Controversies in Management: Treatment is necessaryBMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6955.654 (Published 10 September 1994) Cite this as: BMJ 1994;309:654
- J S Garrow
- Rank Department of Human Nutrition, St Bartholomew's Hospital Medical College, London EC1M 6BQ.
Most people will agree that mending machinery which has broken, teaching a child useful skills, and preserving an artistic masterpiece are, in principle, useful. Most will also acknowledge that it is possible to do these tasks so badly that the final state is worse than at the start. Similarly, it is possible to treat obesity so incompetently that the net effect is to make the obese patient worse. We should not argue from this that we should not treat obesity, any more than that we should not mend machinery, teach children, or preserve artistic masterpieces. I will assume, therefore, that by treating obesity we mean doing so with reasonable competence. Two further definitions need stating. By “obese” I mean having a Quetelet's index (body mass index) over 30. Also, I assume that the objective of all medical treatment is to make life more tolerable to patients by increasing the extent to which they can undertake activities or projects that they reasonably want to do.
Adverse effects of obesity
Disabilities associated with obesity are decreased longevity …