Tag Archives: people

Trump’s biggest enemy isn’t the media. It’s poor people | Ross Barkan

Whenever talk turns to Donald Trump’s enemies, the Democrats and the media are always assumed to be at the top of his hit list. This is a man, after all, who cries out “Fake News!” almost as often as he draws breath.

But Trump’s truest enemy isn’t any card-carrying journalist, progressive Democrat, or disgruntled member of the Deep State. It’s any American who doesn’t have much money.

The irony of Trump was always his tin pot populism, speaking to people’s economic anxiety while doing everything possible to screw them over. It’s a testament to his cult of personality that he even retains the little popularity he has.

Trump’s most dramatic move yet to dismantle Obamacare will surely punish many of the poor people who voted for him and the rest who didn’t. It will hurt the sickest and most vulnerable. More than anything else, that is Trump’s modus operandi.

On Thursday, the White House announced that it would scrap subsidies to health insurance companies that help pay out-of-pocket costs for low-income people. This move came hours after Trump said cheaper policies with fewer benefits and protections for consumers would eventually hit the market.

While some younger, healthier people could benefit from low-cost plans, both announcements threaten to further destabilize the Obamacare marketplace. If healthier people opt out of more comprehensive coverage, the cost of care for the oldest, sickest, and poorest will skyrocket.

Obamacare is imperfect, but it did promise coverage to people with preexisting conditions who, under the old system, would’ve been locked out of the healthcare market.

None of this matters to Trump. Since the Affordable Care Act – once upon a time, a market-driven approach to healthcare championed by conservatives – was Barack Obama’s signature achievement as president, it deserves to be destroyed. He cannot stomach anything related to the legacy of the first black president. If it carries Obama’s stamp, it must be eradicated.

Trump couldn’t do this legislatively because he had no serious alternative to Obamacare. Republicans in the Senate balked at his madness. Now, he will chip away at our healthcare system anyway he can, proving to his frothing base he is trying his best to eviscerate what Obama left behind.

The poor, of course, will be collateral damage, and in that way Trump is more your conventional 21st century Republican, only less organized in thought and action. Had Marco Rubio or Ted Cruz prevailed last year, they would also likely be in the process of trying rip healthcare away from people. The national Republican party is the plutocrat party. Its entire intellectual foundation rests on the assumption that the poorest and weakest deserve to suffer.

This isn’t to excuse Democrats, who have been too beholden to corporate interests. The greatest corrective to Obamacare, a public option, died during negotiations because insurance companies with plenty of clout in a Democratic Congress insisted they shouldn’t have to compete with a cheaper, government-run plan. Obamacare was good for insurance companies: it created new customers.

A single-payer, Medicare-for-all plan is the only humane answer here, though a public options could at least help stabilize markets. We know Trump has no interest in pursuing either path. He is a rich bully who fights for rich bullies. As vacuous as he is mean, he is willing to shred healthcare as we know it to make a point.

What he doesn’t understand is how much his own party will be blamed for this coming debacle. Barack Obama doesn’t live in the White House anymore. Republicans control every level of government. Were Trump a different kind of person – wiser, saner – he would probably give this some thought.

Trump’s biggest enemy isn’t the media. It’s poor people | Ross Barkan

Whenever talk turns to Donald Trump’s enemies, the Democrats and the media are always assumed to be at the top of his hit list. This is a man, after all, who cries out “Fake News!” almost as often as he draws breath.

But Trump’s truest enemy isn’t any card-carrying journalist, progressive Democrat, or disgruntled member of the Deep State. It’s any American who doesn’t have much money.

The irony of Trump was always his tin pot populism, speaking to people’s economic anxiety while doing everything possible to screw them over. It’s a testament to his cult of personality that he even retains the little popularity he has.

Trump’s most dramatic move yet to dismantle Obamacare will surely punish many of the poor people who voted for him and the rest who didn’t. It will hurt the sickest and most vulnerable. More than anything else, that is Trump’s modus operandi.

On Thursday, the White House announced that it would scrap subsidies to health insurance companies that help pay out-of-pocket costs for low-income people. This move came hours after Trump said cheaper policies with fewer benefits and protections for consumers would eventually hit the market.

While some younger, healthier people could benefit from low-cost plans, both announcements threaten to further destabilize the Obamacare marketplace. If healthier people opt out of more comprehensive coverage, the cost of care for the oldest, sickest, and poorest will skyrocket.

Obamacare is imperfect, but it did promise coverage to people with preexisting conditions who, under the old system, would’ve been locked out of the healthcare market.

