. It’s time for sense. People should get told to get off their backsides and work for a living or be on the streets. I wouldn’t give anyone money – vouchers for food that can only be used to buy meat, fish or vegetables.That would soon deal with their fatness, pathetic lack of will-power and drain on the economy. And as for the culture of feeders in British offices etc too, make employers liable for fines if they allow that nonsense. It’s time for the government to stop allowing this nonsense. The doctors should be told to tell all fat people to consume 1500 calories a day and go walking. Period. No ifs buts or maybes.

  • ClemenceDR

    I lost almost five stone in the last 8 years, and now dress in a size 14, which if not ideal is nevertheless within the range of normal.I achieved this the way you describe: sensible diet, exercise three or four hours a week; so what you write is accurate. However, what you dismiss so airily is that this was the most difficult thing I have done in my life, and I include finding myself in life-threatening situations in war zones. I found a good, VERY costly clinic to go on a stringent diet and get better eating habits, and went once a year. I slowly worked myself into a healthier lifestyle the rest of the time. I went off the wagon like an alcoholic, and hoisted myself painfully back on. It was hard, depressing at times, expensive, and unacknowledged. Of course you tell us of the sillier abusers you see in your examining room, and I can see how they would annoy you, but the vast majority of people aren’t like that; it’s more that unlike me they haven’t had proper personalised and sensible help. I was lucky in that I could afford the effort. Throughout, as a fat person, I felt the contempt of everyone around me; I was aware of the jobs I didn’t get and the countless social occasions when I was passed over. So your article, while factually accurate, doesn’t help. Don’t you think most people, bar scroungers, would help themselves if they could?

  • Stephen Griffiths

    No NHS treatment for those with a BMI over 25!!
    Professional Rugby players (of both codes)?…………virtually everyone of them above 25.
    Heavyweight boxers…….all above 25.
    My son completed the Tough Mudder Challenge this summer and is training for a marathon next year.He runs and cycles(and rows) dozens of miles a week.He’s at 26.5
    And you think he should be refused NHS treatment.
    What about someone who develops an illness that is in no way connected to their BMI being above 25?…….a disease of the eye,for example….can they be treated?

    You mention alcoholics too.What about those reckless people who break their legs ski-ing?…..Motor racing!..Madness going at 200mph in a car surely.They can go on your list.
    Mountaineers?…..all that slipping and falling.
    We can end up with just a few thousand non-eating,non-drinking,non-smoking,non sporty,skinny types for the NHS to bother with.

    • Fergus Pickering

      And, dear God, what bores they would be!

    • Lucy

      Yes you do make a good point – they should be judged on their muscle to fat ratio. Hadn’t really thought that one through.

      To be frank, if they are skiing they are probably in the Alps somewhere and have holiday insurance to cover their broken legs. I’m sure if you look at 1000 athletes VS 1000 fatties and look at how much they both cost the NHS over a lifetime, the difference would be staggering, with the fatties costing far more.

      If I were to apply for car insurance as a reckless driver with 9 points and a huge claim history, it would be extortionate. No one would want to cover me and it would probably make me want to drive safer in future.

      Exactly the same should apply to fatties and smokers – if you can’t control your reckless behaviour than pay the price with costly health insurance. That might teach these fat people with no will-power a lesson. I have no sympathy. Their fat problems are stopping everyone else from getting the health care they deserve in a timely fashion, because they are taking up all the time and money.

  • John Smith

    There was little or no issue with this in the 1950/ 60’s
    Have people become more stupid, self entitled, or reliant on the state?

  • justejudexultionis

    Obesity is the result of greed, stupidity and lack of self-control.

    • Fergus Pickering

      The4se are three different and distinct causes of obesity. Or being fat as we used to say.

  • Rodrigo Gil

    Oh god… Max do you really knows what disease means??!

  • Lucy Wright

    Many people have swapped cigarettes for chocolate, sweets and crisps. I’m no fan of tobacco but could the obesity epidemic be (partly) a by product of government sponsored anti-smoking campaigns? People have put down the fags but picked up the sweeties as a replacement. We’ve just replaced one health problem with another and as a result we are no further forwards.

  • Burbage

    I can see Pemberton’s point, but it misses a wider picture.

    Despite the best efforts of the press, obesity takes a lot of time and effort to solve. Eating less, or better, and taking exercise more sound almost tempting in the surreal environment of the NHS’s leaflet-peddling empire. But out in a cold, dark, thankless, unforgiving world, where there’s not much to look forward to but death, it’s not going to win the battle against comfort food for very long. The sunny picture of a happy jogger bears no relation to reality and, as gyms will confirm, the humiliating ritual of a wintry trudge to a sweat-fogged gym to spend a few dozen futile minutes wheezing under the sneery gaze of those with genuinely nothing better to do, rarely lasts more than a fortnight.

