Merit and Maya

A Merit System for Obesity Care?

A new study of public preferences for determining who gets bariatric surgery provides a remarkably clear answer. The public mainly cares about a patient’s lifestyle. The findings suggest a merit system for obesity care. “Lifestyle commitment was considered to be more than twice as important as any other criterion,” the authors found.

These results are unsurprising and depressing at the same time.

The public cares not about medical needs of people with severe obesity. The deeper concern is commitment to a lifestyle that would make these people worthy of treatment. The public’s attraction to such moral judgements is evident in a large body of weight bias research. It surfaces in hurdles to bariatric surgery that payers impose. Some require patients to prove that they can lose weight in a supervised weight management program — at their own expense — before they are granted access to this medically necessary procedure. Other payers require them to prove they can’t lose weight without surgery. This might qualify as being “damned if you do and damned if you don’t.”

Such requirements are common despite the absence of any evidence to support a rationale for them.

The only merit system for access to obesity care should be medical need. Moral judgements and public bias have no place in the process.

Click here to read the study in BMJ Open and here to read the ASMBS review of preoperative weight loss requirements.

Merit and Maya, photograph © Rob Koopman / flickr

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October 30, 2015