None of this matters to Trump. Since the Affordable Care Act – once upon a time, a market-driven approach to healthcare championed by conservatives – was Barack Obama’s signature achievement as president, it deserves to be destroyed. He cannot stomach anything related to the legacy of the first black president. If it carries Obama’s stamp, it must be eradicated.

Trump couldn’t do this legislatively because he had no serious alternative to Obamacare. Republicans in the Senate balked at his madness. Now, he will chip away at our healthcare system anyway he can, proving to his frothing base he is trying his best to eviscerate what Obama left behind.

The poor, of course, will be collateral damage, and in that way Trump is more your conventional 21st century Republican, only less organized in thought and action. Had Marco Rubio or Ted Cruz prevailed last year, they would also likely be in the process of trying rip healthcare away from people. The national Republican party is the plutocrat party. Its entire intellectual foundation rests on the assumption that the poorest and weakest deserve to suffer.

This isn’t to excuse Democrats, who have been too beholden to corporate interests. The greatest corrective to Obamacare, a public option, died during negotiations because insurance companies with plenty of clout in a Democratic Congress insisted they shouldn’t have to compete with a cheaper, government-run plan. Obamacare was good for insurance companies: it created new customers.

A single-payer, Medicare-for-all plan is the only humane answer here, though a public options could at least help stabilize markets. We know Trump has no interest in pursuing either path. He is a rich bully who fights for rich bullies. As vacuous as he is mean, he is willing to shred healthcare as we know it to make a point.

What he doesn’t understand is how much his own party will be blamed for this coming debacle. Barack Obama doesn’t live in the White House anymore. Republicans control every level of government. Were Trump a different kind of person – wiser, saner – he would probably give this some thought.

Trump’s biggest enemy isn’t the media. It’s poor people | Ross Barkan

Whenever talk turns to Donald Trump’s enemies, the Democrats and the media are always assumed to be at the top of his hit list. This is a man, after all, who cries out “Fake News!” almost as often as he draws breath.

But Trump’s truest enemy isn’t any card-carrying journalist, progressive Democrat, or disgruntled member of the Deep State. It’s any American who doesn’t have much money.

The irony of Trump was always his tin pot populism, speaking to people’s economic anxiety while doing everything possible to screw them over. It’s a testament to his cult of personality that he even retains the little popularity he has.

Trump’s most dramatic move yet to dismantle Obamacare will surely punish many of the poor people who voted for him and the rest who didn’t. It will hurt the sickest and most vulnerable. More than anything else, that is Trump’s modus operandi.

On Thursday, the White House announced that it would scrap subsidies to health insurance companies that help pay out-of-pocket costs for low-income people. This move came hours after Trump said cheaper policies with fewer benefits and protections for consumers would eventually hit the market.

While some younger, healthier people could benefit from low-cost plans, both announcements threaten to further destabilize the Obamacare marketplace. If healthier people opt out of more comprehensive coverage, the cost of care for the oldest, sickest, and poorest will skyrocket.

Obamacare is imperfect, but it did promise coverage to people with preexisting conditions who, under the old system, would’ve been locked out of the healthcare market.

None of this matters to Trump. Since the Affordable Care Act – once upon a time, a market-driven approach to healthcare championed by conservatives – was Barack Obama’s signature achievement as president, it deserves to be destroyed. He cannot stomach anything related to the legacy of the first black president. If it carries Obama’s stamp, it must be eradicated.

Trump couldn’t do this legislatively because he had no serious alternative to Obamacare. Republicans in the Senate balked at his madness. Now, he will chip away at our healthcare system anyway he can, proving to his frothing base he is trying his best to eviscerate what Obama left behind.

The poor, of course, will be collateral damage, and in that way Trump is more your conventional 21st century Republican, only less organized in thought and action. Had Marco Rubio or Ted Cruz prevailed last year, they would also likely be in the process of trying rip healthcare away from people. The national Republican party is the plutocrat party. Its entire intellectual foundation rests on the assumption that the poorest and weakest deserve to suffer.

This isn’t to excuse Democrats, who have been too beholden to corporate interests. The greatest corrective to Obamacare, a public option, died during negotiations because insurance companies with plenty of clout in a Democratic Congress insisted they shouldn’t have to compete with a cheaper, government-run plan. Obamacare was good for insurance companies: it created new customers.

A single-payer, Medicare-for-all plan is the only humane answer here, though a public options could at least help stabilize markets. We know Trump has no interest in pursuing either path. He is a rich bully who fights for rich bullies. As vacuous as he is mean, he is willing to shred healthcare as we know it to make a point.

