Obese people to be refused surgery

[ReallyReallyNearly]

Isn't this just another form of discrimination, www.bbc.co.uk/news/uk-england-york-north-yorkshire-37265752
Argument seems to be on financial reason rather than health, do we stop nhs services for people who smoke, or those who drink too much etc. Where does one draw a line?!

Presumably they were not the kind of dressings they sell in Boots...

Oliver..why didnt he buy some dressings. Unless an ulcer or a complex wound we give enough dressings for a couple of days then advise where to get more. Gp will prescribe if low income.

When you sign up for private health care coverage you have to pay a higher premium if you smoke, are overweight or take part in risky sports, so I suppose with this policy the NHS is just taking the same line.I think it's justified.

Cushion53 - I think with private insurance you also pay a higher rate if you have lots of previous specialist referral, tests or investigations. I think they want to see if you will be spending the money on lots of private referral requests and treatments. I wouldn't hold this model up as a good example of practice or the moral high ground.

See username.

Sorry! Wrong thread

I'm obese ( just! -- was heavier but have just lost nearly 2 stone and on my way to at least another stone and a half off!)
I also have problems with my knees - mainly down to dislocated joints in my teens. However, I think it would be sensible for the docs to refuse me knee replacements until I lose some more weight. The surgery would be a waste of time and money until I'm nearer my target weight.

Same kind of principle applies to many procedures for smokers and drinkers. So I don't have a problem with this.

However a lot comments are confusing 2 different issues - yes, there are some political threats to the NHS and these need to be challenged.

On the other hand, no matter what the politics, the bill for the NHS is just going to keep soaring and will become less and less affordable due to:

1. Ageing population (thanks Brexit for making this worse!)
2. Medical advances resulting in more and more possible interventions which all cost money.
3. Binge-drinking culture (the impact of health issues from this, not just Sat night A&E visits, is going to be scary over the next few years)
4. Ignorance about what is appropriate for A&E treatment - survey says 2 in 3 visits are unnecessary!!!

So, these kinds of dilemmas are going to become more and more common, no matter who is running the country.

Visceral fat is the real problem and so waist to height ratio would be a better indicator of whether a person should lose weight before having surgery
Here's a handy calculator if anyone is interested

www.health-calc.com/body-composition/waist-to-height-ratio

Crikey, look at those comments on the site Shining linked.

It's often said that being overweight has been normalised and people don't recognise when they're slightly overweight.

Maybe that's so. But consider the other side- what percentage of healthy teenagers and children actually believe they're at a healthy weight? Especially girls? I remember being convinced I was fat myself and I think it's only getting worse.

disclaimer! I didn't know there were comments

"Sorry you were speeding when you crashed so we can't help you"

"Sorry you were taking part in an extreme sport when you injured yourself so we can't help you"

Could go on and on.

It's not nearly as much a slippery slope as some suggest. Obesity is crippling the NHS. Skiing/car accidents are not.

When you're trying to reduce outgoings, you consider your major outlays first.

One good thing that may have come out of this announcement is there may be more people like me who have now taken a long hard look at themselves.

Perhaps something like this really could turn the obesity epidemic around?
currently it is gaining momentum, as more of us become overweight so it becomes average normal, ok and not unusual to be overweight

It is already the case for NHS England and Wales that those with a BMI over 35 do not get a knee or hip replacement. And smokers have to give up. TBH I agree with it.

DH is a hip and knee surgeon. A BMI over 35 equals poor results, more risks of death and other complications and the surgery is much more difficult too...imagine the need to bend a knee beyond 90' in order to expose the joint and replace it-imagine the fact that the patient is so obese that their knee will not bend beyond 60'. The same goes for hips, which have to be manually dislocated to expose the joint. DH is a tall chap and has had his whole body weight pushing against a joint that just won't go as there is too much fat in the way.

It may seem unfair as I know a lot of patients struggle with their weight and losing it and are in pain, but it is not life threatening. Losing weight also extends the length of the new joint being put in. No one wants to go for multiple revision surgeries slowly losing bone stock.

But it is right that people need to start looking at their lifestyles and eating habits and shouldn't be having surgery that will risk their lives and probably won't be as successful as if they lost the weight first.

Apparently the decision is going to be reviewed:

www.bbc.co.uk/news/uk-england-york-north-yorkshire-37265752

Posters are still giving examples of people who have a high BMI but who are very muscular and not fat. There is a process which allows for these cases in the policy.

