So here’s the thing. You are faced with a body of people – let’s say 800,000 of them at least – who are in real danger of contracting a chronic condition. Or who have got it already. One which brings blindness, amputation and long-term reliance on drugs in its wake.
You can treat these people, radically, with surgery. The surgery is drastic. Each operation might cost, on a modest assessment, £10,000. But having the surgery cancels out the former chronic condition, treatment of which might cost the nation about one 10th of our entire health budget (£110bn). And so Nice (the National Institute for Health and Care Excellence) has advised that the million or so overweight people in the UK ought to be offered free weight-loss surgery to combat Britain’s diabetes crisis.
As Nice sees it, the NHS is awaiting a lardy time bomb, and has clearly envisaged that with, say, over a million people demanding long-term treatment for type 2 diabetes, our hospitals might be brought to their knees. Far better to wheel in the obese before that happens, and give them the short, sharp treatment with gastric bands, stomach stapling, the lot.
What, cry the thousands of thin, virtuous people who are on waiting lists for treatment of medical conditions that are not obviously their fault: removal of tumours, hip operations, cataracts and the like. These people brought obesity upon themselves, they will say, via a combination of fast-food addiction and a refusal to go, ever, to the gym. Why on earth is the NHS willing to spend taxpayers’ money, expertise, time and equipment saving lazy fatties from themselves? It’s your fault, if you are fat. Don’t expect the overstretched and under-resourced NHS to come to your aid. Go for a run and eat an apple.
Except that one of the glories of the NHS is its resolute refusal to be judgemental. It was set up to look after people, not wag the finger and tell them how to live their lives. There are enough institutions that already fulfil that arena. My father, a consultant physician, served the NHS for more than 40 years. As he is a chest doctor, the majority of his patients had lung cancer, and we all know how that is often come by. Did he refuse to treat those on his list because they had once been heavy smokers? (By the time you came to see Dr Millard, you tended to have given up, pronto.) No, he did not. His role was not that of moral arbiter. His role was that of a doctor, and his duty was to try to, if not cure them of their illness, than at least make their days more bearable.
Yes, of course the fatties should do more exercise. Yes, of course overweight people should move to a regime of Ryvita and Marmite, and eat only five days out of two. Everyone knows that. As Michael Winner once said, you can write a best selling diet book in two sentences. Eat less. Move more. Yes, some people don’t live in the way that you or I might choose to live. But is it the NHS’s job to turn away those who have a disgraceful lifestyle, or to refuse to treat those who do things which are inadvisable? If so, then anyone with a motorbike, or indeed a drink habit, or a fast car, or a penchant for riding horses or throwing hard balls about should probably take out an account with Bupa right away, because all those things can land you in dire need of hospital care one way or another.
Furthermore, why blame the NHS for treating people who are in danger of eating themselves to death? Why not point the finger at the fast-food traders, the food giants that inject sugar into absolutely everything, or the modern social trend which dictates that everyone has the right to eat and drink, at any time of day and night, whenever they want to.
When I was a little girl, it was very rude to eat in the street. Nowadays, street food is a desperately trendy aspirational genre. Meanwhile, if you go to former pristine bastions of food abstention such as the National Theatre you will have to run the hideous gauntlet of rows and rows of people stuffing their faces with crisps and mints, because they simply cannot wait for the 90 minutes before the interval to feed their guts a bit more. And don’t get me started on the cinema.
I imagine that the queues of people having their weekly weigh-in at Weight Watchers will feel very hard done by when they read the headlines this week. Losing weight is a slow and very boring process. Going for a run for an hour takes, well, an hour. And you are all sweaty afterwards. Whereas these fat people, well, they have truly had their cake, eaten it and now they are having a quick fix to rectify the insulin-overloaded situation. Except it’s not really unfair. Having a gastric band fitted, or your stomach stapled, seems like a horrendous and deeply traumatic option fraught with potential danger. It truly is the last resort.