    For any fitness efforts to work, people need to build diet and exercise into their lives, and that’s not easy. They need workable, tailored, dietetic plans that aren’t wasteful, can be practically shopped for and that don’t cost the earth. They need exercise plans that don’t assume that, after a twelve-hour shift, a trip to the gym is something that’ll happen, or that everyone’s got access to a park or garden. But, above all, they need a reason to live, and there are precious few of those in most lives. Smoking, obesity, alcoholism, procrastination and worse are all, to at least some extent, symptomatic of problems in the mind, and though it’s unsurprising that the massed quacks of the NHS routinely dismiss that particular elephant, we won’t see much progress until they start taking their job more seriously. Not providing pills is fine, not providing help is something else.

    • KeysorSozeII

      I burn about 600-800 calories by running for a hour.

      I go to McDonalds and have a Quarter Pounder Value meal and I have just consumed 1400 calories.

      You don’t lose weight by solely exercising. You lose weight by counting your calories.

  • Stephen Griffiths

    Usain Bolt just scrapes into Lucy’s list at 24.73.He is 1.95m tall and weighs 94kg.
    So,just to clarify.Usain Bolt,the fastest sprinter of all time and multiple gold-medal winner who is probably as close to the perfect physical specimen as can be found on the planet,is only just less than 3lbs away from officially being overweight.

  • BoiledCabbage

    Fatties who complain should be put into Concentration Camps and fed gruel once a day. From the photographic evidence of the last century, it is obvious that everyone lost a good deal of weight without pills or diets of any kind.

  • Fergus Pickering

    You get fat (sorry, obese) because you eat a lot. That is not always true, but it is true most of the time. You get thinner by eating less. Do we have to say this? I don’t care how fat you are. Thatis your business. Or how fat your children are. But I want you to keep your fat, greasy hands off my money.

  • Fergus Pickering

    Smoking more would make people thinner. I suggest cutting the price of cigarettes. Girls in my youth used to smoke to suppress their appetites. It worked too.

  • Leelywhite

    A least three blockbuster weight reduction drugs have been taken off the market in the last decade because of unwanted side effects. There’s no magic bullet. And studies have shown that a starvation regime will lead to kidney failure before a thirty percent weight loss. So starvation will kill a 250 kg man while he’s still overweight.
    Literally, a huge problem.

    • SmartOne

      Would you kindly show the links for this study. I recently lost weight in a medical clinic where we ate 500-700 cal per day, if that. It would be considered ‘starvation diet’ but most people thrive as weight loss is fast and also with that it is fast removal of host of other things that go with obesity.

      Even if you can find that study, it would be interesting who financed it, because VLCD work and are recommended by doctors for very obese patients. Or course the ones who prefer to do something about their body that sit, whine and wait for a magic pill.

  • splotchy

    Interesting article – although a doctor daring to be ‘judgemental’ is a rare being.

    I’m from a family of fatties and am not naturally slim. Nor has my diet ever been particularly unhealthy. It was, I told myself, one of life’s injustices that my colleagues were slim and I was lardy. Until I read a book about habits and how they differ and actually observed my colleagues when eating. Unlike me they weren’t cramming food into their gobs at a rate of knots. Even healthy food fattens if you eat vatfulls of it – suddenly became a bit more clear where my extra bulk was coming from.

    I wish I could have been pointed to this truth earlier – a (politely) judgemental GP would have been a bonus.

  • Ronald B.


    You eat, you drink, you smoke, you drive, you take drugs, you do sports – that’s life
    You eat to much you become obese.
    You drink to much you become an alcoholic.
    You smoke you become a smoker.
    You drive to fast or badly you have accidents.
    You take drugs – you might become an addict.
    You do sport – you will get injuries
    In all cases you will cost the society money to rectify what you do.
    In the cases of driving, sport, drinking, smoking, drug misuse you might even not injure just yourself but others too.

    Shall we just screen everyone if the condition with which
    they come to the doctor or hospital isn’t self inflicted and then refuse
    to treat them?

    What right has an adrenalin junkie got over an
    obese person to get treatment for a broken bone when doing a sport which
    is dangerous and carries risk?

    Just think what it takes to stop smoking, alcoholism or drug taking.
    It will not work if you drink less or take less drugs or smoke less.
    Only total denial will bring the effect you need to give up an addiction.

