Tuesday, November 04, 2008

Obese teenagers set to get stomach surgery on NHS in rule change

The NHS has got so much money that they can waste it on this nonsense?? How about confining treatment to people who are ill? There are plenty of ill people who are not getting timely treatment. Very few overweight people have exceptional health problems. Treat the illness (if any), not the speculative cause.

Whenever "obesity" is mentioned, diabetes gets dragged in as an excuse for medical concern over what is really only a social problem. The truth is, however, that very few people get diabetes and very few of them are obese. The case for a causal link is not strong at all. See here and here

And the bottom line is that the lifespan effects of weight are quite small, with people of middling weight having the longest lifespans

Severely obese teenagers in Scotland would be put forward for stomach surgery on the NHS under new draft guidelines for doctors. Considering giving adolescents operations - including the fitting of gastric bands - is set to be included in official advice for Scottish clinicians on how to manage weight problems for the first time. The move comes amid concern that Scotland is following America where experts say there has been an "alarming rise" in the number of young people dubbed "super obese".

Already Scottish youths have developed conditions such as type two diabetes, high blood pressure and asthma because of their weight. At least three teenagers in Scotland are said to have been fitted with gastric bands, which create a small pouch at the top of the stomach that fills-up quickly and limits appetite. However, the first official guidelines for Scottish doctors on dealing with obesity in children, which were published in 2003, do not mention bariatric - obesity control - surgery.

Dr David Wilson, consultant in gastroenterology and nutrition at the Royal Hospital for Sick Children in Edinburgh and the co-chair of the expert group writing the new guidelines, said: "There were no (research) publications at all on surgical treatment in teenagers when we did the last guideline. Since that time there have been very few publications, but we know world-wide that there are teenagers having bariatric surgery, particularly in the states where there are people who are super obese' including children."

The latest figures show not only that 31% of 13 to 15-year-olds in Scotland are overweight, but that almost 10% are considered severely obese. Dr Wilson said clinicians were dealing with adolescents who had developed type two diabetes because of their weight and this situation was unheard of seven years ago. He added: "We seem to be lagging behind the States, but following them. It is not just the number of children who are moving from normal weight, to overweight, to obesity, but the number who are moving to massively obese. "It is that group which is worrying. That group not only has health problems in their future, but health problems now and the success rates for lifestyle changes with them may be pretty slim."

The draft guidelines, published by the Scottish Intercollegiate Guidelines Network (Sign), say surgery should only be considered for severely obese teenagers post-puberty who have other serious health problems because of their weight.

Dr Wilson said all other options, including diet, exercise and the use of anti- obesity drugs, should have been tried without success before surgery became an option. He also said the patient should be looked after by a specialist team and have the operation as part of a long-term plan.

Other ways to tackle weight problems in teenagers before they become severely obese are covered by the guidelines. There is an emphasis on doctors involving entire families in lifestyle changes, rather than expecting the patient to adjust on their own.

Dr David Haslam, clinical director of the UK's National Obesity Forum, said: "It is extremely alarming but there are kids who are so fat that surgery is the only option. There are kids whose health is reaching critical levels and are going to lose decades of their life because of obesity."

He said many guidelines and documents about obesity prevention had not been acted upon, among them the original Sign guidelines on obesity published in 1996 which received international recognition at the time.

Dr Dean Marshall, chairman of the British Medical Association's Scottish general practitioners committee, said: "It appears there is not a huge amount of evidence behind bariatric surgery for teenagers and that would be a concern." Consultation on the draft guidelines is currently under way and they are likely to be finalised after revisions next year.


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