Tough Love Approach Reinforces Fad Dieting

Increasing
numbers of waiting list patients are now being forced to slim before
being allowed to have routine operations on the British National
Health Service.

A
newspaper investigation claims that the localised policy is now to be
rolled out nationally by the end of 2007.

Doctors
will allocate treatment to patients according to their Body Mass
Index, the BMI being the formula relating putative optimum weight to
height.

If
people have a BMI over 30, which is commonplace in the UK and very
much towards the average zone in the US, they will be denied
non-emergency operations such as hip and knee surgery, or procedures
including IVF treatment.

The
new guidelines already apply to about 1 in 15 of the PCTs in the UK
and, when implemented nationally, the BMI-rule will affect about 1 in
5 of the population. Failure to achieve the threshold for operations
will result in being recommended a crash slimming regime and
reassessment after six months.

Health
officials state that their rationale behind the strict new
qualification for treatment is justified by research which shows that
slimmer people have better recovery rates from surgery. Whatever the
proven scientific case for this viewpoint and also not forgetting the
debatable validity of the now 150 year old BMI standpoint, a
considered critique reveals troubling implications within this
clampdown.

One
of the central paradoxes of the current major debate surrounding
obesity is the question of why people persist in long term dieting
cycles when dieting is increasingly discredited as an effective means
of lasting weight control.

It
can be argued that individuals are being driven into fad dieting not
so much by the long standing notion of Yo Yo Dieting (itself, we
would contend, simpliste and flawed) but rather by overwhelming
instit
utionalised and cultural pressures. From this perspective, the
creeping criminalisation of overweight, which is advancing steadily
deeper and deeper into the denial of erstwhile civil liberties, is a
major stepping-up of these institutionalised pressures.

Some
would also argue that the extension of public health care
intervention into wider and wider aspects of modern living is not so
much a wellbeing aspiration as a symptom of the current western
governmental drift towards an increasing micromanagement of the whole
lifestyle.

This
is not necessarily a claim either of the left or the right, as both
perspectives would be critical of an excessively big state overriding
basic liberties.

The
problem with all of this in relation to the overweight arena is that
it is leaving those already involved in failed fad dieting with
nowhere to turn except straight back into more fad dieting.

Gradual
lifestyle adjustments, new coping strategies for the emotional
stresses which trigger overeating, a relaxed appreciation of the
cultural drivers towards fad dieting cycles and the fostering of a
choice to move in fresh directions – all of these healthful options
are blown away by the official decrees to lose weight fast. In the
absence of alternatives, what are people to do except to plunge back
into the fad dieting mainstream?

Government,
unchallenged, is always going to be relatively short term in its
outlook; it is simply the way that it tends to work.

The
short termism in this instance is exacerbating the very issues it is
seeking to address. The macho “tough love” approach will do
little except deliver “tough luck” on those problem dieters who
now have less freedom than ever to break away from fad dieting.

This
is another expression of the growing yet implicit official view that
the overweight are deviants who must be brought back within the
correct moral line. Is this fair or accurate?