Re: this article.

A mother chooses to disclose the contents of a private letter telling her that her son that he’s on the 98th centile for BMI. She does this by calling him “fat”. This upsets him. So she has a picture of him printed in a national newspaper with a report explaining that he’s reportedly “fat”. And then blames the NHS. Exasperating!

Perhaps the letter she received needs refining. Perhaps a letter isn’t the appropriate way to communicate this info.

But the bare choice is between:
a) Not monitoring children’s health
b) Monitoring but not disclosing the results
c) Monitoring and giving advice to parents of children with a high BMI

I can only ever see “c” being the ethical option.

Would this mother really have preferred not to know that her child is at statistically increased risk of a variety of diseases? Would she really rather not have been given advice on how to help? Was it really ethical of the Daily Mail to cash in on her unhappiness rather than pointing her in the direction of her GP?

I suspect the answer to all three is “no”.

Rant over.

A story is doing the rounds today, much like recent similar stories, about a child called Tom Halton and receipt of a letter telling his parents that his BMI was higher than expected for his age.

Before I go any further with this post, I need to point out that the BBC are talking rubbish about the story. Their second paragraph:

Tom Halton, 11, of Barnsley was told he was overweight after taking part in a national scheme which measured children’s body mass index.

Not true. The letter was sent to Tom’s parents, not Tom. They chose to share it with him. This upset Tom, and he didn’t eat his dinner that night.

The facts are these: Tom’s BMI is heavier than 93% of children his age. The World Health Organisation classifies him as overweight. An increased childhood BMI is associated with lifelong adult illness, in particular Type II Diabetes.

Yes, there are problems with using BMI for purposes like these, particularly in children, and the letter should have acknowledged those more clearly. But it is wrong to simply ignore the best indicators we have in children of their future adult health.

Tom’s dad said:

These letters are doing more harm than good. You might as well send a T shirt with FATTY on it. The impression it gives is that your child is fat, it’s your fault and they will die from a horrible disease.

The letter is not the best written in the world, but it makes the point fairly clearly that the high BMI increased Tom’s risk of future illness. Which, to be blunt, it does.

As for the T-shirt comment, it strikes me firstly that it was the parents who shared this letter with their child, and have now plastered him over the papers with headlines calling him “fat”. Why?

I note that the “grovelling apology” from the DoH actually apologises for causing the parents offence if they felt their parenting skills were being derided – which is not suggested at any point in the letter.

So where do Dan and Tracy Halton suggest we go from here? I’m genuinely interested to hear their views – and yours. Do we inform parents of modifiable statistical risks to their children’s health and wellbeing, or not? If so, how do we go about it? Is writing to parents not the best way to tackle this? Would individual consultation where the full facts could be clearly explained be a better option? Or does that come across as being “summoned to the headmaster’s office”, and yet more punitive (and expensive)?

What do we do? How do we tackle this? I’d love to know your thoughts.

Some years ago, when I used to be involved in public speaking and debating competitions, I relied heavily on one strategy: Choose the most ridiculous point of view, and argue forcefully for it.

Thus, over a time, I ended up arguing in favour of littering, staunchly defending the poaching of endangered species in Africa, and strongly advocating the bypass an upcoming election and the simple investiture of me as the next Prime Minister.

This strategy always served me well. It allowed for wit, a re-examination of issues from a completely new perspective, and – ultimately – the chance to guide people down a seemingly sensible path to a position where the most absurd solution suddnely becomes the most logical.

This is actually something that’s really quite simple to do, and it always attracts attention – and, in my context, often attracted prizes.

Having seen today’s Daily Mail, I’m beginning to wonder whether Amanda Platell is employing the same strategy to boost her fledgling career. Unfortunately for her, she’s terrible at it.

In an admittedly arresting column, Platell tries to argue against preventative medicine. There are many well rehearsed arguments against preventative medicine, not least that the logical conclusion is that everybody is in need of some form of ‘treatment’, the cost of which will ultimately be unsustainable within the NHS.

But Platell tries to be provocative, by picking on ‘fat people’. She suggests that fat people should not be supported by the NHS to lose weight, as the money would be better spent on Herceptin and Aricept.

She’s comparing the furore surrounding the delayed provision of drugs whilst evidence about them is weighed against their cost effectiveness with the provision of weight loss treatments which are not only proven to work, but allow a person to improve their physical wellbeing to a point that they are likely to use fewer NHS resources in future.

This would possibly be passably illogical – after all, one has to skirt around the logic of an issue to convince people that something ridiculous is right – had she not then gone and pointed out the flaw in her theory in the fourth sentence, where she points out the long term costs of providing knee replacements, hip replacements, back pain treatments, and mobility aids to fat people. But Amanda! If we stop the people being fat, those costs disappear!

She points out that the patients of her friend who works in an NHS weight-loss clinic – a ‘friend’ she evidently wants to see sacked – don’t know what foods are healthy and unhealthy, and then suggests that withdrawal of services advising them on healthy eating would ‘shock a huge number of the overweight’ into losing weight.

She talks about her childhood in “post-war, food-scarce, ration-booked Britain”, despite growing up in Perth, Australia, and being born three years after rationing ended.

Right at the end of her column, she slips in that alcohol and tobacco are equally ‘the result of individuals choosing an unhealthy lifestyle”, and we should only treat the malignant results of these aberrations rather than stop the original cause.

There was a time when I liked Amanda Platell’s writing. Back in her New Statesman days, her column would be a must-read. I rarely agreed within anything she said, but in a strange way, that made it all the more compelling.

So why is she wasting her time writing sub-standard articles for the Daily Mail – not quite spiteful enough to be Melanie Phillips, not quite outraged enough to be Richard Littlejohn, and not quite far enough up her own backside to be Quentin Letts?