What he doesn’t understand is how much his own party will be blamed for this coming debacle. Barack Obama doesn’t live in the White House anymore. Republicans control every level of government. Were Trump a different kind of person – wiser, saner – he would probably give this some thought.

Obese people deserve surgical treatment, too | Richard Welbourn

One in four people in the UK suffer with obesity. Severe and complex obesity is a lifelong condition associated with many major medical problems, the costs of which threaten to bankrupt the NHS. The major ailment caused by obesity – type 2 diabetes – is linked to shorter life expectancy, decreased quality of life and increased socio-economic and psychosocial problems. A new report out this week suggests the global cost of treating obesity will rise to $ 1.2tn a year from 2025.

Yet in the UK, less than 1% of those who can benefit from it receive bariatric (sometimes called weight-loss) surgery, such as gastric bypass or gastric banding. So why is a safe, cost-effective therapy for a deadly disease so under-utilised?

For severely obese people, the hormonal effects of being obese mean that medical therapies, lifestyle changes and attempts at dieting rarely succeed in maintaining long-term, clinically beneficial weight loss. It isn’t just surgeons saying this – it is described in guidance by the British Obesity and Metabolic Surgery Society which is endorsed by 21 other professional organisations, including nine medical royal colleges.

The World Health Organisation identifies obesity as a chronic disease. But on the other side we have the popular perception – shared by some healthcare professionals – that it is purely a lifestyle choice. This totally disregards the fact that, driven by powerful food industry advertising, it is those who are poor who are most affected. Our tendency towards obesity is rooted in evolutionary biology: human beings have spent two million years developing a metabolic system which conserves energy in times of scarcity. It is only in the last 70 years that we no longer eat because of hunger alone.

The annual volume of bariatric surgery in the UK – about 5,000 operations a year – is five to 10 times lower compared with other European countries with similar population sizes and disease prevalence. In France, which has a similar population size to the UK, more than 37,000 surgeries are carried out each year. Belgium, with a population of 11.3 million, undertakes 12,000 surgeries while Sweden, with a population of 9.9 million, carries out more than 7,000 a year.

As a practising bariatric surgeon, I and my colleagues believe the social stigma of obesity is holding back the deployment of cost-effective treatments for vulnerable people. Health commissioners are aware of the figures, but remain slow to increase provision. Cost can’t be the issue. Getting a patient off insulin or other expensive anti-diabetes medications is cost-saving within two to three years of surgery: a win-win for the GP, the NHS and the taxpayer. Patients are also more likely to go back to work, and therefore pay more tax and claim fewer benefits.

I believe the problem is that commissioners and medical professionals, like the public, still see obesity as a lifestyle choice, and so blame patients. But there is a point of no return with obesity. There are parallels with other diseases. You may well suggest to someone who is a bit down in various ways for them to try and improve their mood, but once they become clinically depressed expert treatment is needed. We encourage our friends to stop smoking, but we don’t then begrudge them treatment for lung cancer.

Yet the reluctance to treat obesity lingers. Some argue that resources should be directed to prevention rather than treatment. Whenever possible, prevention is obviously better than cure. But this is no longer an option for people who have missed the boat of prevention and have gone on to develop severe, complex obesity with conditions such as diabetes.

Patients should be given quicker access to surgical assessment. If bariatric surgery is right for them, then the sooner the better. We already know that the UK is one of the most obese countries in Europe, and the patients we operate on are the sickest. The NHS should be performing 50,000 surgeries a year, closer to the European average.

To achieve this, health workers must be persuaded to put prejudice to one side and promote surgery where appropriate. GPs and commissioners alike must recognise both the health benefits and cost savings.

All the clinical evidence points to the fact that, as a country, we should be performing more weight-loss surgeries. It is the social stigma of obesity that is holding us back. Making fun of obese people is an endemic societal prejudice, and stigmatisation is allowed – and even encouraged – by the media. It’s time to stop judging and let the experts start treating the condition.

Richard Welbourn is a consultant bariatric surgeon at Musgrove Park Hospital, Taunton

Obese people deserve surgical treatment, too | Richard Welbourn

One in four people in the UK suffer with obesity. Severe and complex obesity is a lifelong condition associated with many major medical problems, the costs of which threaten to bankrupt the NHS. The major ailment caused by obesity – type 2 diabetes – is linked to shorter life expectancy, decreased quality of life and increased socio-economic and psychosocial problems. A new report out this week suggests the global cost of treating obesity will rise to $ 1.2tn a year from 2025.

