To agree with the NHS Trusts to make people lose weight and/or give up smoking before an operation

[Villagebike3]

Im really not looking to antagonise and start a fight. I'm a size 20 so I'm no skinny minni' but I don't smoke. Losing weight (or at least not gaining more) is bloody difficult. I just love to eat and drink, as my dear mother says "eating is the second greatest pleasure in life".

Thing is, our country is running out of money, we can't afford every drug or operation for everyone. I wish we could, but we can't. I believe that however uncomfortable it may be for the individual, there is a need to have a range of criteria. Setting that criteria should be by one organisation/body and should be applied across the whole of the country evenly. At the moment it isn't and that, in my opinion, is wrong.

However, a criteria that includes weight and smoking is not unreasonable. Many Medical problems that require operations or drugs are negatively affected by excess weight and smoking. Smoking increases the risk of infection after operations. A knee operation recovery is affected by excess weight.

Ironically and importantly, the need for the drug or operation in the first place is sometimes negated totally by losing weight or stopping smoking! I'm thinking fertility as one example or sleep apnoea as another.

Goodness knows how much diabetics costs the country, how about a criteria where for continued drugs a certain % of weight each year at an annual check up? If I was diabetic and 12 stone overweight (as my mother in law is), surely being asked to lose, say, 10% of your excess weight each year is just sensible?

My mother in law has been asked that for years and years but does nothing about it as there are no consequences. If she were told no more Metformin till you lose 1.2 stone (at her weight that wouldn't take long), and then knew for a fact that over the next 12 months she would be expected to lose another stone to continue the Metformin, she would.

Isn't it about time we had a financial reality check on what the NHS can afford and say there needs to be a threshold with criteria? Such criteria may not just be weight or smoking, it could be a whole range of criteria, just as long as it is the same across the whole country and it is set in an open and informed way.

My 50 year old husband is 3 stone overweight and has sleep apnoea, it isn't unreasonable to have a criteria that says that before he goes to the sleep clinic, which costs hundreds, that he needs to lose his excess weight, or at least a certain % of it? He is currently doing this.

As I said, I'm a size 20. If I had fertility issues, which are known to be affected by excess weight, shouldn't I have to lose the weight or a % of it before the NHS spend thousands on fertility intervention? In fact I wasn't falling pregnant and had been trying for over a year for my second child, but did fall pregnant after losing a stone and half.

My mum had her hip replacement operation 8 weeks ago, she isn't overweight but has found the recovery really really difficult. One of the things she found hard was for the first 7 weeks she was not allowed to sleep on her side, she had to lie on her back only. Well, if she was overweight with sleep apnoea, lying on her back could have caused a whole host of other problems, costing the NHS yet more money.

Sorry, I've gone on too much. I was just trying to show a logical thought process, not just wanting to piss people off.

[wasonthelist]

How about refusing to treat people who injure themselves due their own reckless driving OP?

BTW I hope your husband doesn't drive - or at least has notified DVLA and his insurer about his sleep apnoea.

I think the fertility criteria you mentioned are probably already being applied.

[angelos02]

I agree. I thought this was already the case actually? Same as alcoholics need to prove they have resolved their issues before a liver transplant?

[GiddyOnZackHunt]

Yanbu to think people should take responsibility for themselves however overall yabu.
Where do you draw the line? People who ride motorbikes? People who cycle? People who go skiing? People who get injured playing contact sports? People who get injured whilst drunk? All of those place you at increased risk even though cycling and sport are good for you.
And private healthcare means none of the above apply to you, so the rich have freedom to make poor choices but everyone else must follow the rules?

[AyeAmarok]

I agree, to an extent. If the treatment or operation is for anything that is exacerbated or even just not helped by smoking or being overweight, then yes, people should have to lose weight or quit smoking before they get the treatment (if it's still needed).

But if someone needs a knee operation and is a smoker and the two are entirely unconnected, then they should of course quit anyway, but their operation shouldn't depend on it.

[Villagebike3]

Totally agree that there needs to be a line drawn. Which is why an open and informed criteria needs to be set. The example of no liver transplant if you are still an alcoholic is true and it isn't a huge step to include cigarettes and obesity.

I don't ski myself, but if a skier broke his leg or sustained a head injury, because he chose to partake in a sport, in my opinion, of course that should be covered. Or any dangerous sport or activity.

But there are issues in our society that are breaking the bank. Smoking and weight are endemic and the country can't afford it.

A friend of the family had lung cancer and had a full operation and chemo etc. he still smokes over 40 a day! He kept going out of the hospital to light up. Yes, I really do think that a criteria of no cigarettes before and after in order to qualify for the medical care.

[AyeAmarok]

And private healthcare means none of the above apply to you, so the rich have freedom to make poor choices but everyone else must follow the rules?

