Tough Love Approach Keeps Fad Dieting Going

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 institutionalised 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?

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