Yet in the UK, less than 1% of those who can benefit from it receive bariatric (sometimes called weight-loss) surgery, such as gastric bypass or gastric banding. So why is a safe, cost-effective therapy for a deadly disease so under-utilised?

For severely obese people, the hormonal effects of being obese mean that medical therapies, lifestyle changes and attempts at dieting rarely succeed in maintaining long-term, clinically beneficial weight loss. It isn’t just surgeons saying this – it is described in guidance by the British Obesity and Metabolic Surgery Society which is endorsed by 21 other professional organisations, including nine medical royal colleges.

The World Health Organisation identifies obesity as a chronic disease. But on the other side we have the popular perception – shared by some healthcare professionals – that it is purely a lifestyle choice. This totally disregards the fact that, driven by powerful food industry advertising, it is those who are poor who are most affected. Our tendency towards obesity is rooted in evolutionary biology: human beings have spent two million years developing a metabolic system which conserves energy in times of scarcity. It is only in the last 70 years that we no longer eat because of hunger alone.

The annual volume of bariatric surgery in the UK – about 5,000 operations a year – is five to 10 times lower compared with other European countries with similar population sizes and disease prevalence. In France, which has a similar population size to the UK, more than 37,000 surgeries are carried out each year. Belgium, with a population of 11.3 million, undertakes 12,000 surgeries while Sweden, with a population of 9.9 million, carries out more than 7,000 a year.

As a practising bariatric surgeon, I and my colleagues believe the social stigma of obesity is holding back the deployment of cost-effective treatments for vulnerable people. Health commissioners are aware of the figures, but remain slow to increase provision. Cost can’t be the issue. Getting a patient off insulin or other expensive anti-diabetes medications is cost-saving within two to three years of surgery: a win-win for the GP, the NHS and the taxpayer. Patients are also more likely to go back to work, and therefore pay more tax and claim fewer benefits.

I believe the problem is that commissioners and medical professionals, like the public, still see obesity as a lifestyle choice, and so blame patients. But there is a point of no return with obesity. There are parallels with other diseases. You may well suggest to someone who is a bit down in various ways for them to try and improve their mood, but once they become clinically depressed expert treatment is needed. We encourage our friends to stop smoking, but we don’t then begrudge them treatment for lung cancer.

Yet the reluctance to treat obesity lingers. Some argue that resources should be directed to prevention rather than treatment. Whenever possible, prevention is obviously better than cure. But this is no longer an option for people who have missed the boat of prevention and have gone on to develop severe, complex obesity with conditions such as diabetes.

Patients should be given quicker access to surgical assessment. If bariatric surgery is right for them, then the sooner the better. We already know that the UK is one of the most obese countries in Europe, and the patients we operate on are the sickest. The NHS should be performing 50,000 surgeries a year, closer to the European average.

To achieve this, health workers must be persuaded to put prejudice to one side and promote surgery where appropriate. GPs and commissioners alike must recognise both the health benefits and cost savings.

All the clinical evidence points to the fact that, as a country, we should be performing more weight-loss surgeries. It is the social stigma of obesity that is holding us back. Making fun of obese people is an endemic societal prejudice, and stigmatisation is allowed – and even encouraged – by the media. It’s time to stop judging and let the experts start treating the condition.

Richard Welbourn is a consultant bariatric surgeon at Musgrove Park Hospital, Taunton

Obese people deserve surgical treatment, too | Richard Welbourn

One in four people in the UK suffer with obesity. Severe and complex obesity is a lifelong condition associated with many major medical problems, the costs of which threaten to bankrupt the NHS. The major ailment caused by obesity – type 2 diabetes – is linked to shorter life expectancy, decreased quality of life and increased socio-economic and psychosocial problems. A new report out this week suggests the global cost of treating obesity will rise to $ 1.2tn a year from 2025.

Yet in the UK, less than 1% of those who can benefit from it receive bariatric (sometimes called weight-loss) surgery, such as gastric bypass or gastric banding. So why is a safe, cost-effective therapy for a deadly disease so under-utilised?

For severely obese people, the hormonal effects of being obese mean that medical therapies, lifestyle changes and attempts at dieting rarely succeed in maintaining long-term, clinically beneficial weight loss. It isn’t just surgeons saying this – it is described in guidance by the British Obesity and Metabolic Surgery Society which is endorsed by 21 other professional organisations, including nine medical royal colleges.

The World Health Organisation identifies obesity as a chronic disease. But on the other side we have the popular perception – shared by some healthcare professionals – that it is purely a lifestyle choice. This totally disregards the fact that, driven by powerful food industry advertising, it is those who are poor who are most affected. Our tendency towards obesity is rooted in evolutionary biology: human beings have spent two million years developing a metabolic system which conserves energy in times of scarcity. It is only in the last 70 years that we no longer eat because of hunger alone.

