Wednesday, 14 November 2007

Bariatric surgery

I'm well behind with news, but then I remember that not everything can go in this blog. Can it be true that some of my life is of no interest whatever, to anyone? So more slash and burn in the garden, the trip to the tip to get rid of the evidence: garden waste, old shoes, radios, cat food (don't ask) and hoovers, Mr A's accounts, playing squash, badminton, the arrival of loads of classical music CDs ordered from Germany - who cares? Apart from me, that is.

At school there has been much learning activity, and one day this week started at 9am and ended after 6pm. Add the extra hour at each end for driving and it's almost as long as most days I used to work, back in those almost-forgotten days of full employment. I was exhausted! I'm looking forward to a night out in Birmingham catching up with ex-colleagues in a couple of weeks when my coursework deadlines are less pressing.

The most interesting classes recently have been around the Dietetics module. We do very little about actual nutrition this year; it's mostly about getting us all up to speed with basic biology and biochemistry. But in Dietetics the group is relatively small, and sometimes we get to discuss rather than absorb what's being pushed at us from the front. One of the lecturers has returned to full time practice in a hospital, but before she went, she told us about her work in bariatric surgery - the 'stomach stapling' or 'gastric banding' surgery that you read about in lurid detail in shiny magazines between stories about WAGs and TV 'celebrities'.

There are government-led guidelines, laid down by NICE - the National Institute for Health and Clinical Excellence - about who can receive gastric surgery on the NHS, free of charge. To qualify as a prospective patient, as well has having a body mass index (BMI) of 40 or above, "all appropriate non-surgical measures have been tried but have failed to achieve or maintain adequate, clinically beneficial weight loss for at least 6 months." Nothing needs to have been tried previously if BMI is 50 or above.

This is all fine as far as it goes. I don't have a problem with surgery to help weight loss per se. I was concerned to hear that the pre-surgery appointment with the dietitian is only 30 minutes... but my real question was whether the 'appropriate non-surgical measures' included psychological help, or counselling, or therapy. No, they don't. We were told that "there aren't enough places where such therapy could be delivered anyway".

This has seriously blown my mind. No counselling or therapy available, before spending a fortune on an irreversible surgical operation, with all the associated risks during and after the procedure, for people who must clearly be desperate to lose weight, and haven't succeeded before? Aren't we treating symptoms here, rather than the cause?

Nobody would suggest that someone who compulsively cuts himself or herself should undergo irreversible and risky surgery to graft a cut-proof teflon skin onto their body to prevent self-harm. Much more likely is a referral to a psychiatrist, or psychologist, or psychotherapist, or someone who can help with sorting out the reason for the behaviour. Why isn't morbid obesity classed as self-harm, and given appropriate priority and resources, and suitable treatment?

Yesterday I listened to a Radio 4 podcast (how I love them) about Chronic Fatigue Syndrome/ME (that's the official classification, I learned). Not too long ago, there was some debate whether this was real, physical or psychological, or just malingering. NICE officially recognises this condition now, and recommends onward referral to specialist provision under certain circumstances. The specialist in the broadcast (who works with children) was very pleased with this, because she said that very little provision exists, and the NICE guidelines provide a lever that she can use to approach NHS Trusts or whoever, to get funding for more.

So perhaps that's what needs to happen for bariatric surgery. Clearly I'm not in any position to influence the situation, and perhaps I've got it all wrong anyway. What do I know after less than two months at university? It really brought me down to earth - dietitians aren't the paragons of virtue that I'd hoped; the situation is imperfect; people get what they get. I have no idea whether I'm even going to be involved in diet for weight loss in later life, but if I do, I hope this is something I'll be coming back to with a vengeance.


The library at Sutton Bonington

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