Yeah, but it was ever thus.

Plus, the rich will pay more for their health insurance if they are making bad lifestyle choices (smoking, drinking too much etc, it will have an impact on the premium they pay). If they're paying, then it's their call.

[AppleSetsSail]

I agree with you. One of the good things about a private health care system is that people are financially incentivised to look after their health. Once it's nationalised, there's absolutely no reason to consider the true cost of smoking, drinking, or being overweight or indeed skiing, riding a motorcycle, etc.

I'd like to see drivers and motorcyclists forced to carry an insurance rider to cover their health care costs should they drive either drunk or dangerously. That's pretty easily done. Same for skiing - tack it onto the cost of the lift ticket.

[GiddyOnZackHunt]

Aye and the rich can pay accountants to offshore their wealth so that they pay less tax. Meanwhile they use the NHS for stuff if they want to.

Apple I have never and have no intention of ever drunk driving so why should I pay into a pot for dealing with the injuries of those who do? I'd like to think I don't drive dangerously either but that's more subjective!

[expotition]

The point of the NHS is that it is free at the point of access without discrimination.

If there is solid evidence certain behaviours cause health issues, you can tax those behaviours, or educate people about them, or criminalise them, or otherwise discourage them - but this should be applied at the point of engaging in the behaviour, not at the point of seeking medically necessary care. Taking that approach means people are discouraged from starting (e.g. smoking), which is much more effective than trying to persuade everyone to give up once they've been doing it for so long most of the damage has already been done. Also, focusing on the behaviour means you can apply pressure on other parties than those who bear the health consequences - e.g. tobacco companies, people driving polluting cars, etc - which increases the chance of success.

Encouraging individuals to make healthier choices is great but should not be linked to their access to healthcare, except where the medicine actually won't work unless they change their behaviour.

I get tense when this conversation centres on obesity as (a) efforts to lose weight seem to cause more health issues than obesity and have very low success rates anyway and (b) we have enough body shaming already without people being afraid to mention their chest pains to the doctor because they know they'll just be told to lose weight.

And as PP have said, where do you draw the line? Soon you end up with a model where everyone has a personalised risk profile and pays for access to healthcare based on that - insurers and private healthcare providers would love it but it's not the NHS, and it's not fair.

[Osolea]

YABU.

Healthcare is a basic human need, and if a persons health issues can be treated, then they should be. I understand where you're coming from, some people contribute nothing to the system and cost it a lot through poor choices, but I just couldn't support a system that judged people worthy or not based on the vice they have, and we all have one somewhere.

I'm a smoker, but I excercise, eat well, am the weight I'm supposed to be, don't do the type of sport that is likely to lead to injury, contribute to society and I pay plenty of tax. If I got a knee injury just by tripping up the stairs or something, would you really think I deserved to live in pain with reduced mobility when it was easily fixed just because I smoke?

[Villagebike3]

The knee op and smoking are related. A knee op is a bigger or at least more complex op than a hip replacement op. The recovery is also more challenging. One of the major risks of all operations is post op infection. Smoking hinders the body's ability to fight infection and the risk of infection is far greater if you smoke.

It is complicated. My mother (from her recent hip replacement op) found out that increasingly younger people are having hip and knee replacements. Apparently this is due to more of us pounding the streets in our 20s etc to keep fit. Yet, my friend who does this is a healthy weight, eats healthily, exercises nearly every day by running, she smokes 20ish a day. She laughs at the irony that she will immediately light up a cigarette when she leaves her Zumba class.

She is one of those candidates for an early knew op. She is pretty much super healthy other than smoking. Should she be refused the op? Hummmm not sure. However, if it were explained to her that the recovery from a knee op has a (picking figs) 25% chance of infection with smoking or a 5% if she quits. That an infection could render her invalid, I think she would understand the reasoning albeit very hard for her to quit.

Sorry, just want to emphasise that I'm really not looking to start a fight. I just truly think we are at crunch point as a country with our finances and need to start facing up to what is affordable.

It is very 'nanny state', which has negative connotations. But there are thousands who aren't taking responsibility for their health and expect the country to pick up the pieces... And the bill.

As I said, I'm a size 20. I try to lose weight and manage well with the right motivation. I can shed 2 stone ready for a big event to look better. I just tend to regain it once the event is over! If I was told you need X op or X drugs but to have them you need to lose 2 stone over the next 6 months waiting list and then a further half a stone a year to stay on those drugs... That would be an excellent motivator for me!!!

[AppleSetsSail]

Apple I have never and have no intention of ever drunk driving so why should I pay into a pot for dealing with the injuries of those who do? I'd like to think I don't drive dangerously either but that's more subjective!

Then your premiums would be very low in this hypothetical arrangement.