    This clearly is not an option for someone who is obese.

    You can’t stop eating forever and when you restart you’ll soon be back.

    Justas someone who gave up smoking, drinking or drug taking would have if
    they just tried a puff from a cigarette, just one drink or this one
    sleeping tablet because I really can’t sleep.

    Be more understanding and tolerant to each others weaknesses

  • Ronald B.


    You eat, you drink, you smoke, you drive, you take drugs, you do sports – that’s life
    You eat to much you become obese.
    You drink to much you become an alcoholic.
    You smoke you become a smoker.
    You drive to fast or badly you have accidents.
    You take drugs – you might become an addict.
    You do sport – you will get injuries
    In all cases you will cost the society money to rectify what you do.
    In the cases of driving, sport, drinking, smoking, drug misuse you might even not injure just yourself but others too.

    Shall we just screen everyone if the condition with which
    they come to the doctor or hospital isn’t self inflicted and then refuse
    to treat them?

    What right has an adrenalin junkie got over an
    obese person to get treatment for a broken bone when doing a sport which
    is dangerous and carries risk?

    Just think what it takes to stop smoking, alcoholism or drug taking.
    It will not work if you drink less or take less drugs or smoke less.
    Only total denial will bring the effect you need to give up an addiction.

    This clearly is not an option for someone who is obese.

    You can’t stop eating forever and when you restart you’ll soon be back.

    Justas someone who gave up smoking, drinking or drug taking would have if
    they just tried a puff from a cigarette, just one drink or this one
    sleeping tablet because I really can’t sleep.

    Be more understanding and tolerant to each others weaknesses.

    • Mary Naszados

      This is simply not true. You can change your eating and exercise habits. It will take a very long, slow time, but you have to start somewhere. Dieting does not work, but lifestyle change does. You need not starve yourself thin. I have struggled with my weight all my life. At 55, I am obese; but I drag my sorry fat butt into the gym and my wallet to the farmer’s market. I also don’t circle parking lots for a spot close to the door anymore. I am also going to group therapy with a cognitive behavioral therapist so that I can manage the changes I need to make. The truth is that I needed to change my mind first, so that my body will follow suit. I love myself. I buy myself the most gorgeous food I can afford, after all I am not a garbage pail. Trust me it took me a while to believe this. I have learned to take my pleasures at places other than McDonald’s.

      Your life is the outworking of your beliefs.

  • ambleve

    Obesity is just the Gene pool weeding itself, and the NHS should not interfere.

  • NeilMc1

    You should stop using the term “Us”. It isn’t us, it is largely a socio economic issue and the obese would not be reading the Spectator.

  • Phil McCann

    as obesity is not a ‘disease’ but a ‘mindset’, I would have thought that hypnosis was the best and cheapest prescription.

  • Phil McCann

    as obesity is not a ‘disease’ but a ‘mindset’, I would have thought that hypnosis was the best and cheapest prescription.

  • Scylla

    David (custard n cream) Cameron is very over-weight…should set an example. As for Pickles…

  • Martin

    Just write up ‘Letter On Corpulence’ by William Banting into airborne leaflet propaganda and bomb the fattest areas repeatedly.

  • Ines Subashka

    That’s a great article! I loved this part ” Patients blame obesity on the government, cunning food manufacturers,
    their parents and their genes. They demand fat-loss pills on the NHS and
    stomach-stapling surgery as a right. In a world where health care is
    becoming consumerised, patients see themselves as customers. There’s not
    much demand for hard truths.”

    People need to realize the fact, that their health is in their own hands. Their life depends on their day to day behavior, on the choices they make or the once they don’t dare to make. We’ve become a society, where we always find somebody or something to throw the blame on, just because we are too weak to face the truth: it is us that should carry the responsibility for our own lives! 🙂

  • Anna Montana

    I am currently classed as ‘overweight’. My mother is also classed as ‘overweight’, as is my brother. My father is not. My brother is 6ft 2″ and has a heathly waistline of 26″ and is a medium shirt size. Why is he classed as overwieght? Because he works out like a demon and is therefore very muscular, muscle weighs more than fat.

    I on the other hand ate too much at Uni and didn’t really give a damn about sorting it out. I was far too busy achieveing a 1st, than I was worrying about my weight gain. Now, however, I have tried all the diets: jenny craig, weightwatchers, lighterlife, slimming world, cabbage soup and diet chef. It didn’t work for me. I went to see my GP, who told me I was a ‘little heavy’ (a size 20) and discovered the type of conraception I was using was making my appetitie increase and my thyriod was not metabolising my food quick enough. I ceased the medication and waited for the weight to drop off. It didn’t.

