Monday, 5 October 2009

“Beauty” and the “Beast” that is Obesity. Some idle thoughts while driving home.

Driving home one evening last week, after a relatively early finish, we caught a piece towards the end of the Radio 4 PM programme about a BMJ obesity report with the incredibly media friendly Dr Sarah Jarvis talking with a surgeon who was advocating annual weight checks.

(The scientists among us here at ND like her media appearances particularly her one during the great flu Panic(demic) saying that a sneeze is the speed of a bullet. It got us thinking if one accidently sniffed a piece of lead shot up ones nose before seeing a favourite patient it would have to be death by natural causes?)

But we digress, Dr Jarvis was countering a surgeon who had only lost weight by gastric banding by saying it would make very little difference. We agree with what she said. She may actually do some real general practice from time to time from what she said.

Obesity is basic thermodynamics although lard arses never have the same problems with their cars. Some basic facts:

1)You are what you eat.
2) Eat more than you burn off then you get fatter.
3) Put more fuel in your car than you burn off when you drive your car and it gets heavier and slower.

Try watching Formula 1 for a believable explanation of the above thermodynamic principles but remember what happens to petrol in a Formula 1 car does not ever apply to food or patients.

However, you can bet that your average lard arse will be an expert on fuel strategy as they will watch a Formula 1 Grand Prix and then spend hours at their GPs saying they cannot understand why their weight goes up after a hard worked Grand Prix watching session of burgers and tinnies combined with a heavy physical workout on their remote control.

If you are fat it is not because:

you are big boned that is just a longer version of the word fat,
you eat healthy foods and have a “good” diet as healthy eaters are not fat,
it is not because your metabolism is slow (OK you may have a roughly 1 in 50 chance of thyroid disease.)

You are fat because you are greedy and idle so please do not waste your doctor’s time trying to convince them that your case is different - unless you have an under active thyroid gland or you have some incredibly rare metabolic condition (other than eating too much and doing sod all) which we will happily look for but rarely, if ever, find in patients who can’t lose weight.

Some of us here at ND Central have stopped giving anti obesity drugs because all that happens is that people keep coming back and pleading for them as they do not loose weight on them for the very simple reason that they are missing the point.

They eat too much and do even less. Rant over (well actually several rants by us here at ND Central which is what prompted this post.)

People like their food and what they want is to lose weight but carry on eating the same as before. Listen up people it does not work.

So as we trundled along the high moors and forests of rural Northernshire heading home for a healthy calorie rich Chinese take away, Double Choc Sara Lee gateau washed down by bottles of a well known Northernshire brown ale which our patients insist is healthy eating we got thinking as to how could we help the Party with the obesity problem?

Of course the Party resent paying anyone other than lawyers and management consultants huge salaries for dealing with huge numbers of patients and feel that giving GPs the task of reducing obesity is a most excellent and cost (and benefit) neutral idea as it won’t work and so GPs won’t get paid. This is why they have been trying to introduce obesity into the points for payment scheme called QOF (Quality and Outcomes Framework) for GPs.

Given the success of supermarkets we thought why not introduce a Lard Arse Tax (Latax) at the point of sale?

Historically Governments have not liked the idea of taxing food but why not tax the person buying the food?

A new Porky Poll tax perhaps?

It might work like this:

If a person of ideal BMI (Body Mass Index) buys their groceries they get charged no tax as they stand on a scale at the checkout which says welcome to supermarket X you are healthy no tax to pay please come again. Have a nice day.

If your average “I don’t eat anything, I eat healthily and I am always on the go” lard arse steps on the supermarket taxometer scales and it says you are a fat b*****d, soory have a high BMI, you have to pay double/triple/quadruple or more for your food based on a sliding scale based on your BMI can you see what might happen?

Well certainly the surgeon on Radio 4’s PM program will be very happy as they will get much more than a just annual weight check. Twice weekly perhaps even better as for some reason an annual weight check would have stopped him, a very intelligent person, putting on 10 stones.