Healthcare is a basic human need

Just like food and shelter.

[Jayne35]

I do agree and I don't because as other people have said it would be difficult to decide where to draw a line. With regard to fertility treatment, I was peri-menopausal at 32 and would have liked another baby, I was a smoker at the time (Two years smoke free now!) and would have had to have stopped for 6 months before any fertility treatment could be offered.

Fortunately my employers offer private healthcare (at the cost of a small increase in tax) which I have recently taken up though and DH is going to pay for private healthcare, we aren't particularly high earners either.

[Lookingagain]

It's totally unreasonable and shameful.

Now, if losing weight would help the condition, and NHS wants to help the patient lose weight as part of their treatment: nutritional guidance, counselling, gym membership, etc. Then I might take them seriously.

[AppleSetsSail]

Now, if losing weight would help the condition, and NHS wants to help the patient lose weight as part of their treatment: nutritional guidance, counselling, gym membership, etc. Then I might take them seriously.

They do.

[Littleelffriend]

I agree. A lot of the time, overweight people or people who smoke get a better deal. For example, I'm pregnant, am not overweight and do not smoke, therefore have had no extra scans, no consultant led care etc. Doesn't this mean that if (god forbid), there was something wrong with my baby, it would be less likely to be picked up? Whereas someone who is overweight and receiving more care would find out sooner.
One of my friends has recently had 2 rounds of IVF on the NHS. Her husband smokes, and she is overweight. My taxes help pay for that, and I don't agree with it.

[MattDillonsPants]

What about anorexic people? Shall we make them put weight on before say an operation to mend a broken ankle? What about a brain injury? No op till you get fatter?

YABU OP.

Also...what about people who drink more than the reccomended units weekly? Stop them having hip replacements eh?

[runningincircles12]

Well, if you find it extremely difficult to lose weight yourself, what makes you think that it would be any easier for your mother in law? Is it just because she has developed diabetes, (which you may well develop yourself)? What if the NHS said to you that you couldn't have medication in the future because your diabetes had been caused by excess weight that you could have lost earlier?

[AppleSetsSail]

Without googling, I'm willing to bet that the cost of anorexics to the NHS is negligible. That said, I'd be happy with any set of carrots or sticks that the NHS could reasonably employ to either shape behaviour or reduce costs.

[Noodledoodledoo]

I agree to some extent ( am also a size 20) but do think such criteria should come with support.
I have battled with weight for my whole adult life. I don't eat badly, generally follow a healthy diet but something isn't adding up as weight is not coming off (two pregnancies in past 2 years prob not helped although not gained anything have been unable to lose anything) I have seen doctors for help in the past, a lot of my current weight was caused by comfort eating when suffering from depression, easy to put on not so easy to shift once out of the fog.
Support to help lose weight is lacking from NHS, I have tried all sorts over the years. Once this pregnancy is done it's my aim to shift it but I know it's down to me and lots of conflicting advice to shift through!

[t1mum]

Great post expotition.

OP - what would you suggest that the NHS do if your MIL fails to lose weight (which would be even more difficult without the metformin as insulin resistance causes carbohydrate craving and weight gain)? Should they withhold any treatment for complications?

Also, on the topic of diabetes, please note that some Type 2 diabetes is related to lifestyle factors (mid-line obesity is a symptom of Type 2) but some isn't, and that other types of diabetes are not caused by diet or lifestyle.

[GiddyOnZackHunt]

But OP if you can and do lose a couple of stone to 'look better' when you have motivation, why don't you lose more weight and keep it off? The motivation being you will be healthier etc.
It isn't always as simple as why don't people just do X or Y?

Apple if my premiums were low (although how you'd determine that apart from convictions, I don't know) then conversely other people would have high premiums. Given that they have a propensity for breaking the law, what's their incentive for actually having the insurance? People are driving around without the currently required insurances, tests and tax already.

[TimeOfGlass]

Littleelffriend - The reason pregnant women who are obese or smokers tend to get extra scans, consultant led care etc is because those things mean there's a higher chance of something going wrong with the pregnancy and with the unborn baby in the first place.
The NHS wouldn't bother giving these women "a better deal" if the risks were the same as they are for non-smokers at a healthy weight.

[GreenMarkerPen]

I'm in two minds about this.
on one hand it us sensible to want the best possible outcome of a treatment, and stopping smoking and/or losing weight helps.
but on the other hand it's cruel to deny people treatment that wiuld mean less pain and better health in the long run.

[sharonthewaspandthewineywall]

Ive asked for support with weight loss before and been told basically there is nothing, no counselling or anything like that available. I dont need weight watchers membership, I need counselling to address the reasons for overeating. I am only a little overweight though and have managed to lose a stone and a half by myself in a year though but can see how people larger than me would really struggle.