    I signed up to a gym and exercised at least 3 times a week. No difference in weight, even after a year. I agreed to do a ‘lbd’ workout for christmas. 2 sessions in and I feel slimmer. Plus my hubbs and I agreed to stop buying junk food and we’re both eating much healthier! It seems to be working.
    My mother refuses to diet. She says she is fine the size she is (20) and when she looses weight, she looks seriously ill, gaunt and sick. Her body maintains a natural weight which is considered by doctors to be ‘unhealthy’ yet she drops a dress size and becomes so sick, her GP tells her to ‘put some weight on!’

    It seems we ‘fatties’ can’t win!!

  • badu

    What a quisling little coward you are, picking on an easy target.You have known for decades that diets don’t work, your response was to refuse to acknowledge that and bully fat people instead. You thought getting others to turn on fat people would magically turn failure into success. Guess what dum dum, wrong. Keep raving about it you bitter little shit.

    The idea that people used to diet more is the stupidest thing I’ve ever heard. I used to meet people who didn’t even get the notion of weight loss diets, no more. Everyone’s on a diet and bores on about it endlessly, in between senseless wittering about how much they love the food they try not to eat on their diet. You are so utterly brain dead that you think more of the same is going to work. So you argue that you’ve been pussyfooting around fat people; oh really? I think you’ll find its the other way around you brain dead piece of shit.

    Bring it on. Start doing what you claim you’re not doing now and we’ll see the difference. But I think you’ll find it hard to hate fat people even more beside the endless hagiographying of slim people.

  • Rachael Parkman

    Two things – firstly, we all know lots of people who eat rubbish all the live long day, don’t exercise and don’t put on a pound. Some people (me included) put on weight relatively easily. Disclaimer – I am 2/3 of the way to losing 6 stone through eating differently and exercising vigorously, but I won’t pretend it is easy or it’s the first time I’ve done it. Losing weight is hard, long and probably doomed to fail If diets worked, we’d only do them once.
    Secondly, changing lifelong habits is not a matter of being told what to do. There are lots of reasons why people behave in a certain way, and believe certain things, and those reasons need to be addressed by people with the time and skills to do it. Being lectured by a GP who is probably a bit chubby is not the way forward.
    Also, please can we stop demonization of fat people. People who smoke outside offices because they are stressed arent’ told what to do by strangers, nor are office workers enjoying a G&T or two after work. Fat people eating a bar of chocolate because they’re stressed are. Please stop this, it’s not helpful.
    And the last thing I’ll say is that sugar and fat are massively addictive. Not making excuses (as I say, I’m a self-confessed fattie on the way to being less so), but once you get a taste of these sorts of foods it is incredibly hard to stop, and it is all around us. When everyone else is perfect, and never does anything that can possibly impact on the taxpayer (breaks an arm playing sport for example), then you can be as totally judgemental as you like. Until then, please stop.

  • Prannock

    Fat people should be shot. Not only are the societally expensive, but they are ugly.

    • MikeDLN

      And sweaty; and smelly …

  • Craig Sweaton

    Wow! What a blinkered and thoroughly unpleasant person you are. I suppose you think that anorexic people just need a good slap and a hearty meal then?
    Many people become obese during periods of mental illness and stress and this adds to their feeling of being useless and unworthy, which triggers more eating.
    I myself am overweight but my weight gain is as a result of a spinal injury and knee damage so, I now can’t play rugby or do the cross-country running that I so loved. I suppose I’m just lazy too?
    I won’t deny that some people don’t care about the food they pile into their faces and do consider it their right to be as fat as they like but, most overweight people do care and don’t know how to change.
    Maybe what you should do is spend some time with psychologists and hear about what drives people to over-eat.

    • MikeDLN

      “I myself am overweight but my weight gain is as a result of a spinal injury and knee damage … ”

      No it isn’t: it is the result of eating more than you need to.

  • Victoria Cochran

    For those of us in the US paying attention, national health systems, in other countries, are famous for their preventative stance. Where is the intervention before patients become obviously obese? It doesn’t happen overnight and it is surely the result of multiple factors. Ours is probably socialized, to a large extent, via elementary school nutrition and pedagogical practices. Yours?

  • Horace Boothroyd III

    These comments certainly confirm every stereotype of the median Spectator audience.