The annual volume of bariatric surgery in the UK – about 5,000 operations a year – is five to 10 times lower compared with other European countries with similar population sizes and disease prevalence. In France, which has a similar population size to the UK, more than 37,000 surgeries are carried out each year. Belgium, with a population of 11.3 million, undertakes 12,000 surgeries while Sweden, with a population of 9.9 million, carries out more than 7,000 a year.

As a practising bariatric surgeon, I and my colleagues believe the social stigma of obesity is holding back the deployment of cost-effective treatments for vulnerable people. Health commissioners are aware of the figures, but remain slow to increase provision. Cost can’t be the issue. Getting a patient off insulin or other expensive anti-diabetes medications is cost-saving within two to three years of surgery: a win-win for the GP, the NHS and the taxpayer. Patients are also more likely to go back to work, and therefore pay more tax and claim fewer benefits.

I believe the problem is that commissioners and medical professionals, like the public, still see obesity as a lifestyle choice, and so blame patients. But there is a point of no return with obesity. There are parallels with other diseases. You may well suggest to someone who is a bit down in various ways for them to try and improve their mood, but once they become clinically depressed expert treatment is needed. We encourage our friends to stop smoking, but we don’t then begrudge them treatment for lung cancer.

Yet the reluctance to treat obesity lingers. Some argue that resources should be directed to prevention rather than treatment. Whenever possible, prevention is obviously better than cure. But this is no longer an option for people who have missed the boat of prevention and have gone on to develop severe, complex obesity with conditions such as diabetes.

Patients should be given quicker access to surgical assessment. If bariatric surgery is right for them, then the sooner the better. We already know that the UK is one of the most obese countries in Europe, and the patients we operate on are the sickest. The NHS should be performing 50,000 surgeries a year, closer to the European average.

To achieve this, health workers must be persuaded to put prejudice to one side and promote surgery where appropriate. GPs and commissioners alike must recognise both the health benefits and cost savings.

All the clinical evidence points to the fact that, as a country, we should be performing more weight-loss surgeries. It is the social stigma of obesity that is holding us back. Making fun of obese people is an endemic societal prejudice, and stigmatisation is allowed – and even encouraged – by the media. It’s time to stop judging and let the experts start treating the condition.

Richard Welbourn is a consultant bariatric surgeon at Musgrove Park Hospital, Taunton

Obese people deserve surgical treatment, too | Richard Welbourn

One in four people in the UK suffer with obesity. Severe and complex obesity is a lifelong condition associated with many major medical problems, the costs of which threaten to bankrupt the NHS. The major ailment caused by obesity – type 2 diabetes – is linked to shorter life expectancy, decreased quality of life and increased socio-economic and psychosocial problems. A new report out this week suggests the global cost of treating obesity will rise to $ 1.2tn a year from 2025.

Yet in the UK, less than 1% of those who can benefit from it receive bariatric (sometimes called weight-loss) surgery, such as gastric bypass or gastric banding. So why is a safe, cost-effective therapy for a deadly disease so under-utilised?

For severely obese people, the hormonal effects of being obese mean that medical therapies, lifestyle changes and attempts at dieting rarely succeed in maintaining long-term, clinically beneficial weight loss. It isn’t just surgeons saying this – it is described in guidance by the British Obesity and Metabolic Surgery Society which is endorsed by 21 other professional organisations, including nine medical royal colleges.

The World Health Organisation identifies obesity as a chronic disease. But on the other side we have the popular perception – shared by some healthcare professionals – that it is purely a lifestyle choice. This totally disregards the fact that, driven by powerful food industry advertising, it is those who are poor who are most affected. Our tendency towards obesity is rooted in evolutionary biology: human beings have spent two million years developing a metabolic system which conserves energy in times of scarcity. It is only in the last 70 years that we no longer eat because of hunger alone.

The annual volume of bariatric surgery in the UK – about 5,000 operations a year – is five to 10 times lower compared with other European countries with similar population sizes and disease prevalence. In France, which has a similar population size to the UK, more than 37,000 surgeries are carried out each year. Belgium, with a population of 11.3 million, undertakes 12,000 surgeries while Sweden, with a population of 9.9 million, carries out more than 7,000 a year.

