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Independents' Day

'Vaccine shortage averted'

Obesity management (Clinical, July 2) is an area where we may quite rightly grudge NHS prescriptions for drug treatment unless patients provide evidence of being well-motivated to lose weight.

The way I get round this is to measure patients' weight, and then offer them diet advice and a private prescription for sibutramine or orlistat for one month if there will be significant benefits from weight loss.

I offer to renew the script as an NHS prescription after a month if they have lost 3kg or more. Thereafter continuing monthly NHS scripts can be justified if they lose 2kg per month, but they go back on private scripts if they fail to meet their goal. So far no patient has objected to this, and the policy seems to be working.

Dr AJ Munro

Cranford, Middlesex

Thank you to Dr Bolitho-Jones for emphasising the importance of both sides of the energy balance equation in the aetiology of obesity (Letters, July 2). It is hard to disagree that excessive food and no exercise is fundamental to the obesity problem. However, the point is not why an individual becomes obese but what the sequelae and co-morbidities are once the obesity has occurred.

Would Dr Bolitho-Jones consider lung cancer, emphysema, chronic bronchitis and smoking-related CVD as chronic disease or would he hold up his hands in horror and say: 'Your fault ­ nothing to do with me.'

Obesity leads directly to diabetes, heart disease, cancer, sleep apnoea, infertility and sexual dysfunction and many other conditions and is, therefore, fundamentally a chronic medical condition.

It is not acceptable in this day and age to ignore obesity as a risk factor and it must be dealt with appropriately in primary care.

Dr David Haslam

Watton at Stone, Herts

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