The proposal by the health secretary, Wes Streeting, that weight-loss drugs could be provided to unemployed people deemed to be obese, as a way to help them get back to work and ease the demands on the NHS caused by obesity, should raise ethical alarms (Employers should be fined for unhealthy workplaces, says thinktank, 16 October).
Would taking the drug be voluntary, or would it become a condition for entitlement to benefits? Recalling Labour’s previous support for conditionality and sanctions, one can guess which way it would go.
Would giving drugs for obesity be a precedent for drugs for other medical conditions deemed to affect the probability of obtaining jobs? Many who become unemployed become depressed. Will the Department for Work and Pensions insist on their taking antidepressants, or lose benefits? Many unemployed people become angry. Will they be given anger‑suppressing drugs?
Another set of ethical issues relates to the implied selectivity. Will anti-obesity drugs be provided for free just to the unemployed, or to all who wish to lose weight? The latter would be impractical, but any form of discrimination would raise questions of fairness.
It is also worrying that research suggests that weight-loss drugs could have unfortunate medical side-effects. And once on the drug, a person may have to stay on it to avoid regaining any lost weight.
In short, medical policy should be based on medical criteria, not on grounds of dubious instrumentality.
Dr Guy Standing
Professorial research associate, Soas University of London
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