As a practising bariatric surgeon, I and my colleagues believe the social stigma of obesity is holding back the deployment of cost-effective treatments for vulnerable people. Health commissioners are aware of the figures, but remain slow to increase provision. Cost can’t be the issue. Getting a patient off insulin or other expensive anti-diabetes medications is cost-saving within two to three years of surgery: a win-win for the GP, the NHS and the taxpayer. Patients are also more likely to go back to work, and therefore pay more tax and claim fewer benefits.

I believe the problem is that commissioners and medical professionals, like the public, still see obesity as a lifestyle choice, and so blame patients. But there is a point of no return with obesity. There are parallels with other diseases. You may well suggest to someone who is a bit down in various ways for them to try and improve their mood, but once they become clinically depressed expert treatment is needed. We encourage our friends to stop smoking, but we don’t then begrudge them treatment for lung cancer.

Yet the reluctance to treat obesity lingers. Some argue that resources should be directed to prevention rather than treatment. Whenever possible, prevention is obviously better than cure. But this is no longer an option for people who have missed the boat of prevention and have gone on to develop severe, complex obesity with conditions such as diabetes.

Patients should be given quicker access to surgical assessment. If bariatric surgery is right for them, then the sooner the better. We already know that the UK is one of the most obese countries in Europe, and the patients we operate on are the sickest. The NHS should be performing 50,000 surgeries a year, closer to the European average.

To achieve this, health workers must be persuaded to put prejudice to one side and promote surgery where appropriate. GPs and commissioners alike must recognise both the health benefits and cost savings.

All the clinical evidence points to the fact that, as a country, we should be performing more weight-loss surgeries. It is the social stigma of obesity that is holding us back. Making fun of obese people is an endemic societal prejudice, and stigmatisation is allowed – and even encouraged – by the media. It’s time to stop judging and let the experts start treating the condition.

Richard Welbourn is a consultant bariatric surgeon at Musgrove Park Hospital, Taunton

Obese people deserve surgical treatment, too | Richard Welbourn

One in four people in the UK suffer with obesity. Severe and complex obesity is a lifelong condition associated with many major medical problems, the costs of which threaten to bankrupt the NHS. The major ailment caused by obesity – type 2 diabetes – is linked to shorter life expectancy, decreased quality of life and increased socio-economic and psychosocial problems. A new report out this week suggests the global cost of treating obesity will rise to $ 1.2tn a year from 2025.

Yet in the UK, less than 1% of those who can benefit from it receive bariatric (sometimes called weight-loss) surgery, such as gastric bypass or gastric banding. So why is a safe, cost-effective therapy for a deadly disease so under-utilised?

For severely obese people, the hormonal effects of being obese mean that medical therapies, lifestyle changes and attempts at dieting rarely succeed in maintaining long-term, clinically beneficial weight loss. It isn’t just surgeons saying this – it is described in guidance by the British Obesity and Metabolic Surgery Society which is endorsed by 21 other professional organisations, including nine medical royal colleges.

The World Health Organisation identifies obesity as a chronic disease. But on the other side we have the popular perception – shared by some healthcare professionals – that it is purely a lifestyle choice. This totally disregards the fact that, driven by powerful food industry advertising, it is those who are poor who are most affected. Our tendency towards obesity is rooted in evolutionary biology: human beings have spent two million years developing a metabolic system which conserves energy in times of scarcity. It is only in the last 70 years that we no longer eat because of hunger alone.

The annual volume of bariatric surgery in the UK – about 5,000 operations a year – is five to 10 times lower compared with other European countries with similar population sizes and disease prevalence. In France, which has a similar population size to the UK, more than 37,000 surgeries are carried out each year. Belgium, with a population of 11.3 million, undertakes 12,000 surgeries while Sweden, with a population of 9.9 million, carries out more than 7,000 a year.

As a practising bariatric surgeon, I and my colleagues believe the social stigma of obesity is holding back the deployment of cost-effective treatments for vulnerable people. Health commissioners are aware of the figures, but remain slow to increase provision. Cost can’t be the issue. Getting a patient off insulin or other expensive anti-diabetes medications is cost-saving within two to three years of surgery: a win-win for the GP, the NHS and the taxpayer. Patients are also more likely to go back to work, and therefore pay more tax and claim fewer benefits.

I believe the problem is that commissioners and medical professionals, like the public, still see obesity as a lifestyle choice, and so blame patients. But there is a point of no return with obesity. There are parallels with other diseases. You may well suggest to someone who is a bit down in various ways for them to try and improve their mood, but once they become clinically depressed expert treatment is needed. We encourage our friends to stop smoking, but we don’t then begrudge them treatment for lung cancer.