My completely unscientific guess is that the majority of people with a BMI of over 30 are very overweight and not very muscular.

This announcement has shocked me into realising that I NEED to make more effort to lose weight. I have a BMI of over 30 (just) and am a size 16/18 - I have never been slim but, after 2 children, I am the biggest I have ever been. Realising that I am now classed as obese has been a bit of a wake up call and I suspect this will have a similar effect on a number of people in the same situation as me - no medical reason for being overweight, just lack of will power/ willingness to diet or exercise enough. However, the issue of obesity is not always as simple as mine and a blanket rule set with BMI levels is a very tricky one I think?

Perhaps anecdotal, but I'd say that around 80% of the patients who come through my ICU are obese. The risks are higher for obese patients. There is more weight on your thorax, which makes the load of breathing higher and deep breathing harder. This makes it far easier to get a chest infection. It can be harder to intubate because the fat in the neck makes positioning more difficult. Mobility is reduced. Surgery is harder because instead of cutting through 10cm of fat there is 20-30cm - there is so much tissue that has to be held back to access the area that the surgeon is working on.

The statistics are actually quite awful. ICNARC is quite a good source for statistics on patient outcome and obesity is a key risk factor. Mainly because obesity never comes on its own. It comes hand in hand with hypertension, high cholesterol, low albumin (often due to poor nutrition), low vitamin B (again, nutrition),...the list goes on.

Sadly, for many of our patients you could simply glance at them and start writing their past medical history without being told - it's all so predictable.

It's not about deserving and undeserving. It's about effective and non-effective. It's not kind to put someone through a painful and risky operation when the outcome is not likely to be good.

Thank you for explaining that lougle.

So by asking the patients to lose weight, they will face less risks during their surgery. Makes very good sense to me.

where's thanks for putting it so clearly. Operating on someone where there is a lesser chance of success and a greater chance of the replacement joint failing prematurely due to the excess weight being placed on it isn't ultimately in the patient's best interest nor that of the NHS.

I really don't think it is too much to ask someone in need of an expensive and time consuming operation like this to put a bit of effort in to ensure that the treatment is a success.

It saddens me that being fat has become normalised compared to how things were 40-50 years ago. I'm older than many Mnetters and can easily remember when being fat was quite unusual, children rarely were, etc.

It's become a PC issue and it annoys me that people defend obesity. Yes, some people are fat because they have 'issues' so they comfort eat, just like others are addicted to booze, fags or drugs, but that doesn't make it right when people who make a huge effort to live healthily are paying for operations and care that are a direct result of obesity.

You can't compare it with dangerous sports- there aren't almost 70% of the population putting themselves at risk of being ill or disabled because of their fatness just because they go skiing or hang gliding now and then.

I feel one of the main culprits are GPs who are taking a PC line with patients whose weight is clearly impacting or going to impact on their health, yet it's never mentioned when they see their GP for other reasons. The NHS ' whole approach to health is to fix the symptoms once they arise, not practise preventative medicine.

As someone who was once quite chubby as a young teen, it annoys me when people say 'I don't need to worry about my weight' or I'm 'lucky to be slim' when in fact I'm only slim now because I make a huge effort to be careful about what I eat and try to exercise enough. It's not 'luck' it's a constant lifestyle change that keeps most slim people that way. And that involves daily denial of food that is tempting.

lougle being obese doesn't always equate with poor diet. My bmi is 31ish after losing weight for day case surgery. Was home within hours with no post-op complication despite all the belly fat they had to cut though. My diet is not perfect but it is relatively healthy. On the other hand my sister whose bmi is probably bottom end of healthy lives off apples white bread cheese sweets processed meats and occasionally veg and gammon. She had anaroxia and bullimia in her twenties and her bones and teeth are shot
Yet I was denied surgery until I list weight and indeed would again if I needed further surgery..

O and my cholesterol and blood pressure was still acceptable even with a bmi of 40.

Or GPS who when a patient asks for help with losing weight are told sorry you don't qualify.

If you have an additive personality you can go cold turkey with alcohol or smoking but not food as you need it to survive. This is why eating disorders are do hard. By eating disorders I mean all types. As my example shows my aneroxic sister still has an unhealthy relationship with food.