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.

So Villagebike, it sounds as though you are saying that you and your husband should be refused treatment in the future as you are both overweight, or possibly obese. Your husband has to lose weight to get treatment. But what if you need emergency treatment that may be caused by eating too much ( as you admit to doing?) In my view, the question here is not about whether you should bevallowed treatment, but why and how you have allowed your bodies to become overweight?
There are comments on here referring to conflicting advice about weight loss, but it is very clear that if you are eating more then you are burning of you will put on weight ( unless you have something like a thyroid problem etc).
I have spent a lot of time around hospitals recently as I needed a foot op that was not weight related. Unfortunately there are too many people becoming so overweight that it will be very difficult for them to lose it. People know what the answer is, but there seems to be a view that not matter what happens the NHS will sort it. The reality is that being overweight and obese will cause some damage to your body that can never be repaired. The same with smoking. The fact that you appear fit and healthy at 35 does not mean that you will be at 45, 65 or 75 ( if you live that long). You are poisoning yourself and the people around you with a range of toxins including arsenic, cyanide and DDT.
I believe in a NHS that is free but people need to accept responsibility for the consequences of their own actions, and recognise the impact of their chosen behaviour on a a service that cannot continue to care for people who make unwise lifestyle choices.

Sherlockmaystealyourpug-you say that smoking has replaced life threatening self harm and low weight, smoking is life threatening as well

I sort of agree and I sort of disagree.

I agree that it can be OK to not operate until someone loses weight/stops smoking where their weight or their smoking significantly affects the outcome of the operation - such as the probability of them dying on the table. My dad had a triple bypass operation, but had to give up smoking before he would be operated on.

I agree it can be OK to prescribe weight loss or smoking cessation as the treatment for a medical problem, in which case I would expect the patient to be given help to achieve this.

I do not agree that it should be used as a way to ration healthcare.

expotition is right, but - some healthy behaviours e.g. exercise, result in predictable injuries. Where do we draw the line? When I fell off my horse and broke my wrist, should treatment have been denied? When my husband trashed his leg skiing, should treatment have been denied?

On the other hand, I have no cartilage in my knee and as a result am running in pain from bone on bone - I need a new knee, I'm not getting one because there's no money. And yes, it has been suggested to me that I should lose weight to see if that helps my knee, but at 55kg and 163cm I'm not sure that's going to make a massive difference .

I actually think we should have personalised profiles and I don't mind paying for a system that gives people who are 20st an operation they need as long as I can get the one I need too. We can either afforded socialised medicine or we can't. Rationing is the wrong response, they need to rethink the whole offer from the ground up. Personally, I think the job of the NHS is to fix things when they go wrong, not try to manage behaviours or prevent things happening in the first place. That's far too big a task and they don't have the skills to do it.

carabos "We can either afforded socialised medicine or we can't. Rationing is the wrong response, they need to rethink the whole offer from the ground up."

This.

And I think the political/media storm about people with certain health conditions being a "burden" on the NHS serves only to undermine the NHS. By discriminating against people for certain lifestyle factors we are lining up to get our heads chopped off.

And yes, it has been suggested to me that I should lose weight to see if that helps my knee, but at 55kg and 163cm I'm not sure that's going to make a massive difference.

Seriously? Please don't tell me it was actually a medical or healthcare practioner who said this!

Shocking.

How many people actually live a totally healthy lifestyle?

Who manages to avoid all pesticides and processed foods (organic food is more expensive), eats 5-10 portions of fruit/veg each day, doesn't smoke, is teetotal, doesn't consume any sugar or caffeine, doesn't come under any stress in situations they've chosen, exercises three times a week, isn't overweight or underweight, sleeps 8 hours a night, doesn't take drugs, does no sport that could result in an injury, has no medical conditions which make it more difficult to live healthily, has a good support network of friends and family nearby, lives in an unpolluted area, gets involved in a friendly local community, has sufficient time away from work and ideally a holiday sometimes, etc?

There's no good reason to pick out people who have a weight problem above anyone else who isn't perfect, i.e. everyone.

ayeAmarok it was the MSK specialist who said that. I actually looked over my shoulder when he said it as I thought he couldn't possibly be meaning me . But yes, he did mean it. When I responded with "In order to lose weight and get more exercise I would have to give up my job" he said "Only you can make the right decisions for your health".

Littleeel - yes, it is, but not in the same way. When I was really unwell I was in a&e regularly taking up time and expensive treatment due to behaviours which were immediately life threatening. Now although I may still smoke I am employed and pay tax and am also training in a sector in which I will give back to the nhs.
I do plan to stop smoking, but I do not want to at present, and I do not think that i should be forced to stop (for an operation or treatment or because it is better for me), I am aware of the risks and the potential long term consequences and would hate to be patronized and 'imformed' that it is bad for my health, or denied treatment, when for me it is the last in a long line of unhealthly coping mechanisms that I have overcome. I'm finding it difficult to articulate what I mean, but I think there are so many different and complex reasons that people choose to engage in poor health behaviours that it just would not work denying health interventions to people that needed them. What would happen if someone who needed a operation did not stop smoking or loose two stone? How could it be enforced? I don't think it would work as an incentive as we still would not focus on the wider psychosocial issues.

Some years ago I lost two stone in three months for surgery (private, nhs waiting list was so long I would have had permanent damage if I'd waited) and had subsequent health problems from the crash dieting.

I now have a chronic health condition that means taking regular medication. My mobility is limited, my ability to work is limited, I'm in pain every day and living around chronic fatigue, and yes, I have gained weight. I managed last year to get from obese to overweight with a lot of effort, I've since had another bad patch of severe pain and illness and gained some of that weight back. If I had to demonstrate a steady weightloss on top of what I already have to handle to cope with daily life - well I would no longer be on meds through failure to sustain weight loss/regaining it, so I'd now be too ill to manage at all and frankly the stress of it on top of the stress of everything else would be more than I could handle. It might be a nice motivator for you, for me it might mean life ceases to be worth the endless battling.

Yes, I agree the NHS cannot be a bottomless pit and there needs to be some responsibility over managing your own health. But drawing a line and letting people sink or swim? A lot of people are going to sink, in a very miserable way. Rather like the disability benefit assessments. And a lot of those people denied ongoing care would then simply use up the money and more in emergency care and end of life care when their unmanaged conditions have gone totally out of control. Or would you advocate that once a person ceases to meet the criteria to access treatment they're on their own and the NHS leaves them to die, even when their feet have gone gangrenous or they're having multiple strokes?

Well I'm fucked then. I have an eating disorder. I have ulcerative colitis. The drugs I need to control the colitis mean I put on weight. I try to control it through eating but I still put on weight, which occasionally means I take myself off the drugs, lovely circle. Now, do I get help for the ed, or get refused help for colitis and diverticular disease because I'm overweight, caused by the drugs fro colitis and diverticular disease...