Yet the reluctance to treat obesity lingers. Some argue that resources should be directed to prevention rather than treatment. Whenever possible, prevention is obviously better than cure. But this is no longer an option for people who have missed the boat of prevention and have gone on to develop severe, complex obesity with conditions such as diabetes.

Patients should be given quicker access to surgical assessment. If bariatric surgery is right for them, then the sooner the better. We already know that the UK is one of the most obese countries in Europe, and the patients we operate on are the sickest. The NHS should be performing 50,000 surgeries a year, closer to the European average.

To achieve this, health workers must be persuaded to put prejudice to one side and promote surgery where appropriate. GPs and commissioners alike must recognise both the health benefits and cost savings.

All the clinical evidence points to the fact that, as a country, we should be performing more weight-loss surgeries. It is the social stigma of obesity that is holding us back. Making fun of obese people is an endemic societal prejudice, and stigmatisation is allowed – and even encouraged – by the media. It’s time to stop judging and let the experts start treating the condition.

Richard Welbourn is a consultant bariatric surgeon at Musgrove Park Hospital, Taunton

So the Tories want to be ‘cool’ to attract young people. They don’t understand | Abi Wilkinson

Among a certain section of the Conservative commentariat, there’s been a lot of chatter about the cultural factors encouraging young people to support Labour. Unwilling to take the steps necessary to address material issues such as spiralling housing costs, wage stagnation and the casualisation of employment, they hunt for alternative answers. Increased higher-education participation is exposing younger generations to the pernicious propaganda of Marxist academics. The nebulous, intractable characteristic that is “coolness” – and how the left seems to have a monopoly on it nowadays.

The thing is, it’s not only teens and 20-somethings who the Conservatives are struggling to appeal to. YouGov has identified that anyone under 47 is statistically more likely to back Labour. It’s embarrassingly obtuse to suggest this trend might be reversed if they could only get a few grime artists on their side.

Actually listen to them speak, and young Labour voters will explain their concerns. They are stuck on zero-hours contracts earning barely more than minimum wage, with no guarantee they will be able to make rent from one month to the next. Some are reliant on disability benefits and – despite the comparative weakness of the 2017 Labour manifesto on this topic – trust Jeremy Corbyn because of his consistent history. They are freelancers who earn a liveable income when things are going well, but know it could disappear at any moment.


They cite the looming threat of climate change as a reason they are hesitant to bring children into the world

For increasing numbers of working-age people, the defining theme of their lives is insecurity. Insecure employment. Insecure, impermanent housing. And for many, there is a more existential feeling of insecurity that comes from living at this exact moment in time, with the knowledge that we’re teetering on the edge of a climate precipice.

When I talk to friends about the future, they often mention financial difficulties as a barrier to settling down and perhaps starting a family. Equally commonly, though, they will cite the looming threat of climate change as a reason they are hesitant to bring children into the world. And it’s not only big decisions that are guided by fear of environmental disaster – your whole outlook changes when total social collapse feels like a realistic possibility in your lifetime. It’s constant background music, preventing you ever getting too comfortable regardless of your current material circumstances. Even if you’re lucky enough to have a decent employer-arranged pension scheme, who knows what the world will look like when you’re old enough to cash it in?

Countless trend pieces have been written about millennials’ tendency to live in the moment, and our preference for spending money on experiences rather than objects. But rarely does there seem to be any focus on the structural factors driving these behavioural changes. Many older commentators expressed surprise at a recent piece of research by YouGov, which found that 18- to 28-year-olds list climate change as their top political priority. Some of those same individuals previously scoffed at research showing younger people experience anxiety and other mental health issues at a higher rate than older demographics smugly chuckling about “safe spaces” and the “snowflake generation”. I’m not sure it has even occurred to them that these two things might be related, despite data showing almost half of 18- to 30-year-olds feel worried about the future. Immediate financial stresses and longer-term fears combine to induce an overwhelming feeling of precarity.

Of course, mine is far from the first generation to come of age in the shadow of a looming catastrophe. I imagine the ever-present threat of nuclear annihilation must have influenced many people’s outlook throughout the cold war. During both world wars, people’s lives had very little certainty at all. Soldiers on the frontline knew every day might be their last. Families waiting at home worried they would lose a father, husband or son – and plenty did. A bomb might have reduced their homes to rubble in an instant. Invasion and occupation was a terrifying possibility.

What’s unique about the current context, though, is that the threat isn’t an external entity bringing about unwanted change. The danger is that things carry on exactly as they are. Free-market capitalism has driven the reckless production, consumption and pollution that now threatens continued existence of our species. To avoid our obliteration, it will require stringent government regulation and international cooperation. President Trump’s fossil fuel advocacy and hostility to climate cooperation have made him a symbol of capitalist destruction.

