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.

I'm not sure if I can stay on this thread.

I have had multiple operations and each time.been anxious about problems due to weight.

However I'd be more than happy for proper psychological help with my eating disorder. I attend some help via a charity at the moment but honestly there isn't help on the NHS unless you are life threateningly I'll

They only offer slimming world/ww here (which isn't great for eating disorders) and the basic 6-8 weeks of counselling. I'm learning so much about eating disorders (it's not about the food.... It's about dealing with emotions and feelings etc.)

I'd love so much to be able to eat normally.

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.

As a general rule, I agree with this.

Things like denying knee / hip replacements to obese patients, for instance, makes me uncomfortable - on the one hand, I understand that the operation would be lower risk if the patient was slim, but on the other hand - if someone can't move without pain because they need a joint replacement, isn't that going to make it a lot harder for them to lose weight?

Littleeelfriend I agree to some extent pregnant overweight ladies get more care due to the higher risks of things potentially going wrong. Although for me to be considered high risk I had to have two ticks in the box weight was only one my other was age. My high BMI alone would not automatically put me under consultant led care.

Ironically I am tested for Gestational Diabetes as standard as I am a higher risk but the three people I know who have had it were not over weight.

Oh wonderful cross post sharon. Snap. Although I'm quite overweight. I have a lot of emotional)/childhood baggage but I present as educated and "coping" so can't access help that way. I've learnt so much about how it's all linked. I can't imagine being refused treatment.it will just fuel the boom and bust diet/not diet mentality that fuels obesity.

Expotition, I've read your post three times as it was so well explained. Makes me think and it isn't easy.

My friend who smokes says that she pays more in tax because she smokes and as cigarettes are heavily taxed, she has paid in advance for her care. Actually, I've heard this argument quite a few times from other smokers. So, I'm not so sure taxing heavily is the best way to discourage.

There is proof that the higher taxes on cigarettes have not stopped people smoking or reduced their smoking. It has led to greater deprivation as people have less money to spend on other things.

Additionally, it leads to a black market on the heavily taxed items. The black market goods are not quality controlled and are outright dangerous.

The point of the NHS is that it is free at the point of use without discrimination ... What is discrimination? Race, Religion, totally. Is it really weight or smoking? I don't think it is. Weight and smoking directly affect health care. Weight and smoking are things we control, our race etc is not.

Re personalised health care model, that is black and white thinking. There many shades of grey in between. I think there is a middle ground grey area, but it would be controlled by an open and reasoned organisation setting the criteria. There would need to be a rational reason for the criteria being set... Smoking after an op is regarding blood clots and infection. Weight and fertility is to do with a cost benefit of the likelihood of success.

We have as a country spent years encouraging and educating better lifestyle choices and peoples' behaviour, but we are losing. Our country is getting more obese each year. It is a ticking time bomb. There needs to be a two, three, four+ approach to tackle this.

When the NHS began the number of drugs and operations were far fewer, but research and experience has developed a plethora of drugs and different operations, which we all want... But the country can't afford it. The double whammy is that the need for those drugs and operations has also increased directly because of our lifestyle choices. But he country can't afford it.

BTW op I reject your premise about us running out of money as a Country. There is no shortage of money - it is a question of priorities

It's a horrible idea and a false economy. For example -

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.

Metformin is dirt cheap! Diabetes left untreated can cause blindness and limb loss, neither of which exactly help when trying to stay fit, both of which cost far more to treat and manage than a packet of metformin.

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.

Sleep apnoea causes extreme tiredness and depression which it turn make weight loss more difficult (not to mention the increased risk of accidents). Complications include diabetes and high blood pressure.

There will always be cases where excess weight or smoking make the risks of a treatment outweigh the benefits for that patient. Doctors should continue to make clinical assessments on an individual basis.

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.

