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BMI The Wrong Selection Criterion

March 12, 2014

Obesity and fertility

How fair is the NHS’s policy on funding based on BMI ?

Introduction

IVF is not funded for women whose BMI is above 30. Whilst this is well intended, we think this is a simplistic policy. Using BMI as the sole metric for obesity is wrong.

Why did this restriction come into force?

1.      Fertility treatment has always been the first item on the chopping block whenever the department of health needs to cut costs. Fertility is seen as a “life enhancing” treatment through most couples seeking fertility would not agree. Since it is not life threatening in any case, there will always be a tendency to reduce the money spend on fertility and by restricting the number of eligible clients, the DoH in effect relying the policy of “divide and rule”. The high BMI sub group of the group of infertile couple aims small enough to be chopped without expecting an outcry. Besides the women are made to feel guilty and thus they are less likely to complain.

2.      The scientific argument is that, success of IVF in those with high BMI and low as compared to those with normal BMI. Whilst this may really be the case, most studies will suggest that morbid obesity (BMI higher than 35) is where the success is less. Very few women are that obese. Not offering it to women of BMI about 30 is being too harsh, simply because the success may be a shade lower.

BMI is too simplistic

There is a fundamental scientific argument against accepting BMI as the final parameter of judging if somebody is obese or not. There is a much longer discourse I have on this topic that I have say the BMI skewed against athletic woman in general and black woman in particular.

BMI simply calculates weight upon square of height. Since muscles weighs more than fat, athletes with high muscle mass tend to have a very high BMI though that have far less fat than the average individual. Black women, for genetic reason, have bones which have 15%-20% denser and thus heavier than white or Asian women. Since they also tend to be more muscular than the other ethnic groups, it is not very uncommon for averagely healthy looking black women to have a BMI above 30.

The moral and ethical view point

IVF treatment is successful effectively, in only 30% to 40% of cases (take home baby rate). It means that twice as many women are likely to fail in an attempt in an IVF than those who succeed.  The government seems to forget that even if the attempt of IVF is unsuccessful, there is a satisfaction the couple get that atleast, they gave it their best shot. That the NHS denies them a right to even try, makes it worse for them. Having an attempt at IVF funded by the the NHS, gives the couple a feeling that through the NHS, the society has emphasized with their problem. If they are denied that, it is as if they are being censured for wanting a baby. There is also the suggestion that the woman has somehow brought it on herself by “choosing” to be obese.

Being denied an attempt at IVF for “being obese” is really adding insult to injury.

If you really care about helping the obese woman, this isn’t the way

Most doctors (like most middle aged people) have a strguggle with their weight. I have been trying hard for the best part of the last 30 years to keep a grip on the matter and sometimes i succeed and most often i don’t. I am not much different from my patients. But they don’t critisize me for not doing what is good for my health. I think, likewise, doctors should really support women in their attempt to lose weight without being critical or demanding. Putting a strict BMI 30 criterion, is doing just the opposite.

An attitude of blaming women for being obese is most unhelpful. It is a complex problem or perhaps a simple manifestation of a very complex internal mechanism that has input from economic, social and various other circumstances, most of which are not of the clients choosing. I am not denying that weight loss is important but if we can’t help our clients lose weight the the team should regard it as their own failure instead of blaming the patient. That would be a professionally responsible attitude. But we have chosen the easier option.

At our centre we have put together a team of yoga experts and dieticians and psychologists who will all help the woman to address her own circumstances and help her lose weight.

 

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