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NHSE is treating obesity as a joke

fruit and veg prescription

I think we’d agree that one of the most unrewarding tasks in the unrewarding world of general practice is the ‘management’ of obesity. Until now, that is. Because, suddenly, thanks to a shiny new DES, primary obesity care does come with a reward. Literally. Points means prizes or, rather, pounds mean pounds – to the tune of £11.50 per patient referred to some sort of weight management programme.

If I was a mature professional, this would prompt a considered response about whether:

a) This should be the remit of Public Health, rather than general practice

b) At £20m, it represents a good use of taxpayers’ money

c) It’s worth the arse-ache.

But I’m not, so it doesn’t. Besides, there’s something in Ed Waller’s introductory letter announcing the DES that seems odd. If I didn’t know better, I’d say it was saturated with fattist innuendo and coded jokes.

Note for, example, the use of the word ‘broader’ in ‘broader expansion of weight management services’. Unnecessary. And what about the line: ‘…encourages practices to develop a supportive environment for clinicians to engage patients living with obesity…’? So that supportive environment is, what, a reinforced floor?

And how about that repeated phrase: ‘patients living with obesity’? I accept that we shouldn’t call people ‘fat’, that describing them as ‘obese’ sounds pejorative, and that ‘patient with obesity’ is a little kinder. But ‘patient living with obesity’ distances them so much from the actual problem that it is either adipolitical correctness gone mad, or a joke.

Unless, that is, the DES is actually for people living with obesity rather than suffering from it, ie) it’s to support the relatives of obese patients, like some kind of Fat-Anon – in which case ‘walking away from obesity’ campaigns sound like they’re simply encouraging the family to leave.

And so it goes on, the only joke missed, I think, being the obvious one around the requirement for patients to ‘actively provide and update their records’ – presumably using an app on their, er, BMI-phone.

Now, you could call all of this the puerile rantings of a Comedyspiracy Theorist, and you might be right. And yet. There’s something in this. The signatory, right? Mr Waller. Think about that surname, and it all starts to make some bizarre kind of sense. It’s not exactly a common name, is it? He just has to be the distant relative of a very famous jazz pianist. Indeed, yes, I am talking about the legendary Fats Waller. I rest my case. Although, admittedly, he’d nowadays be known as ‘Patient living with obesity Waller.’

All of which explains why none of us will be taking this DES very seriously. Though there may be other reasons.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at


Decorum Est 22 June, 2021 4:43 pm

…but Radio 4 said that obesity was a medical problem…and some doctor said it was due to your ormones …and somebody else said it was due to control on your fridge…and…

Patrufini Duffy 23 June, 2021 10:15 am

Once you have collated enough BMI data for the extraction – the US corporates can drive bariatric surgery and diabetic drugs down the publics throat.
And the insurance premium can go up.

Angela Parker 23 June, 2021 11:18 am

Why is the definition of obesity apparently racist ? You are obese with BMI 30 if white but 27.3 is it – if you are “any other”. What if you are Mixed ??

Patrufini Duffy 23 June, 2021 1:28 pm

Obese has 2 more letters than Fat.
And unfortunately, 13 less than Self-transformation and 9 less Responsibility.
Spend less time on the numbers and coding and look up at the sky. We’re on for a collision with Andromeda – will be a great spectacle.

Andrew Bamji 15 July, 2021 10:46 am

There are risks of “living with obesity”. There are indeed hormones involved – principally leptin. The bigger your fat cells the more leptin there is, and as leptin is a driver for oncogenesis and inflammation (it’s technically a pro-inflammatory cytokine) obese people are at risk (probably explains why Covid-19 has obesity as a risk factor). So wokeness or not medics should concentrate on getting people to lose weight and not beat about the bush.

Keith M Laycock 17 July, 2021 3:20 am

Copperfield and Duffy to the fore: – Despite the bleatings of the ‘medical specialists’ focused on ‘obesity’ and their physiological algorithm constructs of hormone-this and hormone-that,
the reality is that if you eat too much and physically do too little, you gain weight.

No obese people left Belsen etc……