July 12, 2011

UK: Obesity and the NHS: 'People here are in big trouble'

LONDON, England / The Guardian / Society / Obesity / July 11, 2011

Obesity rates have quadrupled in the past 25 years – one in four adults are now overweight. But as demand for treatment grows, hospital budgets are shrinking. In the first of three reports on the pressures facing the NHS, Amelia Gentleman talks to doctors and patients at one of the UK's busiest diabetes clinics

By Amelia Gentleman

A patient attends the Heartlands hospital diabetes clinic in Birmingham.
Photograph: Christopher Thomond for the Guardian

A young man drags himself slowly in to Dr Shahrad Taheri's weight management clinic, leaning heavily on a stick, with the curious gait of someone whose legs are pushed into an awkward angle below the knee, splayed by excess flesh around the thighs. The tremendous weight he carries has injured his spine, and walking is very painful.

"I've put in for a wheelchair. I've not got one yet," he says. He thinks the delay is due to NHS funding constraints. Peter is 30 and morbidly obese.

Dr Taheri has recommended a gastric bypass to help him lose weight before he damages his health further, but unfortunately the criteria set by the primary care trust (PCT) have recently changed and his patient now needs to be more overweight in order to qualify for treatment.

"The NHS is expected to make savings . . . I don't know how they are going to do that, but one of the ways is by restricting the things they provide," Dr Taheri tells his patient.

"Well, it was just too dear," Peter replies calmly.
The Heartlands clinic is the largest bariatric surgery centre in UK, but surgery is performed only on those for whom all other options have been explored and failed. Dr Taheri acknowledges that it is a controversial procedure but argues that the controversy is largely caught up in popular misconceptions, a failure to understand the dangers of obesity, and its association with strokes, paralysis and a higher risk of various kinds of cancer......

The hospital has invested a huge amount of money transforming its diabetes clinic into a model of how these centres should be run, with the weight management clinics central to the service. There are dieticians on hand, foot clinics (to tend to feet damaged by the effects of diabetes), side-rooms where overweight patients come and spend the night to have their sleep patterns monitored. The clinic backs on to a research centre, and patients can benefit from participating in clinical trials. Since the clinic was reopened, with a £13m new building 18 months ago, all the fittings have been redesigned to suit the clientele, so that the examination beds are extra wide, and the chairs and the wheelchairs in the waiting room are made for bulky patients....

The Heartlands hospital's diabetes clinic which has had a £13m refit and is now a model for how such units should be run.

Photograph: Christopher Thomond for the Guardian.

The above are extracts. To read the full report, click here

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