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?!

So the UK has a large proportion of the population who are overweight or obese, 61.7% in 2014 with about 25% of the population being obese. That is a huge problem, and surely can't be solved by humiliating and scaring people into losing weight.

We have a societal problem if 3/5ths of our population is overweight/obese and 1/4 are obese. You can see why the NHS struggles to find the funds to cope with the associated health issues. We need a really in depth approach to sorting out the health of the nation, rather than a desperate piecemeal approach. I doubt it will happen though given the current economic and political situation.

Great post Lougle👍

There is a world of difference between routine surgery and accidents. So of course the NHS should treat accidents - runners, skiers or RTA's of whatever size or shape.

It is interesting that they do hip op's and the like now on very elderly patients dispite them have very few years left. Are they more or less deserving than the overweight in the scheme of things.

lougie Excellent post!

Highland anorexia doesn't figure into this conversation, the costs to the NHS are trivial.

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

This wouldn't matter though. A BMI of 40 would usually be a risk factor regardless of being metabolically healthy. At lower BMIs you can get away with overweight but metabolically healthy, but there is a point at which that no longer applies.

I know I was bit healthy with a bmi of 40. I was just saying that obesity in itself does not go hand in hand with high cholesterol high blood pressure and poor diet.

Was't healthy but clearly well enough to conceive and have a very health pregnancy and uncomplicated planned C-section. And before you blame m weight for C section it was only necessary due to two previous emergency sections. The 1St when my bmi was about 28.

can't be solved by humiliating and scaring people into losing weight
But it's not about that, it's purely pragmatism, the NHS has finite resources, the need for treatments exceeds the capacity to provide treatment

Really museum. My sister had several hospital admissions for months on end. Loads of dental work and now her spine is crumbling. OK latter could be due to other issues but her diet has not hellped.

that obesity in itself does not go hand in hand with high cholesterol high blood pressure and poor diet
Not always obviously, but on average there is a strong correlation

My other point was about how an obese person can have a better duet than someone a healthy weight with an eating disorder historic or otherwise

reveal
It is interesting that they do hip op's and the like now on very elderly patients dispite them have very few years left. Are they more or less deserving than the overweight in the scheme of things.
the elderly (by which I assume you mean everyone over 65 ) would be in pain from worn out hips due to age (if they were overweight as well the same criteria should apply - to replace a knee or hip on an overweight person who in addition is very elderly is not going to be successful).
getting old (and worn out joints) is not reversable - losing weight over the period of a year (to enable hip and knee ops to be more successful) is possible

I'm sure the decision made by the NHS was purely pragmatic, but it has the effect of scaring and humiliating people.

I appreciate that the NHS doesn't have enough money and that this will get worse in the future. It shouldn't be left to individual NHS trusts to make these kinds of local decisions based on extreme financial difficulties. There should be a long term national plan for the NHS that takes these kinds of issues into account and looks at ways the NHS can be realistically funded and perhaps altered to be maintainable. Doubt that will happen though.

It's not about deserving and undeserving. It's about effective and non-effective

Beautifully put - and I also agree with the PP who mentioned some GPs' reluctance to be more direct about the issue. Given the emphasis on preventative medicine these days, I'd have hoped they'd consider this to be a key part of their role. That said, I appreciate they only have limited time ...

Really museum. My sister had several hospital admissions for months on end. Loads of dental work and now her spine is crumbling. OK latter could be due to other issues but her diet has not hellped.

Your sister is one person. The NHS concerns itself with macro-trends, not individual patients.

"reveal
It is interesting that they do hip op's and the like now on very elderly patients dispite them have very few years left. Are they more or less deserving than the overweight in the scheme of things."

They can use plastic implants and that age group is incredibly high risk if they lose their mobility. A deep vein thrombosis or pulmonary embolism would finish them off and would almost be inevitable if they had a non-functioning hip joint. Fractured neck of femur (broken hip) is a leading cause of mortality in older patients and is a direct risk factor for delirium, which itself doubles a patient's mortality risk.

Fair enough but on an individual basis the expense can be high.

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.

The problem with that analogy is that private healthcare is a choice. Paying into the NHS isn't. If I don't like the policies on offer from Bupa et al, I can vote with my purse and refrain from giving them any of mt money. I don't get to do the same with the NHS. I could, I suppose, ensure I earn no more than the personal allowance. DH and I are lucky in that we have low living expenses so could probably still make ends meet if we chose to do that. But we'd still be paying in via VAT and NI. There's no real way round that unless you own enough land to live off grid, which clearly isn't possible for most.

We are effectively compelled to fund the NHS, and that's why decisions like these when not clinically justified are important in a way they're not when Bupa make them.

mollie you assume wrong. By elderly I mean more like over 80. I don't know anyone of 65 who is in the least bit elderly.

But as the next poster said the elderly are in a similar position to the obese. They will die without surgical intervention.

Again, the statistics don't always support anecdote. Delirium is a massively unreported complication of hospital admission, with a huge morbidity and mortality risk. Being over 65 is statistically a direct risk factor all on its own.

reveal how many over 80s have hip replacements and I mean, elective hip replacements? I work with older people and while I've seen plenty of hips being replaced after fractures, I can't recall anyone over the age of 70 (ish) having an elective replacement.

Very overweight patients have several issues in theatre as do very underweight patients.

For obese patients their surgeries tend to be longer, they need more specialised equipment and more surgeons and assistants just to help with gaining access to the area they're operating on. Positioning is very difficult as you need to make sure there isn't too much pressure on an area which can cause ulceration, we've had to have patients come to theatre weeks before their surgery in order to get them onto the table to see if we can position them safely and securely and organise more equipment if needed. Longer surgeries need longer anaesthetics meaning they're lying on their pressure areas for longer and the longer a wound is left open the higher the infection risk. Due to the nature of certain surgeries it's not always possible to perform pressure care at regular intervals if at all. Longer surgery equals longer recovery and longer stays in hospital plus all the aftercare.

Anaesthetising is more difficult if the anaesthetist can't extend the neck fully, also the amount of weight on their chest means they can desaturate very quickly when lying flat. If access is too difficult/too risky when they're flat then they may need an awake fibre optic intubation which takes longer than an ordinary intubation and is far more traumatic for the patient. If you do get into difficulties which require emergency tracheostomy/cricothryroidotomy it's made even more difficult if there's a lot of neck fat/little space to work on. Even putting in venflons, arterial lines, spinals etc can be very difficult purely because of fat and lines can easily become blocked when positioning.

You also have the other issues which tend to come hand in hand with obesity such as high BP etc.

I don't think surgeries should be declined purely based on BMI, it needs to be looked at on an individual basis. Some patients with a BMI of 30 may not have half of these issues if any so to use something unreliable like BMI wouldn't be fair at all.

Just to clarify you can't buy this particular dressing from Boots and whilst he got 2 dressings, not all the stuff he needed. No wadding etc. When he left hospital, we were told the district nurse would have the dressings only for the district nurse to turn up with nothing and making a make do dressing.
Getting a prescription from the doctor takes 3 working days so on release from hospital on Thursday we didn't get the prescription till Wednesday and then by the time Boots had ordered it and got some of it in it was Friday

Not something I have personal experience of, as I am in good health, but mostly I have seen MNers post that GPs do not shy away from mentioning weight, and will attribute any and every symptom to the patient's weight, however tenuous the connection.