http://www.sundayherald.com/oped/opinion/display.var.2511436.0.no_time_to_g
o_soft_on_obesityplagued_scots.php

No time to go soft on obesity-plagued Scots
Joanna Blythman

A POSTER CAN be found on the walls of GPs' waiting rooms showing a line-up
of bottoms, in all shapes and sizes, with the words: "Your doctors have
seen it all before." It is aimed at people who worry about presenting
themselves for medical treatment because they fear that their particular
ailment or condition makes them perfect subjects for Channel 4's
voyeuristic freak show Embarrassing Bodies.

We can all relate to this. Who hasn't had something on a part of their
anatomy that they would rather not expose to strangers, professional or
otherwise? Who hasn't felt mild anxiety, around this time of year, at the
prospect of finding a swimming costume for the holidays? Let's face it,
there are few experiences less calculated to make you feel good about
yourself than the annual, post-winter try-on session with swim gear. And we
can all swap gory stories about suppurating cysts and disintegrating
toenails.

But if you are fat, very fat indeed, and the prospect of baring all, or
bits of yourself, to a doctor is so unpalatable that you avoid it like root
canal treatment with the dentist, then you might be a victim of "obesity
bias".

Last week, Dr Pat Croskerry, professor of emergency medicine at Dalhousie
University in Canada, was in Edinburgh to warn medics that obese people may
be avoiding or delaying asking for potentially life-saving stomach surgery
because they fear the judgmental attitudes and disapproval of doctors. His
findings chime with other studies which have shown that obese people
postpone important medical checks, such as cervical screening or
blood-pressure testing, because they don't relish being given a dressing
down about their weight.

It certainly can't be very comfortable, can it? There you are, seeking
treatment for your painful knees, your breathing difficulties, your
insomnia or your gout, and you know that you are in for a sanctimonious pep
talk from your GP, who will tell you to "lose some weight and come back and
see me" then send you out the door with some useless NHS diet sheet.

But what else are they meant to do? Just because we are the second-fattest
country on the planet, that doesn't mean that fat people have to be
mollycoddled and sheltered from a truth that they don't want to hear.
Sometimes, you have to be cruel to be kind. Facts are facts. If you are
life-threateningly overweight, you can't expect responsible professionals
to spare your blushes and re-invent reality to ignore the humungous weight
of scientific evidence that shows that being fat is seriously bad for your
health.

There is a school of thought in medical circles that instead of being
viewed as the last resort, radical, invasive operations like gastric-band
surgery should be performed more readily, expanded if you like, to fit the
growing demand. They argue that this would cut deaths from heart disease,
diet-related cancer, stroke and the like, so saving the health service
money in the long term.

Apparently, there are 24,000 severely obese Scots who might, arguably,
benefit from such surgery, but only around 300 have such operations each
year - just half of them on the NHS. Medics who favour magic-bullet
solutions to obesity see this low uptake as yet another symptom of a health
system, and a society, that draws a queasy, moralistic distinction between
the deserving and undeserving sick when allocating NHS resources.

There is another possibility, though. Maybe it sticks in the throat of
thinking doctors to sign up patients for drastic stomach-constriction
surgery or abdominal reshaping with staples when a much more benign
alternative is to ask them to change their eating and living habits.

"Have you any idea how hard it is to lose weight when you are immensely
fat?" I hear you say. I'll admit, I can only imagine and sympathise. But
surely there is a limit to how much we allow our world to be reshaped and
scaled up to accommodate our ballooning phenotype? We now live in the era
of militant fatties; those people who think that the problem isn't obesity
as such, just thin/normal people's attitudes towards it. This supersize
movement demands bigger car, bus, cinema and plane seats. It wants clothes
in ever-expanding sizes. It lambasts fashion retailers for failing to
recalibrate their ranges so that obese sizes, instead of being labelled
XXXL, are normalised. The bigger people become, the more that state is
presented as "normal".

Supersizists castigate fashion designers for encouraging the cult of
thinness, conveniently ignoring the fact that anorexia and bulimia are
Lilliputian concerns monumentally overshadowed by the burgeoning problem of
obesity.

Let's be honest here. Our country's ballooning weight is a shocker and
there is no way we should be accepting of it or view it as inevitable. All
but a few poor souls have it in their power to control their weight and in
the long run, societal disapproval may prove more effective in controlling
fatness than any calorie-controlled diet.