On 16 August 2013, the High Court refused Luis Almario special leave to attempt to reverse the decision made by the lower Court which denied him compensation previously ordered to be paid by his general practitioner. Mr Almario and more importantly his wife and young children have been left not only devastated by the result but also penniless.

Could specialist treatment have saved his life?

Mr Almario’s case was always treated as one involving a fat man who was suing his doctor for not assisting him to lose weight. This is of course not what the case was about. It was about a man who had a deteriorating liver and allegedly denied the opportunity of proper treatment through referral to appropriate specialists, commencing with a liver specialist. The case was argued on the basis that through referral to this liver specialist, as conservative methods of losing weight had failed in Mr Almario’s case, eventually bariatric surgery would have been recommended, performed and in all likelihood its success would have reversed or delayed the deadly effects of Mr Almario’s deteriorating liver. As it happened, Mr Almario was not afforded this treatment and his liver condition deteriorated to the point of no return.

Due to the fact that the ultimate treatment for Mr Almario’s liver would have been by way of addressing his obesity, the case became controversial. It struck a chord with many a health practitioner and the general line of defence revolved around how far a doctor is expected to go to assist a patient in weight loss. There has always been consensus that the role of a general practitioner is pivotal to a patient’s health. What the case highlights however is society’s perception of the obese person. It does not seem to be recognised, surprisingly, that obesity and particularly as in Mr Almario’s case, morbid obesity, is a disease. The aetiology of obesity is no doubt complex. We all know that it occurs in epidemic proportions in this country. It is associated with serious co-morbidities, including diabetes, obstructive sleep apnoea, respiratory impairment and liver disease. Mr Almario had all of these problems including liver disease. His liver became the most serious problem. It is the problem that is now killing him. That liver problem deserved more robust treatment.

Despite the legal outcome, Mr Almario’s legacy has already made a difference. The case has called into question the deeply entrenched view held by society on the plight of the obese person. The traditionally held view that self responsibility remains the mode of treatment for obesity is contrary to the findings of medical science. When that obesity is creating a life-threatening health consequence, as in Mr Almario’s case, patients need to be treated as they would be if faced with any other life-threatening condition; that is with care.