I wouldn't be too judgemental about this if you are a size 20. Unless you are also expecting medical care to be restricted for you. Particularly in terms of hip replacements, CVD treatments and for some types of cancer. You're going to have to be very careful about where you draw the line and that someone doesn't move it again when money is tight.

Isn't there also some evidence that stopping smoking during or just prior to surgery increases the risk of death. Something to do with the extra stress it puts on the body.

was I was going to say the same.
Add to that the constant spending on reorganising and the cost of drugs.
Drug companies have a vested interest in providing medicine that alleviates rather than cures, at the highest cost they can get away with to reflect their R&D costs. Why make a tablet that's a one off price of £1000 when you have someone on a drug for years at £10 a month.
The science may be noble but the economics aren't.

Agree with everything expotition says.

I'm also curious, if smokers and obese people were to be refused treatment as standard, should they really be taxed as they currently are? People pay a huge amount of tax on cigarettes.

I'd agree with the NHs doing this, once the food manufacturers and supermarkets have been taxed to with an inch of their lives for playing a huge part in creating the obi city epidemic.

I'd also like the town planners to be held to account too- why all the out of town supermarkets and shops rather than small local shops?

So once we live in an environment where it's easier and cheaper to buy a pear/strawberries/carrot than a bag of sweets/donuts/crisps where we can WALK to work and shops, then you can tell obese people to lose weight.

And I'm not overweight at all, never have been.

I need to lose weight for health. I have a school reunion at end September, I know I will drop 2-3 dress sizes to look better for that reunion. But then the motivation has gone. Which is when my poor lifestyle choices return.

If I was told I needed a certain drug but being a size 20 I wouldn't get it, unless I lost 10% of my excess weight. That is a motivator. If then to continue to keep the drug I needed to lose 5% of my excess weight each quarter, I would have continue to have motivation. The amount to lose isn't excessive and it manageable.

Of course the losing weight for the said drug would need to be linked to the need for the drug. Ie, if losing weight meant that eventually I no longer needed the drug, then fair dos. But if getting to normal weight had no bearing on the need, it would be unlinked.

" I can shed 2 stone ready for a big event to look better."

Lucky you.

My medication caused me to gain 4 stone in 6 months even though "it doesnt have an effect on your weight" and I'd been exactly the same weight for 10 years before starting it. Went from a 14 to a 22 in 6 months. I've been dieting for 2 years to try and lose any of it without any success at all. Guess I'd better hope I dont get any more health issues from here!

I'm also curious, if smokers and obese people were to be refused treatment as standard, should they really be taxed as they currently are? People pay a huge amount of tax on cigarettes.

You're quite right, that's double-counting.

I have sympathy with obese people as I see it as an addiction. Same as someone drinking a few bottles of wine a day. However I do think people have more distain for alcoholics and drug addicts than those with a food addiction. And people definately have more sympathy for anorexic people than those that are obese even though both are emotional issues - just at different ends of the scale.

I was never overweight, then I got Pneumonia and was on Steriods, dropped underweight, went through that cycle for nearly two years. The blame for my lung damage was because I didn't get a correct diagnosis early enough, I was told it was vital, until I nearly died.

If I thought that, that could have caused me to be denied treatment in the future, I would have taken legal action.

Then everything was fine, then because i was an abusive relationship, I emotionally ate and became classed as Obese.

Last year I lost five stone, I was a daily gym goer.

I've been ill since November, they missed why I was ill and I've piled on three stone, partly because I've had chronic fatigue (through untreated serious illness) and have slept constantly.

When I Tell my consultant that i'm permanently hungry, his answer is 'I can imagine, your body is craving energy', just eat.

I'm waiting on results for a problem, I might need an operation. OP do you think I should be denied this?

I worked in Adult disabilities/Care homes, I've always thought that there is good clinical reason why an effect appetite suppressant should be developed.

I've seen people become addicts, because of waiting lists and inadequate pain relief.

It would cost more to start to categorise patients into, "unable to exercise", "MH issues", "Effects of Lifestyle", "Stupidity" (which would include a lot of teenage boys/young men), "lazy", than it is to adequately treat people.

