‘It’s this gastric band. It’s not working. Something has to be done, Doctor!’
I’d never met Donna, the woman sitting in front of me, before, but I recognised her. Every morning I pop into the local Tesco Express near my surgery to grab a sandwich for lunch. Normally this task is carried out in a foggy blur of early-morning grogginess; I rarely notice my fellow shoppers. However, today had been an exception. And now, the patient facing me in my office, I realised, had been in front of me in the check-out queue that morning. She had caught my attention because she’d bought herself an entire chocolate cheesecake for breakfast and proceeded to tuck into it even before she’d left the shop. Please don’t think that I am some sort of evangelical health-food fanatic; chocolate, cheese and cake are three of my favourite things. A chocolate cheesecake is a thing of great splendour, something in which I have indulged on many occasions, but this was 7.45 on a Monday morning. Who eats a chocolate cheesecake for breakfast?
‘What’s been going on then?’ I asked Donna.
‘Well, when I eat, I always feel sick. I think there’s something wrong with the gastric band. I’m not even losing weight.’
Even without a gastric band I think that eating an entire chocolate cheesecake for breakfast would have made me feel a tad nauseous. Thanks to a bariatric operation, my patient had a band restricting her stomach to only a quarter of the normal capacity. If today’s breakfast was representative, of course she was going to feel sick after meals.
‘Who put the band in?’
‘The NHS wouldn’t do it so I had to go private, but I can’t afford to go to see them again. It cost me a bloody fortune to do it in the first place. What a waste of money.’
Looking through the notes I could see that Donna had come in many times over the last few years requesting help with weight loss. A previous GP had referred her to have a gastric band fitted on the NHS, but the request had been rejected because she didn’t fulfil the criteria: patients need to have spent at least two years trying to lose weight through exercise and diet programmes. Clearly not prepared to wait, Donna had found the money to get the op done privately.
I’m not against the idea of weight-loss surgery being performed on the NHS. Ideally we would all be slim and healthy due to vigorous diets and abundant exercise, but the reality is not that straightforward. Many people simply can’t manage to control what they eat and so end up overweight. When the weight starts getting to dangerous levels, a gastric band can completely turn someone’s life around. Some might argue that the cost of the procedure should never be fronted by the taxpayer, but successful gastric band operations can often cure expensive diseases such as diabetes and high blood pressure, returning to health and work people who were previously facing a future of illness and disability. The potential savings to the taxpayer are enormous.
Most patients who have a bypass operation simply can’t manage big meals any more. They feel full and sick if they eat too much, and soon learn to lessen their portion sizes. But I guess Donna was finding that old habits die hard.
‘Donna, I don’t think you need to see a surgeon. The gastric band is doing what it’s supposed to do.’
‘But this band makes me feel sick all the time.’
‘No, you will feel sick if you try to eat as much as you did before the operation.’
‘But I never really ate much anyway and now I eat even less.’
Donna looked suitably insincere – so much so that I didn’t feel I needed to mention that I had witnessed her choice of breakfast that morning.
‘Let’s make a deal. I want you to promise that you’ll make a massive effort to eat much smaller portions of food for the next two weeks. If you can do that but find you are still feeling sick I’ll refer you to the surgeons on the NHS.’
Donna nodded with what I took to be genuine earnestness, and, sure enough, she didn’t return. I’m hoping that next time I see her, the nausea will have gone and along with it some of the weight.