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?!

But why would they opt out, gem? The NHS can't provide everything we might like, and under these suggestions obese folk would still get countless treatments and all emergency care. All that might be refused is things which, in a clinician's view, aren't in their best interests

Is that really such a bad thing?

Not trying to be rude Helena but people who need joint replacements have more than "aches".

It is risky to operate on some one who is obese. I knew an obese woman who had an operation and she was in more trouble she had difficulty walking. She struggled to lose the weight after because she couldn't walk very far.

Doggity i have had medical professionals tell me its fine for me to maintain where i now am.

Fair enough Doggity. Ive never needed a joint replaced.

Funnily enough the criticism i get about the loose skin left on my tummy is from a woman in RL who is five stone heavier than me.

Doggity I asked you upthread to justify your claim that it's unethical to undertake a hip replacement on someone who's obese by asking what your evidence is wrt to someone with a BMI of eg 30.5. I wonder if you saw that post? I think most people understand the concept that there comes a point when it becomes too dangerous, the risk doesn't justify the benefits, but nobody in this thread seems to have provided any evidence that this point is a BMI of 30.

I also wonder how you can square the reported proposition that someone who loses 10% of their body weight will still be able to have the elective surgery, without any requirement not to still be obese. Meanwhile an obese person who might have the same or a lower BMI than the 10% loser would be denied. Obviously that may not have been reported accurately, but if it has, it seems rather strange.

Helena You've had medical advice and I think you said you had loose skin? Forgive me if I'm confusing you with someone else. I am in awe of your weight loss. I know that maintaining it is the hard bit. I am far from perfect and trying really hard. If you have joint disease, it's more important to be a lower weight. So, BMI 29 is still far too much for me. I wish I wasn't! I'm aiming for BMI 25.5.

Hyancinth Sorry I genuinely into didn't see that post. There has to be a cut off somewhere and there will be people who have BMI of 30.0 who are told "no" while someone with a BMI of 29.9 will be told yes. Although my experience has been I have always been given stern and borderline patronising comments about my weight unless I've been in the normal BMI category.

Unethical was perhaps the wrong word. Although in cases of severe obesity of BMI 45+, the risks may outweigh the benefits. IMO, it is bizarre when there are limited resources, e.g. 18 month waiting list, to operate on someone who will wear out the joint much more quickly. If they can lose the weight, they are less likely to need a revision surgery (as quickly) which is more risky to the patient.

Ive never heard about the losing 10% and I'm sorry if I've not been clear but I am solely talking about orthopaedic surgery. Also, different areas do different things. I don't profess to know much about general anaesthesia or other risks for other surgeries, although I see there are others who have.

I have a bit of loose skin on my tummy but i was talking about another poster who has 4 stones worth.

Doggity you are doing great and i can tell by your posts you are trying really hard. When it comes down to it all we can do is our best.

Aw thank you. I am trying but it's hard. I'm not being flippant on these threads either. Weight issues are so complex. I believe that we need better preventative care and support. We need to stop it before we - as society - get overweight because it's so much harder once you're there.

I wanted to clarify that while I don't think accepting it as normal is helpful, I do not believe we need to tear people down either. My consultant told me off earlier this year and it just made me sad, so I stopped off and got a packet of biscuits on the way home. We do need to stop saying "oh you can be healthy at X weight" because it's not addressing the issue. Even if I was healthy and obese, I'd still rather be slimmer.

Agree that poverty leads to obesity - it's a fucking vile policy

The 10% was in some of the articles about this doggity. I don't know how accurate they are, but it was reported that obese patients who lose 10% of their body weight within the year may be allowed the surgery without having to wait. With no requirement not to still be obese. So you could have someone with a BMI of 37 who loses 10% and has a new BMI of 33 or whatever, being able to have the surgery, meanwhile a person with a BMI of 32 who hasn't lost any weight gets refused. Pretty hard to see the clinical justification with that. Likewise surgery not being denied entirely, simply delayed a year. If a BMI of 31 is too high to make a joint replacement worth it, it's too high regardless of what you weighed a few months back and will still be too high in 12 months time.

And there doesn't have to be a cutoff point. That's kind of the issue. It's perfectly possible to make decisions on a case by case basis. If there is to be one, and it's 30, we'd need to see considerably more evidence than anyone has managed to evince so far. And an explanation as to why that 30 BMI is somehow not dangerous when you've had it for 12 months or it was 33 until last April.

Howyoualldoworkme - FYI, it's perfectly possible to be slim with lipdoema. Having them doesn't affect your overall weight. It's true that there is no way to prevent them, but having them doesn't necessarily go hand in hand with obesity or being overweight.

Your post makes a lot of sense. The article in the OP said they had to lose 10% for a referral but I'm not sure if they meant a referral for the actual surgery or for the clinic? To be honest, most of what I've read suggests the biggest risks are for clinically morbidly obese patients which according the NHS page is BMI 40+. I'm not sure about the grey area but I've heard lots of consultants who've given "strong advice" for people between BMI of 30 and 40 to lose weight pre-orthopaedic surgery, not necessarily joint replacements though.

