The Unintended Consequences of Government-Sponsored Weight-Loss Surgery

Here’s how Darin McCloud, a 45-year-old man in Portsmouth, England, has been eating lately:

He has been scoffing three-quarters of a loaf of bread, several packets of crisps and bacon rolls every day, and tucking into chips, takeaways and junk food for his tea.


Because, according to the Mirror, he wants to lose weight.

And McCloud has apparently decided the best way to lose weight is to have gastric-bypass surgery. (We once wrote a column on this topic.) The problem is that, at 20 stones (280 pounds), he doesn’t quite meet the requirements for NHS-sponsored gastric surgery. So he’s trying to eat his way up to the limit:

“The reason why I want the operation is to help my diabetes. It will help me stop being on insulin and help me with my other problems. I have had diabetes for the best part of 15 years and I’m absolutely scared of being a burden on my family in the future.”

Can you imagine what would happen if Alcoholics Anonymous decided to require a certain level of alcohol intake?

(HT: Colin Gray)


Sounds like an episode of "The Simpsons" to me. One of the better ones, in my opinion...

Ted Han

The real problem with gastric bypasses and surgeries like it, is that it's not not an actual solution to weight gain or maintaining a healthy weight. It is a tool which should be used in conjunction with life style changes ideally supported by health professionals like dietitians.

Unfortunately neither the public at large, or politicians understand this, which has lead to wonderful situations like the one in Ontario, where the government will pay and perform for gastric bypass surgery with minimal support or planning for a patient's care after the procedure.

Arbitrary weight limits aren't the root problem, they're a symptom of a failure to understand an implement sensible plans of care.

This guy should go see a dietician, and if he's serious about losing weight, figure out a plan to lose weight. Maybe that should include gastric bypass. But the fact that he's reaching for this w/o consultation w/ a health professional is like someone walking into a doctor complaining about leg pain and insisting upon an amputation. Proceed with care (pun intended).



This may be an unintended consequence, but I doubt that the "government-sponsored" part plays into it. I would guess that the reasons for the weight limit are less to do with financial reasons and more to do with the relative risks of having the surgery versus being "only" 280 pounds.


How is this a consequence of "government sponsored" health care? Private insurance companies and medical professionals in the US have standards and guidelines for when they will pay for and perform a gastric bypass surgery do they not? Would, if the story was about a US citizen who didn't meet the minimum standards of his HMO, have the headline 'The Unintended Consequences of Private Insurer Weight-Loss Surgery'?


If he had private health insurance, they would also have a standard for gastric bypasses. NHS in this case is doing what any insurer would do: setting a care standard. The government is only involved because it stands behind NHS.


This proves yet again that the British have an even stranger relationship to health and healthcare than Americans.

Mike B

Instead of a weight standard the government should use a cost effectiveness metric that compares the savings from the weight related miladies vs the cost of the surgery. If there is any shortfall they can always have the patient make up the difference instead of outright denying the procedure.

Michael Y

@ #2: "The real problem with gastric bypasses and surgeries like it, is that it's not not an actual solution to weight gain or maintaining a healthy weight."

But his goal in getting the gastric bypass surgery is not primarily weight loss, it's treating his diabetes. And, for reasons that are not well understood, gastric bypass surgery is extremely effective at treating diabetes -- effectively curing it in the vast majority of patients. Further, the diabetes reversal appears to be independent of weight gain -- it often occurs well before any significant weight loss has occurred.

"But the fact that he's reaching for this w/o consultation w/ a health professional is like someone walking into a doctor complaining about leg pain and insisting upon an amputation."

Read the article. His doctor, a diebetes specialist, is recommending that he have the surgery.


Brilliant! I had a similar idea when I didn't quite qualify for a heart transplant. So I resumed smoking and heavy drinking. Then I stopped exercising. My cardiologist says I'm almost there.

Michael Y

One more comment :

"Because, according to the Mirror, he wants to lose weight."

In fact, the Mirror article never actually says he wants to lose weight -- that's entirely Dubner's spin. The article is focused on his diabetes and surgery as a means of treating it. And, as I mentioned above, the benefits of gastric bypass surgery for diabetics appear to be independent of any weight loss.


Do you think this problem would still exist if we used a subsidy that ramped up with weight rather than a harsh weight cutoff?

I could see either it either getting better or worse. People might have the marginal incentive to eat that next cheeseburger, but temporal discounting would work in your favor as people would want to get the surgery now with a greater cost instead of waiting to gain weight for a slightly lower cost.


the implications of this post are entirely false- any such behavior on the part of a patient would disqualify them from the surgery- patients have to show marked progress in controlling their weight and blood sugar BEFORE being cleared for it- and this is common sense, as any noncompliance post surgery can cause complications (including death from ruptured sutures)- nice try in mucking the waters tho...

Jackson Jones III

His dietary habits sound like a lot of Brits I know. Chip butties, fried food and great beer. I'm guessing this is all a ruse so that he can eats what he wants without 'er indoors' giving him a hard time. Clever chap.


I know someone who has a gastric bypass in the US and she said several people in her orientation session said they had gained weight so their insurance would cover the procedure.


Another example of faux news. A case of ONE, reported by ONE paper of general circulation, then spun by an "economist" to create another journalistic trip to the woodshed. Proves one can never stoop too low.


lol british people

Malice in Wonderland

I acschept the challenge from Alkies Anonymous. (hic)

JJ III what the heck does 'er indoors' mean? (no doubt I'll be slapping me forehead when you respond).


Mr. Dubner,

Since when did AA start providing medical care for alcoholics? A disappointing false analogy.

Bobby G

Government intervention leads to skewed incentives? This is a surprise! (Sarcasm off) Good read but I agree with the above, the AA analogy doesn't really work for me.


From Wikipedia:

"When used as the unit of measurement, the plural form of stone is correctly stone (as in, "11 stone"), though stones is sometimes used, but not usually by British natives."