Look around you, people do sports, run (which causes damage), wear high heels, drive too fast, they cross roads in stupid places, they fuck about on water/up mountains, as said, where do you stop judging?

Viral, not vital.

I thinks the risks have to be weighed, I don't think you can have a blanket ban. Not getting the knee op might mean constant pain, immobility and depression costing the nhs more to treat with medication. However it doesn't cost the Trust money as these are primary care problems.

Also people should have a role in making decisions. What is the actual increased risk of someone with a bmi of 30 over someone with a bmi of 28? If it isn't significant then the level which has been set is spurious particularly if a surgeon can't overturn the decision, he may be operating on a T2 diabetic with a bmi of 29 who gave up 30 a day the month before but having to tell an otherwise healthy person with s bmi of 30.5 no it's too risky for you -clearly the first patient has the greater risk.

YABU

On balance, I think YABU. I see what you're saying and healthier lifestyles should of course be encouraged by the medical professionals involved - but success shouldn't be requirement.

Firstly, it ignores the issues of addiction or psychological/emotional reliance on food/cigarettes.
If a very obese person who has COE is refused an op until they reduce their weight it has no more chance of success than an anorexic person being refused an op until they increase their weight. In fact they might gain even more weight through shame, depression and stress.

Secondly, it ignores the fact that, particularly in older people (who are more likely to needs ops) it's really hard to lose weight.
My mum is morbidly obese and has osteoarthritis in her knees. It's likely caused (or at least exacerbated) by her weight. But she doesn't eat huge amounts. She is the size she is because she is completely sedentary and is presumably eating the right amount or slightly more to maintain her weight. But it's not huge amounts and she's over 60. She could lose weight, of course. But I think she'd find it difficult to lose enough.

I don't agree with everyone saying the NHS needs to help people lose weight if it wants to do this. People can do this on their own, if they are determined to (which they would he more likely to be if there were consequences).

Losing weight, in the vast majority of cases, comes down to:
1- Eating healthy food
2- Portion control
3- Exercise

There really is no more to it than that, in 95% of cases. We all have access to the internet and can find this information out ourselves and it's in our control to do it.

If it's medication that causes it so the above won't work then that's different and the NHS should be helping people to manage the side effects of their treatment.

What? I'm having a foot operation soon for a very painful condition. I couldn't have the op whilst pregnant or breastfeeding so I've waited a couple of years for it. The pain has greatly reduced my mobility and meant I had to give up running and therefore - surprise! - I've gained weight. Having the op will make it easier for me to lose that weight because I'll be able to fecking well exercise. If they denied me the op til I lost the weight, I'd be in considerable pain on a daily basis with limited mobility so how much success do you think I'd have? What a stupid idea.

Oh, and the condition isn't weight related, though years of running may have exacerbated it.

I could have stopped breastfeeding to have the op earlier btw but supposedly breastfeeding should save the NHS money so which course should I have chosen?

I smoke
I used to be anorexic, and had 11 years of regulat expensive therapy and hospital stays on the nhs, I was in a unit for over 9 months when a teen which would have cost an awful lot
I am now a heathly weight but I don't eat well so I am aware I am probably setting myself up for health issues in the future but it is a lot better than being incredibly underweight.
I think delaying or preventing access to health care based upon health behaviours and choices is unfair and as others have said there are too many shades of grey
I am very aware how bad smoking is for my health
But I do not want to stop and do not wish to be forced too, for me smoking is a very emotional crutch - I think if it has replaced life threatening self harm and life threatening low weight, then I should be able to choose to smoke if I wish
My cousin has had an eating disorder since childhood also, and is very overweight
If she was told she had to loose weight for a needed operation I don't think she could, so how do you decide where the line is drawn?
I am training to become a hcp within the nhs and offering health promotion is a big buzzword, but it is offer, not force and I think that is such an important distinction