26 Şubat 2017 Pazar

Doctors don’t have to sugar the obesity pill | Barbara Ellen

A lot gets said about how it feels to be overweight, but what is the psychology of having to tell someone that they’re fat if you’re a health professional? Does it feel rude, abrasive, maybe even counter-productive to do so? But perhaps neglectful and harmful not to? A survey of 1,141 GPs by Pulse magazine found that almost one third (32%) of them said that patients became offended and resentful when their excess weight was pointed out.


Of course, there are GPs who feel that “political correctness” has no place in medicine and patients should just be told the truth, however it goes down. But for other GPs, the issue is more complicated. Some wonder whether they should bring the topic up at all, even when the problem is something like knee pain, which could be exacerbated by weight. They feel that to do so would only upset the patient and have a negative impact on their ongoing relationship.


Others believe that some patients are avoiding GPs because they don’t wish to feel pressured about their weight – although the patient is frequently more upset about being overweight than by the discussion.


At this point, some might say, what’s the problem? Britain has an obesity epidemic, and if weight contributes to an individual’s health problems, it should be part of the health advice. At the moment, the NHS approach is to offer all obese patients free places in slimming clubs, and when patients are being spoken to about their weight, there are guidelines suggesting that “the tone and content of all communications is respectful and non-judgmental”. Certainly, there are compelling arguments for telling patients that they’re obese – such as helping them to avoid unnecessary medical interventions.


This last one clinched it for me – a few seconds of tension is surely better than the patient undergoing unnecessary treatment. However, like many of these more sensitive GPs, I’m loath to go along with any narrative that tries to caricature overweight people as thin-skinned children throwing tantrums.


Weight isn’t just physiological, it’s emotional. Someone talking to you about it, while probably not a revelation, would still be painful. Moreover, in Britain today, it’s improbable that any fat person is getting away with living in denial.


Only this week, there was a case where a woman wearing heels fell down nightclub steps, and the judge ruled that she had no case because she was drunk and obese. Fair enough about the alcohol, but what did the woman’s weight have to do with anything? Heels or not, if excess pounds made people fall over more readily, then western civilisation would be full of images of overweight citizens rolling about on pavements like upturned human beetles.


Nor is this behaviour confined to courtrooms – increasingly, casual fat-shaming has become normalised. Which perhaps sheds light on why some GPs instinctively feel that they need to be cautious. Far from the patient being oblivious about their weight, they’re living in a world which, one way or another, never stops pointing it out. Instead of having too little insight into their weight problem, they’re likely to have become over-sensitised.


For these people, a GP surgery may feel like a sanctuary compared to the outside world, so to have their weight mentioned there may be momentarily jarring. Framed this way, the fact that two thirds of GPs aren’t encountering offended patients is a pretty good result. However, that still leaves the farcical situation where obese people are constantly told about their weight by everyone apart from the only people who need to mention it – namely health professionals. While something has gone very wrong here, the blame doesn’t lie with sensitive GPs.


Farage made a demon of himself



Do you want to drink in a pub with this man?


Do you want to drink in a pub with this man? Photograph: Oli Scarff/AFP/Getty Images

Former Ukip leader Nigel Farage is upset because he feels that he’s been “demonised” by the British media, to the point where he’s living like a “virtual prisoner” and is “frightened” to leave the house. Does this explain why Farage has been taking so many hols in America recently – at that well-known international leisure destination, Camp Trump?


As for Farage being “demonised” by the British media, could you excuse me a moment while I go hunting on the internet for the world’s tiniest violin? Nope, sorry, it’s going to have to be tinier than that.


I suppose that some could make a compelling argument for Farage being demonised. However, it doesn’t end there. Farage has also been promoted and feted, far beyond the size and political standing Ukip ever merited. Along the way, he was also reinvented, as a voice-of-the-people folk hero – an entertaining turn, someone you could “have a pint at the pub with”. To which, all I can say is: in all my years of going to pubs, I’ve never been that thirsty.


Which, of course, is just my personal opinion of a man who has always reminded me strongly of a malevolent sock puppet, conjured into life by some demented anti-EU Geppetto, and dressed as though permanently in lickspittle-hope of being invited to a grouse shoot at a grand house in 1953. But I digress.


The point is that, like Boris Johnson before him, Farage has enjoyed quite the “amusing British character” makeover – one which he continues to struggle to deserve in this tumultuous post-Brexit climate.


Indeed, while Farage might claim that he has been demonised, others might say that he and his views have been over-publicised, not to mention assimilated and normalised, to an absurd and dangerous degree.


We should call an amnesty on this shameful chapter



Britain’s smallest library, run by the Brockley Society in London.


Britain’s smallest library, run by the Brockley Society in London. Photograph: Facundo Arrizabalaga/EPA

A startling 25 million British library books are estimated to be overdue. At the close of 2016, libraries had around 50 million books, which was 25 million fewer than they had in 1996. It has only now been discovered because cuts mean that there aren’t enough librarians to carry out proper stocktaking.


That’s an awful lot of unreturned Terry Pratchett and Hilary Mantel. If Britain continues to lose books at this rate, by the end of the century all that will be left is a Ruth Rendell with the last chapter missing and a DVD of In The Night Garden.


Perhaps even as I write this, some people are staring shamefacedly at bookshelves holding tomes encased in incriminating plastic book coversdust jackets, thinking: “Why didn’t I take that Dan Brown book back? And why did I take it out in the first place?”


But enough of recriminations. This national unreturned library book conundrum seems to resurface periodically. Clearly, people are frightened about incurring gigantic fines. Surely there could be a designated period of library-amnesty for returning overdue books? For a limited period only, no penalty at all … unless you’re returning the Dan Browns?


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Doctors don’t have to sugar the obesity pill | Barbara Ellen

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