The Treasury will be rubbing its hands with glee as given the increasing amount of obesity and the fact that food is essential for life they are on an instant earner to rapidly reduce the National Debt. Just like if you pollute the atmosphere with a gas guzzling car you have to pay more road tax and fuel duty and so stop driving the same could apply as an environmentally friendly “green” tax as food production causes pollution too.

A most Prudent idea perhaps?

Of course it is unlikely to cause a rapid drop in weight in those poor “ill” people who “don’t eat anything, eat healthily and are always on the go” but we are sure that sales of helium, light weight clothing and methods of fiddling the scales will be devised very rapidly as people try to avoid paying tax.

There might be a few, probably those who hire accountants to reduce their tax bills, who might invest in personal trainers but most will do nothing about it.

We imagine that that there will develop a black economy where cachectic, malnourished, underweight people will be seen repeatedly wheeling trolleys round different supermarkets loading them up to the gunnels (as they might qualify for a tax discount?) and so the fat will employ "personal shoppers", not personal trainers, to avoid tax and get fatter as they won’t even have to walk round the supermarkets anymore.

They will probably go to see their GPs to get “tax exemption” certificates with spurious medical conditions saying that it is physically impossible for them to lose weight and so they can avoid paying tax but carry on eating.

People like food. Historically producing more food has been both Government and a European policy to protect against war. We have been so successful in that it has led to grain, butter and beef mountains together with wine and milk lakes due to over production.

Obesity is a consequence of food policy, production, cost and availability. Oh yes we forgot “choice” which is why it is never the lard arse’s fault but always the doctor’s responsibility.

GPs are powerless against Government policy and plenty of food.

And yet in most of the world for some reason obesity is not a problem. If you do not have enough food you do not get fat(ter). We can’t work that one out here at ND Central but then nor can our patients.

We must be very thick here up North.

Praise be to the Party and all it has done for the obesity epidemic.

We were surprised they weren’t boasting about it at their conference as an area of consistent year on year growth over the last 12 years but no doubt it will be used to save money on health expenditure as pay back time approaches to service the National Gordon Debt at GPs’ expense.

We really must stop thinking on our long drives home.


Michael said...

The "Lard Arse Tax" is an idea we threw around during a seminar in med school. All those attending felt it a great idea. That said, those attending all understood human physiology (to some degree).

Sadly the average Jo likes to delude themselves thinking their weight problem is genetic (or medical).

I'd personally vote for any politician who proposed such an idea. However, as JD pointed out today, politicians prefer "Populist Crap" to anything that may do some good!

Anonymous said...

My weight goes up and down like a yoyo. It's varied by over five stone in as many years. My diet doesn't seem to change, just my medication. If I increase my depakote, my weight goes up and if I reduce it, my weight goes down. The reverse is true of my pericyazine. The trouble is that whilst I can skip my depakote without my doctor knowing about it, I can't increase my pericyazine. Infuriating. I've been trying to source more pericyazine on the internet.

Lard Arse said...

I used to be a 6ft, 12st. weakling until I was misdiagnosed with anxiety on the basis of my presenting symptoms. Even though I insisted this was not right and I KNEW there was something wrong, I was ignored. Three years down the line after losing my peripheral vision and suffering unbelievable headaches, I was correctly diagnosed. The neurosurgeon estimated the tumour had been there a good eight years.
Goes to prove Gps are not always right, eh?

Now I am a stooped 6ft., 20st. weakling, thanks to hydrocortisone. If I have an infection, I have to double the dose and can gain 1/2 st. in three days.

I am use to the ignorant calling me a fat bastard, but did expect Gps to realise that medications can cause weight gain as a side effect.

Silly me!

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Michael said...

@Lard Arse,

What a silly comment. I'd estimate that below 1% are obese for medical conditions like the one you describe. This post was clearly aimed at the 99%+ who are fat for social reasons.

Anyone with knowledge of your condition will feel sympathetic and certainly agree that you shouldn't be "penalised" in any way for your medical condition. However, suggestions must be made to help those who's obesity is hurting their health and and can be treated quite simply.