I don't see any issue. If you're 30 stone and need non-urgent surgery isn't it perfectly reasonable to be asked to lose weight first? You're at risk of all sorts of complications so why should the NHS bear all the responsibility for that?

Hyacinth actually, there will be a difference. When you lose weight, the weight you lose first is the visceral fat - the fat that lies deeply around your organs. So someone who has lost 10% body fat has shifted a whole lot of that build up. It's also the weight you gain first. So potentially, the person with the slightly lower BMI could have more visceral fat than the person who has lost 10% body weight but has a very slightly higher BMI overall....although at the end of the day it would be better for them both to be of normal BMI of course.

Also, they're perfectly within their rights to ask people to give up smoking before carrying out a procedure or stop drug use so what's the difference?

I've been overweight, suffered from compulsive eating etc so I know what it's like and how it happens but I still feel that getting a hold of it and taking charge of your life is a matter of personal responsibility.

Yeah health government policy is terrible, the advice they're giving people is totally wrong, there are too many sweets on the checkout blah blah blah.

At the end of the day, the truth about what foods are genuinely good for you is there for those with the drive to look for it, as is information on how to eat well on very little money, and anyone can learn to break bad eating habits if they're really driven to do so.

Asking someone to lose weight before an operation is not unfair or discriminatory.

Used to know a woman who had an incredible figure. She was a perfect size 10, nowadays she would be considered a 4-6, she worked out for several hours everyday she was 5ft 2" and weighed13stone. She would be considered obese yet there wasn't an ounce of fat on her.

On the other hand I have a friend who was very active and slim who broke her back in an accident she walks with the aid of sticks and despite watching her food intake has put on nearly 8 stone since the accident a few years ago.

Not everything is black and white there are many shades of grey

A good friend of mine required a knee operation. The Dr kept telling her she must lose weight. She knew herself that she needed to (most overweight people are well aware of their size and have mirrors ) but the knee had got so painful, there was no way she could exercise. She did have the op in the end and I've seen her lately. She's still overweight but nothing like she was before. Now she's active again, the weight's coming off.

So, I don't think denying people operations they need is helpful but perhaps a kind a regime post recovery would be helpful - e.g. free slimming classes. I know you can't force people to join but, often, things like these are a wake up call and leave them more motivated

So you could have someone with a BMI of 37 who loses 10% and has a new BMI of 33 or whatever, being able to have the surgery, meanwhile a person with a BMI of 32 who hasn't lost any weight gets refused. Pretty hard to see the clinical justification with that.
I'm guessing the justification there would be that the person who loses weight has shown themselves to be motivated and willing to work for the op and its benefits. They may then be more likely to engage with physio, exercise and diet post-op whereas the smaller person who has lost no weight appears to be unmotivated and now willing to play their part in improving their own health

I work in healthcare and never cease to be amazed at the people who could improve their health with a little effort and commitment but would sooner have a prescription which they hope might wave a magic wand

Of course the NHS can't go on as it is. The government have the choice to a) fund the NHS at the level necessary b) apply any of the measures the health profession have recommended to them to reduce obesity

With they do either? Of course not.

Now if it were a plan to refuse politicians treatment on the NHS I would be all in favour.

Would this actually resolve the problem of obesity, though, or would it just mean that obese people would have more health problems and be stuck with them unless they could go private? If that is the case, it makes me slightly uneasy.

Of course, they could lose the weight and have full access to the NHS but, if people found it, for whatever reason, that simple to 'just lose some weight' then they would, not just to save the NHS but for themselves for all manner of personal reasons.

Someone I work with has a BMI in the 40s.

She's always been big but not this big and has/had a bad knee. She can't exercise at all. She's had a knee replacement which appears to have worked.

It's also worth pointing out that this will indirectly racially discriminate also. A higher proportion of obese UK adults are from black african groups.

I rather discriminate against politicians and maybe junk food execs than the poor or ethnic minorities...

There are free exercise and / or slimming classes and dietitians through NHS GPs- as well as drugs eg orlistat
the point is- there's scant evidence any of it works......the councils and public health need to take this on- not the NHS.
The NHS is desperate to support weight loss- the development of problems of type 2 diabetes , blood pressure and liver and kidney failure as a result of obesity is further ( on top of vast and increasing number of patients!) is crippling the NHS ........
It's not as simple as some posters claim- "poverty breeds obesity"- not true!
.....that's also skirting the blame and responsibility.....there was more poverty 100 years ago- but far less obesity!
Some one earlier said state schools do far too little sport/ exercise- true!!!........
Need free exercise opportunities, encourage sport- and activity-
bus stops every 10 yards don't help..... Walk more -get out! Get off the i pad and phone and tv.

There are exceptions - I'm talking generally -and of course a case by case basis and exceptions are applied!
but for most it's- "calories used in activity are less than calories of food going in"!!!!
Stop excusing things with poverty- that's no excuse-
I know real poverty where people work hard, keep active and don't smoke- don't "allow" a victim mentality......"oh they have to smoke / drink / use drugs"
I don't think this ban is helpful- but neither is a blanket ban....... Where do u start????