10 Propositions on obesity and rationing treatment for it
Remarks prepared for a National Obesity Forum debate, London, 14 October, 2004

1 Of course treatment for obesity should be rationed. If it's serious enough to be medicalised, its treatment should be rationed, like all other medical matters. This is the only argument the proposition needs: it is sufficient.

Here are some others.
2 Why is obesity medicalised? One of the reasons we need GPs to ration access to expensive medical treatment for obesity is that they can send some (most?) fat people away saying their problem is idleness and greed.

3 The GP stands some chance of exerting a stigmatising influence, even if everyone else in society is condemned to recognise the blobby diversity fat people represent.

4 If obesity is sometimes caused by addiction (rather than by idleness and greed), then it will be for the GP to recognise that and authorise the anti-addiction treatment. (Ditto, if the obesity is caused by a metabolism problem, or some such.)

5 All these points flow from the way medical treatment is now at the public charge. Since people want the state to pay for their illness, the state is bound to inquire where they deserve or can reward treatment.

6 One cannot refuse treatment to people even if their problems are wholly self-inflicted. Smokers, drug addicts, fatties, are all variously blame-worthy or blameless, but at the point at which they're ill, they have to be treated. How aggressively or expensively we treat them is a matter for professional judgement, public debate and political negotiation. We are well short of being prepared to wave open checque books at fat people, and not doing so is rationing.

7 We should aggressively and expensively treat fat people only if they will be very expensive to the state if they go untreated. Our interests, not theirs, should be uppermost in our mind.

8 We need to be bold about describing the sociology of fatness. Rich people have always tended to fatness, because they had access to rich foods and a disinclination to physical work. They spent fortunes at fat-farms and on quack diets and remedies, and mostly stayed fat. None of us worried about them. Now, the ex-working class are suddenly in the same sort of position, but with even less understanding of the need for self-discipline. They'll learn, and in the meantime we should not indulge the one big problem they face (apart from being big): they are self-indulgent.

9 Four out of five children aren't obese. It is a mistake to pathologise fat people, and even ore so to pathologise a whole generation.

10 Men born in the 1920s and 1930s are outperforming longevity trends. This is interesting since though they understood the idea of shortage (food was scarce or plain until the early 1950s) they are the first generation of people to experience Mass Affluence. I don't know what this tells us, except perhaps that it is childhood which fixes our eating habits. It fixed mine as a fat-loving sugar-phile hoovering down everything that was available and loving food.