Extrapolating your suggestion: the public shouldn't feel angry or make suggestions to stop people who murder because a tiny minority of cases are caused by people with a genuine mental health problem diminishing their responsibility. Sadly sometimes stereotyping populations is necessary, especially in cases where it is accurate in all but a tiny number of cases.

(The stereotyping of course should only be used when assessing populations, when discussing an individual, the specifics of that person should be considered. Note this post considered populations)

Lard Arse said...


Why the need to say 'What a silly comment'? I feel I have a right to express an opinion, even if I fall within the >1%.

I did not make a suggestion - read it again - therefore do not know how you can extrapolate it. I made an observation.

You will make a good modern doctor as you were obviously interpretating what I said, without actually listening to what I said - or in this case reading.

Just because I am in the minority of people who are obese and have no control over it, does not mean I am not entitled to an opinion.

Michael said...


It was this particular part I felt was silly, and since it was the conclusion of the post I generalised to the rest of it:

"I am use to the ignorant calling me a fat bastard, but did expect Gps to realise that medications can cause weight gain as a side effect."

Of course GPs realise that.

My point was you are misinterpreting the blog post. The GP here was trying to suggest (perhaps comically) an option to solve the obesity problem. They weren't suggesting that ALL obesity is caused by overeating/lack of exercise.

That final comment wasn't even opinion, you were implying GPs have are unaware weight gain is a medicinal side effect. That claim, I see, as silly.

The rest of your post is a description of your unfortunate problems, for those I have great sympathy and was not trying to call "silly" in any way.

Lard Arse said...


The first and last paragraph of your comment contradict each other.

Of course I realise the blog was satirical as was my last comment.
However, strictly the term of an opinion is also accurate as of course is an implication/inference.

The point of my original comment is that fat people are easy targets for ridicule. I really don't believe that stereotyping is helpful. I accept that the average Joes delude themselves in thinking their weight problem is genetic (or medical) when it is, in fact, a result of overeating garbage and thinking that exercise is some sort of disease.

However, there are other causes such as underlying psychological issues leading to comfort eating, decrease in or loss of mobility and of course medicinal side effects.

Incidently, my Gp is rather rotund. Should I direct him to this blog?

Good luck in your future Michael.
Do accept that even doctors can be wrong and some patients pay the price of it. This fat bastard has.

Michael said...

Lard Arse (I find it absurd starting a response with this name!),

The first paragraph was meant as a means of explanation for the general comment I'd made. I wasn't as clear as I should have been. What I meant is that I'd taken your last words as a sarcastic conclusion and therefore felt it was the sentiment you intended in the comment. My "silly" comment was targeted at that sentiment in particular, rather than the entirety of your comment.

Regardless, I understand where you're coming from. Overweight people are an easy target for ridicule and I in no way condone that. I do think people should take control of their own health in this area and shouldn't be able to pass it off as a medical problem when it isn't. I also think it would be useful to place some sort of incentive to eat less and exercise more in place to prevent and reduce this problem. Constantly medicialising the problem does more harm than good.

There are always going to be exceptions. Even taking into account those with declining mobility, I still think the vast majority fall into the category of those who overeat and laze about do so for avoidable reasons and therefore it's reasonable to target them, and create clauses for the exceptions.

I've met many an overweight doctor. I'm personally blessed with a slim figure and a normal appetite, but I see how easy it is to gain weight and how hard it is to do the opposite. The solutions aren't simple but shying away from the problem and calling anyone who dares to suggest a solution (even if a little crass) will only worsen the situation.

Thanks for the kind words of luck. I'm well aware doctors make mistakes and sadly patients do get the raw end of the deal (sometimes paying the ultimate price). These errors are thankfully uncommon but they must be learned from. I'd hope that when your GP found of your diagnosis he looked back to see what he could have done different to prevent it happening again. That's what I do whenever I make a mistake (which at my stage of training is quite frequent[and less serious]!).

p.s. Part of the problem of blog comments is their brevity. Had we both used twice the words to begin with I think rash responses could have been avoided. Non-the-less, an interesting dialogue.

Lard Arse aka James said...