  • neilcraig

    In a libertarian way I would say the pills should be available over the counter rather than on prescription. As long as the package mentions the side effects let them pay for them and use them.
    A recent article said that in 1870 a working wage would pay for 5,000 calories, in 1700 it was 3,500 calories. The French Revolution was because people couldn’t afford bread.
    Today it is 240,000 calories. Admittedly all potatoes but the 1700 diet wasn’t any more interesting

  • Sad Fatty

    I do dislike the “it’s your own fault” school. If telling people that they are fat because of their own lazy fecklessness worked, we’d be the skinniest nation on Earth. We’ve tried that. From personal experiencce, I’ve been “fat” precisely twice in my life. Both times I was recovering from – not in the worst of, mind, but recovering from – a brush with clinical depression. I put on a pile of weight, and not just from comfort food/not enough exercise. The second time, I saw it coming, I food-policed, I exercised. I had a damn-near perfect diet and I still wasn’t losing any weight – and the food policing was so stressful that it was making the depression worse. Simply writing off the mental component of weight as “laziness”, or “ignoring the facts” is not only unfair and untrue it is unhelpful – people get fatter when you yell at them, not thinner. So sorry to spoil your little two minutes’ hate with facts.

    • Mercenaryali .

      Sorry Sad Fatty but I just don’t buy that excuse. I am 67 years old, do the gym thing every other day, do at least 7 – 8 k walk in between days, eat sensibly and cheaply and cost the taxpayer “jack sh*t”, so don’t give me that “oh it is not my fault I am fat” routine. Who’s f8cking fault is it then?

  • Simon Anderson

    The heart of the problem is sugar. Tax it like tobacco and use the revenues to improve education amongst the obese and provide the additional services that they require.

  • Mercenaryali .

    Whichever way you look at it, by and large [no pun intended] fat folks are fat because they eat too much, most of which is unhealthy, and are unable and/or unwilling to exercise.
    In England 61.9% of adults and 28% of children aged between 2 and 15 are considered obese. They have a higher risk of getting type 2 diabetes, heart disease
    and certain cancers. Excess weight can also make it more difficult for people to find and keep work, and it can affect self-esteem and mental health. Statistics issued by the Department for Work and Pensions show that a total of 7,080 people claimed £29.3m sickness benefits for obesity in the year to April 2012, this means the main reason they are “sponging” on the working taxpayers is because they are fat and too idle to work. In addition their health problems associated with being overweight or obese cost the NHS more than £5 billion every year. That is a total of almost £35 million wasted on fat folks, just because they cannot stop eating and we, the tax payers are paying for their food! How stupid is this?

  • Howdy Boyz

    Since free markets reward us for the usefulness of our actions, they are incompatible with merit-based systems of subjective judgment.

  • Lollie Dot Com

    We’re invited to eat over three hundred times a day… only they don’t say, “would you like to eat a lot of empty unhealthy calories” they say, “aren’t you hungry, aren’t you HUngry?? Aren’t you HUNGRY FOR BURGER KING TODAY??!!??” They say it repeatedly but only because repetition has power. Food ads rewrite the rules of eating in America… when is mealtime? ANY TIME!! What do you eat? ANYTHING YOU WANT TO EAT!! How much should you eat? AS MUCH AS YOU WANT!!
    What is sexy? Food and calorie dense, nutrition empty drinks!! What is the definition of happiness the one thing everyone on earth wants more of? Coca Cola. We’re programmed… That’s right, they’re not just whistling dixie when they call it “programming” because that’s exactly what it is. They program us to give up and just accept it too. Why? Because fat people always buy more food than healthy people. To sell more food, make more people fat. We’re the hogs.. and we pay for our own food. Freaking ingenious!

  • Kelly Flores

    ” It’s not a disease, it’s a mindset ” Really now? I completely disagree. So someone who is annorexic can simply start eating more and gain the weight they need to be at a healthy weight? Give me a break. Yes, people need to be told the truth about their health and their weight. However, in some cases it is a disease. It’s a combination of the two. Foods that are high in fat and in sugar are proven to be addictive. To think otherwise is ignorance.

  • Gele Eerie

    Considering plunder’s ease, liberty has little chance of surviving if the mere existence of democratic processes is expected to preserve it.

  • Fergus Pickering

    They are not obese. They are fat. And they are fat because they eat too much.

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  • Yes. The world can be changed but not ourselves if we don’t want to.

  • D1975d

    Any body can lose weight , no matter what medical condition they have
    Granted it may be reallllyy hard but it still is possible

    • Kell Brigan


  • Kell Brigan

    “…fat people have one thing in common: they eat more than they need to…” Wrong. Thanks for playing, but you need to go do some actual research.