Reaching adulthood around the time of the financial crisis had already given us reason to question the current economic system – lectures from Conservative prime ministers about the wonders of the free market are unlikely to convince when you’re up to your eyeballs in debt, spending half your income on rent and constantly terrified that your employer might cut your hours. People my age are not necessarily avowed anti-capitalists, but there’s a genuine appetite for change. Scaremongering about even the moderate, social democratic reforms proposed by Labour sounds ludicrous when the existing arrangement so clearly isn’t working. And a politics focused on maintaining the status quo seems grossly negligent when the fate of our entire ecosystem hangs in the balance.

Conservatives need to understand that the comparative political radicalism of younger generations isn’t some strange quirk or foible – it’s a rational response to the world as we find it. As living standards decline, financial insecurity rockets and an unprecedented volume of extreme weather events wreak havoc across the globe, the more confusing position is to insist that everything will be fine if we just carry on as we are.

Abi Wilkinson is a freelance writer

Older people don’t need to suffer depression or anxiety in silence | Ann Robinson

Nearly half of all adults surveyed for AgeUK say they have experienced depression or anxiety, but many feel they have to keep a stiff upper lip and soldier on rather than seek help. There has been some great work in raising awareness and tackling the stigma of mental health problems, spearheaded by the glamorous young royals, but it tends to be aimed at young people, with little or no emphasis on elderly people. For them it’s a triple whammy: they are less likely to seek help, GPs may not recognise the signs, and society may expect depression to be a natural consequence of ageing, loss and loneliness.

NHS England is encouraging GPs to look out for mental health problems in older patients, and offer interventions – talking therapies or medication – as appropriate. But is it true that depression is an inevitable part of ageing? Is the older generation more stoical? Are the young more flaky? And how can you tell if you have depression yourself, or if an older friend or relative is suffering unnecessarily?


Research has found older people respond extremely well to talking therapies

It is true that older people may have to put up with bereavement, pain, financial concerns, loneliness and ill health – and all of those can trigger depression and anxiety if you’re susceptible. But it’s not inevitable; people in the UK report being at their happiest between the ages of 65-79 (though happiness levels plummet after the age of 90). In the AgeUK survey, 21% of the people who reported suffering from anxiety or depression said their symptoms had worsened with time – but that left nearly 80% who didn’t feel their mental health had worsened.

Looking at suicide rates – arguably the most extreme expression of unbearable mental distress – the group at greatest risk are men aged 40 to 44. People are less likely to take their own life in their 60s than in their 30s but, of course, every suicide can be seen as a potentially preventable tragedy and there is no room for complacency at any age. The need to identify those individuals at any age who are most at risk and in need of expert intervention, is a priority for all healthcare professionals.

Mental health problems can be tricky – it is hard to know if a relative or elderly friend is sinking gradually into severe depression, or becoming paralysed by debilitating anxiety. It’s even hard to know yourself: when does feeling fed up, sad and a bit socially isolated tip into depression? When does fretting about grandkids, money and the state of the world become unmanageable anxiety? And even with all the training, time and sensitivity in the world, any GP can miss the signs if a person is determined to present a positive front.

The mood self-assessment quiz on the NHS Choices website is a good starting point. GPs also use a range of screening tools, but the simplest version consists of just two questions: over the past two weeks, have you felt little interest or pleasure in doing things? And: have you felt down, depressed or hopeless? You don’t need to be a doctor to ask yourself, a friend or an elderly relative these questions, and see a GP if the answers are a resounding “yes”.

The NHS primer for GPs says an interesting thing; how a patient makes the GP feel is often a good reflection of how that person is feeling. “A person who consistently annoys you could well be depressed or have a personality disorder, and a person who perplexes you might be psychotic.” Specific questions can help, such as: “Do you enjoy seeing your grandchildren?”

And it’s such a shame to miss the signs of poor mental wellbeing because there is help out there. Research has found older people respond extremely well to talking therapies, and medication may be safe and effective. Nearly three-quarters of the people in the AgeUK survey felt that having more opportunities to connect with other people, such as joining local activity groups, would be positive.

The message is clear: depression and anxiety are not an inevitable part of ageing. Older people don’t need to suffer in silence. There’s help out there. We all have a role to play in making sure that anyone who needs it, speaks up. Stoicism and resilience are fine qualities, but you get no prizes for mental anguish that could, potentially, be assuaged.

Ann Robinson has been a GP for 16 years

In the UK, Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org