Thanks for your response. However, I do feel you are squirming out of your comments - that were uncalled for - by blaming brevity. Please be assured that this is not sarcasm. You will make an excellent doctor, as by personal experience, this is what doctors do.

No! My Gp did not learn from experience. Before the diagnosis of my prolactinoma, my Gp wanted me to be his golfing partner - I resisted as I have never played golf - but afterwards the disinterest was loud!

It is perhaps interesting to note that my condition - although he would perhaps have not truly known - was picked up by an optician who I visited after my Gp stated that my loss of peripheral vision was due to conjunctivitis. Headaches - migraine!

Sadly, misdiagnosis is common - unless my direct and indirect family, friends and friends of friends are just an unusual blip. Misdiagnosis of a carcinoma - as there is nothing in the bloods - resulted in the death of my father, my mother-in-law, my best friends wife, another best friend and also of other conditions that did not result in death.

However, I do realise that medicine is neither a science or an art, but a combination of the two with instinct and experience thrown in.

I follow many Dr. Blogs and regard JD as someone pretty spectacular as although he aware that he is a damned good Gp, he also realises he will make mistakes.

I truly do wish you good luck Michael and I think you will make a damned good doctor. But remember humility; there is nothing wrong in stating that you can sometimes be wrong.

I did visit your blog site before writing this and was disappointed that I could not converse with you in the future.

Lard Arse is what you and the Northern Doctor throw around with total disregard to who might be reading it. Fat people are really the LCD's, aren't they? I am not bitter - just used to it.

My name is James, not Lard Arse. I am very obese, have muscle loss, bone degeneration and am an object of derision because my doctor would not listen to me.

Michael said...

Hmm that GP seems to be straying very close to negligence with those misdiagnoses. Never heard peripheral vision loss being due to conjunctivitis before (much more likely to be due to migraine). I still can't grasp why the GP didn't refer. Headache + focal neuro sign (peripheral vision loss) + weight loss, even as a medical student I'd be very concerned.

As I mentioned above, admitting mistakes is crucial in medicine. A case like yours only makes that more apparent.

I don't throw around the terms like "Lard Arse", well ever, really. It's just not something I do (certainly in my online postings going back a few years there is nothing of this sort).

I haven't updated my profile in quite sometime, my current website is here, and on there is an e-mail address and a current blog (lots of random topics I warn you). Feel free to get in touch.

p.s. What does LCD mean?

James said...


With regards to the misdiagnosis of friends and family. All had different Gps.

My Gp had misdiagnosed at least three years prior to the loss of peripheral vision and the onset of blinding headaches. It was the usual diagnoses of "If I don't know what it is - it must be anxiety"

As a result, whenever I presented with new or concerns about ongoing symptoms, I assume he saw these as manifestations of my hypochondria.
He did not even check my vision, just prescribed a tube of oitment for conjunctivitis, hence my visit to the optician.

When I described these symptoms to the neurologist, he was alarmed that my Gp did not recognise them as obvious signs and symptoms of a pituatry tumour. But he did not and what's done is done and it can't be changed.

This Gp no longer practices as he was suspended for inappropriate behaviour towards female patients. I do not know whether he was eventually struck off.

LCD = Lowest Common Denominator = the riff-raff of society.

Michael said...


The neurologist was right to be alarmed. The GP should almost certainly have checked your eyes before trying to palm you off with a description.

While it may be true that what's done is done, there was (or is if less than 3 years has passed) still an option to sue the doctor for negligence. While sadly overused, the option to take a doctor to court is a very useful one. Had you sued, at the least you would have pushed the doctor to consider his actions, at most, prevented an incompetent practitioner risking the lives of others.

Sounds like he got what he deserved in the end either way and hopefully is no longer practising/registered (you can check on the GMC website if you're curious).

On a slightly more positive note: This discussion has made me stop and reflect and will stick with me for some time. Your story will remind me to recognise my limitations and admit mistakes where appropriate. Hopefully over the course of my career this will equate to several patients being helped by the sharing of your bad experience. Thank you.